How is it diagnosed?

Your dog’s veterinarian may need to take skin and other samples to diagnose and treat it. This is because many other skin conditions can cause comedones in dogs, including demodicosis or demodectic mange from Demodex mites.

What causes Schnauzer comedone syndrome?

No one really knows what causes Schnauzer comedone syndrome. However, it may be an inherited condition because it occurs more commonly in certain dog breeds.

How is Schnauzer comedone syndrome treated?

Schnauzer comedone syndrome cannot be curred but can be treated. To loosen and dissolve the comedones, your pet’s veterinarian may recommend a topical therapy, such as a medicated antiseborrheic shampoo or ointment. If comedones become infected, they may need to be treated with an antibiotic. Your pet’s veterinarian may take a sample for a skin culture (bacterial culture and sensitivity) to choose the antibiotic. Especially if the skin infection is itchy or painful, your pet’s veterinarian may do some tests to determine if your dog has other health conditions that are making the Schnauzer comedone syndrome bumps worse.

Parvo can be easily spread by fomites, which are objects such as a doorknob or pet fur that can be contaminated by a virus. Dog-to-dog contact is not required for susceptible dogs to become infected. Dogs can become infected from contact with the remaining virus where an infected dog has been, or on objects an infected dog has used, or even from shoes and clothing carrying the virus. To make matters worse, non-enveloped viruses are not easily killed by most common household disinfectants and antibacterial soaps do not kill it. If you have had a dog with canine parvovirus in your home or yard, you need accurate information about what you can do to decrease or eliminate the risk of exposing other dogs while understanding that you cannot completely eliminate parvovirus from your home; it’s simply not possible.

First, Remove Organic Material

Sanitizing is a two-step process that involves both cleaning and disinfecting. Some surfaces and substrates are easier than others to sanitize. For instance, carpet and grass are difficult to properly sanitize, whereas sealed cement is easier.

Before disinfecting, you need to clean since many disinfectants do not work well on organic material, such as stool or urine. Clean up any organic material from the yard and in the house. Bedding and toys that are not heavily soiled can be washed through a soap/bleach cycle and dried on a hot setting. It is best to discard anything heavily soiled. All areas and items still need to be properly disinfected, but the first step is to mechanically clean them.

Water can also be used to spray down outside areas to help remove any dried poop or vomit. Diluting an area such as a lawn by spraying with water may also help, but only if drainage and temperature allow the yard to thoroughly dry afterward.

Bathe any dogs using regular dog shampoo who were exposed or infected and recovered, as well as other dogs who had contact with the infected dog or area. This will help to decrease the risk of fomite transmission from their fur.

Use an Effective Virucidal Disinfectant

When choosing a disinfectant, make sure it has been proven to kill parvovirus. A label claiming to kill viruses does not mean it kills all viruses, such as the hearty, non-enveloped parvovirus. Additionally, any disinfectant must be mixed to the proper dilution and remain saturated for the proper contact time to be effective against parvovirus. Independent studies or FDA approval backing label claims are the most reliable means of determining a disinfectant’s effectiveness.

Types of Disinfectants

Quaternary Ammonium Disinfectant

Despite its popularity for many years and label claims of efficacy against parvovirus, independent studies have shown this disinfectant to be unreliable against parvovirus. The label claims are based on diluting at 18 ounces per gallon, which is four times the typical concentration. Despite repeated reformulation and label claims, this is not seen as a reliable disinfectant against parvovirus and is not endorsed by independent studies or label-approved by the FDA. It must be rinsed off.

5% Sodium Hypochlorite (Bleach)

Bleach can kill parvovirus when it is used properly. It is readily available and relatively inexpensive but has some drawbacks. It can discolor or even ruin surfaces. The fumes can be irritating to the nose, eyes, and skin. Bleach is most effective on non-porous surfaces from which organic material has been thoroughly removed. For areas where you can safely use bleach, dilute household bleach (5% sodium hypochlorite) using 1 part bleach to 32 parts water (that’s 1/2 cup per gallon of water). The diluted bleach must have ten minutes of contact time with the surface, which means saturating the area or continually spraying for ten minutes. It must be rinsed off.

Potassium Peroxymonosulfate Disinfectant

This disinfectant has some detergent properties, meaning it is effective for mechanically removing organic matter, such as vomit and feces. It can be irritating to the skin and eyes. The label claims efficacy against parvovirus at 1% dilution, even when mixed with hard water or organic material. It can be used in carpet cleaners to clean carpets and furniture (spot test for staining first) and can also be sprayed on yard surfaces. The area must remain saturated for ten minutes. It can be left to dry and does not need to be rinsed.

Accelerated Hydrogen Peroxide (AHP) Disinfectant

This disinfectant has become widely used in animal shelters, where CPV is not uncommon. Its detergent properties make it effective even when there is some organic matter. It can be used in one step for mechanical cleaning and to kill the virus. As in the other disinfectants discussed, proper dilutions and contact time are crucial to ensuring it kills the virus. It should be diluted using one part AHP to 32 parts water (1/2 cup per gallon of water) with a ten-minute contact time. This can be irritating to breathe but is less corrosive to surfaces and mucous membranes than bleach. It can be used in carpet cleaners and sprayed on grassy surfaces as well. It can be left to dry and does not need to be rinsed.

The Yard

Careful and repeated removal of all visible feces is important. If possible, flush the yard with water and allow it to dry. Then apply a disinfectant that is effective with organic material, such as AHP or potassium peroxymonosulfate. These can be used with a pesticide sprayer or hose-end sprayer at the proper dilution to saturate the outside area. Diluted bleach may also be somewhat effective, but since it does not perform as well with organic matter it is less effective than the others. Bleach is also more dangerous to plant life and other surfaces. If your yard has dirt and grass, rather than just cement, there is no guarantee any disinfectant will be 100% effective. It is best to thoroughly clean, dry, disinfect with the proper contact time and dry at least twice. When possible, maximize exposure to sunlight and allow the area to dry completely.

In most home yard situations where there is grass and dirt, it is not possible to completely disinfect a yard. Out of an abundance of caution, you may want to avoid having unvaccinated dogs come to your yard for 6 to 12 months, even after cleaning and attempting to disinfect.

