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.

Pruritus, or itching, in dogs and cats, can involve scratching and licking, chewing, or biting the skin. Pruritus is the most common symptom of skin disease in veterinary medicine. Many conditions can cause pruritus, including allergies, fleas, and other skin parasites. Some skin problems are more common in younger animals, while others are diagnosed more often in older pets. 

Medications are available to manage pruritus, but unless the underlying cause of the pruritus is diagnosed and addressed, it will return once the medication is stopped. Some anti-pruritic medications, such as steroids, can result in other health issues. Providing your dog or cat’s medical history can sometimes help your veterinarian determine the cause of the itching. 

A lack of response to some medications can help your pet’s veterinarian narrow down the possible causes. Additionally, some medications can actually cause itching.

When Did the Pruritus Start?

It can be helpful to know when the itching started. If allergies cause itching, it is beneficial to know if the problem is worse at different times of the year.  

Other Health Problems 

Sometimes, skin conditions develop secondary to another health problem. Your veterinarian will ask questions about other symptoms that could point to a specific cause of pruritus. For example, pets with food allergies may have frequent bowel movements or soft stools.

Location of Skin Lesions

Some pruritic skin conditions cause skin lesions more commonly in one body region than another.

Type of Skin Lesions

Although most pruritic skin conditions look the same to pet owners, there are actually many types of skin lesions, and some skin lesions occur more commonly with specific skin conditions. However, if the pruritus has become chronic, many pruritic skin conditions look similar to each other. Your veterinarian may need to run some tests to help determine the cause of the pruritus.

What Tests are Used to Diagnose the Cause of Pruritus?

Below is a list of some common tests for diagnosing the cause. Your veterinarian will select tests based on your pet’s medical history and examination findings. 

Skin Scrapings

To look for skin parasites, a scalpel blade is used to gently scrape the skin layers to collect cells and any skin mites. The sample is then examined under the microscope.

Skin Cytology

To look for bacteria and yeast organisms, skin cells and debris samples are collected and placed on a glass slide for examination under the microscope. This test can also help determine what types of cells are in the skin.

Parasite Therapy Trial

For some parasites, the only way to determine if they are the cause of the itching is to treat the parasites. A decrease in pruritus after the anti-parasite therapy would be consistent with the parasite causing the pruritus.

Ringworm Testing

To determine if a dog or cat’s skin is infected with ringworm (a disease caused by a fungus called a dermatophyte, not actually a worm), your veterinarian may start by examining your pet under a special ultraviolet lamp called a Wood’s Lamp. If the hairs glow (fluoresce), this may mean your pet has ringworm  Those hairs are collected for further testing.

In a fungal culture, hair and skin samples are placed on a fungal culture plate. If a dermatophyte grows, the dog or cat is diagnosed with ringworm. In a dermatophyte PCR test, (a test that looks for viral diseases) the hair and skin samples are checked for dermatophyte DNA. 

Food Trial

A prescription or home-cooked diet is fed for several weeks with no other foods or treats to diagnose food allergies. Unfortunately, there is no reliable skin or blood test in dogs and cats to diagnose food allergies.

Allergy Testing

Skin or blood allergy testing is used in dogs and cats that have had other causes of pruritus ruled out through other tests. It is mainly used to select allergens for a type of allergy treatment called allergen-specific immunotherapy. There are no reliable hair or salivary tests to diagnose allergies.

Skin Biopsy

A sample of skin can be obtained through minor skin surgery. Skin biopsy is especially helpful for diagnosing some less common causes of pruritus, such as skin cancer. However, a skin biopsy cannot be used as an allergy test and cannot diagnose the cause of a pet’s allergies.

When dogs or cats develop masses protruding from their vaginas, it can be alarming for an owner. Fortunately, they are not common and are rarely seen in spayed pets.

Is it hyperplasia, swelling, prolapse, or a mass?

Many of these can look similar – a pink, fleshy mass in the cat or dog’s vaginal area. Although vaginal hyperplasia, swelling, and prolapse are similar and often related, they are not the same. Keeping it simple, hyperplasia means that there’s more tissue than there should be due to more cells being present.

Technically, this is different from swelling, which occurs for reasons other than an increase in the number of cells, such as an increase in the amount of fluid in between cells. A prolapse is where the vagina is everted (turned inside out) of the body. Imagine something from the inside of the body pushing the vagina outward, like turning a sock inside out. The tissue will often swell when combined with a prolapse.

