A dog with arthritis around that joint or who has or has had a jaw fracture may chatter their teeth in response to that pain. Teeth can rub together if the jaw is clenched or from grinding the teeth. Imaging such as X-rays or computed tomography (CT) (both done under anesthesia) may be recommended to help your veterinarian better visualize what is happening in the jaws or mouth.

Even though the most common cause is somewhere in the mouth, the source can be elsewhere, including the gastrointestinal tract, or involving a neurologic disease. In some greyhounds, and likely in some other breeds, it’s a relatively common sign of anxiety and often ends as the cause of anxiety ends, such as a veterinary appointment.

Generally, the first step in treatment is a tooth-by-tooth exam under anesthesia with dental imaging, either X-rays or a CT scan.

Tooth Resorption

Tooth resorption is when the dentin, or the harder outside of a tooth, is inflamed and disintegrating. Teeth need to be evaluated closely for any tooth-resorbing lesions, as oral lesions may not be visible even on dental radiographs.

Identifying tooth resorption can be difficult, and choosing which teeth to pull requires experience and judgment. You and your veterinarian should discuss whether referral to a veterinary dentist is in your pet’s best interest.

Gastrointestinal Issues

With some gastrointestinal issues, dogs may become nauseous, vomit, drool, or have gastroesophageal acid reflux. Lab work and imaging, such as ultrasound or endoscopy (a camera scope fed into the GI tract) or surgery, might be recommended. In cases caused by gastrointestinal issues, medications may help stop the chattering within the first week.

Focal Seizures

Focal seizures are sometimes a neurological cause of teeth chattering. A focal seizure is a type of seizure that only affects a certain area in one half of the brain, not both halves. A dog with focal seizures may chatter their teeth or display what may be referred to as “fly-biting behaviors,” where they snap at the air as if chasing an insect. However, unlike other causes of teeth chattering, a dog experiencing focal seizures will not respond to you as they normally would when you call them by name, make noise, or so on, and they may seem to stare off into space.

Before this type of seizure, your dog may act unusual, such as walking back and forth or clinging to you. If your dog stops chattering their teeth during a short trial of anti-epileptic drugs, the cause of the chattering is likely related to the seizures.

Other less common causes of teeth chattering exist, such as pain in other parts of the body or even hormonal changes. A physical examination and consultation with your trusted family veterinarian, along with appropriate testing, can help pinpoint the cause of chattering and help guide treatment.

Additionally, taking videos for your veterinarian and listing all signs can be helpful to get them started on the best diagnostic path for your pet.

Not that malicious poisoning is the issue; most cases are accidental as many gardens with snail problems also have resident dogs. Snail bait is typically formulated in pellets and flavored with molasses or bran to attract snails. Unfortunately, the pellets resemble kibbled dog food and the molasses and bran are also attractive to dogs. Snail baits are also available as liquids and powders that can get onto paws and be licked off in normal grooming. Very little metaldehyde snail bait is required to cause poisoning: less than a teaspoon per 10 pounds of body weight.

Many snail bait products also contain insecticides that make them even more toxic. If at all possible, find out what specific product has been involved in the poisoning so that the veterinarian and animal poison control can determine proper treatment.

In a 2002 retrospective study by the ASPCA Animal Poison Control Center, 28 percent of all metaldehyde poisoning cases happened in California.

Obvious Twitching

Signs of poisoning begin fairly quickly after the poison is consumed. The dog will begin anxious twitching, at first only slightly and then uncontrollably. This progresses to seizures and potentially to death. The muscle contractions of the twitches raise body temperature so high that brain damage can result, leading to the colloquial emergency room term “shake and bake” syndrome.

Patients can also exhibit racing heart rates, vomiting, diarrhea, and rigidity, and respiratory failure.

A liver failure syndrome occurs in some patients approximately two to three days after poisoning, so it is important for liver enzymes to be monitored by blood tests throughout the recovery period. Additional liver support medicine may be needed.

