What is a Skin Biopsy?

In a skin biopsy, a small piece of skin is removed through minor skin surgery. The skin is then examined under a microscope by a veterinary pathologist to diagnose your dog or cat’s skin condition. Skin biopsies are also used to test a growth or mass for conditions such as cancer.

What Happens During My Pet’s Skin Biopsy?

The veterinarian may gently clip the fur near the skin biopsy. A sedative or anesthetic medicine may be given to make your pet more comfortable during the procedure. Different types of surgeries are performed during a biopsy. The type of surgery depends on where the biopsies are being performed and what skin conditions your veterinarian is concerned about. The most common surgeries for a skin biopsy include the following:

1. A wedge biopsy is used to surgically remove not only the skin but also the tissue under the skin (subcutis). The veterinarian angles a scalpel blade to meet as a “V” under the skin.
2. An excisional biopsy is used if your pet has a growth (skin mass). The veterinarian uses a scalpel blade to cut the growth out of the skin. Excisional biopsies are used to diagnose many skin conditions.
3. A punch biopsy is used to remove the full thickness of a small, round piece of skin. The punch tool will be placed on the area where the skin sample(s) will be taken, pressed downward to cut the skin gently, and then the piece of skin will be removed. Punch biopsies are a common way to perform skin biopsies in dogs and cats. They can also be used to obtain a skin sample for a skin culture (bacterial culture and sensitivity) to select an antibiotic for your pet’s skin infection.
4. A shave biopsy is used to surgically remove only the top layer of skin. The veterinarian uses a scalpel blade or other tool to scrape or shave off the skin. Shave biopsies are used to diagnose skin conditions that only affect the top layers of the skin.

What Can I Do to Help Prepare My Pet for a Skin Biopsy?

The veterinarian will provide you with specific instructions for preparing your pet. This may include not feeding your pet in preparation for the sedative or anesthetic medication. For the skin, do not pick at your pet’s skin or remove any crusts or scabs. The veterinarian will also tell you when to stop bathing or applying medications to the skin before the biopsy.

What Will Happen After My Pet’s Skin Biopsy?

When the procedure is over, your pet will be able to go home, and the veterinarian will provide you with specific instructions to care for your pet. Your pet may have bleeding, redness, or swelling after the biopsy. If your pet has stitches where the biopsy was performed, the veterinarian will tell you if and when the stitches need removal. If the fur was clipped for the biopsy, the fur will be shorter but will grow back.

What Happens to the Skin Sample after a Biopsy?

The skin sample is cut into thin sections and put onto glass slides. The slides then go to a laboratory for testing. A veterinary pathologist (a veterinarian trained in interpreting biopsy samples) will check the slides under a microscope to help make a diagnosis. For skin biopsies, a veterinary pathologist who has received additional training in diagnosing skin diseases called a veterinary dermatopathologist, is often used.

Serotonin syndrome is a serious drug reaction to medications that build up high levels of serotonin in the body. A chemical that the body produces naturally, serotonin is needed for the brain and nerve cells to function properly. Medications such as those used to treat human depression, attention deficit hyperactivity disorder, seizures, and pain; illicit drugs such as LSD or ecstasy; dietary supplements including SAMe, St. John’s wort, ginseng, turmeric, Garcinia extract, and Garcinia cambogia; and even certain foods with high levels of tryptophan, such as salmon, spinach, poultry, milk, eggs, nuts, and soy products can all contribute to serotonin syndrome.

In veterinary medicine, serotonin-enhancing medications are often used to treat behavioral issues such as separation anxiety, fear of fireworks, storm phobia, compulsive disorders, aggression, and house-soiling behavior. Serotonin syndrome may occur with the start of a new medication, dosage change, or combination of medications. However, it is most commonly seen when a pet accidentally ingests medication prescribed to a human in the household.

Diagnosis is often based on the history of ingestion and clinical signs. Signs may appear anywhere from 1 to 12 hours after ingestion. Symptoms generally last about 24 hours but can extend for several days. Most animals will show GI upset, such as vomiting, diarrhea, and a loss of appetite.

