DENTAL DISEASE
What kinds of dental problems do dogs have?
Dental disease is as common in dogs as it is in people. The most common form of dental disease in man is decay or caries. In the dog the most common problem is periodontal disease. Tartar builds up and causes irritation of the gums around the base of the teeth. The resulting inflammation is gingivitis. The gums ultimately recede exposing the roots which leads to infection and ultimately tooth loss.

Isn't it correct that dogs that eat dry dog food don't have tartar build-up?
Dry food as well as canine chews and other gnawing toys do reduce the amount of tartar accumulating on the teeth, probably due to the mechanical abrasive action. However once tartar has formed, professional cleaning under a general anaesthetic is often necessary in order to remove it.

One of the main factors determining the amount of tartar build-up is the individual chemistry in the mouth. Some dogs need yearly cleanings; other dogs never need dental attention. Tartar is basically the result of a build up of invisible plaque on the teeth just as with us and a good diet and dental home care does cut down on plaque formation and hence tartar accumulation. This in turn will result in less general anaesthetics for cleaning and polishing throughout the dog's life. Plaque and tartar accumulation can be minimised by the regular feeding of raw bones and possibly by the use of a variety of products including special foods, toothpastes, sprays and other agents which help to reduce the amount of bacterial plaque in the mouth. It is well worthwhile discussing an individual dental hygiene plan for your dog with one of our veterinarians.

What does tartar do to the teeth?
If tartar is allowed to remain on the teeth, several things may happen.

The tartar will mechanically push the gums away from the roots of the teeth. This allows the teeth to loosen in their sockets and infection to enter the root socket. The teeth will loosen and fall out or have to be extracted.

Infection will accumulate in the mouth, resulting in gingivitis, tonsillitis, and pharyngitis (sore throat). Although antibiotics may temporarily suppress the infection, if the tartar is not removed from the teeth, infection will return quickly.

Infection within the mouth will be picked up by the blood stream and carried to other parts of the body. Some kidney and heart disease may be caused by this infection.

What is involved in cleaning my dog's teeth?
Proper cleaning of the teeth requires complete co-operation of the patient so plaque and tartar can be removed properly. For the dog, general anaesthesia is required to thoroughly clean the teeth. Although anaesthesia always carries a degree of risk, the modern drugs in use in practice today minimise this risk, even for older dogs. Depending on your dog's age and general health status, your veterinary surgeon may advise a prior blood test to evaluate liver and kidney function and general health status of the patient.

There are four steps in the cleaning process that will be used on your dog:

1. Scaling removes the tartar above and below the gum line. This is done with hand instruments and ultrasonic cleaning equipment.

2. Polishing smoothes the surface of the teeth, making them resistant to additional plaque formation.

3. Flushing removes dislodged tartar from the teeth and helps to remove the bacteria that accompany tartar.

4. Fluoride coating decreases teeth sensitivity, strengthens enamel, and decreases the rate of future plaque formation.

What type of scheduling is needed for teeth cleaning?
An appointment will be necessary and you will be asked not to feed the dog for approximately eight hours before the procedure. Fluids with the exception of water should also be withheld. Make an appointment with your veterinary surgeon and be sure to attend as requested or to telephone if for any reason the appointment has to be cancelled.

On collection you may be asked to return after a few days to check that all is well, particularly if any extractions have been carried out. Advice regarding dental prophylaxis, brushing, cleaning and use of anti-plaque products etc. may be given.

One useful way of getting your dog accustomed to brushing the teeth is to use an old toothbrush dipped in the dog's dinner since feeding time is, after all, the highpoint of the day for your pet. Unlike us, brushing of the outside of the teeth is all that is really required. A dog's tongue is sufficiently mobile that most of the plaque and in consequence, tartar, is removed from the inside (lingual) surface of the teeth automatically. Once your pet has become accustomed to this procedure it is a simple step to move to the use of special toothpastes which, unlike ours, are meant to be swallowed and are usually meat or malt flavoured. DO NOT USE HUMAN DENTIFRICES, these are foaming products and are not meant to be swallowed and will be universally resented by the dog.

DIABETES MELLITUS
What is diabetes mellitus?
There are two forms of diabetes in dogs: diabetes insipidus (drinking diabetes) and diabetes mellitus (sugar diabetes) Diabetes insipidus is a very rare disorder that results in failure to regulate body water content. Your dog has the more common type of diabetes: diabetes mellitus. This is a fairly common disorder and is most often seen in dogs 5 years of age or older. There is a congenital form that occurs in puppies, but this is not common. Diabetes mellitus is a disease of the pancreas. This is a small but vital organ that is located near the stomach. It has two significant populations of cells. One group of cells produces the enzymes necessary for proper digestion. The other group, called beta-cells, produces the hormone called insulin. Simply put, diabetes mellitus is a failure of the pancreas to regulate blood sugar.

Some people with diabetes have to have daily injections of insulin and others take oral medication. Is this true for dogs?
In humans, two types of diabetes mellitus have been discovered. Both types are similar in that there is a failure to regulate blood sugar, but the basic mechanisms of disease differ somewhat between the two groups.

1. Type I, or Insulin Dependent Diabetes Mellitus, results from total or near-complete destruction of the beta-cells of the pancreas. This is the only type of diabetes known in dogs. As the name implies, dogs with this type of diabetes require insulin injections to stabilise blood sugar.

2. Type II, or Non-Insulin Dependent Diabetes Mellitus, is different because some insulin-producing cells remain. However, the amount produced is insufficient and there is a delayed response in secreting it. People with this form may be treated with an oral drug that stimulates the remaining functional cells to produce or release insulin in an adequate amount to normalise blood sugar. Because Type II diabetes is rare in dogs, generally oral medications are not appropriate for treating diabetic dogs.

