Q:  I have a 12 year old female Boston Terrier, Charlie, who has recently been drinking loads of water and urinating in the house, and steals food from the other dog and cat and even from the dinner table!  My vet feels she may have Cushing’s disease.  He offered radiation therapy, but I have been trying some homeopathic products like Cushex drops from Petalive.com.  It doesn’t seem to be working.  Can you comment? 

A:  I can sympathize with your situation with Charlie drinking and urinating so much (polydipsia and polyuria), along with excessive hunger (polyphagia), all of which are among the most common symptoms we see with Cushing’s disease due to an excessive amount of cortisol production from the adrenal gland(s).  Other common problems include muscle weakness, hair loss, urinary or respiratory infections from a suppressed immune system, and a potbellied appearance from tremendous liver enlargement.  The diagnosis of Cushing’s disease is usually confirmed with hormone testing (ACTH stimulation or low dose dexamethasone suppression testing), before any treatments are administered.  It is one of the most common endocrinopathies (glandular diseases) we see in older dogs.

Because most of the dogs are older and often have concurrent medical conditions, the workup prior to treatment includes basic blood chemistries and urinalysis, chest radiographs, urine culture, abdominal ultrasound, and blood pressure testing.  Pituitary dependent Cushing’s disease (PDH) is the most common form of the disease.  In this form of the disease a small tumor (adenoma) exists in the pituitary gland located at the base of the brain.  Occasionally Cushing’s disease is due to a tumor in the adrenal gland instead of the pituitary gland. 

            The most common treatments for Cushing’s disease are medical for PDH, and surgical for a single adrenal mass.  In the very rare instance of a pituitary macroadenoma, identified by MRI imaging, radiation therapy is recommended.   Although it requires close monitoring, medical therapies are usually very successful in controlling the symptoms of Cushing’s disease and improving the quality of life for both the patient and the pet owner.  Lysodren (generically known as mitotane) has been the traditional medical therapy until recently.  It directly destroys the part of the adrenal gland responsible for the production of cortisone.   I was involved in a multi center study to test a drug called trilostane on newly diagnosed Cushing’s disease patients or patients who had not responded well to Lysodren.  Trilostane is now available in theUS, marketed under the name Vetoryl. Trilostane is an inhibitor of an enzyme involved in the production of several steroid hormones including cortisol.  I now use trilostane almost exclusively for the treatment of Cushing’s disease in dogs, and I have been extremely pleased with the results.  Although both drugs can have side effects and require frequent monitoring, trilostane appears to be handled better by most patients.

I would consider seeking the advice of a veterinary internist as to the type of Cushing’s disease Charlie may have and the possible therapies to address it.  PDH due to a macroadenoma requiring radiation therapy would be an extremely rare condition.  I have not found holistic therapies to be of use in the management of this condition, but have been very pleased in the response of most patients to medical or surgical therapies.  Except in very rare circumstances, the diagnosis and treatment is not considered a medical emergency.  Although fatal complications from Cushing’s disease can occur, the condition is usually a chronic one, and some patients may go for years untreated.  Best of luck with Charlie and I hope she does well!

Mary Ann Crawford, DVM, DACVIM (Internal Medicine)

Dr. Crawford received her veterinary degree at the Ohio State University College of Veterinary Medicine in 1978. Dr. Crawford is board certified by the American College of Veterinary Internal Medicine. She has been board certified in internal medicine since 1985 and joined the Oradell Animal Hospital staff in 1986. Dr. Crawford was Professor and Head of the Medicine Department at Louisiana State University College of Veterinary Medicine before coming to Oradell Animal Hospital. She is also a past president of the American College of Veterinary Internal Medicine and a past president of the Northern New Jersey Veterinary Medical Association. Dr. Crawford was awarded "Distinguished Alumnus" from The Ohio State University College of Veterinary Medicine in 1995 and in 2004 "Outstanding Alumnus" from the Animal Medical Center in New York City. She is also the recipient of the 1997 Friskies Pet Care Award for Feline Medicine and Nutrition given for outstanding clinical research in the area of feline hepatic lipidosis. Dr. Crawford is involved in a number of clinical research projects and acts as a consultant for Antech Diagnostic Laboratories. In her free time she spends time with her family and enjoys biking and swimming.