Making The Diagnosis

Generally, the appearance of a twitching patient is characteristic even if there is no known history of snail bait exposure. Testing of stomach contents or urine for metaldehyde can be done, but is generally not necessary.

Treatment

Twitching can be controlled with methocarbamol (a muscle relaxant) or injectable benzodiazepine sedatives such as diazepam. Fluid therapy and body temperature monitoring will be needed throughout the recovery period.

Potential for complete recovery depends on how much poison was ingested, how quickly therapy was begun, and the general health of the patient. While this is a serious type of poisoning, most patients have a good chance at recovery if treated properly.

At home, the yard should be hosed down with water to dissolve the remaining metaldehyde, and the dog should be restricted from the treated area for a two-week period.

This page is dedicated to Justin, a companion to Saeeda, who did not survive his exposure to metaldehyde. We promised to put up a web page in his honor to help educate dog owners and hopefully save the lives of some snail-bait poisoned dogs around the world.

What is a Seizure and How Do you Know if your Dog has Had One?

A seizure results from excessive electrical activity in the cerebral cortex of the brain. The electrical activity starts in one area (called the seizure focus) and spreads in a process called kindling. Classically, the patient loses consciousness, collapses, becomes stiff at first and then begins paddling or struggling but seizures can take many forms. Any involuntary behavior that occurs abnormally may represent a seizure. Seizures are classified into several categories.

Generalized (Grand Mal) Seizures

This is the most common form of seizure in small animals. The entire body is involved in stiffness and possibly stiffness/contraction cycles (tonic/clonic action). The animal loses consciousness and may urinate or defecate. See a grand mal (violent) seizure. 

Focal Seizures (Also Called Partial Motor Seizures)

Focal seizures involve involuntary activity in only one body part. Consciousness may or may not be impaired. A classic example would be the “chewing gum” fit that frequently is seen in canine distemper infections but can be seen in other seizure disorders as well. See a chewing gum seizure in a Maltese with mild epilepsy. 

Psychomotor Seizures

Psychomotor seizures are focal seizures where the seizure is more like an episode of abnormal behavior than an actual convulsion. The pet’s consciousness is disturbed by this type of seizure as the pet appears to be hallucinating or in an altered state. The seizure may include episodes of rage or aggression where the pet does not recognize family members or may be as simple as a brief episode of disorientation or spacing out. Fly-biting is an example of a psychomotor seizure. See a psychomotor seizure.

Seizures (neurological events) are often difficult to tell from fainting spells (cardiovascular events). Classically, true seizures are preceded by an aura or special feeling associated with a coming seizure. As animals cannot speak, we usually do not notice any changes associated with the aura. The seizure is also typically followed by a post-ictal period during which the animal appears disoriented, even blind. This period may last only a few minutes or may last several hours. In contrast, fainting animals are usually up and normal within seconds of the spell, with no post-episode disorientation.

Post-ictal disorientation is the hallmark of the seizure.

Causes of Seizures and Diagnostics

There are many potential causes of seizures: toxins, tumors, genetic disease such as epilepsy, infections, even scarring in the brain from past trauma. Seizures resulting from metabolic problems or toxicity (i.e. when the brain itself is normal) are called reactive seizures.  Seizures resulting from identifiable brain abnormalities are called structural seizures. Seizures for which no clear cause can be found are called primary seizures and the patient is said to have epilepsy.

It turns out that dogs of certain age groups tend to have common causes for their seizures. This means that certain diagnostic tests are especially important in dogs of one age group while other tests are going to be more important for dogs in another age group. Here are some basic concepts concerning how age is an important consideration:

• Reactive Seizures: Seizures resulting from metabolic problems or toxicity (i.e., when the brain itself is normal).
  
• Secondary Seizures: Seizures resulting from an identifiable brain abnormality.
  
• Primary Seizures: Seizures for which neither of the above problems apply (i.e., when no cause can be found).