The House

It helps to understand the difference between porous and non-porous surfaces. Water can go through porous materials. Non-porous materials include stainless steel, glass, metals, rigid plastics, and painted or varnished surfaces. Granite countertops are porous, but quartz is not. Porous materials include unpolished wood, laminate, granite, drywall, carpeting, ceiling tiles, and unsealed cement.

As mentioned, the first step is thoroughly cleaning the house and removing any feces or vomit that can be seen. Once all areas have been mechanically cleaned, you are ready to disinfect. Non-porous surfaces can be disinfected with diluted bleach or AHP or potassium peroxymonosulfate. Make sure you follow the manufacturer’s instructions for the proper dilution and contact times for parvovirus.

For carpets and porous surfaces, AHP or potassium peroxymonosulfate disinfectants can be used in carpet cleaners to steam clean carpets and furniture. Understand that these areas are sometimes impossible to disinfect and heavily soiled items should be discarded if possible. Make sure you read the carpet cleaner instructions and spot-test any porous surfaces for possible discoloration. These surfaces will need to remain saturated for ten minutes to ensure the proper contact time. After disinfecting, the areas need to dry thoroughly.

Bedding, Porous Items, or Toys

Bedding and other fabric or porous items should either be thrown away, especially if heavily soiled, or washed thoroughly with detergent, hot water, and bleach and run through a hot dryer cycle if possible. If it is not possible to bleach the items, you could steam clean them with disinfectant as recommended for carpet and furniture. Consider if it is worth the risk to keep porous items such as bedding and toys that can’t be bleached, or if it is better to throw them away.

Exposed Bowls and Non-Porous Items

Metal or ceramic bowls and non-porous toys should be washed thoroughly with a detergent, rinsed well, and then disinfected using an effective disinfectant. Throw away any plastic bowls that have any signs of wear, scratches, or teeth marks, which create porous areas. Proper dilution and contact time are important. This can be achieved by soaking the cleaned items in the diluted disinfectant for ten minutes, then allowing the items to dry. After disinfecting, thoroughly rinse the items with water and allow them to dry.

When is my Home Safe?

Unfortunately, there is no guaranteed time frame. There has not been any research that definitively states canine parvovirus can be eliminated from a home or yard environment in a specific number of days. There are many factors that affect whether cleaning and disinfecting efforts will be effective inside the house and outside in the yard. After a parvovirus-positive dog has been in your home or yard, it is safest to only have animals visit who have completed their vaccination series.

Salmon poisoning is also known as salmon disease, salmon poisoning disease (SPD), and Neorickettsia helminthoeca infection. It is an acute, and often fatal, infectious disease of dogs, coyotes, and foxes of the Pacific Northwest. This disease has been found in black bears and Malayan sun bears, but has not been reported in cats.

Despite its name, salmon poisoning does not involve a toxin. Salmon poisoning is an infection that develops when dogs eat raw or undercooked fish (salmon, trout, or steelhead) or Pacific Giant Salamanders that contain a fluke. A fluke, also known as a trematode, is an internal parasite. In this case, the fluke is Nanophyetus salmincola that contains a rickettsial organism called Neorickettsia helminthoeca.

Once the larval flukes reach the dog’s intestinal tract, they embed in the dog’s duodenal mucosa, and release the rickettsiae. The rickettsial organisms then spread through the bloodstream to the liver, lungs, brain, and lymphoid tissue. Clinical signs include, but are not limited to: fever; nausea; vomiting; bloody diarrhea; weight loss; ascites; nasal and eye discharge; enlarged lymph nodes; tachypnea; dyspnea; tachycardia; twitching; and seizures. Approximately 60 percent of cases have generalized lymph node enlargement. Unless the infection is treated, 50 – 90% of affected animals will die of the infection within 7 to 10 days.

Clinical signs usually begin about one week after the animal eats the infected raw fish, although delays of 33 days have been reported.

Geographic Distribution

Although infected fish can be found in the Pacific Ocean from San Francisco to the coast of Alaska, salmon poisoning is most commonly found in Washington, Oregon, northern California, and southern Vancouver Island (Canada). It is also seen inland, along the rivers of fish migration. The Pacific Northwest has the trematode’s first intermediate host, a small snail called Oxytrema plicifer.

Diagnosis

Although clinical signs are caused by the rickettsial organisms and not the fluke, presumptive diagnosis is usually made by identifying the fluke’s ova (eggs) in the feces. Ova are identified in 92% of cases. Direct smears of fecal material usually provide sufficient specimens for diagnosis, although other methods can be used.

Lymph node cytology and histopathology may provide a more definitive diagnosis, if necessary.

A history of access to raw fish also aids in diagnosis.

Treatment

To combat the hemorrhage, necrosis, and infection, affected animals usually need antibiotics, fluid therapy, blood transfusions, antiemetics, antidiarrheals, and anticestodals (drugs that kill flukes).

Prognosis

Many dogs respond well to antibiotic therapy, and resolution of gastrointestinal signs, fever, and thrombocytopenia can occur within 24-72 hours of starting therapy. However, if treatment is not started, death can occur 7-10 days after the onset of clinical signs. In one report, overall mortality rate was 14%. In another study of 43 dogs that were treated with antibiotics, 39 survived.

Preventive Measures

Dogs should not be allowed to eat raw or smoked-raw fish (salmon, trout, steelhead), or Pacific Giant Salamanders.

Dogs that survive salmon poisoning will be immune to re-infection with the same strain. However, infection with an alternate strain can occur because there is no cross-protection.

Vipers can be “old world vipers” or “pit vipers.” In North America, we have pit vipers, chiefly rattlesnakes, cottonmouths (also called water moccassins) and copperheads.  Rattlesnakes are the most poisonous.

Pit Vipers (Also Known as Crotaline or Crotalid Vipers)

Pit vipers are named for their facial heat sensing organ, which is called a loreal pit. The snakes with hinged fangs, such as the rattlers, will strike delivering their poison, release the prey, and then look for the dead body. The prey is rapidly killed through an assortment of complicated mechanisms and the digestion process is actually initiated by the venom.

Snake venoms are highly complicated. At least 26 separate enzymes have been identified with 10 of these enzymes common to all snake venoms (though in different concentrations). All snake bites are not equal. The quality of venom depends not only on the type of snake but on the season, the geographical region, the age of the snake, and how recently it has released venom previously. Treatment depends on the type of venom but more on this later.