Other common symptoms include:

1. dilated pupils
2. increased heart rate
3. fever
4. muscle tremors or jerking
5. restlessness
6. difficulty walking
7. agitation
8. excitation
9. disorientation
10. vocalization
11. seizures

Serotonin syndrome can be a life-threatening situation; therefore, if you think your pet is developing it, visit a veterinarian immediately. Make sure to bring all the prescriptions that your pet may have ingested with you. Don’t forget to mention any over-the-counter dietary or herbal supplements your pet is taking because they could be a cause as well.

Treatment will vary based on clinical signs. Depending on the severity, hospitalization may be needed. Prognosis depends on what your pet swallowed, how much, and how long they have been symptomatic.

Ringworm Environmental Decontamination:

How to Clean and Disinfect the Home

Thoroughly cleaning and disinfecting the home when a pet has ringworm is called environmental decontamination and is a two-step process.

STEP 1: Remove pet hair

Wipe, sweep, and/or vacuum the surface then thoroughly wash the surface until visibly clean of pet hair. Remove any excess water before Step 2.

STEP 2: Disinfect the surface.

Apply disinfectant and let sit for 5 min.

Step 1 is the most important step because many surfaces can be rid of ringworm by removing pet hair. Additionally, many disinfectants do not work in the presence of debris.

Below is a guide to cleaning and disinfecting various materials. Information is summarized from publications by veterinary dermatologist Dr. Karen Moriello of the University of Wisconsin School of Veterinary Medicine.

Material	Cleaning Step	Disinfection Step
Carpeting (small area rugs)	Vacuum daily	Launder. Do not overload the washing machine. Wash separately from other laundry.
Carpeting (wall to wall)	Vacuum daily	Professional steam cleaning or Chemical disinfection (spray with a disinfectant then rinse with a carpet shampooer after 10 minutes of contact time)
Upholstered furniture	Vacuum daily or Lint rollers or duct tape daily	Professional steam cleaning or Chemical disinfection (spray with a disinfectant then rinse with a carpet shampooer after 10 minutes of contact time)
Hardwood floors	Vacuum daily or Use disposable electrostatic wipes daily (Swiffer® pad)	Wash with a cleaning product safe for hardwood flooring (e.g., Murphy’s Oil Soap®)
Hospital towels	Launder daily and use laundry detergent. Wash twice on a long cycle (for ≥14 minutes). Use laundry detergent. Wash separately from other fabrics. Do not overload the washing machine.
Cat trees, pet clothing, fabric collars, etc.	Discard all non-washable items. Wait until after your pet’s infection has been treated to buy new items.
Pet food bowls	Soak dishes in hot, soapy water, scrub until clean, and rinse. Wear dishwashing gloves for protection against infection.

Laundry Tips for When Your Pet Has Ringworm

• Wash towels, bedding, and clothing that have been in contact with your infected pet separately from other household laundry. Wear gloves when handling dirty laundry.
• For any laundry, thoroughly washing is more important than the temperature setting for the washer or dryer. Use the longest wash cycle possible and do not overload the washing machine. This will help the washing machine remove infected pet hairs from the fabric.

Disinfection Tips for Ringworm

• Newer research shows that if the surface is first thoroughly cleaned, many disinfectants can be used to clean household surfaces. Examples include ready-to-use bathroom cleaners that are effective against Trichophyton spp. For any product, follow the instructions on the label and pay close attention to contact time.
• Household bleach (sodium hypochlorite) is an inexpensive option. Although dilutions as high as 1:10 have previously been reported, a lower dilution of 1:100 is also effective and less harsh on surfaces. Prepare fresh solutions each week and store in a dark container. Pay attention to the warnings on the bleach container and do not mix bleach with other cleaners. Bleach will damage some floor finishes, wood, and discolor fabrics.
• Accelerated hydrogen peroxide is a proprietary compound of concentrated hydrogen peroxide combined with other cleaners. It is different from the bottles of dilute hydrogen peroxide available at drugstores and may be available from your pet’s veterinarian.
• In households with less than 2 pets infected with ringworm, twice weekly cleaning and disinfection should be sufficient. However, any visible pet hair should be removed daily.

