Secondhand Smoke Around Dogs and Cats

We all know the hazards of smoking tobacco in humans and that even secondhand smoke has been shown to cause illness and death in non-smokers.  Now, Veterinary News Network indicates there is a concern that secondhand smoke may cause severe disease in our dogs and cats.  Cigarette smoke contains many harmful and carcinogenic ingredients and these chemicals are found in high concentrations on the furniture and carpeting in the homes of smokers.  Pets will get these toxins on their fur and ingest them when licking their fur.  Also, pet’s noses are very close to the ground and they will breathe in a lot of toxins that have settled on the carpet.  Exposure to these toxins has been shown to lead to an increase in the number of dogs with nasal cancer who live with smokers in the home, and it may increase the risk of lung cancer as well.

Cats are especially susceptible to the toxins of secondhand smoke as they are very close to the floor and commonly groom themselves and ingest smoking toxins.  It has been shown that cats who live in homes with smokers are two to three times more susceptible to a malignant cancer called lymphoma than cats who live in a home without smokers.

Another serious cancer with links to secondhand smoke is one of the mouth called squamous cell carcinoma, which can occur in dogs and cats.

So obviously secondhand smoke causes a major problem in our pets and the best option is to quit smoking.  Of course this is difficult and if you are unable to quit and have pets and children in the house, at least smoke outside.  Don’t smoke in the car if your pets and kids are with you as rolling down the window does very little to decrease secondhand smoke.
If you note any masses in your pet’s mouth, or coughing, contact your veterinarian.

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Southern Hills Animal Hospital
3827 Hite St. SW
Roanoke, VA 24014-2377
540-343-4155
Southern Hills Animal Hospital

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Nosebleed: First Aid

A nosebleed (epistaxis) is bleeding or hemorrhage from the nose. It is important to stop a nose bleed, but is equally important to get to the bottom of why it’s happening.   Stopping nose bleeds in pets is often the easy part, but finding out why a nose is bleeding may sometimes be more challenging.

Your pet should be kept calm, as excitement may cause an increase in blood pressure that will make control of the nosebleed difficult.  As a pet owner, you too must remain composed; if your pet sees you getting frantic, he will become further distressed.

Place an ice-pack over the bridge and on the side of the nose to help to control bleeding as that constricts the blood vessels in this area.  If possible, look in the mouth to see if there is blood or if the gums are pale.  In either case, your pet should be evaluated by a veterinarian immediately.

What to Do

  • Notice if the blood is coming from one nostril (note which one) or both.
  • If your pet is sneezing, note how often.
  • Attempt to keep your pet calm. Encourage your pet to lie down and relax.
  • Place an ice pack (covered by one or more layers of clean cloth) or cold compress on the bridge and side of the nose.
  • If the nose is bleeding profusely and/or the bleeding lasts more than 5 minutes, seek veterinary attention.

What NOT to Do

  • Do not put anything up the nose, as this will likely cause your pet to sneeze. Sneezing will dislodge a clot (if one has formed), and the bleeding will resume.

A bloody nose in a cat or dog may be associated with foreign bodies (foxtail awns are common), polyps, infections, poisoning, bleeding disorders, or even cancer. It is a sign whose significance should not be underestimated, and veterinary medical attention should be sought as soon as possible.

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Southern Hills Animal Hospital
3827 Hite St. SW
Roanoke, VA 24014-2377
540-343-4155
Southern Hills Animal Hospital

Itch Relief for Dogs and Cats

The Itching Pet: Alternatives to Steroids

Excessive licking, chewing, and scratching can make a pet’s life miserable for month after month, even year after year. No one likes to see their pet uncomfortable; furthermore, the constant licking, chewing, and scratching can keep a pet owner up at night from the noise. Clearly, uncontrolled itching is a problem to solve before it gets out of hand.

For reliable rapid relief of itch and inflammation, nothing matches the corticosteroid hormones such as cortisone, hydrocortisone, triamcinolone, methoprednisolone, prednisonedexamethasone, and others. There are some animals that seem unable to live with any degree of comfort without these medications. Unfortunately, these hormones have widespread and potentially dangerous actions throughout the body when they are used for inappropriately long periods and it is generally desirable to minimize the use of these hormones when possible to do so. Ideally, corticosteroids are used for a few really tough itch weeks and other forms of itch management are used for general itch maintenance.

Of course, this is easier to write about than to actually do. When your pet is scratching and chewing raw spots on his skin, practical advice is what is called for. The following list includes assorted non-steroidal methods for relieving itch and reducing the amount of corticosteroid hormones needed.