Vaginal hyperplasia is more uniform than a mass. Think of vaginal hyperplasia as the difference between a thin cotton sock and a thick wool one. The “walls” of the wool sock (the vagina) are thicker than that of the cotton sock. If the sock couldn’t stretch outward for some reason, perhaps tight shoes, it would lessen the amount of room inside the sock for your foot, and the sock would feel tight.

Now, if that hyperplasic vagina should prolapse, a round, tongue- or doughnut-shaped mass may be easily seen; it’s often more in the neighborhood of “you can’t miss it” because the dog is paying so much attention to that area. The prolapse generally starts out smooth and shiny but eventually dries out a bit, after which cracks called fissures develop. It’s basically caused by an overreaction to estrogen and tends to occur just before she goes into heat (proestrus) or while she’s in heat (estrus).

Generally speaking, it only happens in dogs and cats who have not been spayed because spayed dogs and cats do not have enough estrogen to cause it. That said, if a spayed pet is exposed to estrogen from outside of her body, like what can happen to a dog that licks estrogen cream off her owner’s arm, there is the possibility of a prolapse developing then as well. Occasionally, difficult labor and delivery may lead to a prolapse, such as if the vagina everts outward as part of the pressure and forces involved in giving birth. Due to a slight increase in estrogen prior to the date of labor and delivery, it occasionally will happen then, too.

During delivery of a litter, if you can see any type of abnormal vaginal protrusion, it is a medical emergency.

Vaginal hyperplasia can interfere with sex while breeding; before the hyperplastic vagina prolapses outside the body, a reluctance to breed or difficulty urinating may be the only signs.

Occasionally, the discomfort continues throughout pregnancy or just recurs when the puppies are born.

Breeds predisposed to vaginal hyperplasia and prolapse include the boxer, English bulldog, mastiff, German shepherd dog, Saint Bernard, Labrador retriever, Chesapeake Bay retriever, Airedale terrier, English springer spaniel, American pit bull terrier, and Weimaraner. Because it tends to run in some family lines, it’s best not to breed dogs if they have had a prolapse even though the genetics and heritability of the condition are not fully worked out yet.

A mass is a collection of cells.  Sometimes, masses will form inside a dog’s (or, rarely, in a cat’s) vagina and grow into a larger mass that eventually pushes itself outside the vagina.  Vaginal masses, whether benign or malignant, are not common in cats and dogs, particularly if spayed.  Continuing with our sock analogy, imagine a burr inside your sock, where the burr is like a vaginal mass.  The burr protrudes into the middle of the sock where your foot sits.  You’re wearing your sock as usual.  If you stick your finger inside your sock, you can feel the burr. 

If it’s a really big burr or you turn your sock inside out, you will see it when protruding from the sock.  Masses can be pedunculated or sessile. If pedunculated (on a stalk) they are nearly always vaginal polyps, which occur more commonly in intact vs spayed bitches but can occur in both. Usually, the bitch is older. Polyps can be single or occur in groups. If the mass is sessile it is more likely a leiomyoma or leiomyosarcoma, which are differentiated by an incisional biopsy.  Occasionally, other neoplasms can occur in the vaginal vault.

Growths called Transmissible Venereal Tumors may sometimes cause vaginal protrusions in dogs.

Treatment for Vaginal Prolapses

With vaginal prolapses, unless the prolapse is extreme, it will generally resolve on its own as the dog’s heat cycle moves along or after the dog is spayed. In minor cases, the dog only needs cleaning and an ointment to keep the tissue moist, so it doesn’t dry out.

If minimal tissue damage has occurred, your veterinarian can push it back in with a gloved hand. It is first cleaned appropriately, and swelling is reduced by applying hypertonic dextrose or sugar. Sutures can then be put in to keep it in place.

If the tissue is dead (necrotic), it has to be removed surgically. Spaying her will prevent another occurrence and can be done at the same time as removing the dead tissue.

Dogs with difficulty delivering litters due to the protrusion will likely need a C-section.

Sometimes supportive therapy involving an E-collar to prevent self-trauma, a diaper with a lubricated pad, and hormone treatment can be given to make ovulation occur faster. However, dogs don’t generally have a good response to hormones, and it’s ineffective if given after ovulation, so it’s not usually helpful.

After treatment, the intact dog should be monitored in case of a relapse.

The only prevention is spaying.