Tips for Making Cleaning and Disinfection Easier When Your Pet has Ringworm

• Try to keep your pet in an easily cleanable room that does not have carpeting or clutter. Bathrooms and other rooms with hard surface flooring work great.
• Change your pet’s bedding daily and use easy-to-launder fabrics.
• After vacuuming, dispose of the vacuum bag at least weekly and wear gloves when handling the vacuum bag.
• Because cleaning and disinfection need to continue until your pet’s ringworm infection has been cured, follow the treatment recommendations from your pet’s veterinarian. This will help your pet recover from the infection as soon as possible.

Rhinitis is inflammation of the mucous membranes in the nose. If the lining of the sinuses is inflamed, that is called sinusitis. If both the nose and sinuses are affected, it is rhino-sinusitis. Rhinitis can occur by itself or as part of an upper respiratory illness/infection. Rhinitis can be mild, with just a bit of clear nasal discharge seen, or it can be severe enough to have green/yellow/hemorrhagic (bloody) discharge.

Potential Causes of Rhinitis 

Many things can cause inflammation of the nose lining in dogs and cats. Some of them are:

1. Tooth root abscess
2. Viruses (feline herpesvirus, feline calici, and canine distemper, for example)
3. Fungal infections
4. Parasites (nasal mites, for example)
5. Inflammatory polyp
6. Birth defects (a cleft palate, for example)
7. Facial/head trauma
8. Foreign bodies (blades of grass, seeds, and grass awns, for example)
9. Allergies
10. Idiopathic lymphoplasmacytic rhinitis (chronic inflammatory rhinitis)
11. Cancer
12. Bacteria

Cases of rhinitis can be chronic (ongoing) or acute (short-term). Chronic rhinitis has intermittent, recurrent episodes of sneezing and nasal discharge; sometimes there will be a partial response to antibiotics, but not enough to get rid of it forever. Chronic rhinitis/rhino-sinusitis cases in cats are often referred to as chronic snufflers.

Idiopathic lymphoplasmacytic rhinitis (chronic inflammatory rhinitis) is uncommon in the cat but may represent a hypersensitivity reaction to one or more environmental air allergens. In dogs, it was diagnosed in 20% of rhinitis cases, in one study. The German shepherd dog, Labrador retriever, dachshund, cocker spaniel, and Yorkshire terrier are the most commonly affected dog breeds. Median age of affected dogs is 8-9 years.

Clinical Signs

Treatment

Treatment depends on the underlying cause of the rhinitis. Medications such as antibiotics, antihistamines, steroids, or anti-fungal medications may be called for. Secondary bacterial nasal infections are common, and nasal discharge often will resolve with antibiotic treatment. For cases involving foreign objects or cancer, surgery may be needed.

Prognosis

The prognosis is dependent on the underlying cause of the rhinitis and how chronic the case is.

Rectal prolapse occurs when the rectum, which is the last part of the intestines, gets turned inside out (everted), and sticks out of the anus. It looks like a red or pink tubular structure sticking out of the area from which your pet normally poops. It can also be crusty, ooze, or be a dark color if it has been around for a while. Rectal prolapse is not the same thing as hemorrhoids, which are swollen veins from the rectum that bulge out of the anus.

Why a Prolapse Happens 

Prolapse can occur after a pet has been straining to poop for a while. Some of the most common reasons this can happen is if the pet has intestinal worms, is dehydrated, constipated, has diarrhea or loose stool, or has an intestinal blockage such as a tumor or has eaten an object that he is having trouble passing. Over time, straining leads to weakening of the structures that keep the rectum in place, causing the rectum to stick out through the anus. 