Infection Control

When an animal becomes suddenly itchier, there is a tendency to assume there must have been a new or sudden allergen exposure. While this is possible, most of the time what has actually happened is an infection has taken root in the skin as a result of scratching and chewing. In many cases, controlling the infection will bring the pet back into its comfort zone and many allergic animals are managed by simply having their infections treated when they flare up.

The usual infections involve the Staphylococci bacteria and/or the Malassezia fungi that normally live on the skin surface. When the environment of the skin changes (allergic skin loses water and may have more oils), these organisms multiply and can gain access to deeper layers of the skin through abrasions caused by scratching and chewing. Soon there is a rash and/or an odor. Antibiotics generally handle these infections, though sometimes culture is necessary to determine what antibiotic is needed. Expect an itchy animal to have some skin samples reviewed under the microscope to check for infection. Some itchy pets need continuous management for these infections while, as mentioned, others only need periodic treatment.

Oral Medications

Antihistamine and Antihistamine Trials
Histamine, a biological chemical, is the chief mediator of inflammation in humans, hence the proliferation of antihistamines available for people both by prescription and over the counter.  Histamine is not the major mediator of inflammation in dogs, thus these medications are not as reliable for dogs as they are for us.

The International Committee on Allergic Diseases in Animals writes guidelines to manage atopic dermatitis, and they divide their recommendations in terms of two situations: itchy acute flare ups and more chronic daily levels of itching. They found little benefit from antihistamines for acute flare ups except for mild cases and consider that the drowsiness side effect may be responsible for any reduction in scratching. For more chronic cases, daily use of antihistamines fared better with the idea that regular use might be preventing flare ups even if antihistamines were not so good at actually treating flare ups. Responses were variable between individuals.

While the chance of any one antihistamine being effective is small (about 15% on the average), trying several antihistamines sequentially often leads to finding one that works. It is important to note that many antihistamines have a drowsiness side effect. Antihistamines commonly used for such trials include:

Fatty Acid Supplementation
The discovery of anti-inflammatory properties of evening primrose oils and fish oils in humans has led to similar products on the market for our pets. These products are not analogous to the oil supplements that are recommended to make a pet’s coat shiny; instead these are true anti-inflammatory medications capable of relieving joint pain, cramps, and itchy skin.

They are not at all useful for acute flare ups of itching as they require weeks to build up in the body in order to exert an effect. Instead, they are used for long-term management in making the skin less able to generate inflammatory mediators. (Essentially, they make the skin less reactive to allergens).
The supplement alone is mild in its ability to prevent itch but it can be used to boost the effects of other anti-itch medications.

Cyclosporine (Atopica) 
Cyclosporine is an immuno-modulating drug originally developed for use in organ transplant patients but also useful in other immune-mediated diseases.  Since allergy is an immune-mediated condition, cyclosporine was investigated as an alternative to corticosteroids and found effective for most patients.  A good four to eight weeks are needed to see a good response to cyclosporine which makes it fairly useless for acute flare ups. Typically it is combined with a medication that yields rapid itch relief so that by the time the itch is controlled, the cyclosporine can take over. Cyclosporine tastes bitter and commonly generates a mild upset stomach when it is first used. Cyclosporine is available for both dogs and cats.

Oclacitinib (Apoquel®)
This relatively new medication represents a new approach to itch relief. It is called a JANUS- kinase inhibitor and it exerts its effects in the skin just as rapidly as do corticosteroids. This makes it helpful for both acute flare ups as well as long-term management of itching. It is important to realize that its effects seem to be only on the sensation of itch and, unlike steroids, there is no anti-inflammatory result. This means that the patient’s itch can be controlled in the face of even advanced skin infection. This might sound like a good thing but there is concern that if the patient is not itching, the pet owner may not be motivated to perform the therapy needed to control the actual skin disease. At this time, oclacitinib is a new drug with a side effect spectrum that is still being defined so most veterinary dermatologists recommend selecting cases for this medicine judiciously. Oclacitinib is for dogs only.

Pentoxifylline
This medication works by making red blood cells more flexible so as to allow better oxygen delivery deeper into tissues. This medication turns out to have many disease applications and has been used in the management of chronic itch (but not useful for acute flare ups). It is best used in conjunction with omega 3 fatty acids.

Long-Acting Injectables

Lokivetmab (Cytopoint®, Canine Atopic Dermatitis Immunotherapeutic, Cadi)
Another new product is lokivetmab, a monoclonal antibody genetically engineered to target the canine version of a biochemical called interleukin 31. Interleukin 31 is a type of cytokine and is an important mediator of itching so when it is inactivated by antibodies, relief from itch is rapidly achieved (usually beginning 8 hours after injection and readily apparent after 1 day). For over 80% of dogs receiving the lokivetmab injection, results are sustained for at least 4 weeks. That said, it does not work for every dog and while some dogs experience more than 4 weeks of relief, others experience less.

