Tuesday, June 30, 2015

June Patient of the Month- Max!!!


Max, a one year old French Bulldog was discovered by Jamie’s Rescue at Miami Dade Animal Shelter after being abandoned. A regular client of Dr. Shapiro, Jamie brought Max to the clinic for a full evaluation. As his photos indicate, Little Max was a bit worse for wear when he came to our door.  In addition to other ‘expected’ challenges that we anticipate with abandoned animals, little Max had many other things going on. After his exam (and a some extra love from Dr. Shapiro’s technician, Dalila) Max was diagnosed with demodex (mange), a deep ulcer in his Left eye and viral papillomas. 

Demodex is a collection of tiny parasitic mites that live in or near the hair follicles of mammals. It is a common infestation for dogs and diagnosed by analyzing a small skin sample under a microscope. A dip, which includes a highly concentrated insecticide, is most often used to treat demodex however in some cases drugs like Ivermectins can be used. In each case, supervision by a veterinarian is highly recommended because of the potential for side effects.

For Max’s demodex, Dr. Shapiro prescribed oral medication which, while treatment would span several weeks, started the healing process immediately. However the ulcer in Max’s right eye would prove to be more challenging. The viral papillomas growing on his face were too close to his eyes and were obstructing the ulcer and causing additional irritation. With no room for medication to access the area, no healing was possible.   Max was in need of some intensive care.  But, before that could begin, the papillomas had to be addressed. 

One treatment for papillomas, is to remove the growths and begin antibiotic treatment; such as azithromycin which has been shown to hasten resolution of papillomas. Since the ulcer in Max’s eye was covered by the papillomas removing them was the necessary next step. Additionally, Max was an intact male so a routine neuter was on the list. Since the demodex was localized primarily to his head and upper body surgery was possible sooner rather than later. 

Dr. Shapiro and Jamie decided to hospitalize Max to begin treatment. After a day of medical treatment, surgery was scheduled. Dr. Shapiro performed a simple neuter and then went to the task of removing all of the papilloma masses from his eye, his mouth and his face. His recovery from surgery was smooth and for the next 2 weeks Max was our guest, undergoing intensive isolated care which included hourly medications for his eye, intense antibiotic therapy and pain medications. 
 After 14 days of treatment by our dedicated day and night crew, Max looked like a new dog. While his spirit stayed high throughout his stay his skin and eyes were now on the mend. His outside were now more reflective of his puppy like attitude.

 Today, Max is nearly fully healed. He has continued treatment for the demodex and continues to stay away from other dogs while the papillomas resolve but he is by all other accounts: back to normal and looking for his fur-ever home.

It is always a pleasure to be able to see the recovery of a pet that just needs some TLC. Time, love and compassion paired with great medical know how works wonders. We are so pleased with his progress and so happy to highlight him as our June Patient of the Month!
* images on blog may be graphic

June Team Member of the Month- Sarah!!!!



Fun Fact! This month’s Team Member of the Month’s mother actually trainined our current Hospital Manager when she was a new tech!  

One could say that her unique histoy with the VCA HAH has made her a part of our family right from the start. Sarah S.,may carry the title of Assistant Receptionist Supervisor but her list of tasks vary by need. 

Hiring on some four years ago, Sarah has made it clear the she is a motivated and capable team member. In these most recent months she has taken the initiative to help whenever there is a need and sincerely, “Step up!” 

She lead our team in fundraising for the Humane Society of Broward Count Walk for the Animals 2015. She (and her children) can be counted on to help at during our outreach events like Boxer Friends’ Dog Bowl and most recently when asked , Sarah stepped into our accounting department to help out. 

Sarah has certainly earned her stripes in our HAH home. We are very pleased that she has continued her family’s history of being a part of the VCA family. We are happy to highlight her as our June Team Member of the Month!!  

Tuesday, June 23, 2015

June Patient of the Month- Max!!!




Max, a one year old French Bulldog was discovered by Jamie’s Rescue at Miami Dade Animal Shelter after being abandoned. A regular client of Dr. Shapiro, Jamie brought Max to the clinic for a full evaluation. As his photos indicate, Little Max was a bit worse for wear when he came to our door.  In addition to other ‘expected’ challenges that we anticipate with abandoned animals, little Max had many other things going on. After his exam (and a some extra love from Dr. Shapiro’s technician, Dalila) Max was diagnosed with demodex (mange), a deep ulcer in his Left eye and viral papillomas. 

Demodex is a collection of tiny parasitic mites that live in or near the hair follicles of mammals. It is a common infestation for dogs and diagnosed by analyzing a small skin sample under a microscope. A dip, which includes a highly concentrated insecticide, is most often used to treat demodex however in some cases drugs like Ivermectins can be used. In each case, supervision by a veterinarian is highly recommended because of the potential for side effects.

