Arthroscopy for Medial Coronoid Process Disease

Coco is a 6 month old female intact Rottweiler who was referred by her primary care veterinarian for further evaluation of right thoracic limb lameness.

The lameness started 3 weeks prior to presentation, and there was no history of trauma or any other inciting cause. Radiographs had been performed, and showed concern for possible osteochondritis dissecans of the right shoulder. Coco was treated with activity restriction/rest and analgesic medication, but there was no improvement in her lameness. Coco was referred to VCA Hollywood Animal Hospital’s Surgical Service for further evaluation.

On examination, Coco was partial weight bearing lame on her right thoracic limb at a walk and trot. She displayed repeated pain on extension of both the left and right elbow joints. She had no shoulder pain, and normal range of motion of her shoulder joints. A CT scan was recommended to further evaluate Coco’s elbows and shoulders, and to identify the underlying cause of the lameness and pain.

 
A CT scan of Coco’s thoracic limbs revealed bilateral medial coronoid process disease, along with right-sided humeroradial incongruity. Her shoulders were within normal limits. Medial coronoid process disease is a term used to encompass several pathologies, including sclerosis, microfracture, fragmentation, fissuring, and cartilage damage to the medial coronoid process. Elbow joint incongruity is another type of 

developmental elbow pathology, and it can occur alone or in combination with medial coronoid process disease. In fact, elbow joint incongruity is seen in 60% of elbows with medial coronoid process disease. Medial coronoid process disease is initiated by a delay in endochondral ossification, as well as biomechanical forces that act on the medical coronoid process during maturation. Disturbance of endochondral ossification could result from unbalanced mechanical factors and supraphysiological loading of the medial coronoid process. Overloading of the medial compartment of the elbow may also result from joint incongruity. This leads to a progressive process of cleft formation, fracture, bone remodeling, fatigue of subchondral bone, and eventual medial coronoid process disease. Medial coronoid process disease most commonly affects young, large and giant breed dogs. Rottweilers, Labrador Retrievers, and German Shepherd Dogs have a breed predisposition for medial coronoid process disease. The age at first presentation is usually between 6 and 18 months of age. Elbow joint incongruity is also primarily seen in large breed dogs, and Rottweilers are over-represented.

Treatment of medial coronoid process disease includes both surgical and non-surgical treatment options. For affected animals, the best prognosis is associated with early surgical treatment in young dogs with minimal to mild osteoarthritis in conjunction with preventative measures against osteoarthritis. Coco is an example of an ideal surgical candidate due to her young age, and the fact that the CT scan showed minimal degenerative changes. Traditionally, surgery for these cases was approached via an open arthrotomy. At VCA Hollywood Animal Hospital, arthroscopy is available as one of our minimally invasive treatment options. Arthroscopy has been shown to result in a shorter period of convalescence and better functional outcome compared to arthrotomy. Additionally, arthroscopy allows for superior visualization of intra-articular structures. Improved visualization allows the surgeon to treat each joint more thoroughly and more precisely. Since it is minimally invasive, patients tolerate arthroscopic treatment of both elbow joints in a single session. Plus, elbow arthroscopy can often be performed concurrently with ovariohysterectomy or castration and/or stem cell harvesting.

Bilateral elbow arthroscopy was performed during a single session and revealed fissuring of both the left and right medial coronoid processes, along with synovitis. Arthroscopy revealed fissuring of both the left and right medial coronoid processes, along with synovitis. Arthroscopic debridement of the diseased medial coronoid process was performed with a power burr until healthy subchondral bone was reached. Debridement of diseased cartilage not only removes the inciting cause of pain/lameness, but it also helps slow the progression of osteoarthritis. Debridement to the level of healthy subchondral bone supplies a means of vascular access to the joint. Coco was hospitalized for one night post-operatively, and she was discharged to her owners the following day. At the time of discharge, Coco was comfortable and already ambulating with minimal lameness at the time of discharge. 

Besides cases like Coco’s of medial coronoid process disease, elbow arthroscopy can be performed for diseases including ununited anconeal process, osteochondoris, and incomplete ossificiation of the humeral condyle. This minimally invasive surgical option provides superior visualization and outcome for treatment of certain disease conditions, as well as, less patient morbidity.