Lokivetmab has no effect on pre-existing infections other than to make them not be itchy. It represents symptomatic relief only but for many itchy dogs, stopping the itch/scratch cycle is needed to curtail the vicious cycle and stop the perpetuation of skin infection.

Topical Therapies

We now know that topical steroids (cortisone crèmes, sprays, and related products) are absorbed through the skin and into the bloodstream, but the systemic hormonal side effects achieved with topical use do seem blunted and probably only of significance for very small dogs. This makes topical steroid use a much safer long-term approach relative to oral or injectable steroids. Of course, the entire animal cannot be enrobed in topical steroid cremes but for small irritated areas (hot spots), topicals can provide excellent relief without the systemic effects of hormones. They are best used for acute flare ups.

Shampoo Therapy

There are many benefits to shampoo therapy: luke warm water is inherently soothing, crusts and dandruff that could be inherently itchy can be removed, pollens and other allergenic substances can be washed away, the skin can be either moisturized or stripped of excess oil depending on what is needed and, of course, medications can be delivered in the shampoo lather itself. Skin can be moisturized with shampoo therapy, which reduces the sensitivity of the skin to itch stimulation. (The itch threshold is raised through skin hydration). As technology advances, new products are introduced and ways to prolong their effects are developed. Here are some general choices that might be helpful:

  • Colloidal Oatmeal Shampoos and Creme Rinse – At first, these products were only available for human use, as powdered soaks to pour into bath water.  Once their value in itch management was determined, their use quickly spread to the veterinary field.  Colloidal oatmeal has an unknown method of action but generally yields one to three days of relief. The creme rinses are meant to yield longer acting relief. They are available plain or combined with local anesthetic formulas (usually pramoxine) to soothe itch.
  • Phytosphingosine-Containing Products Recently a French company called Sogeval® has brought its Douxo® line of products to the U.S. These products contain phytosphingosine, a natural skin biochemical important in maintaining the skin’s natural barrier to infection and inflammatory substances. Phytosphingosine is moisturizing, anti-inflammatory (both directly and by fortifying the skin’s barrier function), and has antimicrobial properties (preventing and treating bacterial as well as yeast infections). The Douxo® line is available in shampoos, sprays, and a top spot formula. Generics are also on the market as well.
  • Lime Sulfur Dip – This product kills parasites, ringworm fungi, and bacteria.  It also dries moist, weeping skin lesions and helps dissolve surface skin proteins that are involved in itchiness. Many veterinary dermatologists recommend it regularly to control itch; however, it has several disadvantages. IT SMELLS TERRIBLE.  The sulfur ingredient smells like rotten eggs and this is how your bathroom or bathing area will smell during the pet’s bath. This dip can stain jewelry and clothing and will temporarily turn white fur yellow.
  • Other Shampoos – Itchy skin can be the result of skin infection, excess oil accumulation, yeast infection, even parasitic infection. The list goes on. The shampoo products listed above can be used against any itchy skin disease but it should be noted that there are many other shampoo and creme rinse products that can be used against the specific conditions.

TEN MINUTES OF SKIN CONTACT IS THE MINIMUM REQUIREMENT
FOR ANY MEDICATED SHAMPOO.
PREMATURE RINSING WILL NOT ALLOW FOR THE THERAPEUTIC BENEFIT TO BE REALIZED.

Respect the Steroid

Severe itching amounts to a reduction in life quality. It is important not to develop the mindset that corticosteroids should be avoided at all costs. This would not be fair to the itching pet. Steroids are valuable tools in the relief of pain and suffering and have an important place the therapy of the itchy pet.

The goal is not to avoid steroid use if possible but to avoid long term dependence on steroids if possible.  Despite all of the above management tricks, some pets will still require long term steroid use to achieve any reasonable comfort. There are monitoring protocols in place for such cases.  It should also not be forgotten that underlying allergies and recurring skin infections can be addressed specifically and that as these conditions are managed, the itch is also managed.

Steroid hormones have many side effects and, as helpful as they are for allergic skin diseases, it is best to reserve them for only the most itchy episodes.

A Few Words about Flea Control

We receive email on a daily basis from people with itchy pets who are convinced that fleas are not involved in the problem. When we examine such pets, we find fleas actually are contributing to the itching in at least 50% of cases and the owner is invariably surprised to see the live fleas when they find them. Since any itchy skin disease is made worse by fleas, good flea control is imperative and it is important not to assume that not seeing fleas means they are not there. For example, if your pet’s itchiest areas include the lower back, this is a strong indicator that he has fleas whether you see them or not. Often, becoming diligent with flea control is the least expensive and least labor-intensive way to control a pet’s itch symptoms.