Why is insulin so important?
The role of insulin is much like that of a gatekeeper: it stands at the surface of body cells and opens the door, allowing glucose to leave the blood stream and pass inside the cells. Glucose is a vital substance that provides much of the energy needed for life, and it must work inside the cells. Without an adequate amount of insulin, glucose in unable to get into the cells. It accumulates in the blood, setting in motion a series of events which can ultimately prove fatal.

When insulin is deficient, the cells become starved for a source of energy. In response to this, the body starts breaking down stores of fat and protein to use as alternative energy sources. As a consequence, the dog eats more; thus, we have weight loss in a dog with a ravenous appetite. The body tries to eliminate the excess glucose by excreting it in the urine. However, the excess blood sugar attracts water; thus, urine glucose takes with it large quantities of the body's fluids, resulting in the production of a large amount of urine. To avoid dehydration, the dog drinks more and more water. Thus, we have the four classical signs of diabetes:

CLASSICAL SIGNS OF DIABETES MELLITUS

• Weight loss
• Ravenous appetite
• Increased water consumption
• Increased urination

How is diabetes mellitus diagnosed?
The diagnosis of diabetes mellitus is based on three criteria: the four classical clinical signs, the presence of a persistently high level of blood glucose and the presence of glucose in the urine.

The normal level of glucose in the blood is 4.4-6.6 mmol/l. It may rise to 10 mmol/l following a large meal. However, diabetes is the only common disease that will cause the blood glucose level to rise above 22 mmol/l. Some diabetic dogs will have a glucose level as high as 44 mmol/l, although most will be in the range of 22-33 mmol/l.

To prevent glucose loss from the body the kidneys only allow it to pass out in the urine when very high levels of glucose are circulating in the blood. This means that dogs with a normal blood glucose level will not have glucose in the urine. Diabetic dogs, however, have excessive amounts of glucose in the blood, so it will be present in the urine.

What are the implications for me and my dog?
For the diabetic dog, one reality exists: blood glucose cannot be normalised without treatment. Although the dog can go a day or so without treatment and not get into a crisis, treatment should be looked upon as part of the dog's daily routine. Treatment almost always requires administration of insulin and some modification of the diet.

For the owner, there are two implications: financial commitment and personal commitment.

When your dog is well regulated, the maintenance costs are minimal. The special diet, insulin, and syringes are not very expensive. However, the financial commitment is significant during the initial regulation process and if complications arise.

Initially, your dog may be hospitalised for a few days to deal with the immediate crisis and to begin the regulation process. The "immediate crisis" is only great if the dog is so sick that it has stopped eating and drinking for several days. Dogs in this state, called ketoacidosis, may require a week or more of hospitalisation with a number of laboratory tests. Otherwise, the initial hospitalisation may be only for a day or two in order to start stabilisation. At that point, your dog goes home for you to administer medication. At first, return visits are required frequently to monitor progress. It may take a month or more to achieve good regulation.

The financial commitment may again be significant if complications arise. We will work with you to try and achieve consistent regulation, but a few dogs are difficult to keep regulated. It is important that you pay close attention to our instructions related to administration of medication, to diet, and to home monitoring. Another complication that can arise is hypoglycemia, or low blood sugar. If severe, this can be fatal. This may occur due to inconsistencies in treatment. This will be explained in subsequent paragraphs.

Your personal commitment to treating your dog is very important in maintaining regulation and preventing crises. Most diabetic dogs require insulin injections once or even twice daily. They must be fed the same food in the same amount on the same schedule every day. If you are out of town, your dog must receive proper treatment while you are gone. These factors should be considered carefully before deciding to commence treatment.

What is involved in treatment?
Consistency is vital to proper management of the diabetic dog. Your dog needs consistent administration of medication, consistent feeding, and a stable, stress-free lifestyle. Generally most dogs are healthier and happier if they receive insulin injections twice daily.

The first step in treatment is to review your dog's diet. Diets that are high in fibre are preferred because they are generally lower in sugar and slower to be digested. This means that the dog does not have to process a large amount of sugar at one time. The preferred diets are on prescription but will be supplied by the veterinary surgeon. If your dog is overweight, a special weight reducing diet may be first prescribed and then once the proper weight is achieved, another diet will be introduced.

Your dog's feeding routine is also important. The best way to feed a diabetic dog is to feed twice daily around one and a half hours after the insulin injection. If your dog is currently eating on a free choice basis, please try to make the change. However, if your dog will not change or if you have several dogs that eat in a free choice fashion, you may find that this change is not practical. If a two-meals-per-day feeding routine will not work for you, it is still very important that you find some way to accurately measure the amount of food that is consumed and consider a once daily injection.

The foundation for regulating blood glucose is the administration of insulin by injection. Many people are initially afraid of giving insulin injections. If this is your initial reaction, consider these points.

1. Insulin does not cause pain when it is injected.

2. The injections are made with very tiny needles that your dog hardly feels. The injected volumes are minute.

3. The injections are given just under the skin in areas in which it is almost impossible to cause damage to any vital organ. Please do not decide whether to treat your dog with insulin until we have demonstrated the injection technique. You will be pleasantly surprised at how easy it is.

The injection technique is as follows:

About Insulin. Insulin comes in an airtight bottle that is labelled with the insulin type and the concentration. Shake the bottle to mix the contents. Some of the types of insulin used in dogs have a strong tendency to settle out of suspension. If it is not shaken properly, it will not mix well, and dosing will not be accurate. Therefore, the trick is to shake it vigorously enough to mix it without creating foam. Since bubbles can be removed (as described later), it is more important to mix it well than to worry about foam formation.