What do I do if my dog or cat gets burned?

Burn wounds can be caused by heat, chemicals, or electricity.  Some common causes of burns in animals are a hot car engine or tailpipe, hot air dryers, spilled fluids and fire.  With dogs and cats caught in house fires, the first concern should be breathing.  Carbon monoxide and ash in smoke can be life-threatening and taking your pet to your veterinarian for assessment and oxygen treatment should happen quickly.

Skin burns can be obvious with full thickness (3^rd degree) burns, but other burns can be harder to see because of the hair coat.  Some burns don’t become obvious until one to two weeks later.  The temperature of the source of the burn affects how long it takes to cause a burn: at 111º it would take 6 hours, at 124º it would take only 4 minutes, but at 158º, it takes less than one second to burn.  Immediately treatment of burned skin should include removal of the heat source and running room temperature water over the area.  Cold water can make the damage worse.  It is a good idea to shave the hair in the area for mild burns so the skin can be watched closely for any worsening.  Depending of the depth of the burn a topical antibiotic cream can be helpful.

With burns that are deep or that cover a large area of the body or that involve the mouth, eyes, or genitals, then treatment at your veterinarian is best.  The burns can be treated with surgical removal and closure of normal surrounding skin or they can be treated with bandaging to allow for the skin to heal on its own.  How long the burn takes to heal varies with how large and deep the burn was, but could take one to three months for complete healing to occur.  Excessive scarring, bacterial infections, and chronic pain are important factors that must be controlled during treatment.

Jonathan Miller, DVM,MS,DACVS (Surgery)

Dr. Miller received his DVM degree from the University of Illinois, completed a rotating internship at the Atlantic Veterinary College, a surgical internship in Houston, and completed a residency in surgery at Virginia-Maryland Regional College of Veterinary Medicine. Dr. Miller has interests in both general and orthopedic surgery with a special interest in laparoscopy and arthroscopy.

Q:  My granddaughter Kyara would like to know why dogs and some cats get heartworms and humans do not? 

A:  Dogs are the definitive host for heartworm disease.  This means that heartworms are able to complete their lifecycle (mature into adults and reproduce) in the dog’s body.  Mosquitoes are required for transmission from one dog to another; they are called “intermediate hosts.”  Heartworm infection occurs primarily in dogs, but the incidence of heartworm infection in cats is increasing.  Although extremely rare, it is possible for humans to be infected with heartworms from a mosquito bite.  Since humans are not natural hosts of heartworms, the heartworm larvae cannot develop into adult worms and they die.  Heartworm disease has become less prevalent in dogs in this area of the country thanks to the large scale use of preventatives, so the risk for human infection is extremely low.  It is important to administer monthly heartworm preventative to your pets to limit their risk of heartworm infection as well as the potential for your pet to act as a reservoir for the disease.

Elizabeth Cole, DVM, Diplomate, ACVIM (Cardiology)

Dr. Cole graduated from the University of Illinois at Urbana-Champaign College of Veterinary Medicine. She completed a one year internship in small animal medicine and surgery at the University of Missouri College of Veterinary Medicine. She then completed a three year residency in cardiology at The Animal Medical Center in New York City. Dr. Cole joined the cardiology department at the Oradell Animal Hospital in September of 2008. Her areas of interest include the pathophysiology of congestive heart failure and feline cardiomyopathies. She has two four legged children, Scrappy, an 8 year old terrier mix who had heartworm disease when he was first adopted, and Chewy, a 14 year old miniature dachshund who she affectionately calls Grandma.

