Getting to the Heart of the Matter: November 2018 UPDATE

About 4 months ago, I wrote about a specific type of canine heart disease (dilated cardiomyopathy, DCM) and the recent concern over its association with diet (pet food).

This past week a commentary appeared in a veterinary journal on the subject . It was important to see what is considered expert opinion and have a peek at the results of a survey on this concern, as there’s no doubt it’s a complex issue with serious canine health impacts.

The commentary (quite rightly IMHO) highlights the importance of nutrition and incredible value of obtaining a thorough diet history on all pets as part of a clinic visit. Perhaps as importantly (for me), it also indicates that:

1) there is still an awful lot to learn about nutritional needs-requirements (and how these may vary from dog-to-dog and in dogs of different health states),

2) there is a dearth of peer-reviewed studies, articles or commentaries on canine nutrition, and, 3) there are myriad complexities (and lack of clarity) when it comes to pet food formulation, manufacturing and sales.

The commentary also introduces new terminology (i.e. boutique or exotic diets) to the pet food dialogue. I’m not convinced these terms assist with causation of concern (with respect to cardiac disease or any other). I’d also guess they further cloud a complicated issue (and for me at least, conjure images of fancy French shops) …vs. convey what is (or isn’t) known about these diets and why they may be associated with DCM. The connotation of boutique, i.e. ‘perceived as high-end’, is hard to miss as well….

At present, we simply do not know why (or if) these diets may be linked with canine DCM…and there is much speculation on cause, i.e. low taurine, reduced taurine precursors (i.e. methionine and cysteine), deceased bioavailability, increased (high) fibre preventing enterohepatic binding and recycling, increased taurine loss via the gut and potentially a heightened breed susceptibility…or the association may be naught, i.e. there isn’t one. After all, …a LOT of dogs eat diets containing these ingredients (or ingredients in the speculated proportions), and it appears that the vast majority are unaffected.

Unfortunately, along with the lack of veterinary peer reviewed publications on this subject there has not been disclosure by the FDA on what diets are being investigated… However, I strongly suspect (and really hope!) that plenty of canine diet reformulating (change in diet recipe) has been occurring since this concern was raised, and have my fingers crossed that manufacturers are doing things like:

1)    Ensuring all diets have increased taurine (vs. prior levels)

2)    Ensuring all diets with significant amounts of water-soluble fibre (peas, lentils, chickpeas, tomato pomace, beet pulp, pea fibre, pea protein) have even higher allotments of taurine (again vs. prior levels)

3)    Limiting all new canine diets to 30% legumes (i.e. peas, lentils, chickpeas, pea fibre, tomato pomace)

4)    Including additional methionine to try and provide additional precursors for taurine synthesis (if necessary, and vs. prior levels) 

The recommendations provided by the commentary similarly provided insight on what we do not know about laboratory sampling and various dietary supplements, e.g. taurine. It’s a tough order to advise the checking of taurine when there is a known lack of consistency in lab standards for analysis, or good understanding of what sample is optimum, i.e. whole blood or plasma. Additionally, it’s hard to feel good about advising taurine supplementation without a standardized supplement and/or optimal dose…

So, what’s a dedicated dog-owner (or DVM) to do? Ask (or keep asking) the tough questions about the diet your dog (or your client’s dog) is eating, be aware of this concern and critically evaluate what information is available, and after a thoughtful dialogue on what makes that dog unique (e.g.  risk factors, susceptibilities) and what the diet(s) in question does (or doesn’t) contain…make an informed decision (together) on what is best- for that dog.

We may still have a lot to learn about pet food, K9 heart and overall health & nutrition, but in the meantime, we can work together in a collaborative way to try and keep dogs safe- and maybe even learn more about what they might (or might not) need in the process.