Other Symptoms 

If your pet has a rectal prolapse, you may also have noticed that he has been spending a lot of time trying to poop recently. An example of straining is standing in the classic, “hunched” posture used for emptying the bowels for longer than usual. It can also mean pooping more times than usual, even if he is able to finish quickly. You may also have seen an unusual change in the poop, such as being small and dry, looser than usual, or covered in intestinal worms. If you haven’t noticed any change in regular habits, either because keeping an eye on your pet’s bathroom habits is gross or because you have a sneaky pet that hides in order to go, it isn’t a big deal. Your veterinarian will know what to do. 

Diagnosing a Rectal Prolapse 

To officially diagnose a rectal prolapse, your veterinarian will give a pretty thorough physical examination, including a rectal exam in which they feel the prolapsed tissue. A fecal sample will likely be taken to check for worms and other intestinal issues. If a blockage is suspected, x-rays and/or an abdominal ultrasound may be necessary. 

Treatment 

To treat the prolapse, the vet will have to carefully clean the area before replacing it back into its original position. If it is swollen, additional medications or solutions may need to be applied to shrink the prolapse. Sometimes sedation or anesthesia is needed because a prolapse can be painful, especially if it becomes infected. 

If the prolapse can be replaced, the vet may tie a “purse-string” suture around the anus to keep the opening small and prevent the rectum from prolapsing again. This fix is temporary until your pet heals. The suture will need to be removed later (your vet will tell you when), but it is important that you don’t let your pet chew the area or the suture may break. Antibiotics and pain medications may be sent home, as well as an e-collar, to ensure the rectal tissue heals properly. 

Occasionally, a rectal prolapse cannot be replaced, or the tissue is too damaged. In these cases, surgery will be necessary to either remove the damage tissue (called a resection and anastomosis) or tack the rectum into the body wall from inside the abdomen (called a colopexy). 

In addition to treating the prolapse, your veterinarian will also want to treat the cause of the prolapse (e.g., treat for intestinal worms). Stool softeners may also be prescribed for a short period to keep your pet from straining. Most pets improve and do not continue to have issues once the rectal prolapse heals. If you have any questions or concerns about your pet’s diagnosis and treatment, give your vet a call so they can guide you further.

 We can assure you that there is nothing normal about being overweight.

Why Obesity is Bad

A common justification for over-feeding treats is that a pet deserves a higher quality of life as a trade off for longevity. While this might on some level makes sense (after all, a pet munching on a treat is certainly getting a great deal of satisfaction from doing so), the other consequences do not make for higher life quality in the big picture. Here are some of problems that obese animals must contend with while they are not enjoying their treats and table scraps.

Arthritis

The over-weight animal has extra unneeded stress on joints, including the disks of the vertebrae. This extra stress leads to the progression of joint degeneration and creates more pain. Weight management alone decreases and can even eliminate the need for arthritis medications. The problem is compounded as joint pain leads to poorer mobility, which in turn leads to greater obesity.

Respiratory Compromise

The obese pet has a good inch or two of fat forming a constricting jacket around the chest. This makes the pet less able to take deep breaths as more work is required to move the respiratory muscles. Areas of the lung cannot fully inflate, so coughing results. The pet also overheats more easily. Many cases of tracheal collapse and chronic cough can be managed with only weight loss.

Diabetes Mellitus

Extra body fat leads to insulin resistance in cats just as it does in humans. In fact, obese cats have been found to have a 50% decrease in insulin sensitivity. Weight management is especially important in decreasing a cat’s risk for the development of diabetes mellitus.

Hepatic Lipidosis

When an overweight cat goes off food or partially off food because of illness or psychological stress, body fat is mobilized to provide calories. Unfortunately, the cat’s liver was not designed to process a large amount of body fat. The liver becomes infiltrated with fat and then fails. A stress that might have been relatively minor, such as a cold, becomes a life-threatening disaster.

Reduced Life Span

A study of age-matched Labrador retrievers found that dogs kept on the slender side of normal lived a median of 2.5 years longer than their overweight counterparts.