Treatment for Vaginal Masses

Treatment for any kind of mass in the vagina will depend on many factors including the type of mass it is (such as a benign mass or cancer), the exact location, the extent of it, and whether or not it has metastasized to any other location.  If your pet has a vaginal mass, talk with your veterinarian to discuss treatment options.

In summary, if you notice a pink mass protruding from your cat’s or dog’s vagina, notify your vet. If your cat or dog seems to be in discomfort or having trouble urinating, contact your veterinarian or a veterinary emergency clinic right away.

Sugar substitutes are big business. Less sugar can mean weight loss, improved health, diabetic control, and even reduced tooth decay. The quest for products that can sweeten and cook like sugar is ongoing. Xylitol (also known as birch sugar) is a common sugar substitute, especially when it comes to sugarless gum, toothpaste, and more recently certain brands of peanut butter for bodybuilders. It is worth noting that even though birch sugar sounds natural and xylitol sounds like a chemical both are toxic to your dog.

Not only does xylitol offer sweetness with 40% of the calories of sugar, but it also has antibacterial properties in the mouth so it can reduce periodontal disease and has been found to have far-reaching health benefits in other areas of the body. Xylitol may help with osteoporosis, prevent ear and throat infections, and may reduce the risk of endometriosis, uterine fibroids, and even breast cancer.

Sounds wonderful and maybe it is if you are a human. If you are a dog, xylitol (birch sugar) is potentially lethal.

Two Deadly Effects of Xylitol

Hypoglycemia

In dogs, the pancreas confuses xylitol with real sugar and releases insulin to store the “sugar.” Even worse, the canine pancreas releases 3-7 times the amount of insulin that it would release to address a similar amount of actual sugar. Blood sugar levels plummet resulting in weakness, disorientation, tremors, and potential seizures.

It does not take many sticks of gum to poison a dog, especially a small dog (see below for toxic doses). Symptoms typically begin within 30 minutes and can last for more than 12 hours but, since xylitol can be absorbed into the body slowly, symptoms may not begin until 12 hours after the xylitol was eaten. Symptoms begin with vomiting and then progress to incoordination, collapse, and seizures.

Hepatic Necrosis

The other reaction associated with xylitol in dogs is the destruction of liver tissue. How this happens remains unknown but the doses of xylitol required to produce this effect are much higher than the hypoglycemic doses described above. Signs take longer to show up (typically 8-12 hours) and surprisingly not all dogs who experience hepatic necrosis will have had hypoglycemia first. A lucky dog experiences only temporary illness but alternatively, a complete and acute liver failure can result in death. Internal hemorrhage and the inability of blood to clot are commonly involved.

How Much Xylitol is Dangerous?

The hypoglycemic dose of xylitol for dogs is considered to be approximately 0.075 – 0.1 grams per kilogram of body weight (about 0.03 – 0.045 grams per pound). Chewing gum pieces have surprisingly variable amounts of xylitol depending on their flavor. (For example, most flavors of Orbit gum have about 0.009 grams of xylitol but their strawberry mint flavor has over 0.3 grams per piece). A small dog can easily be poisoned by a single stick of gum depending on the gum, how much the dog ate, and the size of the dog. It is important for you to bring the packaging for the xylitol product in question to the veterinarian’s office so that the amount of xylitol consumed can be estimated.

Treatment

Ideally, the patient can be seen quickly (within 30 minutes) and can be made to vomit the gum or candy. Beyond this, a sugar IV drip is prudent for a good 24 hours. Liver enzyme and blood clotting tests are monitored for two to three days. Blood levels of potassium are ideally monitored as well. Elevated blood phosphorus levels often bode poorly, and patients that develop hepatic necrosis usually do not survive.

What about Cats?

Xylitol toxicity appears to be limited to dogs. Cats have no significant ill-effects from xylitol.

What about Xylitol-Containing Mouthwashes for Pets?

The oral health benefits of xylitol do seem to hold true for dogs if appropriately low doses of xylitol are used.

Several products have been marketed for canine oral care, specifically for dogs that do not tolerate other methods of dental home care. These products are mixed in drinking water to provide antibacterial benefits.

Aquadent^®, for example, comes in a 500 cc (a half liter) bottle that contains a total of 2.5 grams of xylitol. It also comes in small packets to mix in drinking water. Similarly, Breathalyser Plus® from Ceva is similarly packaged. If you follow the dosing instructions on the bottle or packet, there should be no problems.