FDA: https://www.fda.gov/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/ucm616279.htm

 

DCM Heart.jpg

The risks of importing (and traveling with) pets

Bridge closed.jpg

We live on an island, and sometimes life on PEI can bring various ‘Alice in Wonderland’ quirks. This past week quite a few folks traveled to the island, and probably more travelers would have reached PEI, if not for the ‘predictably unpredictable’ November weather that resulted in flight delay and bridge closure. A number of travelers brought their pets with them during their visit to PEI (i.e. once the bridge opened), and it made me ponder (not for the 1st time), the infectious disease risks associated with animal importation. Although these risks are highest from imported animals lacking a known medical history (e.g. strays, rescue animals, etc.), particularly those who come from countries with known infectious disease, these risks are still present (albeit on a reduced scale) with any type of animal importation, including owned pets.

beagle in suitcase.jpg

A colleague of mine spends a good deal of time trying to eradicate the incursion of canine influenza into our fair country Canada- and he’s been remarkably successful at this (https://www.wormsandgermsblog.com). However, every time I see an update on canine flu, I heave a deep sigh (hope someone buys that guy a beer!) and wish that the practise of importing higher-risk animals from other countries was something that either, a) didn’t happen, or b) if considered absolutely necessary, was thoughtfully considered (& vetted) prior to doing so. Since, these types of canine influenza outbreaks (or the risk of them occurring) seem largely avoidable with a bit of rational planning, i.e. imported (or adopted) dogs from countries with known flu (e.g. Asia, or portions of the U.S.A with known risk), should be isolated from other dogs for 28 days, until the risk of disease (and disease spread) has passed. 

Over the past number of years, I’ve done consults for or seen patients in Canada that are ill with diseases including leishmaniosis, coccidioidomycosis, hepatozoonosis and trypanosomiasis. These diseases may sound like the poem of the Jabberwocky, but they are in actuality infectious concerns that can affect dogs (and sometimes humans) from places outside of Canada. However, when dogs travel (with their humans) or are imported from other countries, these infectious concerns (just like with canine influenza) may ride along (or cross bridges) also.

As such, I’d gently suggest that any animal importation should be done with a degree of thoughtful consideration (i.e. risk assessment on a sliding scale), in order to minimize adverse impacts on the entire animal community (local, regional and national). Probably this is a tough ask, but as we approach the holiday season (and no…black Friday isn’t a holiday), perhaps it’s a request that’s in keeping with a sense of community, accountability and what is ‘looking a lot like Christmas’ in many parts of Canada?

 

 

Winter is Coming! (Could Leptospirosis be coming, too?)

Winter is coming (& canine leptospirosis may be more likely) … In B.C. and other parts of Canada.

On September 14th, I posted a draft map (http://www.canadian-k9.com/puppy-tales-blog/) provided by our collaborative research team (Universities of Guelph and PEI) on Canadian canine lepto test positive incidence.

This past week, an article quoting a veterinarian in Sooke, British Columbia was released, warning dog owners about a local sick dog that had been diagnosed with leptospirosis and encouraging vaccination to prevent more sick dogs (https://www.goldstreamgazette.com/news/veterinarian-warns-dog-owners-of-leptospirosis-in-greater-victoria/)

Test results (like those on our map) don’t equate with clinical disease in all instances, and that’s important to keep in mind. However, based on our preliminary assessment of the Canadian lepto test results, it’s also not too surprising (to me) that dogs in BC are at risk of (and are it seems) being diagnosed with leptospirosis. How many dogs are being diagnosed or are sick is quite another topic, since lepto: 1) isn’t always on dog owners’ (or veterinarians’) radar, and as such may be missed by not being considered or tested for, and 2) the lepto vaccine isn’t considered a ‘core’ vaccine in the traditional sense, and thus not used when perhaps it may be beneficial (https://www.aaha.org/guidelines/canine_vaccination_guidelines/practice_vaccination.aspx).

Lepto has been worrying me (hence the blogging), and there are few things I hate more than disease in dogs that I consider largely preventable through awareness and vaccination. The end result of that concern is that we’ll be expanding the Canadian K9 Lifetime Study in early 2019 to try and sort out a few more canine welfare troubles…or make a solid attempt on it.

Ongoing we’ll include Leptospira spp. serovar testing on puppies (and as they grow up-dogs) and also be expanding new puppy enrollment into Western Canada. We appreciate the support of those in the Canadian Veterinary Community who have helped us enroll such amazing puppies and pet-owners. We simply cannot do our work to raise awareness and help protect dogs without this- and it is our hope that you will continue to help us achieve these expanded Canadian K9 goals.