Insulin is a hormone that will lose its effectiveness if exposed to direct sunlight or high temperatures. It should be kept in the refrigerator, but it should not be frozen. It is not ruined if left out of the refrigerator for a day or two, although this is not advisable. Insulin is safe as long as it is used as directed, but it should be kept out of the reach of children.

Drawing up the Insulin. Have the syringe and needle, insulin bottle, and dog ready.

Then, follow these steps:

1. Remove the guard from the needle, and draw back the plunger to the appropriate dose level.

2. Carefully insert the needle into the insulin bottle.

3. Inject air into the bottle; this prevents a vacuum from forming within the bottle.

4. Withdraw the correct amount of insulin into the syringe.

Before injecting your dog with the insulin, check that there are no air bubbles in the syringe. If you get an air bubble, draw twice as much insulin into the syringe as you need. Then withdraw the needle from the insulin bottle and tap the barrel of the syringe with your finger to make the air bubble rise to the nozzle of the syringe. Gently and slowly expel the air bubble by moving the plunger upward.
When this has been done, check that you have the correct amount of insulin in the syringe. The correct dose of insulin can be assured if you measure from the needle end, or "0" on the syringe barrel, to the end of the plunger nearest the needle.

Injecting the Insulin. The steps to follow for injecting insulin are:

1. Hold the syringe in your right hand (switch hands if you are left-handed).

2. Pick up a fold of skin from somewhere along your dog's abdomen with your free hand (pick up a different spot each day).

3. Quickly push the very sharp, very thin needle through your dog's skin. This should be easy and painless. However, take care to push the needle through only one layer of skin and not into your finger or through two layers of skin. The latter will result in injecting the insulin onto your dog's haricot or onto the floor.

4. To inject the insulin, place your thumb on the plunger and push it all the way into the syringe barrel.

5. Withdraw the needle from your dog's skin. Immediately place the needle guard over the needle and store the needle and syringe back in the fridge. The needle and syringe can be reused many times over.

6. Stroke your dog to reward it for sitting quietly.

7. Be aware that some communities have strict rules about disposal of medical waste material so don't throw the needle/syringe into the rubbish until you know if this is permissible. If it is not, we can dispose of them for you.

It is neither necessary nor desirable to swab the skin with alcohol to "sterilise" it.

There are four reasons:

1. Due to the nature of the thick hair coat and the type of bacteria that live near the skin of dogs, brief swabbing with alcohol or any other antiseptic is not very effective.

2. Because a small amount of alcohol can be carried through the skin by the needle, it may actually carry bacteria with it into the skin.

3. The sting caused by the alcohol can make your dog dislike the injections. If you have accidentally injected the insulin on the surface of the skin, you will not know it.

4. If you do not use alcohol and the skin or hair is wet following an injection, the injection was not done properly.

Although the above procedures may at first seem complicated and somewhat overwhelming, they will very quickly become second nature. Your dog will soon learn that twice each day it has to sit still for a few minutes. In most cases, a reward of stroking results in a fully cooperative dog that eventually may not even need to be held.

Is continual or periodic monitoring needed?
It is necessary that your dog's progress be checked on a regular basis. Monitoring is a joint project on which owners and veterinary surgeon must work together.

Home Monitoring
Your part consists of two forms of monitoring. First, you need to be constantly aware of your dog's appetite, weight, water consumption, and urine output. You should be feeding a constant amount of food each day which will allow you to be aware of days that your dog does not eat all of it or is unusually hungry after the feeding. You should weigh your dog at least once monthly. It is best to use the same scales each time.

You should develop a way to measure water consumption. The average dog should drink no more than approximately 300 mL of water per 5 kg of body weight per 24 hours. Since this is highly variable from one dog to another, keeping a record of your dog's water consumption for a few weeks will allow you to establish what is normal for your dog. Another way to measure water consumption is based on the number of times it drinks each day. When properly regulated, it should drink no more than six times per day. If this is exceeded, you should take steps to make an actual measurement.

Any significant change in your dog's food intake, weight, water intake, or urine output is an indicator that the diabetes is not well controlled. We should see your dog at that time for blood testing.

The second method of home monitoring is to determine the presence of glucose in the urine. If your dog is properly regulated, there should be no glucose or only a minimal amount present in the urine.

There are several ways to detect glucose in urine. You may purchase urine glucose test strips in any chemist or we will supply them. They are designed for use in humans with diabetes, but they will also work in the dog. fresh urine sample should be collected and tested with the test strip. If glucose is detected, the test should be repeated the next two days. If it is present each time, we should see your dog for a blood test. Please telephone and discuss.

You should keep a small container to catch urine as the dog voids. We can supply these. A large amount of urine is not needed to test for urine glucose; it is not necessary to catch the entire amount of urine. Because the female dog usually squats to urinate, a shallow pan or dish may be placed under the hindquarters when she begins to urinate. For male dogs, urine can be collected as soon as the dog lifts the leg to void. Male dogs often urinate small amounts in several different places and most often urinate on vertical objects, such as bushes and trees. We can supply special pots to aid collection.

Monitoring of Blood Glucose
Determining the level of glucose in the blood is the most accurate means of monitoring. This should be done about every 3-4 months if your dog seems to be well regulated. It should also be done at any time the clinical signs of diabetes are present or if appreciable amounts of glucose are detected in the urine for several days.

Timing is important when the blood glucose is determined. Since eating will elevate the blood sugar for several hours, it is best to test the blood at least 6 hours after eating.

When testing the blood we want to know the highest and lowest glucose readings for the day. The highest reading should occur just before an injection of insulin is given. The lowest should occur at the time of peak insulin effect. This is usually 4-8 hours after an insulin injection, but it should have been determined during the initial regulation process.