Jonathan Miller, DVM, MS, Diplomate American College of Veterinary Surgeons

             Tearing of the cranial (or anterior) cruciate ligament (CrCL) in dogs commonly occurs in middle aged, overweight dogs, but we have seen it in dogs as young as 10 months old.  The limp or lameness can happen suddenly or it can wax and wane for months.  Anti-inflammatory medications will help the patient to feel better, but in dogs over 15 to 20 pounds, surgery is required to achieve the best possible outcome.  In medium to large breed dogs the treatment of choice at Oradell Animal Hospital is tibial tuberosity advancement (TTA).  At the time of surgery, the “knee joint” (in dogs called the stifle joint) is examined either in the traditional open method or with arthroscopy to assess the integrity of the CrCL and remove any damaged portion.  The joint is also inspected for degree of arthritis and the medial meniscus (cartilage) is examined because 1/3 of dogs with a CrCL tear will also tear the meniscus.  Then, instead of trying to replace the ligament, the forces around the knee are adjusted by moving the front of the lower bone (tibia) forward to stabilize the joint.  This action eliminates the force pushing the tibia forward when the CrCL is not functioning properly (See Figures 1 and 2).  This involves cutting the bone and placing a titanium spacer in order to keep the bone in its new position.  Additionally, a plate is applied to reinforce the repair.  

            Following surgery, the knee needs to be protected from overuse by restricting the dog from running, jumping, rough play, or fast stairs.  Walking is encouraged as part of a detailed postoperative rehabilitation plan.  Pain medications and antibiotics are routinely used following orthopedic surgery.  Typically, the patient is seen at 2 weeks for staple or suture removal and again at 2 months for recheck x-rays of the stifle to assess bone healing (See Figure 3).  At this time an increase in activity back to a normal level is expected.  Many dogs will eventually tear their other CrCL, so keeping them lean and active to improve muscle strength is important.

Figure 1 showing a force vector diagram of instability caused by CrCL tear.

Figure 2 showing the balancing of the stifle’s forces following TTA surgery.

Figure 3 demonstrating typical bone healing seen at two months after TTA surgery.

 Dr. Miller has successfully performed TTA surgery in hundreds of dogs.  He received his master’s degree evaluating the biomechanics of TTA in dogs which he presented at a national surgery conference and has published two scientific articles on the subject:

 Miller JM, Shires PK, Lanz OI, Martin RA, Grant JW. Effect of 9mm tibial tuberosity advancement on the canine cranial cruciate deficient stifle. Vet Surg 2007;36:335-340.

 Hoffmann DE, Miller JM, Ober CP, Lanz OI, Martin RA, Shires PK. Tibial tuberosity advancement in 65 canine stifles. Vet Comp Orthop Traumatol 2006;19:219-227.

Are the effects of second hand cigarette smoke as harmful to cats and dogs as it is to humans? I have never seen this discussed anywhere.

            This is a variation of one of the most commonly asked questions by pet owners once they are given a diagnosis of cancer in their family pet – how did this happen? Unfortunately, this is a very complicated question and there is rarely a single cause of cancer. Although it is very difficult to establish a clear cause and effect between something like second hand smoke and cancer in pets, the evidence for environmental factors being involved is mounting in veterinary medicine.

            One study revealed only a slight increase in the development of lung cancer in dogs living with a smoker and this risk did not increase with greater second hand smoke exposure. There is actually more evidence linking second hand smoke with other types of cancers in pets. Cats living in a household with a smoker have been shown to have an increased risk of developing both lymphoma and cancer of the mouth (squamous cell carcinoma). Regarding lymphoma, the risk became even greater with increased time and amount of exposure to the smoke. It is suspected that cats are at greater risk of problems from second hand smoke because the smoke settles on their fur which is then ingested during their fastidious grooming habits. This results in ingestion of the carcinogens with high concentrations in the oral cavity.