Animals Less than Age Six Months

In this age group, seizures are usually caused by brain infections. For dogs, the most common infectious diseases would be canine distemper or a parasitic infection such as with Toxoplasma or Neospora. Analysis of cerebrospinal fluid, obtained by a tap under anesthesia, would be important though now that PCR technology is available for detecting DNA of infectious agents, less invasive testing may be recommended depending on the infectious under suspicion.

Animals Between Ages 6 Months and 6 Years

The most common reason for a dog, particularly a purebred dog, to begin having seizures in this age range is genetic epilepsy (also called primary epilepsy.) Epilepsy is diagnosed when no other cause of seizures can be found, there are no neurologic symptoms between seizure events, and the first seizure episodes begin in this age range. Usually basic blood work is done to rule out metabolic causes of seizures but more sophisticated and expensive testing (such as advanced brain imaging) is forgone as the presentation is fairly classic.

Schnauzers, basset hounds, collies, and cocker spaniels have two to three times as much epilepsy as other breeds. Labrador retrievers and Golden retrievers are also predisposed to epilepsy but tend to begin their seizures relatively late, closer to age five.

Animals More than 5 Years Old

In this group, seizures are usually caused by a tumor growing off the skull and pressing on the brain (meningioma would be the most common tumor type). Consult your veterinarian about treatment options. Such tumors may be operable or can be treated with radiation if found early. A CT scan or MRI would be the next step. Referral is usually necessary for this type of imaging. For patients where surgery is not an option, corticosteroids may be used to reduce swelling in the brain. Treatment to suppress seizures may also be needed using one of the medications discussed below.

When to Begin Treatment

In 2016, the American College of Veterinary Internal medicine published a consensus statement on this very subject.

If the dog fits into any of these criteria, medication to suppress seizures should be initiated:

1. When seizures occur in clusters, which is more than 3 seizures within a 24-hour period.
   
2. When two or more isolated seizures occur within a 6-month period.
   
3. If a seizure has lasted 5 minutes or more.
   
4. If the seizures or their post-ictal disorientation periods are particularly severe.
   
5. If the dog has a visible structural lesion on a CT, MRI or even a radiograph.
   
6. If the dog has a history of brain injury or trauma.
   
7. It should be noted that the German shepherd dog, border collie, Australian shepherd, golden retriever, Irish setter, and Saint Bernard breeds are notorious for difficulty in seizure control. It is best not to wait for frequent seizures in these cases as each seizure makes the next more difficult to control. Often medication is started in these individuals after the first seizure. The more seizures the patient experiences, the more difficult control becomes in the future.

Treatment Choices: Medication

There are currently four main medications that are used in suppressing seizures in dogs in the United States: phenobarbital, potassium bromide, levetiracetam, and zonisamide. If adequate control cannot be achieved with one medication, often two or even three are combined. The ideal first line anti-convulsant medication is effective, reasonably priced, convenient to administer, and has limited side effects potential. Most dogs are started on either phenobarbital or potassium bromide but we will take a moment to review the pros and cons of all four of these medications.

Phenobarbital

Phenobarbital has been the first-line therapy for canine seizure control for decades as it is effective, reasonably priced, and can be given twice daily which is relatively convenient. When dogs with seizures are started on phenobarbital, approximately 31 percent of them can be expected to become seizure-free. Approximately 80% of dogs on phenobarbital will experience a greater than 50% decrease in seizure frequency. Approximately 20-30% of dogs on phenobarbital will require a second anti seizure medication to achieve acceptable seizure control.

The downsides are phenobarbital use stem from its side effects potential. Phenobarbital blood levels need to be periodically monitored as higher levels are associated with the development of liver disease. The phenobarbital dose must maintain the phenobarbital blood level within a safe therapeutic range and be adjusted accordingly. There is some expense associated with such testing.

