Cushing disease in Dogs

Cushing disease in Dogs

By Dr. Karen Becker

 

Cushing’s disease is most often seen in dogs — especially Terriers, Poodles, Dachshunds and the American Eskimo/Spitz. It rarely occurs in cats.

The medical term for this condition is hyperadrenocorticism. Hyper means too much, adreno refers to the adrenal glands, and corticism refers to a syndrome involving the hormone cortisol. Simply put, hyperadrenocorticism describes a condition in which too much cortisol is released by the adrenal glands.

Overproduction of This Powerful Hormone Can Trigger a Cascade of Health Problems

In a healthy dog’s body, cortisol, known as the fight-or-flight hormone, is released in small amounts by the adrenal glands in response to perceived stress, so the dog can prepare to battle or run for his life. A release of cortisol also triggers a release of glucose from the liver. Glucose provides energy to the cells of the muscles used to fight or take flight.

Cortisol also impacts a number of other important functions in your dog’s body, including blood pressure, electrolyte balance, bone and fat metabolism, and immune function. Cortisol is secreted in response to any type of stress in your pet’s body; physical or emotional, short-term or long-term.

If for some reason your dog’s body up-regulates its demand for cortisol, the adrenal glands begin overproducing the hormone, which can lead to a state of toxicity. In dogs who experience chronic stress in any form, the adrenals release more cortisol than their bodies need.

This situation can result in a number of serious disorders, including elevated blood sugar that can lead to diabetes, elevated blood pressure that can result in heart and kidney disease, extreme hunger in response to lots of excess glucose being burned, thinning of the skin and coat, decreased muscle and bone mass, and increased risk of infection.

If your dog’s body is continuously overproducing cortisol, his immune function is compromised, which opens the door for infections anywhere in the body — especially the gums, eyes, ears, skin and urinary tract. If your dog has recurrent infections or a persistent infection, it’s possible too much cortisol is the cause.

Symptoms of Cushing’s Disease

Most dogs have a few, but not all of the symptoms of the disorder unless diagnosis comes very late in the disease. Symptoms most commonly seen in dogs with early Cushing’s include:

Increased thirst and urination, which can lead to incontinence Bruising
Increased panting Hair loss
Abdominal weight gain (pot belly appearance), despite a reduction in calorie intake Irritability or restlessness
Thinning skin and change of skin color from pink to grey or black, symmetrical flank hair loss Much less commonly, rear limb weakness and blood clots

These symptoms are so diverse and can affect so many organs because every inch of a dog’s body contains cortisol receptors.

Typical or Atypical Cushing’s?

If your dog is diagnosed with hyperadrenocorticism, it’s important to know which type of Cushing’s she has. Typical Cushing’s is either adrenal dependent or, much more commonly, pituitary dependent. About 85% of affected dogs develop the latter form, in which the pituitary gland sends too much stimulating hormone to the adrenals. The adrenal glands respond by over-secreting cortisol.

The remaining 15% of cases are adrenal dependent, in which a tumor develops in an adrenal gland and triggers an up regulation of cortisol production. It’s not uncommon for veterinarians to unintentionally trigger typical Cushing’s by prescribing a too-high dose of oral prednisone (synthetic cortisone), or a course of prednisone therapy that is too long in duration. If your dog has taken prednisone for any length of time, she’s predisposed to Cushing’s disease.

The atypical form of hyperadrenocorticism occurs when the adrenals overproduce aldosterone, a hormone that balances electrolytes in the body. Atypical Cushing’s can also result from an overproduction of sex hormone (estrogen, progesterone, and rarely, testosterone) precursors.

Diagnosing Hyperadrenocorticism Can Be Challenging

The actual diagnosis of Cushing’s is often complicated. It’s typically done with blood tests like the ACTH stimulation (stim) test and the low-dose dexamethasone suppression test. Both these tests require at least two blood draws to compare cortisol levels for a definitive diagnosis of Cushing’s.

When Cushing’s is confirmed, your veterinarian will want to determine if it’s pituitary or adrenal dependent. In my opinion, the best way to rule out an adrenal gland tumor is with a non-invasive ultrasound test. However, some vets prefer to do a third blood test called a high-dose dexamethasone suppression test.

Whichever method is used, it’s important not only to establish a definitive diagnosis for Cushing’s, but also to determine whether the form of the disease is adrenal or pituitary dependent.

Unfortunately, in the majority of cases, the disease is diagnosed only after it is full-blown and there’s no holding it back. Once a dog has full-blown Cushing’s, she will live with the disease for the rest of her life. It’s a horrible illness that can be managed in many cases, but never cured.

Many veterinarians tend to ignore repeated and progressive elevations in serum Alkaline Phosphatase (ALP), one of the commonly elevated enzymes found on routine bloodwork, until several Cushing’s symptoms are present, or a pet parent becomes concerned that their dog is suddenly urinating in the house or losing her hair.

The better, proactive approach is to try to prevent the disease from taking hold. That’s why I recommend getting a copy of your pet’s yearly bloodwork results. Your pet should age with picture-perfect bloodwork, or there’s work to be done.

Never let a veterinarian tell you your pet’s abnormal bloodwork is “normal for their age,” as this means disease is taking place without anyone addressing it. If your dog’s ALP is two to three times higher than normal, ask your vet if your dog could be in the early stages hyperadrenocorticism.

The Importance of Catching This Disease Early

Most of the drugs currently available to treat Cushing’s disease have many undesirable side effects. It’s extremely important to discuss your concerns about possible side effects with your veterinarian. I recommend you do your own research as well.

I try to avoid using Lysodren and other potent Cushing’s drugs because in my opinion, the side effects are often worse than the symptoms the animal is dealing with. If Cushing’s drugs must be used, I prefer to use Trilostane, which has fewer side effects. Obviously, the goal is to catch the disease before high drug doses are required.

If, however, your dog requires drugs to manage full-blown Cushing’s, I recommend starting with the lowest possible effective dose, and using it in conjunction with a natural protocol to reduce potential side effects. Identifying pre-Cushing’s syndrome as early as possible and reducing your pet’s risk for full-blown disease is the approach I always recommend. Dogs don’t suddenly wake up with this disease — it happens over time.

Unfortunately, many conventional veterinarians ignore the early signs of adrenal dysfunction because they don’t know what to do about it until a dog fails the ACTH stim test. The problem with this approach is it takes months and sometimes years for an animal to be officially diagnosed with Cushing’s.