Trouble could occur if there are animals of different sizes drinking from the same water bowl or if a dog is on medication or has a disease that causes excessive water consumption.  One should dose for the smallest animal to use the bowl to be sure overdose is not possible. Alternatively, a dental water additive that does not contain any xylitol can be used. Ask your vet what he or she recommends. A dog finding the bottle and chewing it up, drinking a substantial quantity of the undiluted product could easily be poisoned, depending on the dog’s size.

Why does my pet need this medication? 

High levels of FAS can have negative effects in many ways.  It isn’t healthy for your pet.  Elevated stress hormone levels can suppress the immune system, change lab work results, and over the long term may even shorten your pet’s life.

Every time your pet is in a stressful situation such as going to the veterinarian, they learn to associate it with feeling anxious or scared.  That means that each time they go back to the clinic or a groomer, or you try to do something that they find scary, they get more and more scared.  They also anticipate something bad happening, so the anxiety starts sooner and sooner.

If they stay at a high level of FAS, your pet may learn that the only way to make people stop doing the things that scare them is to be aggressive.  This adaptation could result in a situation where your pet is sick or injured and making sedation risky but necessary because of aggression due to repeated negative experiences.  This risk can limit your veterinarian’s ability to provide necessary medical care to your pet.

My pet isn’t aggressive, can’t you just do what they need?

Physically we might be able to do these things, but it would have a negative impact on your pet’s mental health.  We don’t want them to learn to be more afraid at the vet’s office or start being afraid of strangers or you or in other situations.

He didn’t need medication last time, why are you saying he needs it now?

FAS often increases because of memories of bad experiences.  Giving medication to lower FAS also changes what your pet is learning so they don’t continue to become more and more anxious or aggressive. 

What if my pet is still fearful after taking these medications?

The medications you give at home may not be enough for your veterinarian to do full procedures but may allow injectable sedation to be given without causing undue stress.  If they don’t need urgent care, you may need to try a different combination of medications or different doses. 

What else can we do to lower my pet’s FAS?

Happy visits

If your pet travels in a carrier, use treats so they’re happy about going in and out of the carrier at home and take them for car rides in it so it isn’t a scary thing. Take your pet to the clinic when nothing is needed so they can learn that it’s a good place to be.  Start out just giving treats in your car or out in the parking lot.  Call ahead; if it’s a quiet time, staff may be able to come out and give your pet treats or have them come inside for some.

Home exams

If your dog or cat is fearful at the veterinarian’s, but is not aggressive or extremely fearful at home, you can get a pulse and respiratory rate and take their temperature at home.  You can also take pictures of their teeth in case they need to be muzzled, in which case teeth can’t be examined.

Basket muzzle training for dogs

For the safety of your clinic staff and ultimately of your dog, many fearful dogs require muzzles.   If the muzzle is introduced properly, your dog will associate it with treats and good things, so it will lower anxiety when worn.  If it is not introduced properly, putting a muzzle on a fearful dog can increase anxiety and aggression. 

A dog’s body language is often instinctive and happens naturally, such as trying to settle down a tense environment through actions or responding to an invitation to play. This form of communication can be used between dogs, during dog and human interactions, or between dogs and other animals. Knowing what your dog is communicating can help you understand his needs better and keep him comfortable in any given situation.

Below are some common types of body language that dogs use. It is important to recognize that many of these types of body language can mean different things in different settings and should be used in context of whatever is happening in the moment. A common example of this is panting, which could mean “I am nervous,” or “Gosh, it’s hot out,” or even “I’m tired.”

Diffusive Behaviors

These are types of body languages that dogs use to avoid conflict, help diffuse a potentially intense or threatening situation, and keep interactions from getting out of hand. Some refer to these behaviors as calming signals because, in a way, they signal to others things like “everything is ok,” “things have gotten a little too tense,” or “I am not a threat.” That being said, these types of behaviors indicate more than just calming; they communicate both how the dog is feeling and her ability to react and interact with others.

Be aware that some of these behaviors can be misinterpreted as signs of guilt, such as the slow, creeping walk towards or away from you when you correct your dog for doing something wrong. This behavior does not mean your dog is acting guilty for getting into the trash. It means she is trying to diffuse the situation and lessen the intensity of your correction. She honestly may have no clue at all why you are upset with her, and she just wants you to stop yelling.