For Max’s demodex, Dr. Shapiro prescribed oral medication which, while treatment would span several weeks, started the healing process immediately. However the ulcer in Max’s right eye would prove to be more challenging. The viral papillomas growing on his face were too close to his eyes and were obstructing the ulcer and causing additional irritation. With no room for medication to access the area, no healing was possible.   Max was in need of some intensive care.  But, before that could begin, the papillomas had to be addressed. 

One treatment for papillomas, is to remove the growths and begin antibiotic treatment; such as azithromycin which has been shown to hasten resolution of papillomas. Since the ulcer in Max’s eye was covered by the papillomas removing them was the necessary next step. Additionally, Max was an intact male so a routine neuter was on the list. Since the demodex was localized primarily to his head and upper body surgery was possible sooner rather than later. 

Dr. Shapiro and Jamie decided to hospitalize Max to begin treatment. After a day of medical treatment, surgery was scheduled. Dr. Shapiro performed a simple neuter and then went to the task of removing all of the papilloma masses from his eye, his mouth and his face. His recovery from surgery was smooth and for the next 2 weeks Max was our guest, undergoing intensive isolated care which included hourly medications for his eye, intense antibiotic therapy and pain medications. 
 After 14 days of treatment by our dedicated day and night crew, Max looked like a new dog. While his spirit stayed high throughout his stay his skin and eyes were now on the mend. His outside were now more reflective of his puppy like attitude.

 Today, Max is nearly fully healed. He has continued treatment for the demodex and continues to stay away from other dogs while the papillomas resolve but he is by all other accounts: back to normal and looking for his fur-ever home.

It is always a pleasure to be able to see the recovery of a pet that just needs some TLC. Time, love and compassion paired with great medical know how works wonders. We are so pleased with his progress and so happy to highlight him as our June Patient of the Month!
 



Papillomas covering the ulcer in his eye.


Demodex is visible around his eye as well.



Friday, June 12, 2015

The Importance of Microchipping Your Pet


It's Hurricane Season and that means the most prepared that you can be for your family, and your pets.

If your pet is not already microchipped, call VCA Hollywood Animal Hospital for more details at 954-920-3556.

Tags or collars can get lost. Microchips are a permanent form of identification for your pets should they become lost during a disaster.

The microchip is administered under the skin between the shoulder blades of your pet much like a vaccine. Each microchip is assigned a definitive ID number, this number is registered with a national database with your personal contact information on it. If your pet is picked up by any animal control, shelter or veterinary office, it is scanned for a microchip. If a microchip is found, your pet will be returned to your loving home. 

If your pet is already microchipped, be sure that any microchip information is up-to-date. If  you have changed addresses, phone numbers or important contact information, that need to be updated in database.

Tuesday, June 9, 2015

Canine Viral Papillomas!!



Papillomas of the Skin

These notes are provided to help you understand the diagnosis or possible diagnosis of cancer in your pet. For general information on cancer in pets ask for our handout "What is Cancer". Your veterinarian may suggest certain tests to help confirm or eliminate diagnosis, and to help assess treatment options and likely outcomes. Because individual situations and responses vary, and because cancers often behave unpredictably, science can only give us a guide. However, information and understanding about tumors and their treatment in animals is improving all the time.
This can be a very worrying time. If you have any questions please do not hesitate to ask your veterinarian.

What is a papilloma of the skin?
Papillomas are benign, sometimes multiple, tumors caused by viruses. They are commonly known as "warts". The tumors often disappear spontaneously because the animal slowly develops immunity to them. Some papillomas may need to be removed surgically because they have become inflamed or infected, or bleed. They are permanently cured by total surgical removal and do not spread to other parts of the body, although there may be multiple tumors.

A squamous papilloma resembles a viral papilloma, but is without evidence of viral infection.

What do we know about the cause?
The reason why a particular pet may develop this, or any tumor, is not straightforward. Cancer is often the culmination of a series of circumstances that come together for the unfortunate individual.
After invading the cells, papilloma viruses insert their genetic information into the host cell's DNA (nucleic acid) and upset the normal regulatory mechanisms of cell division, so that the cell divides abnormally and more frequently. The virus activates growth-promoting genes in the DNA (oncogenes), at the same time it inactivates suppressor genes that would normally limit cell proliferation and alters the genes that regulate normal, programmed cell death.

There are many different types of papilloma virus and they occur in all species of animals, including people. Each species of animal has its own viruses and their related tumors. One of the best known is the verruca of human feet (plantar wart).

Why has my pet developed this tumor?
Your dog or cat has been infected with one of these papilloma viruses. Normal animals and people carry many viruses asymptomatically (without any clinical signs). Over 130 subtypes of papilloma virus have been identified in people and eighty of these have been fully gene-sequenced. However, we know little about canine and feline papillomaviruses. Only two subtypes have been fully characterized in the dog and two subtypes are recognized in cats.