Therefore, the proper procedure is as follows:

1. Feed your dog its normal morning meal then bring it to the surgery immediately. If you cannot get it there within 30 minutes, do not feed it. In that situation, bring its food with you.

2. Bring your dog to the hospital early in the morning without giving it insulin.

3. A blood sample will be taken immediately, then we will give insulin and feed your dog if it did not eat at home.

4. A second blood sample will be taken at the time of peak insulin effect.

If your dog gets excited or very nervous when riding in the car or being in the hospital, the glucose readings may be falsely elevated. If this occurs, it is best to admit your dog to the hospital the morning (or afternoon) before testing so it can settle down for testing the next day. In this way the tests are likely to be more accurate.

Does hypoglycaemia (low blood sugar) occur in dogs?
Hypoglycaemia means low blood sugar. If it is below 2.2 mmol/l, it can be life-threatening. Hypoglycaemia occurs under two conditions:

1. If the insulin dose is too high. Although most dogs will require the same dose of insulin for long periods of time, it is possible for the dog's insulin requirements to change. However, the most common causes for change are a reduction in food intake and an increase in exercise or activity. If your dog does not eat, you need to call your veterinarian. Always remember that it is better for the blood sugar to be too high than too low.

2. If too much insulin is given. This can occur because the insulin was not properly measured in the syringe or because two doses were given. You may forget that you gave it and repeat it, or two people in the family may each give a dose. A chart to record insulin administration will help to prevent the dog being treated twice.

The most likely time that a dog will become hypoglycaemic is the time of peak insulin effect (5-8 hours after an insulin injection). When the blood glucose is only mildly low, the dog will be very tired and unresponsive. You may call it and get no response. Within a few hours, the blood glucose will rise, and your dog will return to normal. Since many dogs sleep a lot during the day, this important sign is easily missed. Watch for it; it is the first sign of impending problems. If you notice it, telephone and we will organise blood tests.

If your dog is slow to recover from this period of lethargy, you can try feeding sugar or glucose. A teaspoonful of sugar in a little water, poured into the dog, should bring about an improvement. If not repeat it after 15 minutes.

If there is still no response, contact us immediately for further instructions.

If severe hypoglycaemia occurs, a dog will have seizures or lose consciousness. This can only be reversed with intravenous administration of glucose. Please telephone immediately, be it day or night. THIS IS AN EMERGENCY.

SUMMARY OF INSTRUCTIONS
Read and reread this material so that you understand the basics of proper regulation and how to recognise and treat hypoglycaemia.

Make sure you have sufficient supplies of insulin and syringes. These will either have been supplied by the practice or on prescription from your local chemist.

Give the first injection of insulin of _____units at about_________AM and _______PM and feed each ________ gms of ___________ or _________ approximately ________ hours after dosage.

Please return on ____________ and be prepared to leave_______________in order that we can carry out further blood tests.

Follow instructions regarding urine testing and let us have the results as requested.

If you cannot test the urine for glucose, please telephone us and we will arrange further blood tests. This should be done over a 5-8 hour period after an injection of insulin.

Please return for a blood glucose test in ___________in order that we can evaluate progress.

If at all concerned about any aspect of management, please telephone without delay.

DIARRHOEA
DEFINITION: Strictly the term diarrhoea involves:

1. unformed faeces
2. an increase in frequency of defaecation
3. an increase in volume of faeces

If your dog is only passing soft faeces once or twice a day, although abnormal it is strictly not diarrhoea but merely looseness of the bowel.

What causes diarrhoea?
Diarrhoea is not a disease; rather, it is a sign of many different diseases. Many mild cases of diarrhoea can be resolved quickly with simple treatments. Others are the result of fatal illnesses, such as cancer. Even diarrhoea caused by mild illnesses may become fatal if treatment is not begun early enough to prevent severe fluid and nutrient losses.

How serious is diarrhoea in dogs?
We attempt to determine how sick the dog has become as a consequence of the diarrhoea. When the dog is systemically ill (i.e., more than one body system is involved), some of the following may be noted:

• Vomiting
• Dehydration
• Loss of appetite
• Abdominal pain
• High fever
• Lethargy
• Bloody and/or watery diarrhoea

What types of tests are performed to find the cause?
If diarrhoea is associated with several of the above signs, we perform a series of tests in the hope that a diagnosis can be made. This permits more specific treatment. Diagnostic tests may include radiography (x-rays) with or without barium, blood tests, bacteriological cultures, biopsies of the intestinal tract, and exploratory abdominal surgery. Once the diagnosis is known, treatment may include special medications and/or diets, or surgery.

If your dog does not appear systemically ill from diarrhoea, the cause may be less serious. Some of the minor causes of diarrhoea include stomach or intestinal bacteria or viruses, intestinal parasites, and dietary indiscretions (such as eating garbage or other offensive or irritating materials). A minimum number of tests are performed to rule out certain parasites and infections. These cases may be treated with drugs to control the motility of the intestinal tract, drugs that relieve inflammation in the intestinal tract, and, often, a special diet for a few days. This approach allows the body's healing mechanisms to correct the problem. We expect improvement within 2-4 days; if this does not occur, a change in medication or further tests are done to better understand the problem. Please keep us informed of any lack of expected improvement so that we may manage the situation properly.