Happy/Relaxed

1. Keeping the mouth open, often with the tongue lolling out, is typically a very relaxed posture for a dog.
2. Bowing down on the front legs, often known as a play bow, can be an invitation to play or a diffusive tool indicating that the dog is not a threat to someone or something else.
3. Tail wagging can often be content, happy, or excited body language. In certain settings, it’s important to know that tail wagging can indicate nervousness, anxiety, or an effort to diffuse a tense situation. Be mindful of what else is happening in the dog’s environment and remember that a wagging tail does not always mean a happy dog.

Anxiety/Fear/Worry

1. Cowering or making the body small, and crouching low to the ground can be a sign of fear.
2. Yawning frequently, especially when not obviously tired can be a sign of stress, fear, or anxiety. It can be a way to diffuse a tense situation the dog either finds himself in the middle of or in his immediate surroundings (e.g., other dogs fighting, intense talking amongst a dog’s owners, or being spoken to harshly by an owner).
3. Licking the lips or nose, even when no food or water is around, can be a sign of anxiety or fear. This is frequently used as a diffusive behavior.
4. Panting but not interested in water, or hot, can be a sign of fear, anxiety, or stress.
5. Combination of the ears positioned low and out to the side and the pet’s brows down or furrowed can be seen with anxiety or worry. This can often occur with other postures such as lowering the head and neck, and keeping the mouth closed. Be aware that lowering the head, neck, and ears can also be a sign of assertiveness or aggression in really tense situations, so assess what else is happening in the environment.
6. Creeping around or moving slowly when walking can be a sign of fear or anxiety. It is frequently a diffusive signal. This type of walking can also be a hunting maneuver, such as if a dog has spotted potential prey. Moving away quickly and darting around is also a sign of anxiety or fear.
7. Appearing on alert and trying to look around at everything quickly is a sign of anxiety or fear.
8. Unwillingness to eat or take a treat during a potentially stressful situation is a common sign a dog is anxious or afraid.
9. Pacing around and unwillingness to settle down in one place can be a sign of anxiety.  It can also be a sign of excitement and happiness.
10. Averting the eyes, turning the head away or to the side can be a sign of anxiety.  This can also be a diffusive tool as well, to avoid conflict or help diffuse a situation.
11. Pausing, holding position, or freezing can be a hunting behavior (sometimes called pointing), a sign of anxiety or uncertainty, or a diffusive behavior.
12. Tail tucked between the legs is often a sign of fear or anxiety and can occasionally be a diffusive behavior
13. Sniffing or snuffling along the ground can mean a great deal; it is often a way for dogs to get a feel for the environment, follow the trail of a recent inhabitant, discover signals left behind by other dogs or animals, or just enjoy the delights of nature. It can also be a sign of anxiety and a diffusive tool, such as when being approached by someone or something that may be a potential threat.
14. Raising a front paw can be a diffusive behavior or indicate anxiety/stress.
15. Rolling onto the back is often a sign of fear, although the occasional very confident dog may have learned to do so in order to get tummy rubs.
16. Barking or whining could be due to fear, anxiety, or excited/worked up. Growling could be assertiveness and/or aggression, or fear. High-pitched barking often means the dog is too excited and vocalizing to try to calm themselves down. Barking can also serve as a warning that the dog is too scared or too aggressive and a bite may come next.

Assertiveness and Aggression

These types of body language behaviors may occur in a dog attempting to use diffusive behavior that has been ignored, or may occur without initial signals such as in an overly excited/worked up or aggressive dog on high alert. Dogs that are too worked up or excited are said to be highly aroused. Assertive or aggressive posturing can frequently be seen in dogs exhibiting these body languages. Often the more aroused the dog, the more intensely she will respond to perceived threats or issues in the environment.

1. Direct eye contact is the most common initial body signal for displaying assertiveness or aggression, often when a dog is in a threatening situation. Assertiveness in combination with aggression is not always the case, of course, because your own dog may stare directly at you with his “sad, puppy dog eyes” when he wants something. Thus, other body signals or the situation itself should be evaluated (e.g., a new dog showing up) before determining if aggression is involved. In other words, a confident dog can be assertive, using body language to get what he wants, without demonstrating aggression, which involves behavior that can result in damage to someone else.
2. Pulling the lips back and displaying teeth can also be a signal of assertiveness or aggression.
3. As the dog’s perceived threat continues, holding the head, ears, and neck up initially may be seen (to make the dog appear bigger to the threat), but lowering the head and flattening the ears can be a signal that the dog feels the threat is worsening and the problem is escalating. This progression is an instinctive way to appear even larger and to protect important organs from attack.
4. The tail held straight up or curved over the back can sometimes mean a high alert or a threatening situation is occurring. Slow tail movements or rapid wagging that looks more like vibrating (known as flagging) can also be a sign the dog is feeling threatened and responding in an assertive or aggressive manner.
5. The dog’s weight may appear shifted toward the front of his body, which allows for quick action if needed.
6. The hair along the dog’s back may be standing on end, sometimes referred to as raised hackles. This can be an unconscious way of making the dog appear larger and more threatening. Hair standing on end indicates high alert and increased arousal, so it can sometimes be seen during intense play without any aggression.