"Papilloma viruses... can survive for long periods in the environment."

Sometimes the viral infection is recent but in other cases, the immune system in an infected animal becomes less competent for some reason. In these cases, a papilloma virus that has been carried by that animal for a long time is then able to induce tumors. Papilloma viruses are very resistant to adverse conditions so can survive for long periods in the environment outside an animal. They gain access to the body when the skin becomes softened by moisture, through cuts and abrasions, or with the assistance of ticks or biting insects (fleas, mosquitoes, et cetera).

Is this a common tumor?
Papillomas are uncommon in cats but common in dogs. Clinical syndromes include multiple oral (mouth) papillomas in young dogs, solitary cutaneous (skin) papillomas in dogs of any age, venereal (genital) papillomas, eyelid or conjunctival papillomas and fibropapillomas. There are probably different viruses associated with different sites and in young and old animals.
In dogs, we see most of these tumors on the feet, or around and in the oral cavity.
Skin papillomas in cats are usually flat and plaque-like (sometimes scaly). There is also a fibropapilloma or sarcoid in cats caused by a special subtype of papilloma virus.

How will this tumor affect my pet?
The lesions are usually inflamed polyps ("warts"), but they may be flat, scaly plaques or inward growing hard masses. They may ulcerate or bleed. The inward growing ones may cause pain, particularly if they are on the feet.

There may be some genetic subtypes of animals who fail to recognize viral protein antigens. In these animals, immunity cannot develop and the tumors persist. We do not know about genetically determined immunity in dogs - but some dogs have persistent tumors. Some viral papillomas in man are associated with cancer and papilloma viruses have been found in feline cancers (squamous cell carcinoma).

How is this tumor diagnosed? 
Clinically, most papillomas of the skin have a typical appearance, although the more common sebaceous tumors of dogs are very similar. Definitive diagnosis relies upon microscopic examination of the tumor. To obtain suitable samples of the tumor, your veterinarian may recommend one or more sampling techniques such as needle aspiration, punch biopsy and full excision of the tumor. Cytology is the microscopic examination of cell samples. This is used for rapid or preliminary screening tests, but accurate diagnosis usually requires microscopic examination of tissue (histopathology). Your veterinarian will submit the appropriate samples to a specialized laboratory where a veterinary pathologist will evaluate the tumor samples, make a diagnosis and predict the prognosis. Histopathology also rules out other diseases including more serious cancers.

What types of treatment are available?
Some of these tumors regress spontaneously but the usual treatment is surgical removal.
In humans, a topically applied immune-modifying agent that stimulates interferon production has successfully been used to treat papilloma virus lesions. It may have potential use in animals.

Can this tumor disappear without treatment?
Yes, the body's immune system can cause this type of tumor to regress in time (weeks to months).
 How can I nurse my pet?

Preventing your pet from scratching, licking or biting the papillomas will reduce itching, inflammation, ulceration, infection and bleeding. Any ulcerated area needs to be kept clean.

After surgery, you will need to keep the incision site clean and dry, and prevent your pet from by rubbing, licking, biting or scratching at it. Report any loss of sutures or significant swelling or bleeding to your veterinarian. If you require additional advice on post-surgical care, please ask.

When will I know if the tumor is permanently cured?
'Cured' has to be a guarded term in dealing with any cancer.

The histopathology report will give your veterinarian the diagnosis that helps to indicate how it is likely to behave. The veterinary pathologist usually adds a prognosis, which describes the probability of local recurrence or metastasis (distant spread). 

In healthy animals, the tumor is usually cured by surgery. If the viral infection persists because an animal has incomplete immunity, further tumors may develop. Rarely, the same site is affected by repeated re-growth of the tumor.

Are there any risks to my family or other pets?
"Although this is an infectious tumor, the viruses are species specific and not transmissible to humans."
No, although this is an infectious tumor, the viruses are species specific and not transmissible to humans. The tumors in dogs, cats and people are not related nor are they transmitted between species.




This client information sheet is based on material written by: Joan Rest, BVSc, PhD, MRCPath, MRCVS

Mange in dogs!



Mange - Demodectic in Dogs

Mange is a parasitic skin disease caused by microscopic mites. Two different mange mites cause skin disease in dogs. One lives just under the surface of the skin, while the other resides deep in the hair follicles. Although both mites share similar characteristics, there are also important differences. It is important not to confuse the two types of mange because they have different causes, treatments, and prognoses.

What causes demodectic mange?
 Demodectic mange, sometimes just called "demodex" or "red mange", is the most common form of mange in dogs. It is caused by the Demodex canis, a parasite that lives in the hair follicles of dogs. Under the microscope, this mite is shaped like a cigar with eight legs. 