Side effects of the drug include sedation, which is usually temporary during the first one to two weeks of medication use and wanes as the patient’s body adjusts. The patient is likely to be unusually hungry and thirsty on phenobarbital. These side effects can be objectionable. Some lab test changes are associated with phenobarbital usage and need to be recognized as such. Phenobarbital is removed from the body by the liver so good liver function is essential for phenobarbital use and phenobarbital can alter the metabolism of numerous other medications. 

Potassium Bromide

Potassium Bromide was used for human seizure control nearly 100 years ago but was eclipsed by the development of phenobarbital. It turns out that while phenobarbital may be a superior seizure drug for people, potassium bromide may be superior for dogs. When dogs with seizures are started on potassium bromide, 52 percent of them can be expected to become seizure-free. Approximately, 70 percent will have greater than 50 percent reduction in seizure frequency.

Potassium bromide is associated with pancreatitis and probably should not be used in patients with a history of that disease. Potassium bromide takes many months to reach a stable blood level which could leave the patient vulnerable to seizures during that time. As with phenobarbital, there are monitoring tests associated with potassium bromide use and sedation is a side effect.

Levetiracetam (Keppra®)

Levetiracetam is popular for refractory epilepsy in dogs because it has been shown to be fairly reliable and has minimal side effects potential. It appears to work best in combination with other seizure medications rather than as a sole therapy but many dogs are able to use it as a single agent. There are no monitoring tests recommended for its use and an extended-release formula allows for twice-daily use.

Zonisamide (Zonegran®)

Zonisamide is a sulfa class anti-seizure medication that is rapidly becoming a first-line treatment choice but might also be used to supplement more traditional therapies. Because it is a sulfa, it is vulnerable to the side effects associated with sulfa antibiotics: mostly tear production/dry eye issues but also some immune-mediated reactions. (Sulfa side effects are reviewed more completely in our pharmacy library under the sulfa antibiotics such as trimethoprim sulfa). Zonisamide can be used twice a day in dogs but lasts long enough in the cat to possibly be used once daily.

Treatment Choices: Diet

In 2017, a veterinary therapeutic diet designed to supplement anti-seizure medications was released. The diet uses medium-chain fatty acids as a fat source (fats come in short, medium, and long-chain types which relate to the length of their chain of their carbon chain) and it turns out that MCTs have a direct anti-seizure effect. Dogs that were not able to achieve full seizure control with medication were able to improve control or achieve total control after a 3-month trial on this diet. It is not meant to replace medications by any means, just to give them a nutritional boost.

Seizures at Home (When is it an Emergency?)

A Single Breakthrough Seizure

It is a lucky pet that never has another seizure after beginning medications, but an occasional breakthrough seizure (as disturbing as it may be to watch) is rarely of serious concern. In most cases, one can simply give an extra dose of the oral anti-seizure medication that has been in use and consider the episode over with. The veterinarian should be appraised of the situation and the medication regimen evaluated to see if adjustments should be made to prevent further breakthrough seizures in the future.

A Second Breakthrough Seizure within 24 Hours

If a second seizure occurs within 24 hours, one might consider bringing the pet to the vet’s office for a “seizure watch” (which means the pet can receive medication to interrupt any further seizures) as well as for re-evaluation of the current medication protocol.

Since emergency care can be expensive, one might consider rectal administration of diazepam (valium®) as a means of first aid and tiding the pet over until one’s regular veterinarian is available. In anticipation of late-night seizing, one can request a set-up for rectal diazepam to keep on hand. The injectable product is delivered rectally with a special syringe that can be kept at home. The rectal route avoids any danger of being bitten while trying to administer medication. 

Recently compounding pharmacies have been able to produce diazepam rectal suppositories which may be easier to use than the syringe method, however, absorption rates are unknown with these products and most neurologists prefer using the injectable product. Rectal diazepam administration has been used successfully for many years in epileptic children; the technique has adapted well to veterinary patients. Diazepam can also be given nasally but there is a greater chance of being bitten.