Diarrhoea Questionnaire
1. Has your dog got diarrhoea?

a) is the faeces unformed
b) greater volume than normal
c) occurring more frequently

2. How long has the diarrhoea been present?

3. Is the diarrhoea more severe now than a few days ago?

4. Circle the letter of each item that applies:

Consistency

a) Watery faeces
b) Stool is the thickness of pancake batter

Blood

a) Very bloody faeces
b) Only sporadic blood present
c) Blood not present in faeces
d) Bright red blood present
e) Dark, tarry blood present

Degree/Frequency

a) Entire faeces is soft or watery
b) Only portions of the faeces are soft or watery
c) Diarrhoea with each bowel movement
d) Diarrhoea is sporadic (some bowel movements are normal)
e) Only 1 or 2 bowel movements per day
f) More than 4 bowel movements per day

Colour

a) Stool is dark brown in colour
b) Stool is very pale in colour
c) Stool is black and tarry in appearance

Miscellaneous

a) Thick mucus or pieces of tissue present in faeces
b) Loss of bowel control (defecates in the house on the floor)
c) Straining when having a bowel movement or squatting unproductively.

Is your dog's appetite normal? If not, is it eating at all?
What have you been feeding your dog during the last week? (Include dog or cat foods, treats, table foods, milk, and anything else that it gets on a daily basis. Also state what percentage of the diet is in each item or category.)

Does your dog have access to foods other than what you feed it? If so, what?
1. Has there been a significant diet change in the last few weeks? If so, does that correspond with the onset of the diarrhoea?

2. Is your dog as active as normal?

3. Describe any change in water consumption (up or down).

4. Has vomiting been occurring? If so, how frequently and for how long?

5. Does your dog go outside your house?

6. Does your dog go outside your garden ?

7. Could your dog have access to rubbish bins, either within your house and garden or in some other place?

8. Does your dog have toys that it plays with that could have been swallowed?

9. Does your dog have access to sewing materials, such as thread or needles, or rubber bands, or string?

10. Do you have other dogs or cats that live with this one? If so, do the other pet/s have diarrhoea?

11. Do any of the members of your family currently have a diarrhoea problem?

12. Please leave a contacting telephone number where we may reach you today if we need to discuss anything further.

EAR INFECTIONS (OTITIS EXTERNA)
How common are ear infections in dogs?
Infection of the external ear canal (outer ear) by bacteria or yeast, is one of the most common types of infections seen in dogs. It is called otitis externa. Some breeds, particularly those with large or hairy ears like Cocker Spaniels, Miniature Poodles or Old English Sheepdogs, seem more prone to ear infections, but they can occur in any breed.

What are the symptoms of an ear infection?
A dog with an ear infection is uncomfortable and the ear canals are sensitive. The dog shakes its head and scratches its ears trying to get the debris and fluid out. The ears often become red and inflamed and develop an offensive odour. A black or yellowish discharge commonly occurs.

Don't these symptoms usually suggest ear mites?
Ear mites can cause several of these symptoms, including a black discharge, scratching, and head shaking. However, ear mite infections occur most commonly in puppies. Ear mites in adult dogs occur most frequently after a puppy carrying mites is introduced into the household. Sometimes, ear mites will create an environment within the ear canal which leads to a secondary infection with bacteria and yeast (fungus). By the time the dog is presented to the veterinary surgeon, the mites may be gone, but a significant ear infection remains.

Since these symptoms are similar and usually mean an infection, can I not just collect some medication?
There are several kinds of bacteria and at least one type of fungus which might cause an ear infection. Without knowing the kind of infection present, we do not know which medication to use. In some cases, the ear infection may be caused by a foreign body or tumour in the ear canal. Treatment with medication alone will not resolve these problems. Also, the dog must be examined to be sure that the eardrum is intact. Administration of certain medications can result in loss of hearing if the eardrum is ruptured. This determination is made by the veterinary surgeon at the surgery.

How do you know which drug to use?
First, the ear canal is examined with an otoscope, an instrument that provides magnification and light. This permits a good view of the ear canal. This examination allows us to determine whether the eardrum is intact and if there is any foreign material in the canal. When a dog is in extreme pain and refuses to allow the examination, it may be necessary to sedate or completely anaesthetise the dog for a thorough examination.

The next step is to examine a sample of the material from the ear canal under a microscope to determine which organism is causing the infection. Microscopic examination is very important in helping the veterinary surgeon choose the right medication to treat the inflamed ear canal. Further bacteriological examination may also be necessary before treatment is started.

How are ear infections treated?
The results of the otoscopic examination and bacteriology usually determine the course of treatment. If there is a foreign body or tick lodged in the ear canal, the dog is sedated so that it can be removed. As stated previously, some dogs have such a heavy buildup of debris that sedation is needed to cleanse the canal and examine it completely. Cytologic study of debris from the ear canal dictates which drug to use. Sometimes, it reveals the presence of more than one type of infection (i.e., a bacterium and a fungus, or two kinds of bacteria); this situation usually requires the use of multiple medications or a broad-spectrum medication.

An important part of the evaluation of the patient is the identification of underlying disease. Many dogs with chronic or recurrent ear infections have allergies or low thyroid function (hypothyroidism). If underlying disease is suspected, it must be diagnosed and treated, if at all possible. If this cannot be done, the dog is less likely to have a favourable response to treatment. Also, the dog might respond temporarily, but the infection will recur (usually when ear medication is discontinued).

What is the prognosis?
Nearly all ear infections that are properly diagnosed and treated can be cured. However, if an underlying cause remains unidentified and untreated, the outcome will be less favourable. Several examinations may be needed before the process is completed and we can expect ultimate success.

How important is it to treat an ear infection?
Dogs with ear infections are miserable. Their ears are a source of constant pain resulting in head shaking and scratching. However, that is not the only problem. Head shaking and scratching can also cause broken blood vessels in the ear flap, requiring surgery, and chronic ear infections can penetrate the ear drum and result in an internal ear infection.

My dog's ear canal is nearly closed. Is that a problem?
Closing of the ear canal is another result of a chronic ear infection. There are medications that can shrink the swollen tissues and open the canal in some dogs. However, some cases will eventually require surgery.