Waiting this long to take action often means waiting too long. I consider a dog to have pre-Cushing’s syndrome when he exhibits classic symptoms but is still able to pass the stim test. Often there are minor changes in bloodwork, for example, the UCC (urine cortisol:creatinine ratio) is slightly elevated, there are elevated cholesterol levels, and/or the elevation in ALP has been proven to be cortisol induced (your vet can check what fraction of ALP is coming from cortisol vs. other sources).

I’m able to reverse many pre-Cushing’s patients with nutraceuticals, Chinese herbs, homeopathics, nutritional therapy, and lifestyle management (reducing biologic and metabolic stress).

My advice is to be proactive by having your pet’s ALP level checked annually, which should be a part of a basic “wellness blood test,” along with a physical exam that evaluates muscle mass, coat condition, and an environmental stress assessment. Ask your veterinarian to establish baseline blood levels and address any elevation from the baseline through a screening test like the UCC or CiALP to determine if your dog’s body is over-secreting cortisol.

Never accept steroids prescribed for your pet unless they’re required to dramatically (and temporarily) improve quality of life (e.g., if your pet has acute head trauma and steroids are needed to control brain inflammation, etc.).

Having this information will help you better manage a pre-Cushing’s situation before it develops to full-blown disease. And don’t ignore symptoms. If your pet has consistent Cushing’s-type symptoms, no matter how minor, they are absolutely worth investigating for a possible endocrine or adrenal disorder.

It’s during the development of Cushing’s disease that many dogs are also over-prescribed aggressive traditional drug protocols for full-blown Cushing’s disease, often with disastrous results.

When these potent drugs are prescribed for mild adrenal dysfunction, the result is often an acute Addisonian crisis in which there are insufficient adrenal hormones necessary for normal physiologic function. A natural protocol to manage pre-Cushing’s is essential to avoid drug-induced hypoadrenocorticism (Addison’s).

Prevention Tips

There are some common-sense steps you can take to reduce your dog’s risk of developing hyperadrenocorticism, including:

Feed a moisture rich, nutritionally optimal, species-appropriate anti-inflammatory diet to reduce biologic stress; this means eliminating all grains and carbohydrates from the diet, since carbs trigger insulin release and insulin triggers cortisol release
Exercise your dog daily to help combat stress and promote the release of endorphins
Instead of spaying or neutering, consider a sterilization procedure that leaves your dog’s testicles or ovaries in place; if that’s not possible, wait until your pet has reached his or her full adult size, and in the case of females, after the first and preferably two estrus cycles
Minimize your pet’s exposure to xenoestrogens
Investigate adaptogenic herbs and adrenal-supportive natural substances like magnolia (rhodiola), ashwagandha, and phosphatidylserine
Address abnormal hormone levels early on with natural support, such as melatonin, DIM, glandular therapies and high lignan flax hulls

 

 

 

An integrative approach to chronic kidney disease (CKD) in cats

By: Barbara Fougere, BSc, BVMS (Hons), BHSc (Comp Med), MODT, MHSc (Herb Med), CVA, CVCP, CVBM

CKD is a common but manageable condition in feline patients, and responds well to integrative medicine. Herbs and acupuncture are key therapies.

Chronic kidney disease (CKD) is a common problem in cats, and one which all veterinarians encounter in practice. An integrative approach that includes herbs and acupuncture can help treat and even reverse this condition in feline patients.

CKD can be detected early through careful monitoring at annual wellness programs. IRIS (International Renal Interest Society) staging allows for the conventional staging of treatment, including any dietary changes. Key treatment strategies for feline CKD include supporting hydration, reducing phosphorus (usually through protein restriction), regulating blood pressure and controlling calcium levels. The intensity of intervention increases with disease progression.

Integrative treatment goals

Using integrative approaches to CKD, we have observed cats moving from IRIS Stages 2 and 3 to Stage 1, and remaining there for years. This reversal implies that nephrons are hypoxic and under-functioning, and that improving their functional capacity is a key goal. See below for integrative treatment goals for CKD.

Herbs can optimise kidney cell function by reducing oxidative stress, improving renal blood flow and mitigating fibrosis, thereby maintaining patients in early stages for extended periods. Acupuncture, manipulative therapies and other modalities can also be a part of the integrative approach.

With acute renal disease, the goals are modified to regulate/decongest the kidneys by reducing blood flow, and provide anti-inflammatory support to inflamed glomeruli. This may be a starting point with pyelonephritis, for example. Most cats, however, benefit from increased perfusion unless the renal disease is acute in onset (inflammatory).

Dietary considerations

Despite numerous experimental studies and clinical trials, questions about feeding protein to cats with chronic kidney disease (CKD) remain. What is the optimal amount of protein for a cat with CKD? How much restriction is necessary? Do different types of kidney disease require different dietary therapies? At what point in disease progression should protein restriction be implemented? Does the type of protein make a difference? Does every meal have to be restricted? Will a cat in IRIS Stage 3 or 4 benefit if phosphorus is restricted by other means? Might some cats with advanced disease benefit from increased protein levels?1 These concerns remain despite the common practice of prescribing therapeutic renal diets to cats in any stage of CKD.

Integrative practitioners provide, or are requested to provide, natural feeding advice to cat owners. Excellent resources include the veterinary Diplomats in Nutrition; Balance It and several software programs that can be used for formulating diets while taking feline preferences into account. See page xx for an example of a low-phosphorus diet for cats with CKD.

From an integrative perspective, real food is considered to have many benefits, including palatability for ill cats, and these benefits may outweigh those offered by processed foods. In IRIS Stage 1 and early Stage 2, the diet may not need to be modified, although serum phosphorus and the phosphorus content of the diet should be evaluated. From late Stage 2 onwards, consideration may be given to reducing protein by diluting with fat and carbohydrates.

Herbal help

Herbs can delay the onset and progression of CKD in cats by improving mitochondrial function, and providing antioxidant protection and ACE-inhibiting effects. Many herbs are anti-inflammatory, anti-fibrotic and nephroprotective, and several improve renal blood flow. A principle of herbal medicine is that formulations containing multiple plants can have greater effects than the same herbs taken separately. These synergistic effects enhance the desired action.2

Following are several herbs to be considered and included in formulas for renal treatments.