The only venomous snakes in California are the rattlesnakes and there are eight species: the Southern Pacific rattlesnake, the Northern Pacific rattlesnake, the Great Basin rattlesnake, the Western diamondback, the red diamondback, the sidewinder, the speckled rattlesnake, and the Mojave green rattlesnake. The Western rattlesnake has eight subspecies including the Southern Pacific rattlesnake, which is the only one native to the Los Angeles Basin. Ask your veterinarian what venomous species are native to your area.

The physical appearance of each snake species is variable and it is difficult to tell what species of snake you are looking at.

Some general principles in distinguishing poisonous snakes are:

1. Broad, triangular head with a noticeable neck behind the head.
   
2. Vertical pupils (non-poisonous snakes have round pupils), though hopefully you would not be close enough to evaluate this.
   
3. As mentioned, the Crotalines are also called pit vipers because they have heat-sensing pits on their faces between the eye and nostril as shown above. The pits help them locate prey. If you see a pit, you are looking at a poisonous snake.

Rattlesnakes can be found in rural areas as well as suburban areas where there is sufficient natural habitat. In Northern California snakes will hibernate during cold months and are active March through September. In Southern California they are active all year round.

Dogs Vs. Snakes

Dogs encounter snakes in the snake’s natural habitat during play or work. Most bites to dogs occur on the face or extremities. The rattlesnake bite is generally hemotoxic, which means that it exerts its toxin by disrupting the integrity of the blood vessels. The swelling is often dramatic with up to one-third of the total blood circulation being lost into the tissues in a matter of hours. The toxin further disrupts normal blood clotting mechanisms, leading to uncontrolled bleeding. This kind of blood loss induces shock and finally death. Facial bites are often more lethal as the swelling may close the throat or impair ability to breathe.

The bite of this Mojave rattlesnake causes rapid paralysis. This includes paralysis of the respiratory muscles and suffocation. Because the Mojave rattlesnake venom is different, treatment may be different and snake venom vaccine (see below) is not protective against this venom.

The severity of a snake bite depends largely on these factors:

• The species of snake
• The size of the dog
• The location of the bite
• How much venom was involved.

The amount of venom injected (approximately 20-25 percent of bites are dry, meaning no venom has been injected; 30 percent of bites are mild meaning they cause local pain and swelling in the bite area and no systemic symptoms; 40 percent of bites are severe with approximately five percent being fatal.

Treatment

The faster the bite is recognized, the more effective the treatment is. Do not try to cut the bite wound open or suck out the poison. Pressure bandages have been advocated but while these will help keep the poison from moving centrally in the circulation, they also can increase the local tissue damage by concentrating the poison near the bite wound. It is best to seek veterinary care immediately for proper treatment.Seek veterinary care immediately for proper treatment, even if your dog has been vaccinated against snake venom.

IV Fluids

Since the most common mechanism of death from rattlesnake bite is circulatory collapse, IV support and monitoring for signs of blood pressure drop are important. Fluids may be started at a relatively slow rate if the patient is stable but if signs of impending trouble occur, circulatory volume replacement is as easy as opening a drip set valve. After a bite, 24 hours of observation is a prudent timeframe while giving IV fluids throughout.

Antivenin

There are numerous misconceptions about antivenin. The first is simply the name of the product. It is not “anti-venom.” It is not a single injection that provides the antidote to snake bite venom. Antivenin is a biological product consisting of antibodies made by horses in response to exposure to four common Crotaline venoms. The antibody serum is reconstituted into an intravenous drip that is run into the patient over at least 30 minutes or so.

Antivenin is expensive (at least $400 per vial) and a large dog with a severe bite is likely to require several vials. Because the product is of horse origin, often a scratch test to the ear flap is used to test for immunological sensitivity (i.e. to predict whether the patient is likely to have anaphylactic reaction to the antivenin once it is given by IV). The patient will likely always be sensitive to equine products after being given antivenin, which makes future snake bite treatment problematic.

A more purified antivenin of sheep origin has recently been marketed (Cro-Fab antivenin) but this is even more expensive at approximately $700 per vial. This product is made for human use but also works in dogs.

Other products include: Rattler Antivenin® (which actually includes antivenin against the Mojave green rattlesnake), VenomVet®, Antivipmyn Tri® (a Mexican product), and Polivet-ICP® (a Costa Rican product).

Antivenin is very helpful in the inactivation of snake venom but there is a narrow window during which it must be used. After about 4 hours post-bite, antivenin is of minimal use.

A separate antivenin is available for coral snake venom but this is not an issue for California.

Suctioning of the snake bite and using bands or tourniquets to prevent the venom from traveling are urban legends and should not be done. It may be helpful to remove collars or other items that could become constrictive once the swelling starts.

Vaccination

Red Rock Biologics has released a vaccination against the venom of the Western Diamondback (Crotalus atrox). This vaccine also has activity against the venom of six out of seven of the other California rattlesnakes (the Mojave Rattlesnake has such significantly different venom that it is not covered) and there is at least partial cross-protection against numerous other venomous snakes native to areas outside California. Hiking dogs and dogs that live in rattlesnake areas are good candidates for this product. That said, there is controversy about how well it works as the manufacturer does not wish to do efficacy testing that would involve a control group of unvaccinated dogs. Furthermore, a history of vaccination does not preclude the need for emergency treatment after snake bite; the goal of the vaccine is to lessen the poisoning. Efficacy studies thus far have involved mice.

Basics about the Vaccine

1. Initial vaccination is given in two doses three to six weeks apart. Dogs over 100 pounds and dogs less than 30 pounds in body weight need three doses 3 to 6 weeks apart.
   
2. Annual boosters are best given approximately one month before snake season starts in the spring. Dogs who live where snake season is year round or where they hike year round should have boosters every six months. If a vaccine is skipped, the initial vaccination protocol should be re-started.
   
3. Vaccination is safe in pregnancy, lactation, and for puppies four months of age and older.
   
4. Vaccination reactions occur in 0.27 percent of cases (27 per 10,000 doses given) and are largely limited to swelling at the vaccine site seven to 10 days after vaccination. This is particularly true for dogs with a past history of bee stings.
   