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Rat-a-tat-tat (or Rin-Tin-Tin-Tin) …K9 Sentinels marching in

Rin Tin Tin.jpg

There are certain words that guarantee my interest, and a short list of these (in no particular order) would include: Dogs, Canada, Infectious, Food, and the names of my two human children (probably accessing the internet right now). As such, I was thrilled to see a review article featuring the first three, Dogs as sentinels for Human Infectious Disease and Application to Canadian Populations: https://www.mdpi.com/2306-7381/5/4/83

The publication takes on the valiant task of summarizing research utilizing man’s (or in my case, woman’s) best friend, Canis familiaris (aka the dog) as a sentinel for human infectious disease, i.e. dogs being sick with or that have had exposure to disease-causing pathogens acting as a flashing warning sign for risk to the 2 legged animal (i.e. you, me and…girls-it’s time to stop with the screen time!). As is no real surprise, the idea of using dogs as infectious disease sentinels isn’t very common and per the article is even more radical for us Canadians (only 3% of the included studies, or if you prefer 4/142).

Animals have long been used as human risk sentinels, and as someone who spent much of my childhood in Flin Flon, Manitoba (https://en.wikipedia.org/wiki/Flin_Flon) the author’s use of ‘canary in the coal mine’ was a great way to consider (and re-consider) myriad ways animals have worked to warn us of threats to human health- be these environmental or infectious disease related.

In many ways dogs are the ideal sentinel for human health risk and I’ve written about this before on the Pets and Ticks website, while paraphrasing (parroting) Public Health Ontario’s Systematic Review on Companion Animals and Tick-borne disease (https://www.petsandticks.com/companion-animal-and-tick-borne-dis), which identified considerably more studies (n =44). For the very few of us who do research with dogs acting as sentinels, the human-animal bond and wealth of shared environment, e.g. dogs sleeping in the same room,+/- on the bed, and sharing a life full of things both of us (i.e. dogs and people) need (i.e. snuggles and all items unconditional), makes dogs the ideal (and admittedly just plain fun) research warning bell.

Most of the research (76%) identified by the review was on the use of dogs to estimate seroprevalence (blood antibodies in most cases) to certain pathogens that can cause infections, such as those spread by Ixodes scapularis (black-legged) ticks, most commonly Borrelia burgdorferi (the agent of Lyme disease), but also potentially emerging anaplasmosis, babesiosis and Powassen encephalitis. In ‘Our true north, Canada’, the researchers pointed out that using dogs to look for: 1) viruses like California serogroup viruses, Chikungunya and West Nile, 2) bacteria and rickettsia such as, Rickettsia and Ehrlichia spp., and 3) parasites, like the worm Dirofilaria immitis (canine heartworm), should be strongly considered due to disease emergence caused by our homeland’s increasing hospitality to ticks, mosquitoes and other disease vectors.

Finally, the study concluded with what most of us who do this type of research already know…in order to achieve study ‘do-ability’ a number of critical factors are non-negotiable. I’ve summarized these (and added a few) to create a ‘Top 10 Needs for K9 Sentinel Surveillance Studies” list:

1.    Be very clear on what you are looking for, i.e. what disease, type of disease emergence, and/or range of disease spread

2.    Do the study in an identified risk (or emerging risk) region

3.    Ensure you have study participants (sentinel units) such as veterinary clinics and pet-owners who will participate, i.e. no sentinels = no study

4.    If you’re looking for something new (emerging), start with naïve (negative for the bug) dogs and follow them over time and space (see #2)

5.    Hope (really hard) that you can repeat your sampling. That means relying on your people (participants and sentinel units) and trusting that they will enable continued study participation (study engagement) and repeat that for as long as the study lasts. This is a big ask.

6.    Allow the researcher (s) time, so as to actually ‘do’ the study.

7.    Allow the researcher (s) funding, so as to actually ‘do’ the study.

8.    Be pet-ethical. Never forget that these dogs have a very important job in many cases- to be a beloved companion. So, don’t do any testing beyond what they are already receiving as routine care from their dedicated veterinary clinic, such as an annual blood draw. Think of them like your own pets i.e. they are not ‘study subjects’.

9.    Save your samples- so that if something changes (or a new test or disease emerges) you can go back and look for it (whatever ‘it’ may be)

10. Work with your community of dedicated pet-owners and sentinel clinics- they know the dog best- and can provide a wealth of information reaching far beyond a blood test. This can help you sort out health concerns, risk factors (for the dogs and their people) and put things like travel beyond or between regions into correct data interpretation contexts.