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Southern Hills Animal Hospital
3827 Hite St. SW
Roanoke, VA 24014-2377
540-343-4155
Southern Hills Animal Hospital

Arthritis in Pets: What can be Done?

Susan G. Wynn DVM, RH (AHG)

Key points

  • Signs of osteoarthritis may be subtle and easy to miss
  • Early treatment is critical to slow progression of the disease
  • Maintaining lean body weight  is absolutely critical for arthritic patients
  • Newer concepts of arthritis management involve proper exercise to maintain muscle mass and decrease pain
  • Structure-modifying agents are most effective when started early and maintained long term
  • Nonsteroidal anti-inflammatory and analgesic drugs, acupuncture, and physical therapy may be recommended for later stages of the disease

Exactly what is Osteoarthritis?

Osteoarthritis is a chronic degenerative disease that may affect any joint but is commonly found in a pet’s  hip, elbow, shoulder, stifle (knee) , carpus (wrist), hock (ankle) or intervertebral joints (in the spine).  It occurs when cartilage in the joint is damaged, either following a traumatic event or with wear and tear that increases in athletic animals, obese animals, or when the joint is congenitally abnormal.

Cartilage decreases joint stress by reducing impact on the ends of the bones in joints, like a gelatinous shock absorber.  When cartilage is damaged, a cascade of inflammatory changes occurs, eventually leading to destruction of the cartilage and subsequent damage to the underlying bone.  Cartilage contains no nerves – if your pet is showing any signs of pain, the damage and changes in underlying bone have already begun.

Signs of arthritis include:

  • Reluctance to take walks of usual length
  • Stiffness (that may disappear once the pet has ‘warmed up’)
  • Difficulty climbing stairs, climbing in the car, on the bed or a sofa
  • Difficulty rising from rest
  • Limping
  • Abnormal gait
  • Licking of a single joint
  • Acting withdrawn, spending less time playing with family (which is often misunderstood as a sign of ‘aging’)
  • Soreness when touched
  • Rarely, aggression when touched or approached

Exactly what can I do?

  • Weight Reduction: Ask your doctor about your pet’s body condition score (BCS), which should be normal (5/9) or slightly underweight (4/9).  If your pet is overweight, discuss a weight loss diet with your veterinarian.
  • Controlled Exercise:  Low-impact exercise is best; swimming or walking through shallow water is ideal.  Leash walking and controlled jogging are also acceptable.
  • Nutraceuticals:  Synergistic combinations of nutraceuticals such as glucosamine/chondroitin sulfate contain compounds that support cartilage structure, prevent further deterioration, suppress inflammation, and reduce free radical damage.
  • Injectable Chondroprotective Agent: Talk to your veterinarian about an injectable agent that may also help preserve cartilage in the joints.
  • Acupuncture and Massage: Both of these therapies may provide additional non-drug pain control.
  • Prescription Drugs: Drugs are available that can reduce inflammation and suppress pain in dogs with more advanced disease.  Side effects can be minimized by monitoring your dog’s blood work regularly.

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Southern Hills Animal Hospital
3827 Hite St. SW
Roanoke, VA 24014-2377
540-343-4155
Southern Hills Animal Hospital

Rabbit Natural Behavior

Much of the information for this article came from a superb book called Why Does My Rabbit…? by Anne McBride (Souvenir Press, Revised edition September 1, 2003) who is an animal behaviorist. This is the finest and most complete book I have seen on rabbit behavior to date. It includes not only extensive background information on rabbits, but specific remedies for specific behavioral problems. I would highly recommend reading this book from cover to cover. It is available at some bookstores, veterinary clinics and online book sites.

Our pet rabbits are direct descendants of the wild European rabbits, which originally inhabited the area around Spain and Portugal. The scientific name Oryctolagus cuniculus means “hare-like digger” (an appropriate name if you ever had a rabbit take a liking to your carpet!). They were originally bred in captivity at least 3000 years ago as a source of food and fur. Not until the 19th century did “fancy” rabbit breeding become fashionable and thus the proliferation of the many shapes and sizes of rabbits we have today.

Rabbits were never bred primarily for behavioral characteristics – as dogs are – but rather for size and color. Therefore the behaviors we see in the domestic rabbit today vary little from their wild ancestors.