1. Rehmannia glutinosa

Rehmannia glutinosa occurs in many Chinese herbal formulas, including Rehmannia Eight Combination (Shen Qi Wan, Jin Gui Shen Qi Wan, Ba Wei Di Huang Wan), which is very useful for cats with CKD and weight loss, loss of strength, polyuria, polydipsia, and that are seeking warmth. It is also included in Zhi Bai Di Huang Wan, which is useful in cats with CKD and hyperthyroidism, particularly in those tending towards constipation, agitation and weight loss, along with polydipsia and polyuria.

Rehmannia has a long history of research and effective use in CKD. In humans, studies have found that it has a 91% efficacy in reducing renal damage from nephritis, due to the enhancement of renal blood flow and glomerular filtration.3 In a model of renal ischemia, ligated rats that received Rehmannia extract showed improved renal blood flow (to near normal levels) and reduced mortality and hypertension compared to controls, through either ACE inhibition or juxtaglomerular desensitization.4 Rehmannia reduces oxidative stress and can promote red blood cell production through bone marrow stimulation; reduce serum creatinine and urinary protein excretion and glomerulosclerosis in compromised patients; and inhibit the expression of Angiotensin II as well as Type IV collagen in the renal cortex.5, 6

Fresh Rehmannia is utilised in Ba Wei Di Huang Wan and Zhi Bai Di Huang Wan. Interestingly, a recent study supports the use of fresh over prepared Rehmannia; the former acts more powerfully on attenuating interstitial fibrosis by downregulating the expressions of transforming growth factor, a smooth muscle actin, and Type 1 collagen.7

2. Astragalus membranaceus

Astragalus membranaceus is known as a Qi tonic in Chinese medicine, and as a major immune-modulating herb in Western herbal medicine. It should also be known as a major kidney herb. Its major constituent, astragaloside, ameliorates renal interstitial fibrosis in vivo by inhibiting inflammation.8 It has major antioxidant effects.9 Astragalus has been reviewed by Cochrane and was found to offer some promising effects in reducing proteinuria and increasing haemoglobin.10 Its nephroprotective effects against oxidative stress include anti-inflammatory and anti-apoptotic mechanisms.11 In a systematic review of Astragalus on diabetic nephropathy in animal models, this herb was able to reduce blood glucose and albuminuria levels and reverse the glomerular hyperfiltration state, thus ameliorating pathologic changes.12

3. Angelica sinensis

Angelica sinensis contains polysaccharides that inhibit oxidative stress injury in mouse kidneys.13 Like Astragalus, its nephroprotective effects include anti-inflammatory and anti-apoptotic mechanisms.11 Renal microvascular lesions can contribute to the progression of glomerular sclerosis and tubulo-interstitial fibrosis in chronic kidney Both Astragalus and Angelica can improve microvascular lesions by increasing local renal blood flow to lessen hypoxic renal injury, promoting the recovery of renal blood flow and glomerular filtration rate after ischemia-reperfusion; modulating the imbalance of vaso-activators such as nitric oxide and angiotensin; increasing the expression of vascular epithelial growth factor; inhibiting the release of the intracellular calcium ion; and promoting DNA synthesis in endothelial cells to improve the function of endothelial cells. The evidence suggests that both herbs may retard the progress of renal diseases through the above-mentioned mechanisms.14

In one study involving rats with an obstructive uropathy, Astragalus and Angelica were administered with Enalapril and compared to monotherapy. Enalapril with Astragalus and Angelica decreased tubulointerstitial fibrosis to a significantly greater extent than did treatment with Enalapril alone.15

4. Cinnamon

Cinnamon is readily accepted by cats and offers a mono-herbal treatment for fussy felines. It occurs in the Wei Ling Tang formula, which is useful for overweight CKD cats with proteinuria, hematuria, urolithiasis, azotemia, glomerulonephritis and pyelonephritis. Cinnamon can inhibit advanced glycation end products (AGE) and can ameliorate AGE-mediated pathogenesis in diabetic nephropathy.16 Cinnamon is a major antioxidant and anti-inflammatory spice, and has had over 178 papers published on it from 1995 to 2015.17 Cinnamon at a dose of 50 mg/kg for two weeks was given to dogs; the systolic blood pressure and heart rate in the treated dogs was significantly lower than in the normal group.18

5. Silybum marianum

Silybum marianum is one of our preeminent nephron-protective herbs. It should be considered an adjunct to ameliorative potential effects against drug-induced kidney disease, particularly in chemotherapy.19 It is also an herb that could be considered for CKD support. It is a potent antioxidant and free radical scavenger that inhibits lipid peroxidation and stabilizes cell membranes. It also increases intracellular glutathione, which plays a crucial role in the body’s antioxidant capacity, and it has anti-inflammatory properties inhibiting T-cell proliferation and cytokine secretion.20 There is also evidence that Silybum has a regenerative effect on renal tissue after injury.21

Mushrooms — Ganoderma and Cordyceps

Mushrooms are well tolerated by cats when given in the form of powders or concentrated tinctures added to food. Ganoderma lucidum is a medicinal mushroom that has been widely used in China and Japan for hundreds of years for its immune-modulating, anti-inflammatory and anti-tumor effects. Ganoderma compounds are renoprotective.22.The active peptide in Ganoderma counteracts oxidative stress from renal ischemia, and in an animal model of diabetic nephropathies has renal protective effects.23

Likewise, Cordyceps sinensis is extensively used by Chinese physicians to treat chronic renal diseases and to stimulate the immune system. It also displays anti-oxidative activities. It is commonly used in renal transplant patients; it has been shown to significantly improve renal fibrosis.24

Acupuncture and moxibustion

A recent single blinded randomized controlled study in patients with CKD showed that acupuncture at bilateral LI4, ST36 and KI3, and electroacupuncture to right ST36 and KI3 and left ST36 and KI3, once a week for 12 weeks, led to reduced creatinine levels and increased glomerular filtration rates.25 Moxibustion at Bl 23 in patients with CKD reduced renal vascular resistance.26

Most of the benefits that acupuncture offers in renal failure are undoubtedly due to the ability of these points to manipulate blood flow. Local blood flow is manipulated using BL23, BL22 and GB25, while systemic blood flow is manipulated with GB34, BL40 and KI3. Systemic blood flow greatly impacts renal function. Peripheral vasoconstriction can be induced to drive more blood to the kidneys. Peripheral vaso-relaxation can be induced to decongest the kidneys.