            Along with these findings in cats, there is concern over environmental factors being linked to cancer in dogs. There is some evidence of a potential increased risk of bladder cancer in dogs that have been exposed to certain types of herbicides and pesticides. There is also a reported increased incidence of lymphoma, cancer of the tonsils, and cancer of the nasal passages in dogs that live in urban areas as opposed to rural settings.

            Despite all of these reports of possible environmental causes of cancer in pets, there have been no definitively proven links. Cancer takes time to develop; often extended periods of exposure to a carcinogen are needed in order for the damage to be done that can ultimately result in cancer. This means that pets may be less affected by these situations compared to humans who can potentially have decades of exposure to second hand smoke and other dangerous substances. However, it does make sense for pet owners to take any precautions possible to try to limit their four-legged family members’ exposure to potential carcinogens. This preventative strategy combined with regular examinations by your veterinarian is the best way to try to ensure your pets stay healthy.  

Stephen Brenn, DVM, DACVIM (Oncology)

Dr. Brenn received his DVM degree from the College of Veterinary Medicine at North Carolina State University. He then completed an internship at the New Haven Central Hospital for Veterinary Medicine and remained in Connecticut to live and practice general medicine. He recently completed a three year residency in oncology at the Animal Medical Center in New York City. Dr. Brenn enjoys music, sports, and spending time with his two sons.

According to Dr. Lori Siracuse-Parker, veterinarain at Oradell Animal Hospital in Paramus, NJ, Pepto-Bismol (bismuth subsalicylate) can be used in some dogs occasionally for an upset stomach/diarrhea. It is also sometimes used by veterinarians to treat certain gastrointestinal illnesses. You should always call your veterinarian before giving any over the counter medication as many are potentially toxic to our pets. You should always contact your veterinarian for an appropriate dose and to make sure there is no contraindication to giving Pepto-Bismol based on your dogs clinical signs, medical history, and other medications your pet may be taking. It is important to know that Pepto-Bismol contains aspirin so it should not be used in dogs that are sensitive to aspirin, those with a history of GI ulcers or bleeding disorders, or in combination with steroids or other non-steroidal medications. To do so could cause a fatal bleeding episode. 

Lori Siracuse-Parker, VMD (Exotics)

Dr. Lori Siracuse-Parker is a graduate of University of Pennsylvania School of Veterinary Medicine. She completed her internship in general medicine at Oradell Animal Hospital. Dr. Siracuse-Parker is a member of our general medicine service, as well as, the emergency/critical care team. She also has a special interest in avian and exotic animal pets. She and her husband have a daughter Samantha and share their home with 3 dogs, 2 cats, 1 bird, and a rabbit.

“My dog was vaccinated as a puppy. Does he need ongoing vaccination?”

Vaccination, in dogs as in people, is a great way to help the body protect itself from different diseases. A vaccination stimulates the immune system to learn to fight a disease. Often, the body needs a “booster” vaccination to keep the immune system’s arsenal in top shape.

For a puppy to be fully protected, it needs a few booster shots during its first months of life. While there are many different vaccines out there, not every puppy needs every shot. Each type of vaccine has its own schedule to keep your dog’s body able to fight off disease. There are “core” vaccines, which include protection against the most common and most dangerous diseases. “Non-core” vaccines are for diseases that your dog may or may not be exposed to – depending on the area you live in, and you and your dog’s lifestyle.

Core vaccines include Rabies, and a mixed vaccination including canine distemper, parvovirus and adenovirus.  These vaccines are given to puppies usually in a series of three and then repeated every 1-3 years, depending on the type of vaccination your veterinarian uses, and the laws and recommendations in your area. If you travel outside of the U.S. with your dog, the rabies booster may have to be given more often.

Another common vaccine is  Bordetella, to protect against canine cough. This can be given as a liquid squirted into your dog’s nose, or as an injection. To keep up proper protection, this vaccine needs to be repeated every 6-12 months. Since this disease is very contagious between dogs, most boarding kennels and play groups require all dogs to be up-to-date on this vaccine.