Rabbits are herbivorous prey animals, meaning they are low on the food chain and must be on the constant lookout for predators. Even though we don’t like to think about it, in nature they provide food for a whole host of other animals and thus have a prolific rate of reproduction. Thus the three main purposes of the prey animal are to stay alive, reproduce and eat enough to accomplish the first two purposes.

Twitching Nose – Part of the rabbit’s anatomical design is geared towards detecting and escaping predators. Even when rabbits are sleeping they must constantly be monitoring their environment for danger, hence the constant nose movement. As they wiggle their nose and pull in air they also part the split in the upper lip to moisturize the air and improve the ability to pick up scents.

Large Moveable Ears – Rabbits have a large ear surface area for two reasons. The most important is to allow more sound waves to be collected and thus detect potential danger in the area. The other reason, particularly in warm climates, is as a natural “air conditioner” for the body where heat can be released quickly. Rabbits will move their ears independently of each other to further maximize their hearing ability. Only the poor lop-eared rabbit, which of course was genetically altered by man, cannot use his ears in the proper manner.

Large Protruding Eyes – The position and size of the eyes allows excellent vision almost 360 degrees around the head. Rabbits cannot see well directly in front but together with smelling and hearing they can accurately pinpoint where danger is coming from.

Eating Patterns – Rabbits evolved to exist on a wide range of plant materials, including plants of low nutrient value to other animals. Therefore they were designed to be grazing a good portion of the day, which means they may have to travel some distance to obtain food. During any eating behavior, a rabbit will periodically raise its head to scan the area with all its senses, which gives rabbits a “nervous” look when eating.

McBride describes three types of eating behaviors that agree with my own observations of rabbits. Casual feeding is when the rabbit is feeding in a “safe” area such as near the burrow and is comprised of relaxed nibbling here and there. Voracious feeding is when the rabbit is feeding rapidly on anything in sight in a straight line as quickly as possible. It is suggested that this feeding may be seen when there is bad weather or danger that precludes the rabbit being out very long to feed. Normal feeding is what would be seen most regularly within a rabbit’s established territory consisting of a zigzag pattern where there is selection of only the tastiest food items.

Rabbits tend to defecate as they are eating, particularly with the casual or normal patterns. These waste droppings then fertilize the area and keep things growing!

Digging – The European rabbit lived in interconnected burrows called warrens so the main reason for digging is to create a safe place to hide, sleep and reproduce. McBride also describes a second reason for digging, which is to produce a horseshoe-shaped depression called a scrape. The scrape may provide a place to roll in dry earth or it may be where a food item was uncovered. However, she concludes that the most common reason is to provide a place for male rabbits to make small deposits of feces to mark their territory, acting as she states, “like a billboard at the side of an open highway.”

Jumping – Although jumping is not a part of normal locomotion for the rabbit it can be essential when there is a need to escape from danger. A rabbit running for her life can leap not only over obstacles, but also straight up into the air and then twist around so she lands going a totally different direction, thus throwing the predator off guard.

Vocalization – Since rabbits are prey animals they by necessity do not want to draw attention to themselves with a lot of noise. Therefore most of their vocalizations are quiet. Content rabbit noises might include a low purring sound, soft clicking, or slow, quiet grinding of the teeth. Aggressive noises include grunts, growls and loud teeth grinding. Pain and fear can be expressed also by loud teeth grinding. Rabbits have a piercing scream that is given out only when the animal is in extreme fear or pain. It is so startling that is likely serves to shock the predator into hesitating long enough for the rabbit to get away, or as a warning to other rabbits in the area.

Scent Marking – Rabbits can use their feces to mark their territory and to communicate with other rabbits. In addition rabbits of both sexes have scent glands under their chin. They will mark important items in their territory, including other rabbits, with the clear secretion from this gland, which is undetectable to humans but interesting to other rabbits.

Urine – There are two methods by which rabbits urinate. One is simply to empty the bladder in a normal position. The other is lifting the hindquarters and spraying urine on a vertical surface. Most often spraying is done by intact male rabbits to mark another male rabbit or during courtship proceedings with a female rabbit. Animals neutered before or shortly after sexual maturity do not usually spray urine.

Visual Communication – As McBride points out, visual communication is not a large part of rabbit communication. However there are certain postures that are significant.

Body Language

A relaxed rabbit will lie either on his side or belly with the hind legs stretched out or alternatively squat down on the ground with the ears folded against the head.

A submissive rabbit makes himself look small by crouching as flat as possible and staying still, but the eyes still look fairly relaxed and not tense. A fearful rabbit will look similar to the submissive rabbit but the eyes will look tense and “bugged out,” and the body and ears will be pressed tightly in a downward fashion so as to appear invisible to the predator. When a rabbit encounters something distasteful but not necessarily dangerous in his environment, he will shake his head. (Of course constant shaking of the head most often is a medical problem.)