It is important not to put yourself in danger around a seizing pet. Involuntary jaw motion may bite you and in the period of post ictal disorientation, the pet may not recognize you and may snap. 

As mentioned, an isolated seizure at home probably does not require more than staying out of the way and keeping the pet from hurting himself.

 That said, there are some emergency situations:

1. Seizure activity non-stop for five minutes or more.
2. One seizure after another repeatedly.

Either of these situations is called “status epilepticus” and is a “drop-what-you’re-doing-and-rush-the-pet-to-the-vet emergency.

1. More than 3 seizures in a 24-hour period

This is considered “cluster seizuring” and definitely warrants seizure watch in a hospital setting.

Can Seizure Medication be Discontinued Eventually?

While there is some risk to discontinuing seizure medications, this may be appropriate for some patients. Dogs should be completely seizure-free for at least a year before contemplating stopping treatment. In breeds for which seizure control is difficult, it is probably best never to stop medication (German Shepherds, Siberian Huskies, Keeshonds, Golden retriever, Irish Setter, St. Bernard). Phenobarbital is a medication that cannot be suddenly discontinued; if you are interested in discontinuing seizure medication, be sure to discuss this thoroughly with your veterinarian.

Other Information

The Epilepsy Genetic Research Project

Veterinary neurologists at several universities are looking for a genetic answer to epilepsy. They seek DNA samples from epileptic dogs and their close relatives if possible.

Canine Epilepsy Network

Affiliated with the Veterinary School at the University of Missouri at Columbia, this site reviews canine seizure disorders, treatment, history and more.

Storm phobia, or fear of storms, is a common behavior in dogs. Many dogs are terrified of the noise and react by hiding, pacing, panting, trembling, peeing, pooping, drooling, and destroying things. Some dogs even take it to the extreme of hurting themselves by jumping through windows and doors. These behaviors can appear during a storm, or when they see or hear things such as thunder, lightning, rain, or formation of dark storm clouds.

Another type of noise phobia is the fear of fireworks and gunshots. Dogs with this fear show similar behaviors to storm phobic dogs. Some become so fearful they do not want to go outside the house or around the area they associate with these noises.

Treating Storm and Noise Phobia

Environmental Management

The first step in managing and treating all types of noise phobia in dogs is to give them a safe place to hide. This safe haven can be a windowless basement, closet, crate, or bathroom. It is important to make sure your dog has access to this area when no one is home.

Pheromones may be beneficial in some cases. These come in a diffuser, wipes, or spray. These pheromones can be placed on a bandanna, blanket, or a favorite toy to reduce anxiety.

Desensitization and counterconditioning are forms of behavior modification used to reduce the fear of noise and storms. Desensitization exposes the dog to a scary noise at such a low level that the animal is not scared. Counterconditioning changes the association of the noise with fear. Try to play with your dog, or do fun tricks he knows to distract your dog.

Food can also be a distraction, like an extra special treat that only comes out during scary events. Food puzzles (similar to these shown for cats) allow your dog to anticipate something fun and special when a storm is roaring overhead.

Short-Acting Medications

There are medications your veterinarian can prescribe to reduce the fear in your dog.

If medications are used, they must be given before the scary noise to be effective. Watch the weather closely and administer medication before the storm is predicted to arrive. It is better to medicate and no storm, than no medication and a storm. The same is true for other noise events.

Behavioral supplements may be beneficial in some dogs.

A magic pill to treat a noise or storm phobia does not exist. Treatment involves a combination of environmental management, behavior modification, and medication. Fear of noises can be reduced, but a cure is rare.

Sarcoptic mange, also called scabies, is an itchy disease in dogs caused by a mite (Sarcoptes scabiei var canis). Sarcoptic mites are small and not visible to the naked eye. They burrow into the skin and cause itching, redness, and skin crusts at the tips of the ears, elbows, hocks, chest and belly. In a severe infestation, Sarcoptic mites cause problems on the animal’s entire body.