A Note about Snapping and Biting

Bites have different degrees of severity, but a bite is still a bite, even if skin is not broken. A dog may snap at something without making contact; this is generally the dog’s effort at communicating a more intense warning. In this case, anxiety, fear, or aggression have been occurring and the signals have gone unnoticed. It is important to understand that generally, the dog is the one who has decided not to make contact or cause harm. Dogs are fast and can bite hard when they feel it is necessary, so take this warning snap seriously.

When an actual bite occurs, again, degrees of severity exist. Dogs can bite without drawing blood, bite superficially, or in more highly aroused states, give multiple and/or deep bites. Bites that occur without drawing blood are likely inhibited by the dog, meaning she held herself back from inflicting damage. It is important to understand that these bites and other superficial ones are still bites without major harm. They are likely to result in worse bites in the future if the dog doesn’t receive the help needed to move past the cause for the biting. Multiple and/or deep bites, those with no inhibition from the dog, means the dog bit without thought, acting on reaction alone.  Any snaps or bites require prompt assessment and assistance for the behavior issue.

Uveitis is an inflammation of the dark tissues (uvea) of the eye.  The uvea includes the iris, the ciliary body behind the iris, and the choroid in the back of the eye behind the retina.

Uveitis can be acute or chronic in onset, and anterior (iris and ciliary body) or posterior (choroid and retina) in location. Occasionally, all uveal tissues are involved (panuveitis). 

Uveitis has many different causes, including infectious diseases such as bacterial, viral, fungal, rickettsial and protozoal infections. Penetrating trauma, bleeding into the eye, long-standing cataracts, ingestion of fatty foods, immune-mediated diseases, generalized systemic diseases, and cancer of the eye are also potential causes. Occasionally, a cause is never identified.

Any age, sex or breed of dog or cat can develop uveitis. The underlying causes, however, can be influenced by the pet’s age, sex, breed, the geographic region in which it lives, and the environment.

Diagnosis

Figuring out why a pet has uveitis can be challenging. Unless the cause is obvious on the eye exam (such as a cat scratch, tumor, hypermature cataract), a thorough physical examination is required to search for evidence of disease elsewhere in the body. Numerous tests (complete blood count, biochemistry profile, serology for infectious diseases), x-rays (chest, abdomen), and possibly an abdominal ultrasound may also be needed. If the front of the eye is so cloudy that the structures in the back of the eye cannot be seen, then an ultrasound may be recommended. Ophthalmology requires specialized equipment, and your veterinarian may refer your pet to a veterinary ophthalmologist.

Treatment

The goal of treatment is to resolve the uveitis and any underlying causes.  Immediate priorities are to relieve pain, prevent glaucoma, maintain the normal internal structure of the eye and preserve vision. Treatment usually involves topical eye drops and systemic medications. Therapy is often required for weeks or months. Occasionally, treatment is lifelong. Surgery to remove the eye is rarely required; that is most often indicated for eyes that are permanently blind and painful, have a tumor, or when the inflammation cannot be controlled.

Monitoring

Because pets that have uveitis are at risk for vision problems and treatments often must be tweaked, close monitoring is important. Monitoring involves frequent ophthalmic examinations, including eye pressure measurement to check for glaucoma. Repeated laboratory tests may be required, depending upon the underlying cause and the therapy used.

Prognosis

Prognosis is good to guarded depending on the underlying cause, severity, extent of damage caused by the inflammation, duration of inflammation, response to therapy, and development of negative aftereffects. The best outcome occurs when uveitis is diagnosed early, treated promptly and aggressively, and the underlying cause is responsive to therapy.

Platelets (thrombocytes) are produced in the bone marrow. Platelets circulate in the blood. When your pet gets cut, platelets stick to the edges of the cut and to one another, forming a plug. They then release chemicals that react with fibrinogen and other plasma proteins, leading to the formation of a blood clot.