Dr. Andrea Clark, DACVS-SA

Andrea.Clark@vca.com

For a list of the Minimally Invasive Surgeries we are offer include (but are not limited to) click here!

For a quick list of doctors and services at VCA Hollywood click here!

Dr. Andrea Clark's surgical service is available Wed-Sat. She can be reached through our dedicated referral line @954-600-9835. This line is provided only to area veterinarians and there staff for their sole use. A doctor is always in at VCA Hollywood Animal Hospital. 

  

A Spay is Not Just a Spay.

A spay is one of the most common surgical procedures performed by veterinarians. But what exactly is a spay? The term spay is a generic term that means surgical removal of the female reproductive organs. This can mean one of two things. The term spay can refer to ovariohysterectomy, which is the removal of the ovaries and the uterus. Alternatively, spay can refer to ovariectomy, which is removal of only the ovaries. So why do most veterinarians recommend spaying dogs and cats? There are numerous healthy benefits that come from spaying your pet. Spaying female dogs and cats helps prevent accidental pregnancy, reduces the risk for mammary cancer, and eliminates other possible health conditions such as uterine infection (pyometra), ovarian cancer, and uterine cancer. 

 Both ovariohysterectomy and ovariectomy are equally effective, and research has shown no difference in health benefits between the two procedures. So regardless of whether the ovaries and uterus (ovariohysterectomy) or just the ovaries (ovariectomy) are removed, spaying your pet can ultimately lead to your pet living a longer and healthier life. So what is new to learn about the common spay?

Historically, in veterinary medicine, the only way a spay could be performed was by open abdominal surgery. This surgery involves making an incision in the muscles of the abdominal wall, opening the abdominal cavity, and removing the reproductive organs through the abdominal incision. While there is nothing wrong with that method, advances in veterinary medicine and technology have given veterinarians a second way to perform a spay procedure through minimally invasive techniques. This minimally invasive procedure is called laparoscopic surgery.

Laparoscopic surgery uses high-definition cameras, fiber optic lights, and high tech small instruments that are inserted into the abdominal cavity through two tiny incisions. The high-definition cameras allow for superior visualization of your pet’s internal organs – much better than the naked eye. The superior visualization allows the surgeon to see more precisely and this greater detail makes a big difference for your pets’ safety.

Better visualization allows surgeons to be more precise with their surgical techniques as well as detect and address things such as small amounts of hemorrhage present during the procedure. Additionally, the entire surgical procedure can be documented through high definition pictures and videos and the minimally invasive approach, through two tiny incisions, means less pain after surgery and a quicker recovery for your pet.

With the ability to perform minimally invasive surgery, a spay is no longer just a spay. Now pet owners have options when it comes to spaying their pets. And you and your veterinarian can choose how to best serve your pet – either the traditional method, or minimally invasively.

Dr. Andrea Clark, DACVS-SA

Veterinary Surgeon

The feeling in your stomach when you know you ate too much!

Recently Zoo Miami asked our surgeon Dr. Danielson to help with a special case.  Learn about what Leroy ate! 

Have you ever eaten anything that you have regretted? Many of us have eaten too much candy at Halloween or too much dinner on Thanksgiving and we have had to live with a stomachache as the consequence. However, it is rare for a person to eat a toy or other item that is not digestible.

Unfortunately, animals sometimes do eat items that cannot be digested and the consequence can be much more severe than a stomachache. Eating non-digestible items can obstruct the intestinal system. An obstruction occurs when the item gets stuck in the stomach or intestine and blocks anything else from passing through. An obstruction can make animals very sick and in some cases is life-threatening.

Veterinarians call these non-digestible items foreign material or a foreign body. If a foreign body is very large or is stuck, it will require removal.

Removal may be accomplished through a non-surgical approach with a piece of equipment called an endoscope (scope) or, it may require surgery. A scope is a long instrument with a camera at the end. The scope allows for things within the stomach to be seen with the camera and removed with graspers. However, sometimes the foreign material is too large or cannot be retrieved with graspers. In these cases, surgery is performed. Surgery usually involves opening either the stomach or the intestine to remove the foreign material.