And we all know that when a rabbit thumps the ground energetically, he is warning other rabbits of danger. He will then dash off with the white underside of the tail raised as a warning signal to all rabbit buddies within sight.

Have fun with your bunny and enjoy the species you have chosen to take into your home. We are lucky to be able to share our space with a creature that is in reality little changed from its wild ancestors, but has adapted to life with us crazy humans in spite of it all!

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Southern Hills Animal Hospital
3827 Hite St. SW
Roanoke, VA 24014-2377
540-343-4155
Southern Hills Animal Hospital

Litter Box Care Guidelines

House-soiling, inappropriate urination/defecation, spraying. A cat’s use of locations other than the litter box comes under many names. Why do our cats do this? First and foremost, it is critical to ensure that there is no medical component to the behavior. Urinary tract-related disease can lead to death in less than 48 hours. The diseases are painful and debilitating.

Consult your veterinarian IMMEDIATELY if house-soiling commences. Waiting to see what happens could mean the difference between life and death. Once your veterinarian assesses the cat for health problems, discussions about diets and behavioral problems can follow. Many times, the veterinarian will identify multiple factors contributing to the problem, including medical, diet and behavioral problems. We are here to work with you and your cat to resolve these concerns.

Litter-Box Care

Location Location Location
Provide more than one location in the household for litter boxes. Consider having one on each floor if space allows. Avoid moving boxes around.

Depth Matters
Experiment with different depths of litter. Most cats prefer 1-1.5 inch depth while others may prefer deeper litter. Add a new litter box if attempting to try different litter depths (or types). Try not to alternate the litter depth or type within existing litter boxes. Take note of which litter boxes get used the most and choose that depth of litter for the majority of the boxes.

Negative Associations
Keep litter boxes away from rooms that contain noisy equipment such as furnaces or washing machines. The noises may frighten the cat. Avoid administering medications or doing anything unpleasant to your cat while they are in the litter box or litter box area.

Don’t Soil Where You Eat
Keep food and water dishes in a separate room or more than 5 feet away from the litter boxes. Cats are fastidious by nature and do not favor a soiled box. In the wild, they have endless location options in which to do their business. How can we expect them to walk in a pile of old feces and urine clumps?

Litter-Box Criteria

Feline behavior specialists have comprised a list of litter-box criteria based on studies demonstrating what is preferable to cats:
Number of Boxes
Provide one litter box per household cat PLUS one additional box. For example, a household with three cats should have four litter boxes.

Scented or Unscented
Use unscented clumping litter. Most cats prefer this texture best next to sandbox sand. Scented litters can be unpleasant and even painful to cats, since their sense of smell is significantly more sensitive than a human’s.

Clay Versus Other
While some cats will tolerate some of the newer ‘natural’ types of litters (corn, wheat, etc.), they are generally not preferred and will not be tolerated in instances where the cat is unwell or experiencing anxiety/stress.

Size Matters
Provide large size litter boxes that the cats are comfortable moving around in. Some older, arthritic cats may prefer boxes with LOW walls or a low door cut in the box. Climbing over the high walls may be painful.

Keep it Open
Remove covers from most or all of the litter boxes. Most cats do not feel comfortable in a covered box.

Keep it Clean
Scoop litter once to twice daily. More often is best. Empty out the litter tray once every one to two weeks. Clean the litter box with a mild detergent, rinse well, and dry well before adding new litter.

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Southern Hills Animal Hospital
3827 Hite St. SW
Roanoke, VA 24014-2377
540-343-4155
Southern Hills Animal Hospital

Kidney Disease in Reptiles

Brad Lock, DVM, DACZM

Kidney (renal) disease is a frequently diagnosed condition in captive reptiles, especially in lizards and tortoises. Kidney failure may be acute or chronic, and both types can occur at any age. Acute renal failure most often is due to an infection or toxins, including environmental toxins and medications. Chronic kidney failure is typically a result of improper husbandry and diet; causes include low humidity, long-term water deprivation or low-grade dehydration, a high-protein diet, and excessive vitamin D supplementation. Non-infectious causes are much more common than infectious ones.

The signs that a reptile might have kidney disease are often nonspecific and for that reason, the majority of reptiles are not taken to the veterinarian until the problem is advanced. Not wanting to eat, lethargy, and sunken eyes are early signs. A foul or unusual odor may be noticed at more advanced stages. A white sheen may be seen in the mouth. The eyes may look blood-shot and vessels can be easily seen in the whites. In really advanced cases, the tip of the tail, fingers or toes may begin to die and thus turn a different color. The color changes because the small blood vessels have reduced function and the blood supply is lessened so the tissues die. Commonly, reptiles with advanced kidney disease will vomit or regurgitate if force fed.