What is the goal of surgery?
The surgery for a closed ear canal is called a lateral ear resection. The goal of the surgery is to remove the vertical part of the ear canal and to remove swollen tissue from the horizontal canal. Removing the vertical canal should be successful, but removal of large amounts of tissue from the horizontal canal is more difficult. In some cases, the ear canal is surgically removed which may result in some permanent impairment of hearing.

Is there anything I need to know about getting medication in the ear?
It is important to get the medication into the horizontal part of the ear canal. Be aware that the dog's external ear canal is "L" shaped. The vertical canal connects with the outside of the ear; the horizontal canal lies deeper in the canal and terminates at the eardrum.

The ear canal may be medicated by following these steps:

1. Gently pull the ear flap straight up and hold it with one hand.

2. Apply a small amount of medication into the vertical part of the ear canal while continuing to keep the ear flap elevated. Hold this position long enough for the medication to run down to the turn between the vertical and horizontal canal.

3. Put one finger in front of and at the base of the ear flap, and put your thumb behind and at the base.

4. Massage the ear canal between your finger and thumb. A squishing sound tells you that the medication has gone into the horizontal canal.

5. Release the ear and let your dog shake its head. If the medication contains a wax solvent, debris will be dissolved so it can be shaken out.

6. If a second medication is to be used, apply it in the same manner.

7. When all medications have been applied, clean the outer part of the ear canal and the inside of the ear flap with cotton wool soaked in some of the medication. Do not use cotton tipped applicators to do this as they tend to push debris back into the vertical ear canal.

FLEA ALLERGY
What are allergies, and how do they affect dogs?
One of the most common conditions affecting dogs is allergy. In the allergic state, the dog's immune system "overreacts" to foreign substances (allergens or antigens) to which it is exposed. These overreactions are manifested in three ways. The most common is itching of the skin, either localised (one area) or generalised (all over the dog). Another manifestation involves the respiratory system and may result in coughing, sneezing, and/or wheezing. Sometimes, there may be an associated nasal or ocular (eye) discharge. The third manifestation involves the digestive system, resulting in vomiting or diarrhoea. The specific response that occurs is related to the allergen and the individual animal’s immune system.

What is meant by the term flea allergy?
In spite of common belief, a normal dog experiences only minor skin irritation in response to flea bites. Even in the presence of dozens of fleas, there will be very little itching. On the other hand, the flea allergic dog has a severe, itch-producing reaction to flea bites. This occurs because the dog develops an allergic response to the flea's saliva. When the dog is bitten, flea saliva is deposited in the skin. Just one bite causes intense itching and this is of a long lasting nature.

What does this reaction do to the dog?
The dog's response to the intense itching is to chew, lick, or scratch. This causes hair loss and can lead to open sores or scabs on the skin, allowing a secondary bacterial infection to begin. The area most commonly involved is over the rump (just in front of the tail). This is probably because fleas find this part of the dog more desirable. Many flea-allergic dogs also chew or lick the hair off their legs.

What is the proper treatment?
The most important treatment for flea allergy is to get the dog away from all fleas. Therefore, strict flea control is mandatory and this involves ensuring the dog is flea-free and also removing fleas from the environment. There are many products available for flea control: we recommend Frontline, Advantage, or Revolution, which give extended and safe flea control. To control flea allergy, we may recommend re-application at a shorter time interval than normal.

Some dogs can be desensitised to the adverse effects of flea bites. Flea saliva extract (flea antigen) is injected into the dog in tiny amounts over a prolonged period of time. This is an attempt to reprogram the dog's immune system so it no longer over-reacts to flea bites. If successful, itching no longer occurs or is less intense when the dog is bitten. However, this approach is only successful in less than 30% of cases.

Corticosteroids can be used to block the allergic reaction and give relief. This is often a necessary part of dealing with a flea allergy. Dogs are more resistant to the side-effects of steroids than humans, but significant side-effects can occur. For this reason, the goal is to administer the smallest amount of steroid needed to keep the dog comfortable. Some dogs develop a secondary bacterial infection in the skin. When this occurs, appropriate antibiotics must be used and steroid therapy reduced even further.

If you have any problems, please telephone us.

FOOD ALLERGY
What are allergies, and how do they affect dogs?
One of the most common conditions affecting dogs is allergy. In the allergic state, the dog's immune system "overreacts" to foreign substances (allergens or antigens) to which it is exposed. These overreactions are manifested in three ways. The most common is itching of the skin, either localised (one area) or generalised (all over the dog). Another manifestation involves the respiratory system and may result in coughing, sneezing, and/or wheezing. Sometimes, there may be an associated nasal or ocular (eye) discharge. The third manifestation involves the digestive system, resulting in vomiting or diarrhoea.

What is food allergy?
A food allergy is a condition in which the body's immune system reacts adversely to a food or an ingredient in a food.

What foods are likely to cause an allergic reaction?
Any food or food ingredient can cause an allergy. However, protein, usually from the meat source of the food, is the most likely offender. Proteins commonly found in dog foods are derived from beef, chicken, lamb, and horsemeat.

Dogs are not likely to be born with food allergies. More commonly, they develop allergies to food products they have eaten for a long time. The allergy most frequently develops in response to the protein component of the food; for example, beef, pork, chicken, or turkey. Food allergy may produce any of the clinical signs previously discussed, including itching, digestive disorders, and respiratory distress. We recommend testing for food allergy when the clinical signs have been present for several months, when the dog has a poor response to steroids, or when a very young dog itches without other apparent causes of allergy. Testing is done with a special hypoallergenic diet. Because it takes at least 4 weeks for all other food products to get out of the system, the dog must eat the special diet exclusively for 4-8 weeks (or more). If positive response occurs, you will be instructed on how to proceed. If the diet is not fed exclusively, it will not be a meaningful test. We cannot overemphasise this. If any type of table food, treats or vitamins are given, these must be discontinued during the testing period.