"As long as the body's immune system is functioning properly, these mites cause no harm. "
All normal dogs (and many humans) have a few of these mites on their skin. As long as the body's immune system is functioning properly, these mites cause no harm.
Demodectic mange most often occurs when a dog has an immature immune system, allowing the number of skin mites to increase rapidly. As a result, this disease occurs primarily in dogs less than twelve to eighteen months of age. As the dog matures, its immune system also matures. Adult dogs that have the disease usually have defective immune systems. Demodectic mange may occur in older dogs because function of the immune system often declines with age. Dogs who have immune suppression due to illness or certain medications are also candidates for demodectic mange.

Is demodectic mange contagious?
"Demodectic mange is not contagious to other animals or humans."
No, demodectic mange is not contagious to other animals or humans. Demodex mites are transmitted to puppies from their mother during the first few days of life. Since the mite is found on virtually all dogs, exposure of a normal dog to one with demodectic mange is not dangerous.
If your dog is showing these symptoms do not wait for the mange to spread. It's better to contact your Veterinarian.

Why doesn't the immune system mature correctly in some dogs?
Development of the immune system is under genetic or hereditary control. Thus, an affected dog often has littermates that are also affected. Owners of littermates should be alerted to watch for the development of mange in their puppies. Because the disease is due to a genetic defect, affected dogs should not be bred, and the parents of the affected dog should not be bred again.

What does demodectic mange do to the dog?
Surprisingly, a dog with demodectic mange usually does not itch severely, even though it loses hair in patches. The hair loss usually begins on the face, especially around the eyes. When there are only a few patches of hair loss, the condition is called localized demodectic mange. If the disease spreads to many areas of the skin, it becomes generalized demodectic mange.

How is demodectic mange diagnosed?
"Your veterinarian will take deep skin scrapings and examine them under the microscope to diagnose this disease."

Your veterinarian will take deep skin scrapings and examine them under the microscope to diagnose this disease. The finding of larger than normal numbers of Demodex mites in skin scrapings confirms the diagnosis. Occasionally, the disease will be diagnosed by means of a skin biopsy in dogs that have chronic skin infections that have not responded appropriately to treatment.

How is demodectic mange treated?
The localized form is usually treated with topical medication. The generalized form requires more aggressive treatment using special shampoos and dips, along with oral medication. Shampooing with special cleansing shampoos containing benzoyl peroxide helps to flush out and open the hair follicles prior to dipping. A separate handout is available to describe the dipping process. In some cases, especially dogs with generalized demodectic mange, secondary skin infections complicate the condition, requiring antibiotic therapy. Dogs with skin infections often have very red, inflamed skin. This is the source of the term "red mange."

Are there any problems with topical treatment?
The dip commonly used for demodectic mange contains the insecticide amitraz. It must be used cautiously because it is a strong insecticide that can cause side effects, both to your dog and to you, if not used properly. Your dog may experience vomiting and sedation for twenty-four to thirty-six hours following each application. Most of these problems are self-limiting and resolve without medical intervention. If your dog reacts in this manner, you should dilute the next dip with 25% more water. Since most dogs develop tolerance to the dip as they are repeated, your dog is less likely to have side effects with each subsequent treatment. After receiving two to three dipping treatments at seven-day intervals, skin scrapings should be repeated and examined for the presence of live mites or mite eggs. The results of these skin scrapings will determine whether further treatment is needed.

I heard that there is a drug that can be given orally for demodectic mange. Is that true?
Yes, under certain conditions.

Ivermectins are a class of drugs that are approved for prevention of heartworm disease in dogs and cats. Milbemycin oxime, the active ingredient of Interceptor® and Sentinel® heartworm preventives, may be used to treat demodicosis in certain cases. Certain ivermectins are used to treat parasites on cattle. In the past, the cattle preparation has been used orally for demodectic mange in some dogs. However, it is a very strong drug that can cause severe side-effects, including death, if it is not administered properly. It is not approved for use in dogs, so we would only consider using it as long as you are willing to accept liability for adverse effects. Veterinarians do not generally recommend ivermectin usage in collies, Shetland sheepdogs, Australian shepherds, old English sheepdogs, or any other herding breed.

What is the prognosis for my dog?
Treatment of demodectic mange is generally successful. However, if the immune system is defective, neither the mites nor the infection may respond to treatment. With generalized demodicosis, successful treatment may take a long time.

Following successful treatment, is it likely to recur?
"It is important to treat as soon as a relapse occurs to minimize the possibility of developing uncontrollable problems."

Because the immune system does not mature until twelve to eighteen months of age, a dog with demodectic mange may have relapses until that age. It is important to treat as soon as a relapse occurs to minimize the possibility of developing uncontrollable problems.

This client information sheet is based on material written by: Ernest Ward, DVM