Bladder stones are commonly seen in many tortoise species and lizards with bladders. The bladder stones are associated with dehydration and kidney disease. There is no single sign that indicates a tortoise or lizard has a bladder stone. Some tortoises may lose their appetites; others may simply be less active. More serious signs are straining to defecate, or failure to do so. Pregnant females may repeatedly dig nests and strain to lay eggs without success. Some tortoises and lizards appear paralyzed or weak in their hind limbs, or they may walk with a limp on one or both sides, a sign sometimes described as a wheelbarrow gait.

Chronic dehydration is thought to be one of the most common underlying causes of developing kidney disease in captive reptiles. The water bowl may be too small for some species; swimming and soaking in the water may be beneficial for reptiles such as green water dragons and green iguanas. Sometimes water isn’t given in the appropriate manner; an anole (Anolis carolinensis) drinks droplets and may not drink from a bowl. Arboreal reptiles such as panther chameleons (Furcifer pardalis) and emerald tree boas (Corallus caninus) may become dehydrated if you rely entirely on automatic drip systems or foggers rather than taking the time to watch that they drink. People often misjudge how much water desert reptiles need, or do not recognize the impact of their local conditions on their reptiles. For example, pet bearded dragons (Pogona vitticeps) and leopard geckos (Eublepharis macularius) do well in humid Florida without “moisture retreats” or weekly soaks in shallow water baths. If that same approach is used in arid Arizona, those lizards will become dehydrated.

A poor thermal environment is often implicated in developing kidney disease. If the reptile is too cold or the room is too dry (often from air conditioning or heating), its kidney metabolism may be slower than needed to move uric acid out of the kidney and into the bladder.

Over-supplementation with powders containing vitamin D3, especially if provided to animals that are housed outdoors, may lead to high blood calcium that can cause mineralization of tissues, including the kidneys. Mineralization of the kidney can lead to reduced function and renal disease.

Malnutrition or poor diet is implicated in kidney disease. Vitamin A deficiency leads to changes in the kidney cells, which leads to decreased function and disease. A diet that has inappropriately high levels of protein, such as feeding animal protein to an herbivorous tortoise, will predispose the reptile to prolonged high levels of uric acid in the blood; that high level of uric acid may cause it to fall out into tissues, causing gout.

If the water bowl is not cleaned and disinfected frequently, a reptile may be forced to drink and bathe in feces-contaminated water. This is likely a major factor in infectious causes of kidney disease.

Affected Species

Any species of reptile can develop kidney disease, and there doesn’t seem to be any age or particular sex that is more likely to have it.

Any species of tortoise may develop bladder stones as it is thought that renal disease may lead to bladder stone formation, and bladder stones can cause ascending infections of the kidneys due to retained fluids in the bladder. However, desert tortoises (Gopherus agassizii and G. morafkai) and African spurred tortoises (Centrochelys sulcata) seem to account for the majority of cases of bladder stones; leopard tortoises (Stigmochelys pardalis) are a distant third. Bladder stones have been found in juvenile tortoises fewer than 2 inches (5 cm) in length. Bladder stones are also seen commonly in green iguanas.

Diagnosis

Your veterinarian will start by taking a thorough medical history and give a physical examination. Expect detailed husbandry questions on temperatures, humidity, diet and water features (water bowl size, how often cleaned). However, because there are few signs that directly point to kidney disease, your veterinarian will likely want to run some blood tests to look at kidney values and x-rays to look for bladder stones.

In some cases, kidney disease will cause the kidney to get bigger; they may get big enough so that your veterinarian can feel them. In lizards, the enlargement can be felt just in front of the pelvis. In snakes, it may be felt in the back third of the body. Large chelonians and lizards may have large kidneys detected with a digital cloacal exam (much like giving a dog a rectal exam). Most reptiles with enlarged kidneys are constipated because the kidneys block the pelvic canal and reduce or prevent feces and urine from passing through.

Other signs that your reptile may have kidney disease that your veterinarian might notice include weakness; lying on the table rather than sitting in an alert and erect posture; bad breath (not yours, your reptile’s!); and dehydration causing sunken eyes and thick ropy mucus in the mouth.

A bladder stone may be felt in those reptiles that have bladders (e.g., green iguana, tortoises) or as a hard object in the colon (e.g., chameleons, bearded dragons). Bladder stones, especially in tortoises, can be hard to feel, so your veterinarian may want to take X-rays or do an ultrasound. Those imaging tests may show large kidneys, bladder stones, or impaction of the colon. Mineralization of the tissues ―another sign of kidney disease―may be detected on X-rays as well.