Unwillingness to Accept Therapeutic Diets

If the pet should develop a condition where a therapeutic diet is of great benefit, the pet that has been maintained primarily on a diet of table scraps may be unwilling to accept commercial pet food of any kind, much less a food modified to be beneficial for a specific disease process. This unwillingness will hamper treatment.

Increased Surgical/Anesthetic Risk

Obesity poses an extra anesthetic risk because drug dosing becomes less accurate. (It is hard to estimate a patient’s lean body mass for drug dosing if it is encased in a fat suit.) Furthermore, anesthesia is inherently suppressive to respiration and adding a constrictive jacket of fat only serves to make proper air exchange more challenging. And still further, surgery in the abdomen is hampered by the slippery nature of the extra fat as well as difficulty visualizing all the normal structures through the copious fat deposits. One never knows when a pet will require an emergency surgery (to say nothing of regular teeth cleanings).

So is the enjoyment of all those extra treats really worth it?

How Did My Pet Get So Fat Without Eating That Much?

You might think weight management might be easier for a pet than it is for a human. After all, the pet relies completely on someone else for feeding and exercise so it should follow that if the humans in control can regulate feeding and exercise, the pet should lose weight. It seems like this would be true but, as with humans, there is tremendous individuality with how different pets store the food they have eaten. Beyond this, sometimes it is hard to know what a pet is eating or the owner may not have a good sense for how much should be fed. Here are some factors involved.

If you do not have a cup measure, you can often get one from your veterinarian’s office as most manufacturers of reducing diets for pets provide free cup measures.

onsider measuring food with a gram scale. This a far more accurate way of measuring food amounts compared to cup measures.

The Package Guidelines are just Guidelines

Many packages of food include on their label some sort of feeding schedule that indicates how much food should be fed to a pet of a certain weight. This information is also available on most pet food web sites as well. The problem is that each pet is an individual and just as one person weighing 150 lbs can be obese and another person of the same weight may be skinny, the same is true of pets. These guidelines are meant as a starting point only. If your pet is too fat on the recommended feeding schedule, then you should reduce the amount of food or change to a diet that is higher in fiber so that a satisfying volume of food can still be eaten without adding calories.

Genetics

Some animals simply have the genes that predispose them to obesity. Dog breeds with genetic tendencies towards obesity include the: Golden Retriever, Cocker Spaniel, Dachshund, Beagle, Shetland Sheepdog, Boxer, Cairn Terrier, Basset Hound, and Labrador Retriever.

Children at Home

It is almost impossible to keep children from providing extra treats to their dog. This may include snacks spilled during play (pets have no “five-second rule”) or purposely feeding the pet unwanted food under the dining table. Similarly, pets that are allowed to roam (usually cats) often find food left out by neighbors, either to purposely feed their own pets or strays, or as unsecured trash. It is almost impossible to control the diet of an outdoor cat.

Low Metabolism

Some pets do not burn calories efficiently; they simply have a slow metabolism. This might be genetic as mentioned or it might be the result of a disease such as hypothyroidism or Cushing’s disease. Testing for health problems such as these is helpful to get the best treatment for resolution of the obesity. It seems like increasing exercise and eating a healthier diet would be easy to accomplish for a pet but it generally does not turn out that way.

Underestimating the Power of Treats

Many people express their affection for the pet by providing regular treats, and the pet happily obliges by begging or even performing cute behaviors. For some people, feeding treats to the pet constitutes a major part of the human-animal bond and they do not wish to give it up or reduce it. Pet treats are often high in calories, though, and four or five treats readily converts into an extra meal’s worth of added fat. Free feeding of dry food encourages the pet to snack as well; meal feeding represents better calorie control.

Treats should not exceed 10% of the pet’s feeding allotment.

Neutering

Sterilizing a pet is good for public health (fewer strays means fewer dog bites, less public resources needed for animal shelters etc.), good for a better house pet (less urine marking, tendency to fight or roam), no unwanted litters, reduced risk of many diseases, etc. The change in the hormonal picture, though, creates a tendency to form more fat cells (creating increased fat storage capacity – especially in female cats), and typically slows metabolism. Spay/neuter is a excellent time to switch from free feeding to meal feeding.