5. Vaccinated dogs typically develop protection comparable to two to three vials of antivenin.

A snake bite should always be treated as an emergency even in a vaccinated dog. If your dog is bitten by a rattlesnake, seek veterinary attention immediately.

Snake Avoidance Training

Dogs can be trained to avoid rattlesnakes by scent, sound, and visual appearance. Training classes exist just for this purpose. If your dog hikes in snake territory, consider looking into one of these classes. Call training schools or ask your veterinarian about these specialized classes.

The EPA has been at odds with Reckitt Benckiser (the makers of d-CON) since 1999 when they began seriously scrutinizing the risks of rat poison products to pets, children, and wildlife. At last, Reckitt Benckiser has aggreed to comply with the EPA directives. This means that second-generation rat poisons (which kill rats in one feeding) will be banned from residential use and that rat poisons for residential use must be secured within bait stations (not in open trays). The traditional d-CON products have not been manufactured since December 2014 and have not been distributed since March 15, 2015. Bromethalin-based rat poisons have since captured the residential market. Commercial exterminators may still use the anticoagulant rodenticides discussed here.

Research continues to create a product that fits this bill but in the meantime be aware of the signs of rat poisoning, particularly if your pet travels with you to places outside the home where bait may be left out.

There are several types of rodenticides available. The traditional products are called anticoagulant rodenticides and are discussed here. If you intend to use a rodenticide, we encourage you to choose this type over others as there is a readily available antidote for the anticoagulant rodenticides. Other rodenticides are more toxic and no antidote is available. You should know what product, if any, you use at home. Common anticoagulant rodenticides are: brodifacoum, dopaquinone, warfarin, bromadiolone, and others.

Most of these products include green dyes for a characteristic appearance; however, dogs and cats have poor color vision and to them these pellets may look like kibbled pet food.

Anticoagulant rodenticides do not produce signs of poisoning for several days after the toxic dose has been consumed. Anticoagulant rodenticides cause internal bleeding. A poisoning victim will show weakness and pallor but bleeding will likely not be obvious externally.

Symptoms

Most of the time external bleeding is not obvious and you only notice the pet is weak and/or cold. If you look at the gums, they are pale. Sometimes bloody urine or stool is evident or nose bleeds may be seen. Signs of bleeding in more than one body location are a good hint that there is a problem with blood coagulation and appropriate testing and treatment can be started.

How Does Rat Poison Work?

You would expect the signs of a poisoning to be evident quickly but anticoagulant rat poisoning signs require at least 5 days to show up. Furthermore, unlike most poisons where treatment involves managing symptoms until the poison is out of the system, there is a true antidote for anticoagulant rat poison and it is actually a vitamin. How can this be? To understand what these poisons do, it is necessary to have some understanding of how blood clots.

A blood vessel is sort of like a pipe carrying rapidly flowing blood along its path. The pipe is lined by smooth flat cells called endothelial cells that facilitate the smooth flow of blood. If the pipe breaks, the structure of the pipe below the lining is exposed to the flowing blood inside.

From there the sequence of events is as follows:

1. The blood vessel automatically constricts and spasms. This restricts the blood flowing to the damaged area and helps minimize blood loss.
   
2. The exposed pipe attracts circulating platelets, cloud-like cells that circulate ready to assist in clotting should the need arise. Platelets clump together over the tear in the blood vessel, forming a plug within the first five minutes of the injury. This is all a good thing but the platelets will not stay in place unless a substance called fibrin can be made to bind them.
   
3. Generating fibrin is complicated and beyond the scope of this article, but a cascade of activating proteins is needed to make the tiny protein threads (fibrin) that bind the platelets and makes a permanent platelet plug on the wound. Four of the proteins involved are called serine proteases, and these are the factors relevant to anticoagulant rat poisoning. These four factors must be able to work or there will be no fibrin, the platelets will not clump properly, and bleeding will continue without clotting.

About those Four Clotting Factors

The four clotting factor proteins are also called the K-factors because they depend on vitamin K for activation. After the clotting situation is under control, the used Vitamin K is recycled in the liver so it will be ready for the next time bleeding needs to be stopped. Anticoagulant rat poisons interfere with Vitamin K recycling. It takes several days to deplete the Vitamin K but after that is used up, there is no more and bleeding cannot be stopped. That is why it takes some 5 days for symptoms to show up and how it is possible to reverse this poison by giving more Vitamin K.

As long as there is plenty of vitamin K, the serine proteases can be activated and clotting can proceed normally. The anticoagulant rodenticides abolish vitamin K recycling. This means that as soon as the body’s active vitamin K reserves are depleted there can be no meaningful blood clotting.

In cases of poisoning you would expect symptoms to be nearly immediate but in the case of anticoagulant rodenticide poisoning, it takes several days to deplete vitamin K. After that, even the smallest of jostles and traumas can lead to life-threatening bleeds.

Testing

Testing can be done using clotting tests called a PTT (partial thromboplastin time) and PT (prothrombin time).  These tests evaluate the activity of the four K-factors. If both these tests are abnormal, there is an excellent chance that anticoagulant rat poison is in the patient’s system. The PT test in particular bears special mention as it tests the least stable of the K-factors called Factor VII. This means that the PT test becomes abnormal before the PTT test becomes abnormal. When it’s time to monitor a patient for recovery, the PT test must be normal in order to declare the poisoning resolved.

Another test called the PIVKA (Proteins Induced by Vitamin K Antagonism) test is more specific. The PIVKA test detects inactive serine proteases. An unusually high amount of inactive K-factors circulating indicates something is wrong with Vitamin K recycling.

Therapy

If the patient has only just ingested the poison, he or she may be made to vomit it up. Cathartics and adsorbents can be used to prevent the poison from entering the patient’s system. Still, it is best to use the antidote anyway. Certainly, if there is evidence that the patient is bleeding, the antidote obviously is required.

The antidote is simply vitamin K.

Vitamin K is generally started as an injection, and when the patient is stable, tablets are prescribed. The human formulation, available as a prescription drug at most drug stores, is a 5 mg tablet. The veterinary strength is a 25 mg tablet. Blood transfusions may be needed to stabilize a patient who has suffered significant blood loss.

