By Emily Hoppmann, DVM

• Your pet must be kept inside in a clean, dry, area with just enough room where he can lay down and stand up comfortably. The ideal place to confine your pet is a small kennel/crate. If that is not possible, we recommend a small space in your home, such as a bathroom or laundry room, where he has no risk of injury.
• Absolutely no running, jumping, or playing is allowed. This includes both inside the home, in the yard, or anywhere else.
• If you are home and want to let your pet out of the crate, he must be monitored at all times. He cannot have any chance to injure himself and that may mean that he needs to be tethered/attached to you during this time.
• During monitored time outside of the crate, you must keep him from jumping on or off of furniture. This can be done by physically placing your pet on/off the furniture with you or by stacking pillows or using a doggie ramp so that he can get on/off himself.
• If there is any chance of injury, at any time, your dog must be in his crate. Examples from previous owners experiences of accidental injury include: having other pets in the house that the confined pet starts to play with, activity occurring outside of the window that your pet runs to bark at, someone knocking at the door or arriving home and your pet runs to greet them, and the list goes on.
• When going outside for your pet to go to the bathroom, place him on a leash that does not allow him to run at all. A short (only a few feet) training leash is perfect. It is best not to have your other pets outside during this time.
• Do not allow your pet to go up or down the stairs. If you have stairs, carry your pet up and down the stairs. If your pet is too big to carry, then be sure to support the injured area when dealing with stairs.
• The best way to support your pet when needed is to use a rolled up towel as a sling. Simply place it around the body where the injury is. If it is a front limb, place the towel directly behind the front limbs and if it is a rear end issue, place the towel directly in front of the back legs. Hold the towel above the body to take all pressure off the injured area.
• It is very hard emotionally to confine your pet even though you know it is the only way he can get better. Here are some tips to keep your pet happier in his crate (which will make it a bit easier for you):

*Give him an interactive toy or favorite toy (A Kong filled with peanut butter or squeezed cheese makes a great toy that can entertain pets for hours).

*Make ice cubes with chicken broth (pets love the taste!).

*Keep your other pets in another area (out of site).

*Keep a radio or TV on for your pet to listen to

• Your pet will feel better before his/her confinement is over. DO NOT let this fool you. Your pet needs to be checked & cleared from your veterinarian before you allow your pet to become active again. This is why rechecks are so important.
• If you are having any trouble with keeping your pet confined, please call us right away for oral medication (sedatives) to help. Please call us in advance so we can have them ready for you.
• The reason that confinement is so important is that it directly affects your pet’s health. For example, should your pet become too active, any of the following can happen:

• Neurologic conditions can worsen; for example, if your pet has a slipped disc he/she can cause further damage & become paralyzed for life.
• If your pet has had surgery, the incision can open internally or externally (or both!) and become infected or even cause organ or bone exposure. This is why the incision needs to be checked daily. There are multiple layers holding the incision together but if any one of the layers opens, there will be complications.

• Additional medications will be required to repair the damage.
• Another surgery may be required to repair the damage should your pet become too active.
• Some complications can end up being fatal.

We Are Always Here to Help so Do Not Hesitate to Call!

By Emily Hoppmann, DVM

Disease Information: Hyperadrenocorticism, usually referred to as Cushing’s Disease, is a health disorder in animals that is caused by abnormally high levels of corticosteroid hormone. While the adrenal gland in the body produces this hormone, the pituitary gland regulates how much is produced. In animals with this disease this relationship is not functioning normally and there is an excess of the corticosteroid in the body as a result. This excess can cause a variety of clinical signs, from thin, fragile skin containing hard plaques with mineral deposits to an enlarged liver or paralysis of nerves in the body. This is a disease that will become progressively worse, even fatal, if left untreated.

Medication: The goal of the life-long therapy is to control the level of corticosteroid hormone in the body, so there is not an excess or a deficiency. Most patients are successfully treated with a medication called trilostane. This medication is usually given just once a day with food, but 20% of dogs will do better with a twice a day dosing. Every patient is different, and the overall dose for medication may decrease over time, so each patient is monitored carefully and things are adjusted based on the individuals needs.

You should always have some prednisone at home in case of a sudden decrease in the steroid level for some reason. Clinical signs to watch for include vomiting, diarrhea, not eating, not drinking, loss of energy/sluggishness, neurologic changes (from not being as alert to walking as if drunk). If you see this, do not administer the trilostane, give the prednisone as directed and call the clinic.