How is sarcoptic mange (scabies) treated?

Several prescription medicines can be used to kill mites. These medicines come in various forms including:

1. dips such as lime sulfur or amitraz
2. spot-ons such as moxidectin (Advantage Multi®) or selamectin (Revolution®, Stronghold®)
3. oral pills such as afoxolaner (Nexgard®), milbemycin oxime (Interceptor®), or sarolaner (Simparica®)
   

Your pet’s veterinarian may also prescribe other medicines to treat itching while the mite medication takes effect.

No matter which treatment is chosen, follow the instructions from your pet’s veterinarian. For some medicines, the amount needed to treat sarcoptic mange is different than the amount needed to treat other health conditions. If you give the medicine less often or in a smaller amount than what your pet’s veterinarian recommends, your pet’s sarcoptic mange will not get better.

Can my other pets or my family get sarcoptic mange (scabies)?

Yes. Sarcoptic mange is highly contagious and can spread from pet to pet or from pet to human. Treat all other dogs in the household. Although mites can only survive a brief time off the dog, clean your dog’s living quarters and wash or throw away the bedding. If your dog has sarcoptic mange and anyone in your family has red and itchy skin bumps, consult your family physician.

Your dog may remain contagious for two to four weeks after starting treatment. Please keep your dog confined and away from other dogs and unexposed persons until your dog’s re-check veterinary appointment.

Systemic lupus erythematosus (SLE) is a fairly rare chronic and potentially-fatal autoimmune disease. The dog’s immune system fights itself by forming antibodies that “protect” it against its own cells and tissues. This results in inflammation and tissue damage in the skin, heart, lungs, kidneys, joints, nervous system, or blood. Usually several organs are affected. SLE can be managed, but not cured. While the disease itself is chronic, signs can be acute, chronic, or both. Lifelong treatment is necessary. It is different from discoid lupus erythematosus (DLE), which is a skin disease.

The word lupus is Latin for “wolf.” (Some humans get a facial rash that has a slight similarity with a wolf’s face.)

Breeds that most typically are affected by SLE include Afghan Hounds, Beagles, German Shepherd Dogs, Irish Setters, Old English Sheepdogs, Poodles, Rough Collies, and Shetland Sheepdogs. Dogs are usually middle-aged when they get SLE. Females are not more likely than males to get SLE.

The most common significant signs of SLE are a non-erosive polyarthritis (an arthritis that affects several joints), painful muscles; shifting lameness; skin sores and blisters; proteinuria (protein in the urine); decreased platelet and white blood cell count; fluctuating fevers, and immune mediated hemolytic anemia (IMHA). Some less-significant signs are mouth ulcers, inflamed lining of the chest cavity or heart, dementia, swollen lymph nodes, and seizures. Usually, dogs with SLE are first taken to the veterinarian because of the skin problems or lameness.

Blood tests are needed for diagnosis. While all dogs won’t have the same signs, dogs with SLE typically test positive for anti-nuclear antibodies (ANA). There are so many effects of this multi-systemic disease that it’s hard to rule any one disease in or out. Diagnosis is typically made using a combination of a positive ANA test with at least two significant signs. A positive ANA test, with one significant sign plus two less-significant signs is also indicative of SLE.

(SLE can be suspected if there is only one significant sign plus positive ANA, or if there are two significant signs with a negative ANA test.) It can be difficult to make a positive diagnosis since other problems, such as drug reactions and cancer, can have many of the same signs. (ANA can be positive with any chronic inflammatory disease, so if there are no other consistent pathologic or clinical signs, your veterinarian may suspect a false-positive ANA.)