If your pet has a condition called thrombocytopenia, his platelet count is low. When the platelet count is low, it is harder for clotting to occur.

Signs of thrombocytopenia vary, but can include petechial (small, pinpoint) hemorrhages in the skin or mucous membranes (lining of the mouth, for example), nosebleeds, hematuria (blood in the urine), melena (blood in the feces), and bleeding into the joints or body cavities. The lower the platelet count is, the more likely it is that your pet will show signs. (Some animals may show no warning signs at all, and the thrombocytopenia may be discovered only during routine health exams.)

Major causes of thrombocytopenia are immune-mediated thrombocytopenia (an autoimmune disease), bone marrow cancers, infectious diseases, hereditary diseases, drug/vaccination reactions, vasculitis (leading to deep vein thrombosis), and disseminated intravascular coagulation.

Thrombocytopenia is not common in dogs and cats, although there are several breeds of dogs that are predisposed to it. Animals with cancer are at higher risk than those without cancer, but it can occur in a dog/cat of any age, breed, or sex.

Diagnostic tests include: blood tests (platelet count, complete blood count, serum biochemistry), urinalysis, chest or abdominal radiographs (to look for diseases that could be causing the thrombocytopenia), tests for specific infectious diseases (Rocky Mountain spotted fever, ehrlichiosis, etc.), bone marrow aspiration, and tests for immune system function.

Treatment is based on the cause of the thrombocytopenia, and may include antibiotics, corticosteroids, blood transfusions, etc.

Prognosis depends on the cause of the thrombocytopenia. A mild, self-limiting vaccine-induced thrombocytopenia has an excellent prognosis, while a thrombocytopenia due to cancer might have a much worse prognosis.

If your pet has been involved in any event that may have caused head trauma, always see your veterinarian or an emergency practice for immediate attention.

What Is a Traumatic Brain Injury?

Traumatic brain injury (TBI) occurs when a sudden event, such as a blow or fall, happens to the head. In both humans and animals, a head injury severe enough to damage the brain is referred to as traumatic brain injury or TBI.

Humans are diagnosed with concussions (a mild form of TBI), and veterinarians may use that terminology to describe a dog or cat with an externally caused brain injury. A concussion is a mild form of TBI that occurs when there has been a rapid back-and-forth movement of the head, essentially causing the brain to come in contact with the skull.

There has been increased attention on TBI in humans as sports injuries have become more recognized and acknowledged, and you may hear the term TBI more often now than in the past.

How Does it Happen?

TBI can occur in any age group or breed of dog or cat. Pets spending time outdoors may be more vulnerable to traumatic brain injury as they are likely exposed to more injury-causing risks. One fortunate advantage that dogs and cats have over humans is that their skulls are relatively thicker and, thus, a bit more protective of the brain. However, violent trauma can easily overcome the protective effect of a thicker skull.

An auto accident, fall, blunt trauma, a bite, kick or violent shaking, or any other sudden injury to the head can result in TBI.

How is TBI Diagnosed?

If your pet is not stable upon arriving at the veterinary hospital, it will be stabilized. A clinical examination will be completed, and your veterinarian may recommend various tests depending on your pet’s status. Your pet may have also been injured in other parts of the body, and your veterinarian will check for those. Blood and urine testing can help determine the extent of the injuries and establish a baseline for further evaluation. Neurological examinations and images of the head and brain using X-rays, MRI, or Computed Tomography (CT) may be needed when there is a suspected history of head trauma. Blood pressure may be monitored.

Evidence of an injury may be apparent. Cuts, scrapes, or broken bones may help tell the story if you were not present when the trauma happened.

If your pet is showing signs consistent with TBI, seeing these signs exhibited can be frightening. More so if you have no idea what is causing them.

Suppose the potential TBI happened in the past, and the history of the trauma that caused the head injury is available. In that case, your veterinarian will use this information to help evaluate the effects of the original injury.

There can be a variety of neurological symptoms from brain trauma that your pet may experience. Motor control issues such as circling in one direction, head tilting or displaying rapid or abnormal eye movement, or a difference in the size of the pupils may be present. Your pet may experience seizures.

Another severe and recognizable symptom of TBI is known as decerebrate posture. The limbs are held unnaturally, straight out, and ridged, with the head back and neck arched. This behavior generally suggests a more serious brain injury.