There are different classes of anticoagulant rodenticides, and they remain in the body for several weeks. It is hard to know when to discontinue therapy, especially if the particular rodenticide is not known. After a couple of weeks of therapy, the medication is discontinued. Forty-eight hours later, a PT test is run. If there is still rodenticide in the patient’s system, the PT will be abnormal, but the patient will not yet have started to bleed. The results of the PT test will tell the veterinarian whether or not another couple of weeks of vitamin K are needed.

It is important to return for the recheck PT test on schedule. Waiting an extra day or two will allow internal bleeding to recur. There is no point in doing the PT test while the patient is still taking vitamin K. The test must be done 48 hours after discontinuing the medication.

When the PT test has returned to normal, it is safe to discontinue therapy.

Vitamin K1 Vs. Vitamin K2 Vs. Vitamin K3

There are three forms of vitamin K but only vitamin K1 is used therapeutically. Vitamin K1 is a natural form of vitamin K that is found in plants and absorbed nutritionally. Its more technical name is phylloquinone. Vitamin K2 (menaquinone) is also natural and is produced by the body’s intestinal bacteria but apparently not in amounts adequate for rescue from the anticoagulant rodenticides. Vitamin K3 (menadione) is a synthetic version that may be injected or taken orally. You may even see it available as a vitamin supplement tablet.

Within the body vitamin K1 and vitamin K3 are converted to vitamin K2. Vitamin K3 might seem like an inexpensive way to treat a pet with rat poisoning but unfortunately, K3 is sometimes toxic and can actually lead to red blood cell destruction. Inexpensive vitamin K3 pills on the drugstore shelf for over-the-counter sale are not acceptable antidotes. Vitamin K1 is used because it is absorbed early in the GI tract and concentrates directly in the liver, which is where the K-factors are activated.

It is only vitamin K1 that should be considered to be the antidote for anticoagulant rodenticide poisoning.

Other Rodenticides

While anticoagulant rodenticide poisoning is a life-threatening event, at least there is an antidote readily available. Other rodenticides are not as readily reversed. These rodenticides include:

• Quintox, Rat-B-Gone,  Bromethalin (see an additional article)
• Strychnine, gopher bait
• Zinc phosphide, gopher bait 

Pets Who Eat a Poisoned Rodent

We are commonly asked about the risk to a cat or dog who eats a rodent that has been poisoned with an anticoagulant rodenticide. The rodent might have already died or simply not have died yet given that several days are required to feel the effect of these poisons. The fact is that when you’re talking about the newer generation anticoagulant rat poisons, such as diphacinone, the risk is real. A greedy rat can eat enough poison to kill 20 rats before he starts to feel sick, and if this was a second generation rodenticide it will accumulate in the rat’s liver ready to poison the cat that eats the rat’s liver. Fortunately, second-generation rodenticides have been banned for residential use. First-generation rodenticides are no longer in the rat’s body after several hours, making pet poisoning less of a concern. Furthermore, most rats do not overindulge in poison. The usual patient for secondary poisoning is a pet or predator that depends heavily on rats for food (a barn cat, for example). There is some controversy over how often this actually happens, as most pets do not consume numerous rats.

The War Against Rodents 

In the past, anticoagulant rodenticides, which were effective and available in virtually every hardware and garden store, were the most common rat poisons in the U.S. residential market. These products were readily consumed by rodents, and after five days or so, they induced internal bleeding and death. Problems with them included toxicity when they were accidentally consumed by pets or by predatory wildlife. Either group of animals might consume the poisons outright or might become poisoned by eating an already intoxicated rodent. The EPA demanded that these types of poisons be phased out, and presently, they are only available to commercial exterminators. Demand for safer products rose.

Bromethalin was supposed to represent a better choice. Because only small amounts are needed to kill a rodent, a predator is unlikely to be harmed by consuming a bromethalin-poisoned rodent. This is good news for owls, hawks, and other rat-consuming wildlife. For dogs and cats, however, this is only a small advantage, as pets commonly consume the rodenticide directly.  Anticoagulant rodenticides have an antidote in case of accidental poisoning, while bromethalin has none, and bromethalin products are readily palatable to dogs and cats.

With anticoagulant rodenticides becoming less available, bromethalin has captured the home rat poison market and has created a new hazard for pets to contend with.

What does Bromethalin do?

Bromethalin has been around since 1985, and it is sold as bars, blocks, and pellets to be used against rats and mice, as well as in the shape of earthworms to be used against moles. The product can be sprinkled on the ground or, for a safer presentation, provided inside a plastic bait station accessible to rodents but not to pets.

Bromethalin acts by uncoupling oxidative phosphorylation in the brain. What that means is that bromethalin makes it impossible to maintain aerobic metabolism in the brain. Oxygen cannot be used. Without the ability to use oxygen, the brain cannot make enough energy to fuel itself. The brain swells, and the victim dies of cerebral edema.

Peak levels of bromethalin are achieved a mere four hours after the poison is eaten.

What Does This Mean for a Pet?

There are two forms of poisoning recognized in pets: the high dose (or convulsant form) and the low dose (or paralytic form).

The Convulsant Form

If a high dose of bromethalin has been consumed, symptoms generally begin in a matter of hours. The patient will develop hyperexcitability followed by muscle tremors, increased body temperature, and seizures. Death is virtually inevitable.

The Paralytic Form

If a lower dose has been consumed, symptoms do not show up for one to four days. Vomiting and appetite loss result. The patient becomes weak in the rear and uncoordinated. The eyes begin to move involuntarily back and forth (nystagmus) and the pupils become unequal in size. Muscle tremors culminating in paralysis result. Treatment is still possible with this form, but it must be aggressive.

Treatment

Treatment for this poisoning must begin immediately, ideally within an hour of eating the poison. The patient is made to vomit and then must receive several doses of activated charcoal to bind any poison in the intestinal tract before the patient’s body absorbs it. Use of activated charcoal can continue for days.

Muscle contractions are treated with sedatives and muscle relaxants. Brain swelling is treated with diuretics. One study in rodents found that if rats were given ginkgo biloba immediately, their toxicity symptoms were greatly reduced but no such research has been performed in dogs or cats.

Survivors may have permanent neurologic deficits and it make take weeks for recovery to plateau so that permanent damage can be assessed. Many patients will not eat during treatment and nutritional support, such as an esophagostomy tube, must be employed.