Often when an animal eats foreign material they do it when no one is looking and veterinarians are left trying to figure out what is wrong with the patient.  In the hunt to figure out what is wrong with the patient, X-rays (radiographs) may be taken to look for a foreign body. However, not all foreign bodies can be seen on a radiograph.  A radiograph can identify very dense material, such as metal and bone however, less dense material (plastic squeakers, cloth toys, rope toys, etc.) cannot be seen and we are left looking for what is called an obstructive pattern on the radiograph. An obstructive pattern is when a portion of the intestine is dilated (wider) than it should be.

It may seem odd that an animal would eat something they cannot digest.  Most of the time animals eat these items by accident. They are attracted to the scent of an item or are playing with a toy and start to chew on it. If the item/toy gets too far back in their mouth, they may swallow it. Remember, most animals don’t have fingers to pull things back out of their mouths.

Dogs and cats are the animals that veterinarians see most often for eating foreign bodies, however; sometimes other species eat things they shouldn’t.

Meet Leroy. 

Leroy is a 297 pound, 35-year-old, male Cuban Crocodile. Cuban Crocodiles are one of the most endangered crocodiles in the world. Their native habitat is a very small area, less than 200 square miles, of the Zapata Swamp in Cuba. Leroy lives at Zoo Miami and has been there since 1998.

In October of last year, Leroy ate a large metal can of lubricating oil that was being used in the maintenance of his enclosure. The can had been accidentally knocked over during the maintenance and fell into the water near Leroy. Crocodiles have a natural feeding response to splashes in the water and, unfortunately, the disturbance the can caused in the water attracted Leroy. At first, Leroy just played with the can. Eventually, he bit into the can and then swallowed it whole.

Given the size of the can, the caregivers and veterinary staff of the zoo were concerned, as it was unlikely to pass. Leroy had a foreign body.

Being a can, Leroy’s foreign body was metal and could be seen on radiographs. Therefore, to help identify the location of the can, radiographs (x-rays) were taken. 

Let’s take a look at the reconstructed image. In these images, Leroy would have been laying down on his stomach with his head at the top and his tail at the bottom of the image. 

Figure 1

Can you see all of the things in the abdomen when there are no arrows to help point them out? Give it a try.  Find out how you did!

As you can see, the can was very big and it wouldn’t have been able to make it through the intestinal system. Because the can was in the stomach, an attempt at removing it with a scope was made. Unfortunately, this was unsuccessful and it was decided that surgery would be performed to remove the can. 

Leroy was prepared for surgery similarly to the way a dog or cat would. He was moved into the operating room at the zoo and his skin was cleaned. However, one big difference was the way the abdomen was opened. In a dog or cat, the approach to opening the abdomen to get to the stomach would be through what is called a midline incision. This means a cut down the center of the abdomen. In the crocodile, the approach is through an incision in the left flank. This is a cut in the left side of the abdomen from the back to the front of the body. The reason the approach is different is that in dogs and cats the abdomen is one compartment and in crocodiles, there is some additional compartmentalization. This approach from the side makes it easier to get to the stomach. Also, crocodiles will sometimes pull their bodies along the ground and an incision on the underside of the abdomen would get very dirty. 

*These images may be considered graphic

The surgical opening and closing of the stomach (in a dog/cat or a crocodile) is called a gastrotomy and this was performed in Leroy similarly to how it would be performed in a dog. Take a look at this picture of the can being removed from Leroy’s stomach.   *These images may be considered graphic

The stomach of the crocodile is larger than that of a dog and it took some feeling around in the stomach to find the can. Take a look at the can after it was removed. There is another can next to the one Leroy ate for comparison. Those are some big holes made by Leroy’s teeth! Can you go back to the radiographs and see the holes in the can on the radiograph? 

Closing the gastrotomy site is performed with suture in a couple of layers. The closure of the stomach is similar in the dog, cat, and, crocodile. However, Leroy’s skin is of course much tougher than a dog or cat. Crocodile skin has what looks like scales on it. Those square areas that look like scales are called scutes. Scutes are very thick and make suturing the skin a little more complicated. A thicker suture was used in Leroy’s skin than would be used in a dog or cat.  Scutes can also be seen on turtle shells and on the feet of birds. You can see some of the scutes on Leroy in his picture and on his radiograph. Can look back to Figure 1 and find them? Find out how you did! 