Leptospirosis and Lyme disease are also rather common in our area.  Your veterinarian may recommend vaccination against either or both of these diseases depending on your dog’s risk factors such as the area you live in and where your dog plays.

It’s important to remember that not all vaccinations, even when given on the ideal schedule, can prevent disease 100% of the time. The main goal is to help your dog fight off disease, so that if he is exposed the resulting sickness will be much less severe. Other important ways to protect your dog’s health include flea, tick, heartworm and intestinal parasite prevention and regular wellness screening.

Discussing your dog’s lifestyle and risk factors with your veterinarian during your annual wellness visits will help you work out the best personalized schedule for vaccinations, parasite prevention, and screening tests.

Karen Joy Goldenberg, DMV

Dr. Goldenberg received her DMV from the Faculty of Veterinary Medicine at the University of Montreal. Dr. Goldenberg's special interests include small animal surgery, behavior, and exotic pets. Dr. Goldenberg lives with her parrot Motek. In her free time she enjoys reading, biking, cooking and travel.

Feeding and Exercising the Pregnant Dog 

Q: My three year old female Labrador retriever mated with my neighbor’s dog about four weeks ago.  Her abdomen is getting larger, so I am fairly certain she is pregnant.  What type of food should I feed her and how much?  What restrictions are there on the amount of exercise that she should be allowed?

A:  It is very important that you take her to a veterinary hospital as soon as possible for a complete examination.  The veterinarian will evaluate her individual condition and determine if she is pregnant or if there might be another problem.  The duration of pregnancy (gestation period) in the dog is approximately 63 days.  A pregnant dog will require an increased amount of food mainly during the last half of pregnancy.  Usually, we do not change the type of food that she normally eats providing it is a good balanced commercial dog food.  She should be fed her regular maintenance diet for the first four weeks of pregnancy.  Then, gradually increase the amount of food by twenty to fifty percent over the last five weeks.  A good way to do this is to increase the amount of food by ten percent per week during the last five weeks.  She will be eating about fifty percent more than her normal amount of food when she gives birth (whelping).  It is best not to let her become overweight as this could make the delivery of her puppies more difficult.  Most pregnant dogs will weigh about twenty percent more than their pre-breeding weight at the end of gestation.  This will vary depending on the size of the litter.  Labrador retrievers often have seven or eight puppies.  During milk production (lactation) and nursing, the new mother will need to eat up to two to three times as much food.  The demand on her body is the greatest in the first four weeks of nursing.  It is best to increase the amount of food by increasing the number of feedings to three or four times a day.  Some veterinarians recommend adding a puppy or growth formula type diet to the regular diet during the nursing period.  This must be done gradually as many dogs will get diarrhea if their diet is changed too abruptly.  In most cases, the regular food is adequate as long as the amount is increased.  A general vitamin and mineral supplement may be given daily. 

The expectant mother should be given regular periods of controlled moderate exercise to promote good muscle strength and general condition.  Frequent walks on a leash for fifteen to twenty minutes would be a good exercise for her.  Prolonged strenuous exercise such as running to chase a ball and leaping in the air should be avoided.  Pregnancy and whelping in the dog is an enjoyable experience for a pet owner.  However, complications can occur.  If you have any questions or problems, consult with your veterinarian.

William Lucker, DVM

Dr. Lucker graduated from the University Of Pennsylvania School Of Veterinary Medicine in 1966. He completed a fourteen month internship in small animal medicine and surgery at the Henry Bergh Memorial Hospital of the ASPCA in New York City. He remained there another year as a resident staff veterinarian. After practicing in the Morristown area for three years, Dr. Lucker joined the staff of Oradell Animal Hospital in 1971. Dr. Lucker is a general practitioner with special interests in cardiology and obstetrics. He has received numerous continuing education certificates from the New Jersey Veterinary Medical Association. He sees appointments at Oradell Animal Hospital as well as our Hasbrouck Heights office. Dr. Lucker enjoys fishing, skiing and photography.