The blood tests checking the calcium, phosphorus (especially the calcium/phosphorous ratio), and potassium levels can indicate how well the kidney is working. If the calcium and phosphorous are abnormal enough, this may be seen by your veterinarian as a white sheen in mouth tissues. The levels of potassium protein, uric acid, red blood cells and other enzymes in the blood may indicate that your reptile has kidney disease. In some cases, your veterinarian may want to do a urine test to look for abnormalities such as white blood cells, red blood cells, or parasites that would indicate kidney disease.

In some cases, your veterinarian may want to get a kidney biopsy to see how advanced the kidney disease is and be able to give you a prognosis for treatment success.

Treatment

Because there are many causes and degrees of kidney disease, your veterinarian will discuss and recommend treatments based on your reptile’s situation. In general, the initial treatments are focused on first stabilizing your reptile, and then long-term treatment will be focused on husbandry changes and possibly long-term medications as well. Initial stabilization usually involves intensive fluid therapy (fluids may be given by mouth, but more commonly will be given by injection) to rehydrate the reptile. Fluid therapy is critical as increased levels of uric acid can result in a condition known as gout. Articular gout occurs when uric acid crystals deposit in the joints and can cause lameness and swelling. Visceral gout occurs when uric acid crystals are deposited in organs such as liver, kidneys, spleen, and/or lungs, and can result in various clinical signs depending on the organs involved. Most kidney infections are treatable, so your reptile may need a course of antibiotics. If left untreated, the kidney infection can be fatal.

Mid and long-term management of reptiles in renal failure is focused on improvement and modifications to the husbandry, such as the thermal environment, adequate hydration, and a diet that provides a small amount of high-quality protein with low levels of potassium and phosphorus. To maintain hydration, your veterinarian may recommend providing a large water bowl for soaking and swimming, as well as you actively soaking the reptile rather than leaving it up to your pet.

Typically, a reptile will show improvement within 5 to 7 days of fluid therapy, although sometimes it may take 2 to 3 weeks. Reptiles that continue to appear depressed following a few days of fluids therapy carry a poor prognosis. Even with aggressive management, it is unlikely for a reptile to live longer than 6 months once diagnosed with advanced kidney failure. There is no data available on mild cases as too few reptiles have been diagnosed early enough for long-term studies.

It is important to realize that kidney failure is usually a manageable disease, but if significant damage to the kidneys has already occurred, there are no quick fixes and treatment may be required for the rest of your pet’s life. Patients with chronic renal failure can survive for variable lengths of time depending on the specific cause. After a diagnosis, your veterinarian will recommend whatever treatment is believed to be best for your pet and will give you a more specific prognosis.

Monitoring

Once a reptile has recovered from acute kidney failure and is doing well, your veterinarian may suggest routine health screenings and annual wellness visits. For those with chronic renal failure, your veterinarian may want to see your pet in more often for blood work to monitor the calcium-to-phosphate ratio and uric acid levels, and for routine x-rays.

Prevention/Prognosis

Providing your reptile with appropriate husbandry for the species is the mainstay of preventing kidney disease. Green iguanas are an example of a species that commonly develops renal failure because they are often kept in a perfect storm of pitfalls leading to dehydration and kidney disease: cage humidity under 80 percent relative humidity; a water bowl too small and/or not cleaned often enough; temperatures that are often too low; and a diet high in dried materials like pellets or biscuits, and/or includes animal protein like dog or cat food. (While green iguanas do eat some animal matter as neonates, adult green iguanas almost entirely eat leaves.)

For tortoises and green iguanas that commonly develop bladder stones, your veterinarian may recommend regular X-ray screening as part of the diagnostic work-up on any ill tortoise or iguana, as well as part of the annual preventive medicine program for these species.

As a general rule, kidney infection (pyelonephritis) has a fair prognosis if caught early and treated appropriately. Reptiles can have infections that do not lead to kidney failure; there are also other causes of kidney failure, such as dehydration. However, once the kidney has been irreparably damaged, making the reptile more comfortable is possible, but a full recovery is unlikely. Reptiles with kidney disease that have elevated phosphorus, elevated potassium, and an inverse calcium to phosphorus ratio carry a guarded prognosis, and will require significant care to be given a chance to recover. If no improvement is seen in 5 to 7 days once treatments begin, the prognosis is poor.

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Southern Hills Animal Hospital
3827 Hite St. SW
Roanoke, VA 24014-2377
540-343-4155
Southern Hills Animal Hospital