The great news is that Leroy did very well after surgery and recovered with no complications!!! There were a lot of people happy to see Leroy make it through his surgery and continue to do well. It takes a large team working together to achieve a successful surgery on such a large, non-domesticated animal including zookeepers, caregivers, zoo administration, veterinary technicians, and veterinarians. 

It is amazing to see what people working together can achieve. I feel fortunate to have been a part of this fantastic team.

If you want to learn more about the beautiful animals at Zoo Miami, check out their Facebook page. There are tons of great pictures and videos for you to look through. Like all of us, Zoo Miami is being challenged by COVID19 right now. If possible, please consider donating to the zoo to help them through this difficult time.

Visit VCA Hollywood Animal Hospital to learn more about our advanced veterinary care for your cat or dog. Follow us on Facebook and Instagram to connect with other pet people. 

Briana Danielson, DVM, DACVS-SA
VCA Hollywood Animal Hospital

The feeling in your stomach when.........

Meet Leroy. 

Leroy is a 297 pound, 35-year-old, male Cuban Crocodile. Cuban Crocodiles are one of the most endangered crocodiles in the world. Their native habitat is a very small area, less than 200 square miles, of the Zapata Swamp in Cuba. Leroy lives at Zoo Miami and has been there since 1998.

In October of last year, Leroy ate a large metal can of lubricating oil that was being used in the maintenance of his enclosure. The can had been accidentally knocked over during the maintenance and fell into the water near Leroy. Crocodiles have a natural feeding response to splashes in the water and, unfortunately, the disturbance the can caused in the water attracted Leroy. At first, Leroy just played with the can. Eventually, he bit into the can and then swallowed it whole.

Given the size of the can, the caregivers and veterinary staff of the zoo were concerned, as it was unlikely to pass. Leroy had a foreign body. Being a can, Leroy’s foreign body was metal and could be seen on radiographs. Therefore, to help identify the location of the can, radiographs (x-rays) were taken. Let’s take a look at the reconstructed image. In these images, Leroy would have been laying down on his stomach with his head at the top and his tail at the bottom of the image. 

Figure 1

Can you see all of the things in the abdomen when there are no arrows to help point them out? Give it a try.  Find out how you did!

As you can see, the can was very big and it wouldn’t have been able to make it through the intestinal system. Because the can was in the stomach, an attempt at removing it with a scope was made. Unfortunately, this was unsuccessful and it was decided that surgery would be performed to remove the can. 

Leroy was prepared for surgery similarly to the way a dog or cat would. He was moved into the operating room at the zoo and his skin was cleaned. However, one big difference was the way the abdomen was opened. In a dog or cat, the approach to opening the abdomen to get to the stomach would be through what is called a midline incision. This means a cut down the center of the abdomen. In the crocodile, the approach is through an incision in the left flank. This is a cut in the left side of the abdomen from the back to the front of the body. The reason the approach is different is that in dogs and cats the abdomen is one compartment and in crocodiles, there is some additional compartmentalization. This approach from the side makes it easier to get to the stomach. Also, crocodiles will sometimes pull their bodies along the ground and an incision on the underside of the abdomen would get very dirty. 

*These images may be considered graphic

The surgical opening and closing of the stomach (in a dog/cat or a crocodile) is called a gastrotomy and this was performed in Leroy similarly to how it would be performed in a dog. Take a look at this picture of the can being removed from Leroy’s stomach.   *These images may be considered graphic.

The stomach of the crocodile is larger than that of a dog and it took some feeling around in the stomach to find the can. Take a look at the can after it was removed. There is another can next to the one Leroy ate for comparison. Those are some big holes made by Leroy’s teeth! Can you go back to the radiographs and see the holes in the can on the radiograph? 

Closing the gastrotomy site is performed with suture in a couple of layers. The closure of the stomach is similar in the dog, cat, and, crocodile. However, Leroy’s skin is of course much tougher than a dog or cat. Crocodile skin has what looks like scales on it. Those square areas that look like scales are called scutes. Scutes are very thick and make suturing the skin a little more complicated. A thicker suture was used in Leroy’s skin than would be used in a dog or cat.  Scutes can also be seen on turtle shells and on the feet of birds. You can see some of the scutes on Leroy in his picture and on his radiograph. Can look back to Figure 1 and find them? Find out how you did! 