Evaluation by Body Score

Sometimes it is hard to recognize that your pet is overweight as the weight gain has come on gradually or it is hard to actually accept that your pet is more than just a little chubby and is now fully obese. To assist in this evaluation, body condition scoring has been developed and is fairly easy to accomplish. There are two scoring systems: a five-point system (where three out of five is considered optimal) and a nine-point system where four to five out of nine is considered optimal).  To evaluate your pet, feel for a small amount of padding over the ribs. It should be possible to feel the ribs and there should be a small tuck in the belly where the hind legs meet the body. 

See the body condition charts for dogs and cats.

What can be Done: Diet and Exercise

This sounds simple, but in fact when you simply try to cut back on food, it just does not seem to work. Begging for food can result plus simply reducing the amount of a regular diet (one not meant for weight loss), can lead to deficiency in vitamins or minerals.

As with humans, a more formal approach seems to work best. This means feeding a prescription diet made for weight loss (typically “lite” or “less active” diets are meant to prevent weight gain, not actually cause weight loss), feeding a measured amount, and coming in for regular weigh-ins at the vet’s office.

This means:

• There must be control over what the obese pet eats. That’s easy enough if there is only one pet and roaming is not allowed, but trickier if there is more than one pet in the home. Use your ingenuity to feed the pets separately.
  
• Feed in meals. Leaving food out encourages snacking. Feeding in meals makes it easier to feed multiple pets different foods or different amounts of food.
  
• Commit to regular weigh-ins. Know what the goal weight is and how long it should take to reach this goal/or how to tell if the pet is on target. It is important not to try to go too fast. If the weight loss is not on track, sometimes it is necessary to feed more rather than less. Your veterinarian may need to be in contact with the clinical nutritionists at the pet food company so as to make the best recommendations.
  
• Consider interactive toys that can be used when you are not home or where your own participation is minimal.

Be sure to rule out health issues that might specifically cause obesity as an initial step in obesity management.

Nutrigenomics

Nutrigenomics is the study of how food influences the expression of genes and how genes influence the disposition of nutrients. This field is still in its infancy but is rapidly developing such that one day nutritional programs can be designed based on one’s own individual genetic composition. We all have seen how different people metabolize the same food in completely different ways and how changing to a similar diet can have varying effects among individuals.

There is currently only one commercial diet on the market that uses principles of nutrigenomics to activate genes of fat-burning and create a fat burning metabolism and that only available through veterinary clinics. This food system employs dry food, canned food, and treats in any combination but in amounts determined by the pet’s initial body composition and calculated healthy weight. This approach has not been found to be more effective with weight loss over the more traditional high fiber diets but at the end of the program when the desired weight had been achieved, the animals on the nutrigenomic diet had been metabolically altered to reduce storage of consumed fat. Pets on traditional weight loss plans were not metabolically altered and were still “fat storers” and potentially ready to regain the fat stores they had worked so hard to lose. This food is for sale only through veterinarians so if you are interested in this concept, talk to your veterinarian.

Do it Yourself without a Therapeutic Diet

Therapeutic diets are available only through veterinary clinics and authorized diet delivery services. These types of foods are likely to cost more and/or be less convenient to obtain than foods available at the grocery store or pet supply store so a pet owner may be tempted towards do-it-yourself weight loss. As discussed, weight loss often turns out to be more complicated than you imagine. If the problem is simply cutting out treats, adding more exercise or in some way changing the human behavior that led to the pet’s weight condition, then you may have a good chance at getting results. If the problem is the pet’s metabolism, then it may be an uphill battle. Regular weigh-ins are still crucial and the pet should not lose more than two percent of body weight per week. High-fiber diets tend to work best for dogs while low-carbohydrate diets tend to work better for cats.

For more specific information, consult your veterinarian, and see the Association for Pet Obesity Prevention.

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.

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. 

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.

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.