HEART DISEASE
DILATED CARDIOMYOPATHY
How does the heart work?
The heart has four chambers. The upper chambers are called atria (auricles.) One chamber is called an atrium, and the lower chambers are called ventricles. In addition to the upper and lower chambers, the heart is also considered to have a right and a left side.

Blood flows from the body into the right atrium. It is stored there briefly, then pumped into the right ventricle. The right ventricle pumps blood into the lungs, where it receives oxygen. It flows from the lungs into the left atrium; it is held here briefly before going into the left ventricle. The left ventricle contains the largest muscle of the heart so the blood can be pumped out to all parts of the body.

What is dilated cardiomyopathy?
Dilated cardiomyopathy means that the heart muscle, becomes unable to pump properly. The pressure of the blood inside the heart then allows this weakened heart muscle to stretch, resulting in a much larger left ventricular chamber. Therefore, the two characteristics of dilated cardiomyopathy are a heart wall that does not contract or pump normally and a chamber that is much larger than normal.

How common is dilated cardiomyopathy?
Dilated cardiomyopathy is not the most common cause of heart failure in dogs in general. However, this is the most common cause of heart failure in large breeds of dogs. Small breeds are only occasionally affected. The most commonly affected breeds are Boxers, Dobermans and Great Danes. Occasionally, medium sized breeds, notably Cocker Spaniels and English Springer Spaniels, and occasionally German Shepherd Dogs are also affected.

Are there any signs of heart failure which would be noticeable to me?
When the heart is not pumping properly, blood backs up into the vessels of the lungs. Increased pressure within the vessels results in small amounts of fluid leaking out of the capillaries and eventually into the air passageways. This fluid collection in the lungs produces coughing and/or gagging, the most obvious sign of heart failure. Dogs in heart failure also tire very easily from minimal exercise.

Congestive heart failure begins when the heart is not able to pump blood with adequate oxygen to the tissues. Without adequate oxygen, the body's cells become desperate and trigger a series of responses. Various hormones are released by several organs in an attempt to correct the problem. These hormones conserve fluid in an effort to increase blood volume and the output of oxygenated blood by the heart.

For a variable period, these compensatory responses help the situation. However, increased fluid retention eventually becomes harmful. More and more fluid leaks out of capillaries, causing increased gagging and coughing, and reduced stamina. Fluid may collect in the abdominal cavity and body tissues. Fluid in the lungs is called pulmonary oedema, fluid below the skin is called peripheral or limb oedema, and fluid in the abdomen is called ascites (dropsy). Congestive heart failure is a common cause of these signs.

My dog seemed to get very ill just in the last day or two. How can this happen?
Dilated cardiomyopathy may have a very sudden onset. Some dogs go into severe heart failure in what appears to be a matter of hours. Rapid, heavy breathing, a blue tongue, excessive drooling, or collapse may be the first signs.

What tests are done to assess the situation?
There are several tests that are used. All provide valuable information while looking at different aspects of heart function.

1. Listening with a stethoscope (auscultation). This valuable tool allows us to identify murmurs, their location, and their intensity and an abnormal heart rhythm (arrhythmia or dysrhythmia). It also allows us to hear lung sounds; this aids in our understanding of what is happening within the lungs. Thus the lungs are also affected.

2. Chest radiographs (x-rays). These give us the best look at the lungs and a view of the size and shape of the heart. In most cases, dilated cardiomyopathy causes tremendous enlargement of the heart. These changes are usually very apparent on the x-rays.

3. Ultrasound examination (Echocardiogram, ultrasonography). This examination uses sound waves which bounce off the structures of the heart and are read on a TV-like monitor. It gives the most accurate determination of the size of each heart chamber, and permits measurement of the thickness of the heart walls. This is seen on the monitor in actual time so the contractions of the heart can be evaluated. Certain measurements can be taken which allow the actual strength of the heart's contraction to be measured as a number and compared to the normal animal. Ultrasound may not be available in all veterinary practices because of the additional training needed to learn how to perform the examination and because of the cost of the sophisticated equipment.

4. Electrocardiogram (ECG). This is an assessment of the electrical activity of the heart. It allows us to accurately determine heart rate and to more accurately identify any abnormalities of rhythm that may be present.

The combination of all of these tests gives us our best evaluation of the dog and its heart function. However, if cost considerations prohibit us performing all of them, two or three will provide much valuable information.

Is there a treatment for heart failure caused by dilated cardiomyopathy?
If the dog has a sudden onset of heart failure, rapid administration of the proper drugs is essential to survival. The following drugs may be used at various stages of treatment. Initial stabilisation usually depends on the first two.

1. Diuretics. These drugs stimulate the kidneys to remove excess fluid from the body. Frusemide is most commonly used, although others will be selected in certain circumstances.

2. Digitalis glycocydes. These drugs improve heart function in several ways. They regulates excess hormones that have been released, slow the heart rate, and strengthen each contraction of the heart.

3. ACE inhibitors. This is a relatively new class of drugs which can directly block the compensation system that has gone out of control.

4. Vasodilators. These drugs dilate the arteries and/or the veins of the body so that the heart doesn't have to generate as much pressure to eject blood. They are effective long-term to stabilise the patient.

5. Bronchodilators which help breathing in a fluid compromised lung.

How much longer will my dog live?
There are many factors that must be considered before this question can be answered. The results of the tests are important, and the response that occurs within the first few days is another indicator.

If response does not occur within a few hours to days, the prognosis is not good. However, most dogs that stabilise quickly will live for a period of a few months to many months, but the long-term prognosis is not good. It can be difficult to generate an accurate estimate for life-expectancy when a dog has heart disease because many variables impact on survival, not least of which is the dog's activity levels.