The great news is that Leroy did very well after surgery and recovered with no complications!!! There were a lot of people happy to see Leroy make it through his surgery and continue to do well. It takes a large team working together to achieve a successful surgery on such a large, non-domesticated animal including zookeepers, caregivers, zoo administration, veterinary technicians, and veterinarians. 

It is amazing to see what people working together can achieve. I feel fortunate to have been a part of this fantastic team.

If you want to learn more about the beautiful animals at Zoo Miami, check out their Facebook page. There are tons of great pictures and videos for you to look through. Like all of us, Zoo Miami is being challenged by COVID19 right now. If possible, please consider donating to the zoo to help them through this difficult time.

Visit VCA Hollywood Animal Hospital to learn more about our advanced veterinary care for your cat or dog. Follow us on Facebook and Instagram to connect with other pet people. 

Briana Danielson, DVM, DACVS-SA
VCA Hollywood Animal Hospital

We Can-cer-vive Cancer! Meet Charlie!!!

Meet cancer survivor Charlie and learn how a team approach to health care is so important when it comes to your pet's health. 

Charlie is a very adorable 14 year old cat that was diagnosed with an ear canal cancer known as ceruminous gland adenocarcinoma. This type of cancer is one of the most common ear canal cancers seen in both cats and dogs. Clinical signs associated with this disease include excessive cerumen accumulation, discharge, swelling, itchiness, and recurrent infections. In order to obtain a diagnosis, advanced imaging such as a CT scan is usually required. 

Most commonly, ear carcinomas are locally invasive and have a low chance of spreading to other locations. The treatment of choice for this type of cancer is surgical resection, which involves completely removing the ear canal (TECA- total ear canal ablation). 


A TECA or in Charlie's case a TECABO is a Total Ear Canal Ablation or Total Ear Canal Ablation Bulla Osteotomy. This procedure involves the complete removal of the ear canal middle ear, leaving only the ear flap remaining. 


Although this type of surgery may sound like a lot for your pet to go through, they tend to feel so much better once it is performed and it gives them the best chance at achieving a long survival time. With successful surgery and no identified negative prognostic indicators, patients can live a long time after removal of their cancer. 

Charlie was initially evaluated by Dr. Irene Vazquez at our the Oncology Service and had a CT scan performed, which showed he had a mass within his ear canal. The mass was sampled and the results were consistent with carcinoma. Charlie was then evaluated by Dr. Andrea Clark at our Surgery Service and had surgery performed to remove his tumor. 

Charlie on his 5 month anniversary cancer free!

Since his surgery, Charlie has been doing great at home and is currently cancer free. He continues to come in for routine evaluations to make sure his cancer is not spreading and so far, he's been doing amazing! He is the sweetest boy and our hearts melt every time he comes in. 

We wish Charlie the best of luck and the longest survival time! Our VCA Hollywood family is SO proud of him 💙.


Contributors: Irene Vazquez, DVM and Andrea Clark, DVM

Charlie after surgery. 

If something's bugging your pet, we can help!

Queen after 24 days of treatment.

"Queen", a 7 month old Shihtzu, presented to the VCA Hollywood Animal Hospital Emergency Service Department for an elevated temperature, lethargy, inappetence, erythema (skin redness) and crusty dermatitis. After hospitalization, advanced diagnostic, IV fluid and a course injectable and oral antibiotics, her temperature decreased into normal range and a consult with our Dermatology Department to further address her skin was prescribed.

When Queen presented to VCA Hollywood Animal Hospital Dermatology Department, Dr. Melanie Hnot, our Board Certified Dermatologist, diagnosed Queen with Demodex mites, as well as with a severe, deep skin infection.

Queen upon presentation to our VCA Hollywood Dermatology Service.

Demodex mites are mites that live in the hair follicle and dogs obtain them from their mothers. They are not contagious to other dogs or people. When a dog has suppression of their immune system, from medications, parasites, or malnutrition, they can develop demodicosis. Demodicosis is when the Demodex mites proliferate and lead to hair loss and skin infections. When Demodex mites live in the hair follicles, it predisposes dogs to superficial skin infections. If

the hair follicles rupture, then dogs can get deep bacterial infection, which Queen had.