Treatment is aimed at decreasing the inflammation and autoimmune activity, so treatment centers around anti-inflammatory and immunosuppressive medications such as corticosteroids (e.g. prednisone). Sometimes a second immunosuppressant, such as azathioprine, cyclophosphamide, or cyclosporine will be necessary. Specific problems, such as kidney or spleen damage, will also have to be treated. Treatment plans depend on what organs are affected.

The ultraviolet rays in sunlight can cause flare-ups of SLE, so exposure to sunlight should be limited.

Prognosis depends entirely on how each dog is affected, but owners can expect that their pets will require life-long treatment. Unfortunately, sometimes the damage caused by this disease can result in death.

Swimmer’s tail is known by many names, including limber tail, cold water tail, dead tail, broken wag and sprained tail. These names all refer to the same condition: a suddenly limp and flaccid tail. Swimmer’s tail most commonly affects large breed, hunting, athletic and working dogs such as Labrador retrievers and pointers.

Dogs with this condition have essentially strained the muscles in their tail. This is thought to result from overuse of the tail, which can happen when a dog swims for a long time, especially in cold water. Sometimes it happens just because the dog has had an exciting day or two and has spent far more time than usual wagging their tail.

For example, maybe they spent the weekend at the lake or the grandchildren came to visit. Other risk factors for swimmer’s tail include intense physical activity, prolonged transport in a cage and being in cold and wet weather. After these activities, signs usually appear quickly, within hours to days.

The primary sign of this condition is a limp tail that droops between the dog’s legs. In some cases the entire tail is flaccid, but in other cases the tail is stiff at the beginning and becomes flaccid towards the end. Because swimmer’s tail can cause pain and discomfort, affected dogs may pace, yelp when lying down or defecating, frequently change position while lying down, and eat less. Some dogs may struggle to stand up because the tail helps with balancing. Other potential symptoms include chewing the tail and raised hair on the top of the tail due to swelling.

To diagnose this condition, your veterinarian will rely on information about your dog’s recent activities, clinical signs and physical exam findings. Your veterinarian may also take X-rays to rule out other causes of your dog’s symptoms, such as tail fractures.

Once swimmer’s tail is diagnosed, your dog should rest and exercise less to allow for recovery, just as you would do if you sprained a muscle. Your veterinarian may also recommend giving anti-inflammatory drugs to reduce the pain associated with this condition. Warm compresses on the tail may also help with pain and quicken the recovery process. Swimmer’s tail has an excellent prognosis, as dogs generally get better within 2-14 days. However, having swimmer’s tail once does not mean your dog can’t get it again. Relapses are possible.

Potential ways to prevent swimmer’s tail include not overexerting your dog, especially if they aren’t trained for it, and, during transport, letting your dog out every 4 hours or so. There is no prevention for over-wagging when your dog is really happy, though!

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

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

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

How to measure SRR

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

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

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

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.

As the name implies, the syndrome is characterized by fevers that seem to arise out of nowhere, run their course, and may or may not be responsive to anti-inflammatory medications.

The dog will feel bad during the fever episodes: listless and without appetite. Fevers typically last 12 to 36 hours and can go as high as 107ºF. Often the dog’s ankles (hocks) become swollen during these episodes. It is normal for a Shar-Pei to have a large skin fold around the ankle called a sock; the swelling that occurs during the fever is different and only lasts during the fever. The muzzle may also swell and become painful, and sometimes there is some associated nausea or diarrhea. It is important to learn how to take your dog’s temperature so you can monitor the situation. 

A fever of 106ºF is a medical emergency. It is good practice to know how to take your dog’s temperature and is especially important if your Shar-Pei seems listless. Normal canine body temperature is 100-102ºF.

The fevers are unpleasant and can be dangerous if the fever rises to 106ºF but what makes this syndrome a serious problem is the accompanying kidney damage. An abnormal protein called amyloid is laid down in the kidney, destroying the kidney’s ability to filter protein. The valuable blood proteins are thus lost in urine along with waste chemicals. The dog becomes thin from the loss of body proteins, develops a propensity to throw abnormal blood clots throughout the body (from urinating out the proteins that would normally prevent this), and high blood pressure results.