MITRAL VALVE DISEASE AND HEART FAILURE
What is the mitral valve?
The heart has four chambers. The upper chambers are the atria (auricles, singular atrium). The lower chambers are the ventricles. The heart is also divided into right and left sides.

Blood flows from the body into the right atrium. It is stored there briefly and then pumped into the right ventricle. The right ventricle pumps blood into the lungs where it receives oxygen. It flows from the lungs into the left atrium where it is held a few seconds before going into the left ventricle. The left ventricle is surrounded by the largest and strongest of the heart muscles. This large muscle is necessary to pump blood to all parts of the body.

Each side of the heart has a valve to keep blood from going backward from the ventricles to the atria. The valve between the left atrium and left ventricle is called the mitral valve. Because of the very large pressure created when the left ventricle contracts, the mitral valve wears out in many dogs. This wearing out process begins with a small leak that gradually gets more severe.

How common is mitral valve disease?
This is the most common cause of heart failure in small dogs. Large breeds have a lower incidence.

What are the consequences of a leaking mitral valve?
The earliest sign of a leaking mitral valve is a heart murmur. This is produced by the turbulence created when some of the blood goes backward through the leaking valve and into the left atrium. Many dogs develop a murmur from the mitral valve as early as 6 years of age. This problem is especially common in small breeds of dogs; most of them will have a murmur by 10 years of age.

However, a murmur does not mean that heart failure is imminent. As time goes on, the leak becomes more severe and more and more blood goes backwards into the atrium. This results in reduced pumping efficiency and, eventually, congestive heart failure. From the time a murmur develops, it may be a few months to several years before heart failure occurs.

How will I know if heart failure is present?
When the heart is not properly pumping blood, the blood moves more slowly through the lungs. This results in small amounts of fluid leaking out of the capillaries into the air passageways. This fluid collection produces the earliest signs of heart failure. The dog attempts to gag up fluid from the lungs (as if trying to clear the throat), a chronic, hacking cough, and lack of stamina when exercised.

Does that mean that heart failure will occur soon?
Congestive heart failure begins when the body is not able to provide blood with adequate oxygen for the tissues. Without adequate oxygen, the body's cells become desperate and trigger a series of responses. Various hormones are released in an attempt to correct the problem. These hormones conserve fluid in an effort to increase blood volume and the output of blood and oxygen by the heart. For several months, these compensatory responses help the situation. However, eventually, the increased fluid retention becomes detrimental. More fluid leaks out of capillaries causing increased gagging and coughing, reduced stamina, and increased fluid collection in the abdominal cavity and body tissues. Fluid in the lungs is called pulmonary oedema, fluid below the skin is called peripheral or limb oedema, and fluid in the abdomen is called ascites. When these are present, congestive heart failure is present.

What tests are done to assess the situation?
There are several tests that are used. All provide valuable information while looking at different aspects of heart function.

1. Listening with a stethoscope (auscultation). This valuable tool permits identification of murmurs, their location, and their intensity. It also allows us to hear lung sounds so that we can better understand what is happening within the lungs.

2. Blood and urine tests. These do not give direct information about heart function, but they allow detection of other disorders in the body that may have significance to heart function.

3. Chest radiographs (x-rays). The chest radiograph is useful for examining the lungs and for viewing the size and shape of the heart.

4. Electrocardiogram (ECG). This is an assessment of the electrical activity of the heart. It allows accurate determination of heart rate and rhythm. Arrhythmias (abnormal rhythms) can be detected and evaluated.

5. Ultrasound examination (Echocardiogram). This test uses sound waves that bounce off the structures of the heart and are read on a TV-like monitor. It gives the best look at the size of each heart chamber, and permits visualisation of the heart valves. This is seen on the monitor in real time so the contractions of the heart can be evaluated.

The combination of all of these tests give the best evaluation of the dog and its heart function. However, if cost considerations prohibit performing all of them, two or three will provide much valuable information.

Is there a treatment for a leaky mitral valve and heart failure?
A leaky heart valve can be replaced surgically in people. However, this is usually not feasible in dogs. There are several drugs that will improve heart function, even in the presence of a leaky valve.

1. Diuretics. These drugs stimulate the kidneys to remove excess fluid from the body.

2. Digitalis glycosides. These drugs improve heart function in several ways, including the regulation of excess hormones that have been released, slowing the heart rate, and strengthening each contraction of the heart.

3. ACE inhibitors which are relatively new drugs that block the compensation system which has become out of control.

4. Vasodilators. These drugs dilate the arteries and veins of the body to permit better blood flow. They are effective long term.

Not all of these drugs are used in each dog in heart failure. The results of the various tests will determine which ones are appropriate.

How much longer will my dog live?
There are many factors that must be considered before that question can be answered. The results of the tests are important, and the response that occurs within the first few days is another indicator.

If response does not occur within a few hours to days, the prognosis is not good. However, most dogs that stabilise quickly will live for many months or a few years.

HIP DYSPLASIA
What is hip dysplasia?
Hip dysplasia is defined as a deformity of the coxofemoral (hip) joint that occurs during the growth period. Hip dysplasia is caused by a variety of factors including genetic, overweight in the young puppy and over exercise, all of which contribute to a poorly fitting hip joint. As the dog walks on this joint, arthritis eventually develops, causing pain in the joint. The degree of lameness that occurs is usually dependent upon the extent of arthritic changes in the hip joint.

Is this found in certain breeds of dogs?
Most breeds of dogs can be affected with hip dysplasia although it is predominantly seen in the larger breeds of dogs, such as the German Shepherd, St. Bernard, Labrador Retriever, Old English Sheepdogs, etc.