For animals in Stage II renal failure (using the IRIS classification system), and particularly where UPC ratios are greater than 2.5, use GB25, BL22 and GB34. These animals will typically have benefited from hypotensive drugs and low-protein diets, but won’t show an immediate improvement from fluid therapy. For animals in Stage I renal failure, or where UPC ratios are less than 2 to 2.5, use KI3, BL40 and BL23. These animals will typically not benefit from low-protein diets and hypotensive drugs, but will show an overt improvement from fluids.27

Integrative treatment goals for feline CKD

·         Mitigate oxidative stress by using antioxidant herbs

·         Improve renal perfusion (in most cases)

·         Prevent fibrosis, which is a natural consequence of renal disease

·         Optimise systemic health and well-being

Example of a low-phosphorus diet for cats with CKD

·         50 grams or ¼ cup pearl barley

·         200 grams raw chicken breast meat

·         10 grams chicken liver

·         1 large egg yolk

·         2 cups raw sweet potato

·         4 teaspoons salmon oil plus 4 teaspoons flaxseed oil

Cook barley, sweet potato, chicken and liver are on low heat with water. When warm, mix in egg yolk to lightly cook it (and preserve the choline). When cool, the recipe is divided into four meals (average 250 kcals) with the addition of 1 teaspoon of salmon oil and 1 teaspoon of flaxseed oil daily. The meals are divided.

The whole recipe provides 1,029 kcal, 36% carb, 40% fat, 24% protein and 724 mg of phosphorus. It needs to be supplemented as it is low in a number of minerals and vitamins, and is still low in choline. Any supplement added should be evaluated for its phosphorus content. This should demonstrate the complexity of balancing diets. Another excellent strategy is to have several recipes and vary the composition of diets over time. More protein can be utilised alongside phosphorus binders in later stages of kidney disease.

Conclusion

Chronic kidney disease in cats is a manageable condition that responds well to integrative medicine. In the author’s experience herbal medicine and acupuncture are key. Many integrative practitioners have reported success with other additional therapies, including homeopathy, cell salts, flower essences and osteopathy.

References

1Larsen JA. “Controversies in Veterinary Nephrology: Differing Viewpoints: Role of Dietary Protein in the Management of Feline Chronic Kidney Disease”. Vet Clin North Am Small Anim Pract. 2016 Nov;46(6):1095-8.

2Bangar OP, Jarald EE, Asghar S, Ahmad S. “Antidiabetic activity of a polyherbal formulation (Karnim Plus)[J]”. Int J Green Pharm, 2009, 3(3) : 211-214.

3Su ZZ, He YY, Chen G. “Clinical and experimental study on effects of man-shen-ling oral liquid in the treatment of 100 cases of chronic nephritis”. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1993;13(5): 259–260,269–272.

4Yi NY, Chu W, Koang NK. “Pharmacologic studies on Liu Wei Di Huang Wan: its action on kidney function and blood pressure of rats with renal hypertension”. Chin Med J-Peking. 1965;84(7):433–436.

5Yuan Y, Hou S, Lian T, Han Y. “Rehmannia glutinosa promotes the recovery of RBC and Hb levels in hemorrhagic anemia by promoting multiplication and differentiation of CFU-S and CFU-E bone marrow cell line”. Chung Kuo Chung Yao Tsa Chih. 1992;17(6):366–368.

6Lee BC, Choi JB, Cho HJ, Kim YS. “Rehmannia glutinosa ameliorates the progressive renal failure induced by 5/6 nephrectomy”. J Ethnopharmacol. 2009;122(1):131–135.

7Liu DG, Zeng M, Gao HY, et al. “Rehmanniae Radix and Rehmanniae Radix Praeparata Ameliorates Renal Interstitial Fibrosis Induced by Unilateral Ureteral Occlusion in Rats and Their Mechanism”. Zhong Yao Cai. 2015 Dec;38(12):2507-10.

8Zhou X1, Sun X1, Gong X1. “Astragaloside IV from Astragalus membranaceus ameliorates renal interstitial fibrosis by inhibiting inflammation via TLR4/NF-кB in vivo and in vitro”. Int Immunopharmacol. 2017 Jan;42:18-24.

9Shahzad M, Shabbir A, Wojcikowski K. “The Antioxidant Effects of Radix Astragali (Astragalus membranaceus and Related Species) in Protecting Tissues from Injury and Disease”. Curr Drug Targets. 2016;17(12):1331-40.

10Zhang HW1, Lin ZX, Xu C, et al. “Astragalus (a traditional Chinese medicine) for treating chronic kidney disease”. Cochrane Database Syst Rev. 2014 Oct 22;(10):CD008369.

11Shahzad M1, Small DM2, Morais C. “Protection against oxidative stress-induced apoptosis in kidney epithelium by Angelica and Astragalus”. J Ethnopharmacol. 2016 Feb 17;179:412-9.

12Zhang J1, Xie X, Li C, et al. “Systematic review of the renal protective effect of Astragalus membranaceus (root) on diabetic nephropathy in animal models”. J Ethnopharmacol. 2009 Nov 12;126(2):189-96.

13Fan YL, Xia JY, Jia DY. “Protective effect of Angelica sinensis polysaccharides on subacute renal damages induced by D-galactose in mice and its mechanism”. Zhongguo Zhong Yao Za Zhi. 2015 Nov;40(21):4229-33. [Article in Chinese].

14Song JY1, Meng LQ, Li XM. “Therapeutic application and prospect of Astragalus membranaceus and Angelica sinensis in treating renal microvascular lesions”. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Sep;28(9):859-61.[Article in Chinese].

15Wojcikowski K1, Wohlmuth H, Johnson DW. “Effect of Astragalus membranaceus and Angelica sinensis combined with Enalapril in rats with obstructive uropathy”. Phytother Res. 2010 Jun;24(6):875-84.

16Muthenna P1, Raghu G1, Kumar PA, et al. “Effect of cinnamon and its procyanidin-B2 enriched fraction on diabetic nephropathy in rats”. Chem Biol Interact. 2014 Oct 5;222:68-76.