All Shar-Pei should be regularly screened for urinary protein loss with a urinalysis. Red flags include urinary protein and dilute urine (specific gravity less than 1.020).

Why This Happens: Wrinkles Gone Wrong

The characteristic skin wrinkles that make the Shar-Pei what it is are caused by excessive production of hyaluronan. Hyaluronan is a structural protein in everyone’s skin but a mutation in the Shar-Pei leads to multiple copies of the genes regulating the production of hyaluronan. The result is a whole lot of extra hyaluronan puffing up the skin and creating all the wrinkles that characterize this breed.

All Shar-Pei have this mutation; without this mutation, the dog cannot really be a Shar-Pei but not all Shar-Peis have this mutation in the same way. Some have a mutation that leads to variable qualities of hyaluronan. In other words, not all the hyaluronan produced is of a healthy quality. Poor quality hyaluronan breaks down rapidly in a process that generates inflammation which, in turn, creates fever and damages organs. The mutation that creates all this poor-quality hyaluranan is often called the meat mouth mutation.

It might seem that you could simply look at a Shar-Pei’s face to determine if the dog is a candidate for fever syndrome but the situation is more complicated.

As for screening tests, there is a genetic test available at Cornell University. The mutated genetic variant that creates the meat mouth appearance is typically in multiple copies within an affected Shar-Pei. The more copies the dog has, the more reactive the inflammation. The genetic test determines the number of mutated copies present and reports the “copy number variant.” The higher this number, the more trouble for the dog. In the absence of a test, a diagnosis is made based on the clinical findings. One episode of fever is enough to make the diagnosis. Fevers classically begin before 18 months but can begin at any age. 

The test requires a blood sample and a six-page information form filled out by both the owner and the veterinary professional drawing the blood. A microchip number or tattoo is required to confirm the identity of the patient. Learn more about testing.

Though testing had been temporarily suspended as of August 21st, 2020, it seems that Cornell’s latest information says SPAID testing has been revived as of December 15, 2022.

Treatment

During a fever episode, anti-inflammatory medications provided by your veterinarian can be used to control high fevers. Pain medication is often needed to control the discomfort during the episode. The real challenge, however, is to prevent kidney damage in the long term. A dog can have substantial kidney damage before the first fever episode even happens therefore, it is important to begin therapy after the first episode and to regularly screen for urinary protein loss in any Shar-Pei whether fevers have occurred or not.

The medication central to preventing amyloid deposition in the kidney is colchicine.

Cell division, a process more scientifically known as mitosis, requires microscopic protein fibers acting like structural cables to pull dividing cells apart. These cables are called mitotic spindles, and colchicine interferes with their formation. The ability of colchicine to interfere with this sort of structural protein formation has led to its use in abnormal protein depositions such as amyloidosis. This means that colchicine can prevent the kidney damage that occurs in recurrent fever syndrome.

Recently, legal issues have forced generic colchicine off the market, leaving only the brand name product Colcrys®. This medication is problematically expensive for most pet owners. An arrangement has been made for the owners of recurrent fever syndrome dogs. An application can be obtained at www.needymeds.com; a valid prescription is required and your veterinarian will need to fill out part of the application. Colchicine can also be obtained through a compounding pharmacy. A prescription is still necessary.

Other Therapy

Antioxidants are important in amyloid prevention in that they help preserve cell membrane fatty acids. Current recommendations include supplements in omega 3 fatty acids (fish oil) and a quality multivitamin. Antioxidants such as vitamin C, lecithin granules, and glucosamine supplements to improve the hyaluronan quality are also recommended. Consult your veterinarian for a specific protocol for your dog. Early intervention is the goal with this condition.

Herbal antioxidants have also been recommended. Normalizing proper hyaluronan metabolism may require magnesium supplementation. Consult your veterinarian for specifics.