If you use a bromethalin-based rat poison, be sure pet access is impossible as there is no antidote for this poison and signs are rapid and not easily treated.

Anti-coagulant rodenticides may have their problems, but at least treatment is straight-forward and there is an antidote. 

If you must control rodents, consider the least toxic methods if there are pets in the vicinity.

What is resource guarding and why does it occur?

Resource guarding is a relatively common behavior problem in dogs. It is defined as a dog using avoidance, threatening, or aggressive behaviors to retain control of food or other items in front of a person or other animal.

 Sometimes, the signs of resource guarding are subtle. In these cases, your dog may show avoidance behavior or mild signs of aggression and anxiety such as stiff or crouched body posture, pinned back ears, lip licking, and physically blocking access to the resource. The aggression may escalate to more severe and overt signs of aggression such as growling, snapping, or biting. Food and food-related items are the most common resources that are guarded by dogs.

However, any resource that is valuable to the dog may be guarded. This includes but is not limited to toys, beds, furniture, bones, resting areas, and even certain people. Resource guarding may have a genetic component and occurs in males or females of any breed. This issue can develop at any age. Resource guarding may be an issue that appears and progresses over time, or it may begin suddenly after a change in environment or routine. 

 Resource guarding does not have anything to do with dominance. It is a common misconception that dogs show aggression or develop behavior problems because they do not understand their “place in the pack.” This misconception is problematic because it often leads to training using force and punishment to show the dog who is “top dog.” However, dominance in this sense has been scientifically debunked. Using force and punishment in a situation like resource guarding often makes the behavior problem worse and can cause your animal to fear you and damage your relationship. To successfully manage resource guarding, we must change the underlying motivation and emotion behind the behavior (anxiety, fear, frustration). Studies have shown that reward-based methods are more effective and humane when managing behavior problems such as resource guarding. 

 To a degree, resource guarding can be considered a normal canine behavior since obtaining resources is necessary for survival. However, just because it can be considered normal does not make it desirable, safe, or acceptable in a household. Unfortunately, over time, dogs may learn that their aggressive responses are effective at protecting their resources, so the behavior will persist or even worsen. Additionally, if a dog’s mild signs of aggression are ignored or punished, this can cause their behaviors to escalate to more severe forms of aggression.

For example, a dog may initially show mild signs such as freezing or hunching over their resource with a stiff body posture. If this behavior is punished or ignored the dog will likely realize subtle signs are not effective. In this situation, dogs are likely to escalate to more overt forms of aggression, such as growling, snapping, or biting. Then it becomes more challenging to manage and treat the issue.

How can my veterinarian help with Resource Guarding? 

Your veterinarian may be able to help you with this problem themselves, or they may refer you to a veterinary behaviorist. If you are experiencing this problem with your pet, it is important that you discuss it with your veterinarian.

Resource guarding may be caused by an underlying medical issue, especially if the behavior starts suddenly in an adult dog. Your veterinarian will complete a thorough physical exam and may request further testing based on their findings to determine if there is a medical issue. Sometimes medications can be helpful in the treatment of resource guarding especially if anxiety is a cause for the behavior.

Treatment and Management: What to do: 

1. Safety is the utmost priority. You may need to use tools such as baby gates, crates, or exercise pens to separate the dog from people or other pets when the object is nearby.
   
   • Separate pets from each other when resources are nearby.
       
   • Attempt to avoid clutter in your home so that it is possible to have more control over things. You do not necessarily want to restrict access to the resources or take them away completely, but you do want to control the situation so your dog can get to their resources in a way that is safe for everyone.
         
2. Identify all situations and resources that are guarded. Recording in a diary or on a calendar may be useful. You may want to record information such as:
   
3. Learn to understand and respect what your dog is telling you. Learn to recognize dog body language and understand how it can escalate from more mild, subtle signs of aggression (such as lip licking, stiff body posture, ears pinned back) to the overt signs of aggression (growling, snapping, biting). If we respect dogs’ body language when they show mild signs of anxiety and aggression, we can likely avoid the behavior becoming more severe.
     
4. Make sure your dog gets enough exercise and play every day.
      
5. Behavior Modification
   
   • All household members must follow the same guidelines to manage this behavior. It must be a collaborative effort.
        
   • Here are some examples of behavioral modification techniques that may be used.
     
     • “Drop it”- Teach your dog to drop the item of value in exchange for a higher-value item or treat.
         
     • Relaxation exercises- this is especially helpful if resting places or certain people are guarded by the dog. With relaxation training, you can teach your dog to relax other places than the valued resting spot or away from the person that they guard. This can also include teaching a “place” behavior such as to a mat or dog bed.
          
     • Basket muzzle training – training your dog to be comfortable wearing a basket muzzle can be a useful tool to restrict access to certain resources for some situations.
          
   • Be realistic about what you can expect from your dog and what you can handle in your specific situation.
        
   • In rare and severe cases of resource guarding and aggression, euthanasia may be considered a humane option for both the dog’s welfare and human safety.
        

Treatment and Management: What NOT to do: 

1. Do not use force or punishment to attempt to correct this behavior.
     
2. Do not attempt to remove the resource of value from your dog as this could lead to injury.
      
3. Your dog’s resource guarding behavior may never diminish completely resulting in long-term management To reduce the behavior.
      

Prevention and Avoidance

1. Expose puppies to a wide range of toys and encourage them to share by calmly exchanging toys during play.
      
2. Train verbal cues such as “Drop it”, “Trade”, and “Leave it” using positive reinforcement training before resource guarding develops.
       
3. Provide your dog with a safe, comfortable space such as a crate or exercise pen that is only for your dog. It is important to not play with your dog’s food or put your hand in the bowl while eating. It is always important to add something like a special treat when humans are in close proximity to the bowl.
      

The treatment of resource guarding needs to be highly individualized for each dog and household. These dogs often need a combination of behavioral modification, training, and environmental and management changes.

Many aspects of kidney failure require attention. The goal of renal therapy, dietary or otherwise, is to prevent or at least postpone advanced uremia (poisoning by toxins the kidneys could not adequately remove) and extend life expectancy and quality. Diet is an important part of achieving these goals and we are lucky to have commercially available diets made specifically for renal patients.