17Mollazadeh H1, Hosseinzadeh H2. “Cinnamon effects on metabolic syndrome: a review based on its mechanisms”. Iran J Basic Med Sci. 2016 Dec;19(12):1258-1270.

18Kaffash Elahi R. “The effect of the cinnamon on dog’s heart performance by focus on Kortkoff sounds”. J Animal Veterinary. 2012;11:3604–3608.

19Dashti-Khavidaki S1, Shahbazi F, Khalili H, et al. “Potential renoprotective effects of silymarin against nephrotoxic drugs: a review of literature”. J Pharm Pharm Sci. 2012;15(1):112-23.

20Sedighifard Z1, Roghani F1, Bidram P, et al.  “Silymarin for the Prevention of Contrast-Induced Nephropathy: A Placebo-Controlled Clinical Trial”. Int J Prev Med. 2016 Jan 22;7:23.

21Sonnenbichler J, Scalera F, Sonnenbichler I, et al. “Stimulatory effects of silibinin and silicristin from the milk thistle Silybum marianum on kidney cells”. J Pharmacol Exp Ther. 1999 Sep; 290(3):1375-83.

22Wang XL1, Zhou FJ2, Dou M3, et al “Cochlearoids F-K: Phenolic meroterpenoids from the fungus Ganoderma cochlear and their renoprotective activity”. Bioorg Med Chem Lett. 2016 Nov 15;26(22):5507-5512.

23Joob B1, Wiwanitkit V2 Linzhi. “(Ganoderma lucidum); evidence of its clinical usefulness in renal diseases”. J Nephropharmacol. 2015 Dec 27;5(1):9-10.

24Du F1, Li S2, Wang T, et al. “Cordyceps sinensis attenuates renal fibrosis and suppresses BAG3 induction in obstructed rat kidney”. Am J Transl Res. 2015 May 15;7(5):932-40.

25Yu JS1,2,3, Ho CH4,5, Wang HY6,7, et al. “Acupuncture on Renal Function in Patients with Chronic Kidney Disease: A Single-Blinded, Randomized, Preliminary Controlled Study”. J Altern Complement Med. 2017 Apr 19.

26Matsumoto-Miyazaki J1, Miyazaki N1, Murata I, et al “Traditional Thermal Therapy with Indirect Moxibustion Decreases Renal Arterial Resistive Index in Patients with Chronic Kidney Disease”. J Altern Complement Med. 2016 Apr;22(4):306-14.

27Marsden S. “Introduction to veterinary acupuncture course notes’> College Integrative Veterinary Therapies, 2017.

 

 

Cat Periodontal Disease

As seen in Petrax

Cat periodontal disease, or gum disease in cats, is an inflammation of some or all of a tooth’s deep supporting structures. It is one of the most common diseases in cats today.

 

If food particles and bacteria are allowed to accumulate along a cat’s gumline, it can form plaque, which, when combined with saliva and minerals, will transform into calculus (tartar). This causes gum irritation and leads to an inflammatory condition called gingivitis.

 

Gingivitis, which is evidenced by a reddening of the gums directly bordering the teeth, is considered to be an early stage of periodontal disease in cats.

 

After an extended period, the calculus eventually builds up under the gum and separates it from the teeth. Spaces will form under the teeth, fostering bacterial growth.

 

Once this happens, the cat has irreversible periodontal disease. This usually leads to bone loss, tissue destruction and infection in the cavities between the gum and teeth.

 

Symptoms and Types of Gum Disease in Cats

 

Periodontal disease in cats generally begins with the inflammation of one tooth, which may progress if not treated during different stages of the condition.

 

A cat with stage 1 periodontal disease in one or more of its teeth, for example, will exhibit gingivitis without any separation of the gum and tooth.

 

Stage 2 is characterized by a 25 percent attachment loss, while stage 3 involves a 25 to 30 percent attachment loss.

 

In stage 4 of cat periodontal disease, which is also called advanced periodontitis, there is more than a 50 percent attachment loss. In the most advanced stage of the disease, the gum tissue will usually recede and the roots of the teeth will be exposed.

 

Cats may also develop a cat gum disease called stomatitis (gingivostomatitis). Stomatitis is the severe inflammation of all of the gum tissue, which may affect the other tissues in the mouth.

 

Stomatitis occurs due to an overactive immune response to even small amounts of plaque and calculus.

 

Causes of Gum Disease in Cats

 

Cat periodontal disease can be caused by a variety of factors,  but is most commonly associated with bacterial infection. Bacteria under the gumline leads to pain and inflammation of the tissue.

 

There may also be a relationship between having a history of calicivirus infection and severe gingivitis.

 

Diagnosis of Periodontal Disease in Cats

 

In the exam room, your veterinarian will look inside your cat’s mouth for red, inflamed gums. That is the first indication of a problem. Your veterinarian may press gently on the gums to see if they bleed easily, which is a sign that a deep dental cleaning, or more, is needed.

 

Once under anesthesia, the diagnosis of cat periodontal disease involves a number of procedures. If periodontal probing reveals more than one millimeter of distance between the gingivitis-affected gum and tooth, a cat is considered to have some form of periodontal abnormality.

 

X-rays are extremely important in diagnosing periodontal disease in cats because up to 60 percent of the symptoms are hidden beneath the gumline.

 

In the disease’s early stages, X-rays will reveal loss of density and sharpness of the root socket (alveolar) margin. In more advanced stages, it will reveal loss of bone support around the root of the affected tooth.

 

Treatment

 

The specific treatment for cat periodontal disease depends on how advanced the disease is. In the early stages, treatment is focused on controlling plaque and preventing attachment loss.

 

This is achieved through daily brushing with pet-safe toothpaste, professional cleaning and polishing, and the prescribed application of fluoride or other pet prescription products to minimize the development of plaque.

 

Sometimes it is necessary to remove the teeth associated with severe stomatitis.

 

In the more advanced stages, bone-replacement procedures, periodontal splinting and guided tissue regeneration may become necessary.

 

Living and Management

 

Follow-up treatment for periodontal disease in cats consists mostly of maintaining good cat dental care and taking your cat for weekly, quarterly or biannual checks.

 

The prognosis will depend on how advanced the cat gum disease is, but the best way to minimize the adverse effects caused by the disease is to get an early diagnosis, adequate treatment and proper therapy.