X-rays will usually be recommended as your pet may have a skull fracture or other broken bones (in other areas). Continuous electrocardiogram (ECG) monitoring may be needed to check your pet’s heartbeat. Additional imaging such as ultrasound, MRI, or CT scanning may be indicated so that your veterinarian can see your pet’s brain and other areas, if needed, in better detail.

Generally, TBI is divided into two categories: primary, which refers to results from the initial injury, and secondary, referring to damage caused by the primary injury.

Primary Injury

There is swelling where there is an injury to any of the body’s tissues. Swelling reduces blood flow, and compressed blood vessels cause pressure to build up in and around the brain. Broken blood vessels cause blood to pool, forming clots (hematomas).

If there is a skull fracture, brain damage can be worse. Surgery may be considered in this case. The severity of the condition is determined by how bad the initial injury and trauma were.

Depending on the overall injury causing a TBI, your pet may also experience difficulties with physical movement or injuries to other parts of the body.

Secondary Injury

Changes within the brain occur immediately after the primary injury, affecting the processes, or metabolism, at work in the entire body.

Because metabolism uses energy to drive many functions of the body, the changes are linked and result in numerous systems reacting, furthering the damage to the brain. Poor blood flow and bleeding in the brain add to these issues.

After the initial injury, a cascade of issues may develop over time. Brain swelling and inadequate blood and oxygen flow occur not only in the brain but also in other organs, such as the heart. Increased pressure within the cranium and brain swelling are major causes of death from TBI in dogs and cats.

Further laboratory testing and follow-up exams help your veterinarian evaluate additional damage to the whole body in addition to the brain that may be present.

Treatment

Treatment for TBI involves mainly supportive care, which may include hospitalization with continuous monitoring, medications, appropriate wound care, blood work, and follow-up X-rays.

Prognosis

Recovery for your pet depends on how severe the primary injury was. Patients who survive the first 24 hours following injury will most likely recover but may need treatment and monitoring depending on the injuries. If referred to a neurologist, you may need to take your pet for checkups or additional therapy, depending on the situation. Brains, both human and animal, have amazing powers of recovery, and positive outcomes happen all the time. Working closely with your veterinarian and/or veterinary neurologist and knowing what signs to look for (both good and bad) can help your pet have the best chance at recovery and, if possible, get back to their normal activities.

Depending on the location and extent of brain injury, the animal may recover fully or be left with varying degrees of altered mental or motor functions. One possible long-term result of TBI is epilepsy, which is recurring seizures. These can usually be managed with medications so that the animal’s quality of life remains good.

However, before it reaches that stage, your veterinarian might have you start measuring the sleeping respiratory rate (SRR) so that you catch congestive heart failure at the earliest stage possible.  Usually, such measurements start when the disease is moderate-to-severe, but not yet showing signs of congestive heart failure.  Your veterinarian will use tests such as chest X-rays (radiographs) or cardiac ultrasound (echocardiography) to determine when measuring the SRR is appropriate.

2. Diagnosis of congestive heart failure.  Sometimes signs of congestive heart failure are subtle and easily confused with other non-cardiac diseases. In such cases, your veterinarian might get you to measure your pet’s sleeping respiratory rate (SRR) to help rule out a diagnosis of congestive heart failure – if the rate is normal, congestive heart failure is extremely unlikely and your veterinarian can focus on other causes of your pet’s clinical signs.

Studies are finding that measuring the SRR is a very sensitive way to tell if your pet’s heart failure is being well controlled by drugs or not.  When the drugs are working well, the pet should be feeling good, but more importantly, the SRR should be between 10-25 breaths per minute (in most cases, it will be less than 30 breaths per minute).  If the SRR increases or exceeds 30 breaths per minute, it might indicate that there is fluid building back up in the lungs.  Your veterinarian will generally recommend you return to the clinic to confirm this is the case, or they might instruct you to increase the dose of diuretics.

How to measure SRR

SRR and RRR (Resting respiratory rate) should be obtained when the pet is comfortable, in a comfortable environment (not too hot or cold), and not after any exertional activity.  If sleeping, the pet should be in a “deep sleep”, not in a twitching or “dreaming” state.

The respiratory rate should be counted for a full minute if possible, although 30 seconds is often sufficient.  One breath is made up of 2 components: breathing in (inspiration or inhalation) and breathing out (expiration or exhalation).

These videos show 2 dogs and a cat either sleeping or resting quietly.  The counter records each breath for over a full minute. Watch these to understand how this is done.