Potpourri - CCL Disease, GOLPP, Tumors, Perineal Hernias, Hyperthyroidism
Cranial Cruciate Ligament Rupture Anterior Cruciate Ligament (ACL) is a common injury in humans, and in dogs. In dogs the same ligament is called the Cranial Cruciate Ligament (CCL). CCL Disease is multifactorial and many times a chronic condition. It is most commonly seen in active dogs, can be hereditary, can occur as a result of trauma, and can be related to an individual’s tibial plateau anatomy. Dogs with steep tibial plateaus are more likely to rupture their CCL.
Clinical signs - You may notice your dog becomes lame on a rear limb acutely, possibly after a slip, fall, or athletic activity. It may be very painful. If it is a partial CCL tear, your pet may partially weight bearing and potentially less painful.
Diagnosis - Your pet’s veterinarian can diagnose a CCL tear during a physical exam. Depending on the stress and pain level, the veterinarian may recommend a sedative and/or pain medication for relaxation in order to complete the physical exam.
Radiographs - X-rays are important to ensure no additional bony abnormalities are present. Many times arthritis is associated with chronic cruciate disease and may be visible on radiographs. If trauma caused CCL rupture, it is good to know there is not any fractures or other bony trauma present.
Treatment - Some small, inactive dogs may heal on their own and be functional; although they may have a bit of a limp. Large or active dogs almost always require surgery. There are multiple surgeries available and you should talk with your pet’s veterinarian about which one is right for your pet. Regardless of the surgery performed, you will need to keep your pet quiet (no running, jumping, playing, etc) for anywhere between 2-8 or more weeks. Dogs that rupture one cruciate ligament have a 60% chance of rupturing their opposite cruciate ligament within two years.
GOLPP Geriatric Onset Laryngeal Paralysis Polyneuropathy (GOLPP) is a disease seen in older dogs, (typically 8-12 years old) many times large breeds, with Labrador Retrievers being over-represented. GOLPP is characterized by gradual paralysis of peripheral nerves of the rear limbs as well as the recurrent laryngeal nerve, which supplies the larynx. This nerve degeneration causes paralysis of the nerves and muscles that open and close the airway. Clinical signs of laryngeal paralysis include loud breathing, exercise intolerance, possibly a change in the sound of your dog’s bark, and may or may not include weakness in the hind limbs. Diagnosis is made by a veterinarian looking in your dog’s throat under sedation (a “sedated laryngeal exam”). Treatment involves surgery to hold the airway open on one side, which is called a laryngeal tie back procedure. Surgery is usually performed on the left side. Dogs that have laryngeal paralysis (regardless of whether or not they have a laryngeal tie back surgery) have about an 8-12% chance of aspiration pneumonia. So any coughing (that is not associated with water or food intake) should be followed closely and examined by a veterinarian and potentially thoracic (chest) X-rays.
Laryngeal Paralysis can cause acute respiratory distress if an affected dog is exposed to strenuous exercise or high temperatures. If this occurs, immediate medical attention is required and may include oxygen supplementation and potentially a temporary tracheostomy tube (a temporary tube into an opening made into the windpipe) to bypass the paralyzed larynx.
Tumors A “tumor” is simply a swelling. There are many different causes of swellings. Abscesses, insect bites, allergic reactions, and cancer are just some of the causes. Your pet’s veterinarian can distinguish between these causes by a physical exam, history and sometimes other diagnostic tests. Each cause has its own individual treatment.
Tumors caused by cancer can be benign or malignant. Benign tumors do not spread to other parts of the body. Malignant tumors usually carry a worse prognosis and have the potential to spread to other parts of the body. Tumors can arise from any type of tissue including bone, skin, internal organs, and even nerve sheaths. Clinical signs of tumors include a swelling. You may feel a swelling under your pet’s skin, or see one in their mouth or ear. The only way to diagnose whether the tumor is benign or malignant, and what type of cell it came from (which dictates prognosis and treatment options), is to obtain cells from the tumor and look at them under a microscope. Your veterinarian might obtain cells by inserting a needle into the tumor (called a “fine needle aspirate”) or by obtaining a chunk of cells, or a biopsy. Fine needle aspirates provide a diagnosis about 70% of the time. Biopsies provide diagnosis almost 100% of the time, but are more invasive, usually more expensive, and may require sedation or general anesthesia to obtain. Treatment and prognosis depend on what the cells or tissue look like under the microscope and what tissue they arose from. Sometimes surgery can be curative, however some tumors require additional surgery,radiation therapy, or chemotherapy.
Perineal Hernias Perineal hernia is when contents from the pelvis or abdomen is pushed between or through the pelvic diaphragm (made up of the coccygeus muscle and the levator ani muscle) into the more superficial tissues. Perineal hernias are most common in intact male dogs. Dogs may strain from a primary problem that may lead to a perineal hernia, so many times perineal hernia is a secondary diagnosis. Primary problems that may cause straining include enlarged prostate, tumors, gastrointestinal parasites, dietary indiscretion, as well as numerous other causes. It is important that when perineal hernias occur, that an investigation into the primary cause of straining is initiated.
Signs of a perineal hernia include straining to defecate, a large bulge to either side or around the anus, and possibly rectal prolapse. Perineal hernias can be diagnosed by a veterinarian on a rectal exam; they will be able to feel the defect in the pelvic diaphragm and sometimes can palpate the contents of the hernia. Any organ in the pelvic can herniate into the hernia and has the potential to become entrapped. This includes the urinary bladder, intestines, uterus, prostate, and others. Clinical signs will differ based on the contents of the henia. For example, vomiting and diarrhea may be seen if intestines are trapped. Difficulty urinating, or straining with no urine production may be noted if the bladder becomes entrapped.
Treatment of a perineal hernia includes surgery to replace the hernia contents and repair the defect in muscular diaphragm. This may include augmentation of the area using surrounding muscles, or sometimes polypropylene mesh is incorporated into the surgical repair for strength. If prostatic enlargement (whether due to cancer or benign prostatic hyperplasia) is present, castration is recommended. Additional surgery may be required depending on the individual circumstances.
Hyperthyroidism in Cats Hyperthyroidism is an endocrine disorder that is commonly diagnosed in cats. It is caused by the thyroid gland in the neck producing too much thyroid hormone. Thyroid hormone affects almost every part of the body and is in charge of metabolism. When the body has too much thyroid hormone clinical signs include weight loss, or no weight gain despite a hearty appetite, always hungry or eating, and having lots of energy. Sometimes cats will have an unkempt haircoat when they have hyperthryroidism. Some cats that are hyperthyroid have a heart murmur. Diagnosis of hyperthyroidism involves a simple blood test. If your cat is diagnosed with hyperthyroidsim, s/he will require treatment for life. The most common treatment is methimazole, a twice a day medication. There are many different ways to treat hyperthyroidism. Methimazole can be compounded into a liquid or a gel that is applied to the inside of the cat’s ear. Commercial prescription diets are also available with medication included in the diet to treat hyperthyroidism, so no medication is required. Cats with hyperthyroidsim require bloodwork usually every six months, as well as close monitoring of their kidney values, as hyperthyroidism can mask kidney disease. However most cats that are diagnosed with hyperthyroidism live long, healthy lives with treatment.