 

Prevention

 

The best prevention for cat gum disease is to maintain your pet’s good oral hygiene and to regularly brush and clean her mouth and gums.

 

Cats can be trained to accept brushing when trained slowly over time and rewarded for their cooperation.

 

Prescription cat food dental diets are available for those cats who are unwilling to have their teeth brushed.

 

Cat dental treats, water additives and other products certified by the Veterinary Oral Health Council (VOHC) are also shown to help reduce plaque and calculus.

 

Is your Dog Anxious??

By Karen Becker and comments by Diane Weinmann

When we talk about “nervous” dogs, we’re really discussing dogs who are anxious. And while it may seem unlikely your pampered pooch has any reason to feel stressed, it’s important to recognize that dog stressors can be quite different from human stressors.

It’s also really important to understand that research clearly shows dogs can and often do experience stress, and according to one study, “There is evidence to suggest that the stress of living with a fear or anxiety disorder can have negative effects on health and lifespan in the domestic dog.”1

When dogs feel anxious, their bodies release an excessive amount of norepinephrine, the fight or flight hormone, which has the potential to alter gut bacteria and interfere with gastrointestinal (GI) tract motility.2 This flood of norepinephrine can result in physical symptoms like diarrhea, which only exacerbates your dog’s stress — especially if she has an accident in the house.

Some dogs primarily experience short-lived stress, but others suffer chronic stress. The more you know about what triggers your pet’s anxiety, the behaviors she tends to perform when she’s anxious, and the effect of stress on her health, the better able you’ll be to identify the signs and take action to minimize or eliminate stressors.

Signs Your Dog Is Anxious

Estimates are that about 30% of dogs show signs of anxiety, identified by either body language or behaviors such as obsessive licking. Since each dog has his own communication style, it’s important to learn your pet’s signals that he’s feeling nervous or stressed. There are many signs of anxiety in dogs, and they can change over time. Some of them include:3

Lowered or tucked tail Trembling/shaking
Ears pulled or pinned back Increased whining, howling and/or barking
Yawning or panting Diarrhea
Nose or lip licking Reduced or absent appetite
Cowering, crouched body posture and/or hiding Destructive behaviors

If your dog is showing one or more signs that he’s anxious, I strongly encourage you to make an appointment with your veterinarian for a wellness checkup. It’s important to rule out an underlying medical condition that may be the cause of or a contributor to the anxiety.

8 Common Triggers for Anxiety in Dogs

Some of the causes of stress in dogs are species-specific, while others are triggers that can cause anxiety in humans as well. And just like sensitive people, sensitive dogs generally tend to be more susceptible to stress. Some common triggers include:

  1. Sudden loud noises (e.g., fireworks, thunderstorms)
  2. Punishment-based training methods involving yelling, hitting, shock collars, etc.
  3. Adverse relationships with other pets or humans in the household
  4. Unwanted attention such as being randomly awakened from a nap, or being forcibly hugged, kissed or held
  5. Lack of opportunities to express normal species- and breed-specific behaviors such as running, retrieving, hunting, herding, etc.
  6. Exposure to the strange and unfamiliar (objects, animals, people, etc.)
  7. Changes in housing, household routine or household members
  8. Separation from family members, including other pets

As you go about identifying the triggers for your dog’s anxiety, also consider her history. If you adopted her, what do you know about her past? Was she abused or neglected? Is she anxious mainly around men or kids? Other dogs? Some of the things that cause anxiety in dogs can be unavoidable, such as thunderstorms passing through or a move to a new home. However, there are several things you can control to minimize stress and improve your dog’s quality of life. Examples:

  • Use only positive reinforcement behavior training/trainers.
  • Help everyone in the family understand and respect your dog’s need for uninterrupted sleep and human handling he feels comfortable with.
  • Increase your dog’s daily physical activity level, since the vast majority of dogs, especially large breeds, don’t get nearly enough. Daily movement is extremely important in mitigating your dog’s stress response.
  • Dogs left alone for several hours during the day get lonely and bored. If there’s often no one home to keep your dog company, recruit a friend or neighbor or hire a dog walker to take him for a stroll around the block, at a minimum. An alternative is doggy daycare.

Tips to Calm an Anxious Dog

  1. Consider adding a probiotic supplement or fermented veggies to your dog’s fresh, nutritionally balanced, species-appropriate whole food diet, as studies show probiotics reduce stress-related GI disturbances in dogs.
  2. Make sure your dog gets plenty of exercise, playtime, mental stimulation, attention and affection. Daily rigorous exercise is one of the most overlooked, free and effective treatments for reducing stress that very few pet parents take advantage of.
  3. Add a flower essence blend like Solutions Separation Anxiety to her drinking water and invest in an Adaptil pheromone collar or diffuser.
  4. When your dog will be home alone, leave him with an article of clothing or blanket with your scent on it and a treat-release toy, place small treats and his favorite toys around the house for him to discover, and put on some soothing doggy music before you leave.
  5. Also play calm, soothing music before a possible stressor occurs. This may relax your dog and have the added bonus of drowning out distressing noises.
  6. If your dog responds well to pressure applied to her body, invest in a wrap like the Thundershirt; also consider Ttouch, a specific massage technique that can help anxious pets.
  7. Consult a holistic or integrative veterinarian about homeopathic and TCM (traditional Chinese medicine) remedies, Rescue Remedy or other specific Bach flower remedies that could be helpful in alleviating your dog’s intermittent stress.   Diane makes custom blends depending on your unique situation after she talks with your pet to determine the triggers for stress and anxiety. Products I use, always in conjunction with behavior modification, include homeopathic aconitum (or whatever remedy fits the symptoms best), Hyland’s Calms Forte or calming milk proteins (variety of brands).

Calming nutraceuticals and herbs that can be of benefit include holy basil, l-theanine, rhodiola, ashwagandha, GABA, 5-HTP and chamomile.

The essential oil of lavender has been proven to reduce the stress response in dogs. Place a few drops on your pet’s collar or bedding before a stressor occurs or diffuse the oil around your house. There are also great oil blends specifically for calming animals. Diane likes Calm-A-Mile by Dr. Melissa Shelton DVM. http://www.animaleo.info/order-animaleo.html

 

  1. If you’ve adopted a dog who may have had a rocky start in life, I highly recommend a program called A Sound Beginning, which is designed to help rescue dogs and their adopters learn to communicate effectively and form an unbreakable bond.
  2. If your dog’s anxiety seems to be getting worse instead of better, consider an individualized approach to managing her stress by allowing her to choose what best soothes her via applied zoopharmacognosy (self-healing techniques offered through a trained professional).