The treatments for demodicosis include oral ivermectin daily, amitraz dips (only licensed treatment for demodex), oral milbemycin or Bravecto. Queen continued treatment for 6 weeks with antibiotics and Bravecto to kill off the Demodex mites and the results of her care are evident. 

Today, Queen is feeling much better. Her puppy personality is back as she is now wagging her tail and playing at home.

In 4 weeks, Dr. Hnot will perform additional deep skin scrapings hoping to reach 2 negative deep skin scrapings before approaching an "all clear" diagnosis. It can take months to treat dogs with

Queen after 10 days of treatment.

demodicosis and therefore treatment will continue one month past her second set of negative deep skin scrapings.

After treatment, Queen will need to be monitored for a recurrence of demodicosis. Certain medications can also increase the risk of demodicosis. Steroids can increase the risk of developing demodicosis so any oral, topical or injectable steroid should be avoided.

For now, Queen is feeling royal and she feels as good as she looks!  

Sarcoptic Mange in Dogs

What causes sarcoptic mange?

Sarcoptic mange is caused by a parasitic mite (Sarcoptes scabiei) that burrows just beneath the surface of the skin. It is important not to confuse sarcoptic mange with demodectic mange, which is caused by a different parasitic mite.

"Sarcoptic mange is a zoonotic disease or a disease transmissible from pets to people."

These mites bury into the skin of healthy adult dogs and puppies, and feed on material in and on the skin. Sarcoptic mange is also known as scabies and is zoonotic, which means it is a disease transmissible from pets to people.

What does it do to the dog?

The presence of the sarcoptic mite causes intense itching. The dog will chew and scratch its skin constantly. This leads to the loss of large amounts of hair, especially on the legs and belly. Eventually, the skin will become thickened and will darken.

Is it contagious?

Yes. Sarcoptic mange is highly contagious to other dogs and humans.

Although sarcoptic mites are not able to complete their life cycle on humans, they will cause severe itching until they die. Since the mite may be found in areas where infected dogs or foxes frequent, keep your dog away from these areas to attempt to prevent infection.

How is sarcoptic mange diagnosed?

Diagnosis is made by a skin scraping examined under the microscope. It is common not to see sarcoptic mange mites when performing a skin scraping. This is because the mites burrow deep into the skin and it takes only a few mites to cause significant itching.

Just because no mites are seen, does not mean your dog does not have sarcoptic mange. A presumptive diagnosis may therefore be made, based on clinical signs. Sarcoptic mange may occur in any dog at any age.

How is it treated?

There are several medications that are effective against Sarcoptes. Your veterinarian will discuss the best treatment for your pet's condition and lifestyle. Treatment varies from medicated baths and dips to injections and oral medications. Many pets will require a combination of treatments to resolve this infection.

Topical treatments may be divided into two categories:

1)   Dips. Some of the dips that are used to treat Sarcoptes include amitraz and lime-sulfur dip. Your veterinarian will provide you with information on how to use these dips.

2)   Topicals. Medication applied topically to one or two spots while the animal is dry. These medications are applied every 14-30 days or as your veterinarian recommends. Some examples of these topical medications include selamectin, imidacloprid and moxidectin, fipronil among many others.

Just like topical medications, there are a wide variety of oral medications available for the treatment of sarcoptic mange. These oral medications may be prescribed in the form of liquid, pill, or flavored chew, depending on the medication prescribed. Some of these oral medications include milbemycin (the active ingredient of Interceptor® and Sentinel®), afoxolaner (NexGard®), fluralaner (Bravecto®), and sarolaner (Simparica®). These medications are used 'off label' for the treatment of sarcoptic mange. The term 'off label' describes the use of a drug for conditions other than what it was approved for. Many of these medications are given for multiple treatments. To prevent re-infection, discard any bedding where your dog sleeps, or wash it frequently in diluted bleach solution (one ounce bleach in one gallon of water). If you dog is still scratching four to five days after treatment has started, please contact your veterinarian.

Can I get mange from my dog?

Yes. If any member of the family develops itching or a skin rash, contact your family doctor immediately. Tell your doctor that you may have been exposed to sarcoptic mange or scabies. In people, the mite cannot complete its life cycle so it will die in a few days. However, it may cause intense itching during that time and medical treatment is often recommended.

