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Health Potpourri - Four Unrelated Topics |
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Written by Myra Ehrman, RN, BA, BS, MScN
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Original Article Written by Myra Ehrman, RN, BA, BS, MScN, on behalf of the Health Education Committee, CKCSCC. Originally Published in The Cavalier King Charles Spaniel Club of Canada Newsletter,"Quotes", in November, 1996
Episodic Falling Syndrome
Taurine and L-Carnitine Supplementation
Prescriptions Filled
First Aid Supplies to keep on hand
EPISODIC FALLING SYNDOME OR EPISODIC COLLAPSE
One of the CKCSCC members bred a puppy and sold it at eight weeks of age. At about the age of four months, he started splaying his legs and falling over. This did not happen with every walk, and was more noticeable when meeting another dog. The owners wondered if there was some correlation to the dogís excitability. The owners took him to their vet, who first began by investigating the dogís cardiac status. He had a heart exam, and an ECG was taken and sent to New York for interpretation.
The breeder then took the dog into a clinic staffed with specialists. First the dog was seen by a vet with a cardiology background. This vet did not come up with any significant findings, but did suggest the dog be seen by a neurologist. A lot of blood work was taken, and a special muscle biopsy was done and a Tensilon (anticholinesterase edrophonium chloride) test was given . Since this medication usually improves a condition called myasthenia gravis, the fact that there was no improvement ruled this condition out. The final diagnosis was "Episodic falling syndrome". The dog is now one and a half years old, and still occasionally has some episodes. The breeder wanted to bring this to club membersí attention, and also raised the question as to how common this syndrome is.
Neurologists affiliated with university teaching hospitals were contacted for assistance in researching this syndrome (I love the Internet for these kinds of contacts). Articles in the professional literature had already been located by the dogís owners. One is "Muscle hypertonicity in the cavalier King Charles spaniel - myopathic features" (1986) by J.A. Wright, S.E. Brownlie, J.B.A. Smyth, D.G. Clayton Jones, P. Wotton", Veterinary Record ,118, 511-512. Another is "Episodic falling in the cavalier King Charles spaniel" (1983), by M.E. Herrtage, A.C. Palmer, Veterinary Record,112, 458-459. The Compendium ? Small Animal, p. 143 also discusses this condition.
Both Drs. R.M. Clemmons of the University of Florida and Dr. W.B. Thomas of the University of Tennessee concur that the condition is not a common one and has not been greatly studied. Even though the articles cited from the Veterinary Record are from 1983 and 1986, no more recent publications were found (except one from Sweden in 1990).
The descriptions of the syndrome in these articles suggest this is a transient and intermittently occurring condition, which was first identified in the 1960s. The article "Episodic falling..." documents nine clinical cases, seven of which were female. In fact, in most of the cases the first signs of the syndrome were seen when the dogs were between three and four months of age. The article on "Muscle hypertonicity..." describes eight dogs which had this syndrome; seven of the dogs were male. Their ages ranged from five-and-a-half months old to four years old. Dogs described in both articles were given thorough neurological exams before and after exercising, and none of them showed any evidence of neurological problems. Blood tests all came back with normal values. As with the club memberís dog, Tensilon was given and no improvements for dogs described in both articles were seen with the administration of the medication. Muscle biopsies were taken from five of the dogs, with some abnormalities of the muscles seen. It appears the disorder is a type of metabolic muscle disorder. It is probable that the disease is an inherited condition.
The description of what happens when Episodic Collapse occurs is as follows. After a period of exercise, which may be of variable length, animals that are afflicted develop a laboured, bounding gait in the hindlimbs which appear stiff and are partially turned out. The movement resembles the hopping of a rabbit. The dogís back may become arched, with the head close to the ground and the rear high in the air, and the dog often cries out. With the lack of coordinated movement, the dogs collapse on their sides or pitch over on to their noses. There is no loss of consciousness or change in colour, although muscle tone in the legs was noted to be increased in the "Muscle hypertonicity..." article, and the legs were held in ëextensor rigidityí. After a short time, which can vary, the animal gets back on its feet; some were noted to be quite distressed, while others acted as though nothing had happened. Stress, apprehension, and excitement can cause an episode. There is no known effective treatment, although if the owner picks the dog up, this seems to help with the recovery phase.
If any club members are aware of other dogs suffering from Episodic Collapse, you might wish to advise the Health Education committee in confidence by contacting Myra Ehrman at marcrest@sympatico.ca.
Taurine and L-Carnitine SUPPLEMENTATION
Taurine and carnitine are amino acids which are needed by dogs, cats, man, and probably most mammals for proper strong functioning of muscles. Carnitine is found in red meat and dairy products; it is required for transportation of a coenzyme into the mitochondria of muscle cells, so that energy is produced. The precise role of taurine is not as well understood, but what is known is that in cats a deficiency will result in decreased contractility of heart muscle.