 

Veterinary Science Can Help Our Pets

By Diana Bocco

Veterinary science has come a long way in the past decade. Pets are living longer, healthier and happier lives thanks to scientific developments such as transplants, new cancer treatments and even stem cell therapy.

 

Here are some of the incredible things our pets now have access to thanks to advancements in veterinary science.

 

New Canine Cancer Vaccine

 

Most common pet diseases already have an associated vaccine that can reduce or eliminate the risk of getting sick. So scientists are now exploring more advanced options to prevent and treat serious illnesses like cancer.

 

The Oncept canine melanoma vaccine is a unique therapeutic vaccine that seeks to treat canine cancer. It has revolutionized the world of veterinary science.

 

“The Oncept melanoma vaccine is Merial’s attempt to trigger the dogs’ own immune system to fight off cancer and heal itself,” says Dr. Carol Osborne, DVM, from Chagrin Falls Veterinary Center & Pet Clinic. Dr. Osborne is leading a US trial that maps the immune cycle of dogs to choose optimal cancer-treatment times. “This is opposed to chemotherapy, which has been the historical practice of trying to treat cancer with strong toxic drugs but in most cases not curing or eliminating the disease.”

 

The canine melanoma vaccine is made of DNA that is encoded with a human protein called tyrosinase (tyrosinase is found in cells called melanocytes that produce a pigment called melanin), Dr. Osborne explains.

 

“Human tyrosinase is very similar to canine tyrosinase,” says Dr. Osborne. “Melanoma cancer cells are loaded with tyrosinase, and the theory is that the two proteins cross-react and trigger the dog’s body to eliminate cancer.”

 

The canine melanoma vaccine is being used extensively by cancer specialists in dogs with stages 2 and 3 of malignant melanoma to try to help prevent it from spreading into the dog’s lymph nodes and lungs, explains Dr. Osborne.

 

“Since 2007, results indicate that dogs who receive surgery and the vaccine survive approximately 12 months longer than those who receive surgery but do not receive the vaccine,” Dr. Osborne adds.

 

Immunotherapy for Cancer in Pets

 

Immunotherapy has become the golden treatment for cancer in pets, thanks to new studies like those conducted by Mason Immunotherapy research studies at the University of Pennsylvania School of Veterinary Medicine.

 

Dog and cat immunotherapy involves getting modified bacteria to target a tumor-specific protein, explains Dr. Osborne. This forces the immune system to fight the cancer cells and heal on its own.

 

Gene Therapy Treatments

 

Scientists are also looking into recombinant DNA (rDNA) to help treat cancer in dogs.

 

“Recombinant DNA has opened the door for gene therapy,” says Dr. Osborne. “Despite ethical concerns, gene therapy would theoretically treat a wide range of diseases by allowing veterinarians to replace abnormal and/or missing genes in the animal.”

 

Preliminary studies include a new therapy for canine mammary cancer using a recombinant measles virus, and a 2018 study that concludes that “oncolytic viruses are gaining ground as an alternative approach for treating cancer in dogs and humans.”

 

While these treatment options are still in the early stages of development, they offer a world of possibilities for the treatment of cancer in dogs.

 

Transplants and Replacements for Pets

 

Eye lens transplants have become rather commonplace to treat cataracts in dogs, according to Dr. Bruce Silverman, VMD, MBA, owner of Village West Veterinary. Dr. Silverman also adds that pacemakers are also becoming more common in dogs.

 

“Organ transplants, on the other hand, are still quite rare and are generally done in university settings,” says Dr. Silverman.

 

The most common organ transplants at this time are kidney transplants for cats. According to the College of Veterinary Medicine at the University of Georgia—one of the few centers in the country that does cat kidney transplants—the typical patient is a cat with chronic kidney disease, as dogs’ metabolisms are different and more likely to reject the new kidney.

 

The transplant program, which is limited and costly (a kidney transplant can set you back $15,000), requires that all donor cats are adopted by the recipient’s family. 

 

Bone marrow transplants are also available for dogs with lymphoma, leukemia, multiple myeloma or generalized mast cell cancer, according to Dr. Osborne. “North Carolina State Veterinary Hospital in Raleigh, North Carolina, and Bellingham Veterinary in Bellingham, Washington, offer the procedure,” says Dr. Osborne.

 

The good news is that dogs weighing over 35 pounds without any major organ dysfunction have enjoyed a 50 percent cure rate for a disease that previously was uniformly fatal, says Dr. Osborne. 

 

“The procedure is quite involved and requires several steps,” says Dr. Osborne. “First dogs undergo chemotherapy, which is used to achieve remission of cancer, then the dogs’ own blood cells are harvested, after which these canines undergo two sessions of full-body radiation.”

 

Finally, the harvested blood cells are then transplanted back into the dog before he’s prepared for recovery, which requires two weeks in complete isolation, according to Dr. Osborne.

 

Stem Cell Therapy for Pets

 

Stem cell therapy is used most often for degenerative disorders in dogs and cats.

 

Although results are somewhat disappointing at this time because it’s such a new development, Dr. Osborne says stem cell therapy for dogs and cats is very effective to treat osteoarthritis of the hips, elbows, stifles and shoulders, primarily in dogs. 

 

Scientists are now working hard to extend the healing benefits of stem cell therapy for dogs and cats.

 

“At the moment, improvements in joint function, range of motion and quality of life have validated lasting effects for an average of 6 months post-procedure,” Dr. Osborne says.  

 

Excessing Drooling in your Dog??

As seen on PETMD -Reviewed for accuracy on April 1, 2019, by Dr. Jennifer Coates, DVM

When it comes to drooling in dogs, “normal” is a relative concept. “Saliva (drool) is a normal part of digesting food, and there is a ‘normal amount’ of saliva that is produced at all times,” explains Dr. Rory Lubold, DVM, CEO of Paion Veterinary in Arizona. “Some breeds of dog, and some dogs within a breed, can produce a higher-than-average amount of drool.”