By Ernest Ward, DVM; Updated by Amy Panning, DVM

https://vcahospitals.com/know-your-pet/mange-sarcoptic-in-dogs

Contributors: Ernest Ward, DVM; Updated by Amy Panning, DVM © Copyright 2018 LifeLearn Inc. Used and/or modified with permission under license.

Demodectic Mange 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 (sarcoptic mange), while the other resides in the hair follicles (demodectic mange). 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 is caused by Demodex canis, a parasitic mite that lives in the hair follicles of dogs. Under the microscope, this mite is shaped like a cigar with eight legs. Demodectic mange, sometimes just called ‘demodex’ or ‘red mange’, is the most common form of mange in dogs.

"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 12 to 18 months of age. As the dog matures, its immune system also matures.

Adult dogs that have the disease usually have weakened immune systems. Demodectic mange may occur in older dogs because function of the immune system often declines with age. Dogs who have a weakened immune system due to illness or certain medications are also susceptible to demodectic mange.

Is demodectic mange contagious?

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, as the immune system must be depressed for mange to develop.

"Demodectic mange is not contagious to other animals or humans."

Why doesn't the immune system mature correctly in some dogs?

Development of the immune system is under genetic or hereditary control. 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, the condition is called 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. 

There are also several 'spot on' topical treatments, such as imidacloprid and moxidectin. These medications are used 'off label' for the treatment of demodicosis. The term 'off label' describes the use of a drug for conditions other than what it was approved for.

There is an injectable form of doramectin, which can also be used for off label treatment of demodex. Your veterinarian will discuss the benefits and risks of these medications with you.

In some cases, especially dogs with generalized demodectic mange, secondary skin infections complicate the condition, requiring antibiotic therapy. Because dogs with skin infections often have very red, inflamed skin, demodectic mange is often called ‘red mange’. Your veterinarian can help you determine whether or not your dog has a skin infection in addition to demodectic mange.

Are there any problems with topical treatment?

The dip commonly used for demodectic mange contains the insecticide amitraz. It must be used very carefully because it is a strong insecticide that can cause serious 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 will resolve without medical intervention. If your dog reacts in this manner, you should dilute the next dip with 25% more water. If you are using a ‘spot on’ topical treatment, you may see drooling if your dog licks the medication.

"Amitraz must be used very carefully because it is a strong insecticide that can cause serious side effects, both to your dog and to you, if not used properly."

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. Certain ivermectins are used to treat parasites on cattle. The cattle preparation has been used orally for demodectic mange in some dogs. However, ivermectin is not approved for use in treating dogs with mange, so its use to treat mite infestations in dogs is off-label.

Ivermectin is a very strong drug that can cause severe side-effects, including death, if it is not administered properly. It is extremely important to follow your veterinarian’s instructions and cautions carefully, as their directions may be very different from those on the label. Veterinarians do not generally recommend ivermectin for use in Collies, Shetland Sheepdogs, Australian Shepherds, Old English Sheepdogs, or any other herding breed because they are sensitive to the medication.

There are a few other oral medications that may be used off label in the treatment of the demodex mite. These include milbemycin oxime (the active ingredient of Interceptor® and Sentinel®), afoxolaner (NexGard®), and fluralaner (Bravecto®). Your veterinarian will help you decide which oral or topical medication is best for your dog.

What is the prognosis for my dog?

Treatment of demodectic mange is generally successful. However, if the immune system is weakened, neither the mites nor the infection may respond to treatment. With generalized demodicosis, successful treatment may take a long time, and may require regular skin scrapings to check the progress of the treatment.

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 12 to 18 months of age, a dog with demodectic mange may have relapses until that age. In addition, dogs with suppressed immune systems may be susceptible to relapse. It is important to treat as soon as a relapse occurs to minimize the possibility of developing uncontrollable problems. Relapses are usually recognized 3-6 months after treatment is discontinued.

By Ernest Ward, DVM; Updated by Amy Panning, DVM

Medical Conditions, Parasites, Pet Services

https://vcahospitals.com/know-your-pet/mange-demodectic-in-dogs

Contributors: Ernest Ward, DVM; Updated by Amy Panning, DVM

© Copyright 2018 LifeLearn Inc. Used and/or modified with permission under license.