My cat Oliver started making a lot of noise while breathing and now he is sneezing and has yellowish discharge coming from his nose. What can I do and what do you think is happening to him?

It sounds like Oliver may be suffering from an upper respiratory tract infection (URI). The vast majority of URIs in cats are caused by viruses. These viruses are spread through direct cat to cat contact, contact with an infected cat’ respiratory secretions, and through indirect contact with contaminated people or objects. Some of the viruses that affect the respiratory tract can “hide” in a cat’s body for long periods of time without causing any issues and may only become a problem after a period of stress (a trip to the vet, a change in routine, an unusual visitor).

Other signs that we typically see with upper respiratory infections include red, watery puffy eyes, discharge from the eyes, corneal ulcers or ulcers in the mouth, poor appetite, and lack of energy. Clinical signs can range from very mild to severe. Sometimes, within a few days cats are feeling back to normal without any treatment at all. Other times veterinarians have to intervene and clinical signs of disease can last several weeks.

At home you should keep Oliver warm, comfortable and clean (by gently wiping his noses and eyes as needed). You should also encourage him to eat and drink so that he does not get dehydrated. Nasal congestion often causes cats to loose interest in food because their appetite is closely linked with their sense of smell. You should coax Oliver to eat with something that has a very strong odor-wet fish-based often does the trick and can help prevent dehydration!

If Oliver looses his appetite for more than a day or two or becomes lethargic, it may be time to see your veterinarian. Adult cats that do not eat for several days are at risk for developing hepatic lipidosis, a life-threatening condition that can lead to liver failure and other metabolic derangements. Your veterinarian may recommend rehydrating Oliver with fluids under his skin, or he/she may give him antibiotics and eye drops to manage any secondary bacterial infections.

Most importantly, if in doubt contact your veterinarian for further recommendations regarding your pet’s health.

Kristin Kicenuik, DVM

Dr. Kicenuik received her DVM from Cornell University School of Veterinary Medicine and her BS from The University of Pennsylvania. She resides in New Jersey with her Dutch Sheepdog Rudi. She enjoys exercising, traveling, skiing and cooking.

Q:  Doc, why is my dog scooting on the carpet?

Q: My Yorkie-Poodle mix has recently been scooting her rear end on the carpet.  Should she see her vet?

                There are several reasons for scooting which your veterinarian can easily check.  The first, and most common cause is a problem with your pet’s anal sacs.  These are two small sacs lined with glandular cells located just inside the anus which produce an odorous fluid that is normally excreted when your pet defecates, or perhaps when she is nervous.  These sacs are akin to the stink-glands in skunks explaining the pungent smell.  They are also the same sacs that dogs sniff when they greet each other, like a sniffing fingerprint. 

                If the sacs become inflamed or abscessed, they can become irritated and even painful requiring intervention from your veterinarian; the pain can be analogous to hemorrhoids in people.  Your visit may be as simple as expressing the sacs to relieve pressure or opening an abscess to allow it to drain.  If anal sacs are not the root of the problem, a few other things should be assessed:

• Have I done an annual fecal check for intestinal worms?  (They can be irritating)
• Has my pet been groomed lately? (Is there any clipper-related irritation?)
• Does my pet have allergies? (Either seasonal, fleas, food, etc – your vet can address any of these concerns)
• Is my pet’s rear end clean?  (If there are any fecal remnants on the fur, your pet may simply be trying to wipe them off).

If, in the end (no pun intended), you have exhausted this list of potential causes for scooting, your pet may simply have an occasional itch down there.  Unfortunately for your carpets, scooting is their best means for providing relief.

Ryan Goupil, DVM

Dr. Goupil completed his veterinary and undergraduate training at Cornell University. He has special interests in oncology and therapeutic research for new drugs. Dr. Goupil enjoys traveling, cooking and wine tasting.