 

As a general rule, most breeds of dogs do not normally have a problem with drooling, according to Dr. Jill Lopez, DVM, MBA, director of marketing and strategic partnerships at the Essentials Pet Care Clinic in Port Richey, Florida. “However, dogs with large upper lips are known to be droolers—and this includes Mastiffs, St. Bernards, Bloodhounds and Newfoundlands.”

 

Excessive drooling in dogs that don’t normally drool can be a sign of a health issue, so it is important to notice when your dog is drooling a lot or more than they usually do. Dr. Lubold advises pet parents to observe what’s typical for their pet so they can easily identify changes.

 

If you notice your dog drooling more than normal, it is important that you talk with your veterinarian as soon as possible.

 

Here are some potential causes of excessive drooling in dogs so you can have a more informed discussion during your vet visit. 

 

Anticipation and Stress Can Result in Excessive Drooling

 

Anticipation can be triggered by both positive and negative things. For example, you’ve probably seen your dog drool a little more than usual when it’s time for dinner or if they think you might share some tasty food with them.

 

“Some dogs may drool if they see a treat or maybe when you are opening up a can of food,” Lopez says. “The body is preparing to eat and is increasing the salivation level.”

 

You might also notice excessive salivation as the result of anxiety caused by visits to the vet, a car ride or even moving to a new home, says Dr. Lubold. Dogs may drool during a car ride due to stress and/or motion sickness.

 

“Stress can be a powerful reason for dogs to salivate,” Dr. Lubold says. “Often it is accompanied by other signs of anxiety, such as restlessness, panting or even diarrhea.”

 

Pain-Induced Drooling

 

“Oral pain or pain in the abdomen often leads to nausea, panting, vomiting and drooling,” says Dr. Lubold.

 

Abdominal pain often appears together with other signs, such as restlessness, diarrhea, loss of appetite or even abdominal distention. Some dogs will brace, or “guard,” their abdomen to avoid being touched where it hurts.

 

If you suspect the drooling is caused by periodontal disease or other oral problems such as a tumor or infection, Dr. Lubold recommends looking for signs such as a mass, blood, pus or a foul odor coming from the mouth.  

 

Eating Dangerous Plants Can Cause Drooling in Dogs

 

Many plants are irritating or poisonous to dogs when chewed on or eaten and can cause anything from drooling to life-threatening side effects. While there are literally thousands of potentially poisonous plants, Dr. Lopez says some are more likely to be found in households everywhere. 

 

“One type of plant that can cause drooling in pets are those that contain calcium oxalate crystals, such as peace lilies and mother-in-law’s tongue,” explains Dr. Lopez. “When the plant is bitten, the crystals inside cause irritation of the oral cavity, mouth, tongue and lips.”

 

While Dr. Lopez says these types of plants are not life-threatening to dogs, they will make them very uncomfortable if ingested. “Dogs will drool excessively and sometimes paw at their mouth,” says Dr. Lopez.

 

Furthermore, Dr. Lubold says, “If a plant is toxic enough to be the cause of excessive salivation, it likely also has other serious effects, and a veterinarian should always be consulted.”

 

You can also call a poison hotline, such as ASPCA Poison Control or the Pet Poison Hotline; it’s helpful if you can tell them the name of the plant your pet ate.

 

Neurological Conditions Will Cause Drooling

 

Dog drooling could indicate damage to the nerve that connects to the salivary gland, damage to the salivary gland or damage to the brain, says Dr. Lopez. “Other signs, like uneven pupils, lethargy and weakness may accompany this,” Dr. Lopez adds. 

 

Some neurological conditions can also cause too much saliva production or even make it difficult for your dog to swallow the saliva produced, says Dr. Lubold.

 

If you notice that your dog has difficulty swallowing, talk to your vet right away.  

 

Oral Injuries Can Lead to Excessive Dog Drooling

 

Injuries to the mouth are a common cause of excess drooling. Blunt force trauma, chewing on a sharp object, or foreign material that’s lodged in the mouth may all be to blame.

 

Dr. Lubold adds, “Many caustic chemicals (such as battery acid) and any electrical burn (like chewing an electrical cord) can cause bleeding and sometimes drooling. Many times, these injuries or chemicals can also cause other health problems, and seeking veterinary care right away can limit the extent of the injuries or toxins.” 

 

Chemical burns are often accompanied by pain and lesions, and your pet may paw at his mouth, says Dr. Lopez. If you notice any of these, call your vet right away, even if you can’t tell what caused the irritation.   

 

By: Diana Bocco

 

Pet-Safe Indoor Plants

Pet-Safe Indoor Plants

By Dr. Karen Becker

If you’re like a lot of pet parents, you’d love to fill your home with greenery, but are unsure which indoor plants are safe for dogs and cats. Whereas some pets are utterly uninterested in sampling houseplants, others — especially cats — can’t resist a nibble or even a mouthful, so your concern is warranted.

Actually, if you have cats that like to sample your houseplants, I recommend providing them roughage that is more palatable and safer than houseplants. You can do this in the form of cat grass, which is wheatgrass, or by offering fresh sunflower sprouts.

In addition to adding beauty and color to your home, plants improve the air quality as well by removing toxins like carbon monoxide, formaldehyde and benzene from the air you and your family (including pets) breathe. These toxic compounds are released into the air each time you use chemical-based products inside your home.

Plants also increase the level of health-inducing oxygen in homes by absorbing the carbon dioxide exhaled into the air by both humans and pets and replacing it with oxygen.

“Oxygen is critical for good brain and muscle function,” veterinarian Dr. Cathy Alinovi tells PetMD. “Therefore, stagnant air can lead to tiredness and brain dizziness, and can even affect heart function. The good news is, safe indoor plants help clean the air and increase oxygen concentration while decreasing waste products.”1

The following is a list provided by PetMD of a few plants that are safe for cats and dogs:2

Perennials Herbs Succulents Palms Ferns
African Violet Basil Blue Echeveria Areca Palm Boston Fern
Aluminum Plant Cilantro Christmas Cactus Dwarf Palm
Bamboo Dill Haworthia
Friendship Plant Lemon Balm Hens and Chicks
Spider Ivy Rosemary
Swedish Ivy Sage

For an extremely comprehensive list of both safe and unsafe plants, visit the ASPCA’s “Toxic and Non-Toxic Plant List – Dogs” and “Toxic and Non-Toxic Plant List – Cats.” The lists are in alphabetical order, and each entry links to a picture of the plant.