As long as the prednisone is given if these clinical signs are seen, there is no emergency situation that threatens the life of your pet. If this occurs, we simply restart trilostane at reduced dose in a few days.

Costs To Consider: This is a medical condition that will have to be managed for the life of your pet and if it is not managed correctly, exactly as your doctor recommends, can be fatal. The costs to consider when budgeting for this care include the medication itself, the cost of the monitoring test (usually the ACTH stimulation test), and the increased monitoring and treatment of urinary tract infection.

ACTH stimulation test: This is the test that shows that the appropriate dose is being given to your pet. The first test needs to be done 2 weeks after starting medication and the second test needs to be done 4 weeks after that initial test. Every patient is different, but ideally pets should be tested every 3 months.

This test will be done as a drop-off. Your pet should be fasted and the blood will be drawn 4 hours after the pet receives the trilostane. The next sample will be taken 2 to 3 hours later. Once completed your pet is free to go home and should have no side effects at all.

Urinary Tract Monitoring: 50% of Cushing’s patients will have a urinary tract infection when diagnosed and will be predisposed to them for life. The urine should be sent in for a culture and sensitivity at initial diagnosis and every 4 to 6 months. If infection is present it needs to be treated with antibiotics for at least 6 to 8 weeks. There are several things that can be done to try to help lower the risk of infection, if you are interested.

At Home Monitoring: Monitor water consumption and appetite daily. Both of these levels should decrease with the medication correctly controlling the corticosteroid hormone in the body. Remember that a total lack of appetite or refusal to drink are signs that prednisone needs to be given. Always remember the clinical signs that might indicate an issue with too little steroid in the body. If seen, do not give the trilostane, administer the prednisone as directed, and call your veterinarian. These signs include vomiting, diarrhea, not eating, not drinking, loss of energy/sluggishness, and/or neurologic changes (from not being as alert to walking as if drunk). Just remember that as long as you always have prednisone to administer, you will never be in an emergency situation where your pet could face serious damage or death. You are also never alone in managing this disease - do not hesitate to call with any questions or concerns.

By Emily Hoppmann, DVM

Most people are not in the habit of inspecting the area under their dog’s tail unless the dog seems to be doing something that indicates a problem. A dog will lick under the tail, scoot the rear end on the ground, or seem to be in pain when sitting or raising the tail. When the tail is lifted and the anus inspected, a dog with perianal fistulae will show deep open crevices and some oozing pus all around the anal sphincter. Odor may be noted, and the dog might be straining to defecate. This condition waxes and wanes but ultimately over time is progressive, ulcerating the surface of the anus and its surroundings.

What Causes this Condition?

At this time, no one knows but recent information suggests an immune-mediated basis. There seems to be some genetic basis as the German shepherd dog seems predisposed to this condition. The average age of onset is 5 years and approximately twice as many males are affected as females. The anal glands may or may not be involved in the fistulation.

What Else Could it Be?

A biopsy is necessary to confirm the diagnosis as the following conditions can appear similar to perianal fistulae:

• Squamous cell carcinoma of the anus (cancer)
• Hyperplastic anus (common in older unneutered male dogs)
• Perianal adenoma (benign tumor also common in older unneutered male dogs)
• Anal sac rupture

Treatment

After the diagnosis is confirmed, there are several aspects to therapy. It can take 2 to 5 months to get the lesions under control, and maintenance therapy will likely be needed for the remainder of the animal’s life.

Antibiotics

Since these lesions are commonly infected at least at the beginning of treatment, antibiotics are essential. A topical antibiotic may be helpful for long-term infection control.

Pain Medication/Anti-Inflammatory

This disease is very painful and the area surrounding the fistula is very inflamed. It is very important to address the pain and inflammation to allow the area to heal.

Immunosuppressive drugs

The most important drug for treatment is cyclosporine. The drug is relatively expensive, but all other treatment plans are not effective and most dogs fail to respond to them at all.
A topical crème called tacrolimus can be used in addition to oral medications or alone for very mild cases. This is also an immunomodulator and is much stronger than cyclosporine. It is best to re-evaluate the patient in 2 weeks, then as often as the veterinarian feels is necessary.