There is some thought that dilated cardiomyopathy in dogs results from dietary deficiencies of these amino acids. It is also possible that some animals may not be able to properly metabolize the nutrients, rather than not have enough of them in the first place.
Dilated cardiomyopathy is most common in giant breeds; Doberman Pinschers are very vulnerable to this disease. Many areas of the heart muscle die or become fibrotic. Symptoms include rapid onset of weight loss, exercise intolerance, shortness of breath, and abdominal distention. The outlook is poor, and dogs seldom live for more than a few months after onset. It must be noted this is a very different disease from Mitral Valve Disease which afflicts Cavaliers.
American Cocker Spaniels with dilated cardiomyopathy have shown evidence of both carnitine and taurine deficiencies. Trials of giving dogs of this breed both taurine and carnitine supplementations have been done, and the dogs apparently responded well to the supplementation.
The recommendations as to whether supplementation is effective are far from clear. This issue was discussed in an article by Dr. Carin A. Smith (1995). Current Concepts, Looking for consensus in treatment of cardiac disease. Journal of the American Veterinary Medical Association, 206 (3), 307-312.
Plasma taurine should be measured in any case of dilated cardiomyopathy in a breed that isnít typically affected with the disease, Dr. Kittleson said. We have seen variable results with taurine supplementation in these cases; sometimes the response is dramatic. I supplement taurine at the rate of 500 mg/kg, BID [twice a day], in a Cocker-sized dog. If there is no echocardiographic response in 2 to 3 months, adding carnitine may help.
Dr. Edwards, another vet quoted in this article, indicated he expected as research continues that taurine and carnitine deficiencies will be identified in many more breeds.
Dr. Michael OíGrady, the cardiologist from the University of Guelph ,Ontario Veterinary College, Veterinary Teaching Hospital, who is working with the CKCSCC to collect data on Mitral Valve Disease was consulted by e-mail about what he thought of giving L-carnitine and taurine supplements to Cavaliers suffering from MVD. In his reply dated 08/16/96, he stated :
To our knowledge a deficiency in taurine is not related to MVD. Serum taurine can be assayed to confirm this. We send our samples to McMaster. Taurine is related to dilated cardiomyopathy. As for l carnitine the picture is muddier. We have no data as to whether l-carnitine is up or down in MVD. It appears blood assays are useless to address this concern. One needs to obtain a myocardial biopsy to determine if l-carnitine is involved. It is my guess that l-carnitine is low in all dogs with heart failure of any cause (this is unconfirmed) and that reduced l-carnitine is not causal but a result of the disease.
Curiously, an article in the August 3, 1996 issue of The Toronto Star addressed the fact that amino acid supplementation is not legal in Canada. L-Carnitine, which is fairly expensive and is used to supplement carnitine deficiency, falls under this category. Since there are no medical contraindications for supplementing taurine and carnitine, we thought weíd try supplementing one of our Cavaliers , who is also getting medically prescribed drugs for her MVD as well, with some of these amino acids. I wondered at the time the L-Carnitine was purchased why the health food store employee snuck into a locked closet to get the bottle out. Meanwhile, or so the article in the paper indicated, supplements that fall under this category can be purchased from U.S. sources and brought back or mailed over the border. Go figure.
BUYER BEWARE - GETTING PRESCRIPTIONS FILLED OUTSIDE VET CLINIC
In the summer of 1996, one of our Cavaliers was brought in to the vet for assessment of a possible urinary tract infection. After the lab work came back with evidence of a low grade infection, our vet decided to start the dog on a course of antibiotics. Since we couldnít get to his office prior to closing time to pick up the medication, we decided to have him call the prescription in to a local pharmacy that we use for ourselves.
When my husband came home with the new medication, I read the bottle label and accompanying literature quite carefully. The bottle was clearly labeled, "Give one teaspoon three times a day until finished". I knew the vet had mentioned the antibiotics would run for about 10 days, but other than that I left it between him and the pharmacy to get the order straight.
A medicine cup was used to pour out the amount (1 teaspoon = 5cc), and since the dog wasnít keen on the taste, the medicine was then drawn up in a syringe and squeezed into the back of her throat (about 3 squeezes). So I knew with some precision she was getting the amount ordered. I was also faithful about giving her the medication approximately every eight hours, or three times a day.
After a day or so, I wondered if there had been a problem in the dispensing of the medication. It just did not look to me like there was enough in the bottle to last for 10 days of treatment. After the dog had received the medication for three days, I brought the bottle back to the pharmacy to check (especially after I had measured out water in the amount I thought was required of the medication, and saw I had much more water than I ever had of medication).
The same pharmacist was on duty who had originally dispensed the medication. When I pointed out the problem, her first response was, we had been given the wrong size bottle. Then she said, the medication was only ordered for twice a day. I pointed out the label on the bottle, and she immediately became very shaky , teary, and flustered. Why? Because a dispensing error had been made, and she had been responsible for it.