The idea behind using diet as therapy for kidney disease involves making alterations in the patient’s diet to correct or at least dampen the toxic metabolic state of kidney failure. A modified diet can thus be used to correct imbalances and slow progression of disease while maintaining a healthy muscle mass and body condition.

In one famous study where 38 dogs in kidney failure were tracked for 2 years, dietary therapy reduced the risk of dying by 69% over dogs allowed to continue eating regular dog food.

Another study in dogs showed that beginning the renal diet when the creatinine was between 2.0 and 3.1 delayed the onset of uremic crisis by 5 months.

A study of 50 cats with stable, naturally occurring renal failure were divided into two groups, one receiving a renal diet and the other receiving regular food. The cats on the renal diet survived over twice as long as the others.

There are more studies where these came from showing great survival and life quality benefit for renal patients who eat renal diets rather than regular maintenance diets.

What Makes a Renal Diet Different?

A renal diet takes into consideration reduction in uremic toxins, control of high blood pressure, calcium/phosphorus balance, maintenance of proper potassium levels and reduction in inflammation. Let’s review the features of a renal diet and why they are important:

Phosphorus Restriction

but sometimes addition of medication (i.e. a phosphate binder) is needed to further reduce intake. Restricting dietary phosphate has been shown to slow the progression of renal disease.

If the goal phosphorus level has not been achieved in 4 to 6 weeks after starting the renal diet, a phosphorus binder should be used.

Potassium Supplementation

In chronic kidney disease, potassium is not conserved properly and becomes depleted. When potassium depletion becomes excessive, the patient’s overall muscle strength, energy and general life quality are affected. Potassium supplements may be needed in the form of oral gels or powders but ideally, potassium is supplemented in the easiest possible way which generally means incorporating more potassium in the diet. If potassium levels can be maintained simply with food, this would mean less medication for the patient to have to take.

Omega 3 Fatty Acids

Studies suggest that kidney failure patients taking omega 3 fatty acids are likely to live longer than patients who do not take them. This has led to the supplementation of most renal diets with fish oils. The full import of fatty acid supplementation is still being worked out.

Other dietary features include B vitamin supplementation (since the damaged kidneys tend to lose excess B complex), which have non-acidifying features to help control acidosis.

Low Protein?

Since a number of renal toxins come from the break-down and processing of protein, one way to give the kidneys less work to do is to eat less protein. How much less protein depends on how serious the kidney disease is as there is a minimum protein requirement for maintaining body condition and a protein-restricted diet must not be restricted below that level.

Exactly how to restrict protein involves a lot of choices. Older animals tend to require a higher dietary protein level in general when compared to their younger counterparts. Protein also adds palatability to the food so that if we try to restrict protein too much we may end up with a pet who will not eat at all. Further, plant proteins tend to produce less difficulty with phosphorus balance but animal origin proteins may be needed for required amino acids.

It is no surprise that decades of research have gone into how protein selection is accomplished to create an effective but tasty diet.

1. There is no protective value to restricting protein prior to the onset of kidney failure. It is not preventive or at all helpful for a healthy senior pet to be restricted in dietary protein.
2. High-protein diets do not cause kidney failure (though they certainly make the patient worse after kidney failure has begun).
3. Protein restriction is probably the least important dietary modification in early stages of kidney disease. There are special diets available for patients with less restrictive needs and others for patients in more advanced states.

At What Point Should a Special Diet be Started?

This question has been controversial for a long time. For many animals, changing diet to a less palatable food represents a definite reduction in life quality. There was some thinking that we are changing the diet too soon. On the other hand, if a pet is in a more advanced state of disease before the switch is made, the pet will be much less willing to change to a food of less palatability. The companies that make these foods have put a great deal of research into improving palatability over the years, which has helped tremendously.

Now the International Renal Interest Society finally has guidelines.

The IRIS Guidelines recommend considering a change to a renal diet by IRIS Stage II (creatinine test between 1.6 mg/ml and 2.8 mg/ml with an SDMA test between 18 & 25 in cats; creatinine test between 1.4 mg/ml and 2.8 mg/ml with SDMA test of 18 & 35 for dogs). The diet should have clear benefits at IRIS stage III which is later on, but the recommendation has been moved to a lower stage because animals in stage III are less likely to accept diet change. It was deemed that the change should be made earlier to have a better chance to be in place when it is more crucially needed.

These guidelines allow the patient to benefit the most from the preventive advantages of the diet. If the pet finds the diet palatable, then there should be no life quality issues with changing foods.

What if my Pet Will Not Eat the Renal Diet?

Animals with insufficient kidney function frequently do not feel well and will not be inclined to eat bland food. Here are some tips in increasing acceptance of renal diet.

Is the Pet Feeling Iill?

As mentioned, the pet that feels ill may be disinclined to eat a new food. Consider using other medical treatments until the pet is feeling better before changing diets.

Consider Feeding Access

Appetite Stimulants/Medications

Medications such as capromorelin, mirtazapine or cyproheptadine can be used to enhance hunger and encourage eating. 

If the pet simply does not respond, it may not be possible to use a renal diet and other medications may be needed (as reviewed in other areas of our Kidney Failure Center) to provide therapy.

If the patient is simply too sick to eat at all, assisted feeding may be in order.

Home Cooking a Renal Diet

Home cooking an appropriate renal diet is a complicated task as might be surmised from the information above. Commercial diets have decades of research behind them as well as government regulation and professional quality control. They are also convenient to use. That said, some pet owners prefer to have more control over the ingredients they feed their pets and want more involvement with diet choices. Commercial diets tend to represent a “one size fits all” approach that may not be best.

For renal patients, it is important not to simply try to make up your own diet based on recipes from non-professional sources. Many recipes float around the internet and many pet owners may support them but this is not the same as getting guidance from a nutrition professional. Your regular veterinarian can guide you to an appropriate service for nutritional consultation. or you may wish to visit the American College of Veterinary Nutrition.

What is Reverse Sneezing?

Reverse sneezing is a disconcerting event in which a dog makes unpleasant respiratory sounds that sound like it is dying — or will die in the next few minutes. This is called reverse sneezing because it sounds a bit like a dog inhaling sneezes. The sound the dog makes can be scary, and reverse sneezing sounds similar to the honking noise made by a dog with a collapsing trachea. However, the good news is that reverse sneezing is a far simpler condition that usually does not need any treatment. 

Because it can be difficult for an owner to recognize a reverse sneezing episode when it first happens, it is a good idea to check with the veterinarian to determine if it’s reverse sneezing or something more serious.

Causes of Reverse Sneezing

The most common cause of reverse sneezing is an irritation of the soft palate and throat that results in a spasm. During the spasm, the dog’s neck will extend and the chest will expand as the dog tries harder to inhale. The problem is that the trachea has narrowed, and it’s hard to get the normal amount of air into the lungs.

Anything that irritates the throat can cause this spasm and subsequent sneeze. Causes include excitement, eating or drinking, exercise intolerance, pulling on a leash, collar/tags pressing on and irritating the throat, mites, pollen, foreign bodies caught in the throat, perfumes, viruses, household chemicals, allergies, and post-nasal drip.

If an irritant in the house is the cause, taking the dog outside can help simply because the dog will no longer be inhaling the irritant. Brachycephalic dogs (those with flat faces, such as Pugs and Boxers) with elongated soft palates occasionally suck the elongated palate into the throat while inhaling, causing reverse sneezing. Small dogs are particularly prone to it, possibly because they have smaller throats.

Monitoring and Treatment

Reverse sneezing itself rarely requires treatment. If the sneezing stops, the spasm is over. Some veterinarians may recommend massaging the dog’s throat to stop the spasm; some may suggest covering the nostrils for a few seconds to make the dog swallow, which clears out whatever the irritation is and stops the sneezing.

Treatment of the underlying cause, if known, is useful. If mites are in the laryngeal area, your veterinarian may use drugs such as ivermectin to get rid of the mites. If allergies are the root of the problem, your veterinarian may prescribe antihistamines. If reverse sneezing becomes a chronic problem rather than an occasional occurrence, your veterinarian may need to look up the nasal passages (rhinoscopy), and may even need to take a biopsy to determine the cause of the problem. Sometimes, however, no cause can be identified.

Some dogs have these episodes their entire lives; some dogs develop the condition only as they age. In most dogs, however, the spasm is a temporary problem that goes away on its own, leaving the dog with no after-effects.

Cats are less likely to reverse sneeze than dogs are.  However, owners should always have the veterinarian examine the cat in case it’s feline asthma and not a reverse sneeze. Feline asthma requires more treatment than reverse sneezing does.

CIRDC signs include:

1.  A “honking” cough that may sound like retching
2.  Sneezing, and discharge from the eyes and or nose
3.  Lethargy, decreased appetite, and labored breathing
4.  Not all dogs show all of these signs, and each case can be slightly different.

There’s always limited info about numbers due to a lack of funding, no real surveillance system, and testing that doesn’t necessarily change treatment for these dogs. Also, the disease description is usually vague…coughing dogs, some that get pneumonia, and unfortunately, a few that die.

The issue is, this largely describes our normal state. CIRDC is endemic (i.e. always present in dog populations), with various known bacterial and viral causes.  These include canine parainfluenza virus, Bordetella bronchiseptica, canine respiratory coronavirus, canine pneumovirus, canine influenza virus, Streptococcus zooepidemicus… roughly in that order of occurrence, and maybe the mysterious bacteria, Mycoplasma. There are also presumably a range of viruses that have been present for a long time but that we don’t diagnose.

I get lots of emails every week asking whether there’s more or more severe CIRDC activity at the moment. The thing is, I’ve been getting those for years, from across North America. To me, that reflects the fact that there’s always circulation of CIRDC and that we notice it more at times, either because of local clusters or, increasingly, local raises in awareness.

We see CIRDC all the time, everywhere. There’s a background level of disease that usually flies under the radar, alongside periodic clusters. Media and social media can drive outbreak concerns. They can be great to get the word out and help sort out issues, but often, they lead to false alarms.

For example, we might have 100 dogs with CIRDC every week in Guelph (a complete guess since we have no way to track this). Usually, few people hear about it. The dogs typically get better, and life goes on. However, if someone starts talking about it on social media, we might hear about 50 of those 100 cases. All of a sudden, we have an ‘outbreak of a disease affecting dozens of dogs’ when in reality, we might just have our normal background level of disease that people are actually noticing.

The same thing happens more broadly. There are thousands of coughing dogs in the US every day since there are millions of dogs. Once people start talking about it, some of these comments go from, “Oh, my dog is coughing. I guess he picked up something at the park.” to comments like “OMG, my dog has this new disease that’s sweeping the nation.” 

With the first approach, no one but the owner usually knows or is concerned.  When people are very worried about their beloved pets, panic, and post on social media, it can lead to further assumptions that things are much scarier or that a “new disease” is developing.

So, what are these reports actually reflecting?

1. A multistate outbreak caused by some new bacterium/virus      
2. A multistate outbreak caused by our usual suspects, for some reason      
3. Unconnected sporadic local outbreaks caused by usual suspects      
4. A slight increase in baseline disease      
5. Our normal disease activity has resulted in an outbreak of media attention.      

I suspect it’s one of the last two. My perception is that we have been seeing a bit more CIRDC activity over the past couple of years and that we see a somewhat greater incidence of severe cases.

Other factors to consider:

• With more cases, we see more severe disease.
• Brachycephalic or short-nosed breeds (French bulldogs, pugs, etc.) with a higher likelihood of dysfunctional breathing are very popular and much more likely to have severe outcomes from any respiratory disease.
• Increases in deaths could be linked to the dogs’ physiology, not disease factors.

Things are still unfolding for the veterinary community with CIRDC, but right now there does not appear to be a need for increased concern.

What can you do to protect your dog?

1. Limit your dog’s contacts, especially traveling family or friends with dogs of unknown health status.
2. Keep your dog away from sick dogs.
3. If your dog is sick, keep it away from other dogs.
4. Talk to your vet about vaccination against causes of CIRDC including canine parainfluenza (CPIV), Bordetella bronchiseptica, and canine influenza (which is more sporadic and vaccine availability is still an issue).

Overall, if you are concerned that your dog may have CIRDC or that they may be exposed due to certain activities, talk to your veterinarian. They can tell you what may increase their chances of contracting CIRDC and what to look out for based on your pet’s health status.