Our vet was called immediately, in case he required the dog back in the office for additional blood or urine tests, because after all, she had received an extra dose of medication for three days. Fortunately, this particular medication was one in which he was not concerned about the extra amount given. The pharmacist also suggested we call the Poison Control Centre, and they too verified that there was no cause for additional concern.
The pharmacist had had a bad week, and there were many distractions. She knows the importance of correct labeling. She knows the consequences of what can happen when too much of some medications are given. She felt awful when this mistake was brought back to her attention.
Moral of the story? If something doesnít seem right to you about your petís medications, ask. Ask the vet what he or she is prescribing, the dosage, if the medication should be taken with meals or not, and any side effects that you need to monitor. If you get the prescription filled by a pharmacy (which, after all, is more used to dispensing medications for people than for animals), make sure YOU have also been given the prescribing information by the vet, so you can check if all is well once it has been filled. I know the pharmacist involved learned something through this experience, and so did I.
FIRST AID SUPPLIES TO KEEP ON HAND
At one of the education sessions held at a Cavalier Fanciers of Southern Ontario meeting, veterinarian Dr. Julian Van Gorder spoke about some canine first aid issues. He also supplied the group with a list of items worth keeping on hand in case of an emergency. The list is provided here, along with a few comments. You are advised to always consult with a veterinarian prior to inducing vomiting. For all but minor injuries (such as cutting a toenail and having it bleed) you are advised to seek proper veterinary attention.
- †Bandages, gauze tape, hypo-allergenic tape, tongue depressors (to use as splints).
- Scissors, pliers (for porcupine quills), tourniquet (rubber tubing) - *n.b. do not leave tourniquet on for an extended period of time.
- Polysporin topical first aid ointment, polysporin ophthalmic and otic (eyes and ears); furacin (another topical first aid ointment), hibitane skin cleanser to scrub your hands and animalís wounds.
- Muzzle (can be made from leash, long strip of cloth, etc.) - important to tie it on with the first knot over the bridge of the nose, second knot under the jaw, and then finish tying behind the ears with a quick release bow.
- Styptic pencil, silver nitrate, or Quik Stop - to control bleeding from cut toenails. Do not forget to apply pressure to the bleeding site in addition to the clotting agent.
- Rectal thermometer and vaseline jelly (use prior to insertion). Normal temperatures for an adult dog range from 100o F to 102.5o F.
- Pepto-Bismol - 1 teaspoon liquid for every 5 lb. or 1 pill every 15 lb, from one to three times a day, to help control diarrhea and vomiting. If diarrhea continues for more than a day or two, consult your veterinarian.
Note: kaopectate is not as good a product to use by itself for diarrhea.
Puppies with diarrhea - ? kaopectate and ? Pepto-Bismol works well
- Gravol (dimenhydrinate) 25-50 mg every 8 hours for vomiting or motion sickness. You can also use Bonamine (meclizine) 25 mg once every 25 hours per dog.
- Hydrogen peroxide (H2O2) - give 5-10 ml (or cc) - (measure with a syringe) every 15 minutes to induce vomiting when the animal has eaten something toxic, such as chocolate or other items - usually 3 doses or less is sufficient. This must be done within 2 hours of ingestion. Do not induce vomiting if acids, alkalis, or petroleum-based products have been ingested, or if the pet is unconscious or semiconscious.
- NaCl (table salt) can also be used to induce vomiting, but hydrogen peroxide is better.
- White vinegar to make "swimmerís solution": one part vinegar to 2 parts or 3 parts water - to use on dogs with water in their ears. This mixture is also a good routine preventive.
- Lard or cooking oil - massage in to remove tar from the hair coat or feet.
- Mineral oil - 8 - 10 drops per ear will drown ear mites - treat for 1 week, stop for 1 week, repeat treatment for 1 week.
- Brewerís yeast 0.2 gm/kg daily for fleas (Dr. Van Gorderís comment is, "Very controversial, if it works for you...Great!).
- Buffered or regular aspirin - the average Cavalier dosage is about 80-90 mg, or º of a 300 or 325 tablet no more frequently than every 12 hours - for fevers, deep joint pain, arthritis. Please administer with food to reduce the risk of gastric upset.
- Benadryl 2-4 mg/kg or 1-2 mg/lb (usually one 25 mg tab) if the dog gets vaccine reactions or hives. If the dog has a history of vaccine reactions, give Benadryl prior to receiving vaccines.
- Tranquilizers - be very careful with older animals or if travelling by air!! Please discuss with your veterinarian prior to administration.
- Heartworm pills - start by June 1 or July 1, at the absolute latest, and continue to November 1 if residing in southern Ontario. If travelling in the southern United States through the winter months, tablets must be given year round. Testing every spring is recommended.
Thanks are extended to Dr. Van Gorder for reviewing this list and the recommendations prior to publication.
Disclaimer: Your veterinarian is the most qualified person to answer all of the questions you have about your pet's health. Nothing in this article should be construed as medical advice regarding any individual animalís condition.
© Copyright April 12, 1999.
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