Working with our canine protectors is not a new concept, but it can be a novel for some researchers and particularly funding agencies. The review also does a nice job (IMHO) of emphasizing that enhanced communication and collaboration between doctors of all species (veterinary and human), is looking more and more likely to be the way to identify, increase knowledge and stay safe from intruding infectious disease, particularly in Canada.

It’s heartening to see that research such as the Canadian K9 Lifetime Study or Pet Tick Tracker are regarded as illuminating (at least by researchers from the land of bagpipes, whiskey & Gaelic), and I’ve no doubt that dogs will continue to shine a Lyme-light on ground-breaking studies, that similarly helps their humans.

Cough, gag, hack, snort…STOP (CIRD-C spread)

Dogs who cough are a common concern for pet-owners and veterinarians. Just like in people, coughing, sneezing and hacking are frequently (but not always) associated with an infection of the lungs, trachea (windpipe), nose and/or eyes. Unfortunately (and again just like in people), it’s not possible to know just by looking or listening what type of infection (bacterial, viral, etc.) is causing the clinical signs (symptoms in people). In dogs, the myriad possible infectious causes of coughing, snorting and hacking (aka canine infectious respiratory disease complex-CIRD-C) makes things challenging. This can impact veterinarians knowing what to do to help patients feel better, AND how to prevent other dogs from becoming sick if they are in contact with those who are coughing or hacking, or in contact with those animals who are carrying bacteria or viruses without showing clinical signs (canine carriers) but are still able to pass on disease.

It’s not fun to feel ill or see those we care for get sick, and the first reaction as devoted parents of pet patients is to seek relief. This typically means heading into the veterinary clinic for diagnosis and therapy. Unfortunately, seeking aid in this way can endanger other dogs through spread of infection, i.e. dog nose to dog nose contact or cough droplets inhaled in a shared air space like a veterinary clinic lobby, treatment room, or ICU. When people (the big and little versions) are sick with a respiratory infection, most clinics will have you check in and wait at a different location from everyone else or put on a mask.  Why wouldn’t we want the same level of precaution (and protection) for our pets? …granted the mask thingie is less easily done with animals, i.e. not practical aside from trying it for fun with your dog at home and please send me pictures if you do. 

The very best thing to do when your dog suddenly (acutely) begins coughing, hacking or snorting is to contact your veterinary clinic to let them know what you are worried about BEFORE walking into the clinic with your dog. This type of ‘STOP, CALL (email or text if you prefer) and then PROCEED’ strategy with patients who have an acute onset of cough or nasal discharge can reduce spread of illness to other dogs who may happen to be in the veterinary clinic. In fact, your veterinary clinic may ask that you remain in your car with your dog and then come out to you to do an exam and ask questions to gather more information. This isn’t because they don’t like you (or your dog) it’s because they are responsible for all the other dogs who come to the clinic to be seen for various ailments- and the last thing anyone wants is to inadvertently spread an infectious disease from one dog to another causing an outbreak of something like canine flu (influenza virus) or another CIRD-C illness (outbreak links below).

So…if you’re worried about a brand-new cough or nasal drip in your dog, please CALL your veterinary clinic to alert them, relay your concerns and ask how they want you to proceed…but please STOP the instinct to hustle your dog into the clinic before doing so. Similarly, veterinary clinics appreciate your input and mentioning that you’re worried your dog’s cough may be infectious can help them remember to take steps to help your dog- and all the other K9 cuties they care for.

 Recent outbreaks of CIRD-C:

Canine Influenza, Ontario, Canada 2018:

https://www.wormsandgermsblog.com/2018/01/articles/animals/dogs/canine-influenza-ontario/

Respiratory disease outbreak in a Canadian veterinary hospital associated with canine parainfluenza virus infection: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3524821/

Spread of Canine Influenza A (H3N2) Virus, United States.

https://wwwnc.cdc.gov/eid/article/23/12/17-0246_article

 

Autumn is coming (& lepto may be more likely)...in Canada.

Autumn is coming (& lepto may be more likely)...in Canada.

Autumn is coming (& lepto may be more likely)…in Canada.

Here in Canada we don’t have much in the way of current publications on K9 lepto hot spots. However, due to the veterinary grapevine, willingness of diagnostics labs to share results and word of mouth, many of us are sadly aware that near the Halifax (and surrounding Nova Scotia) area leptospirosis established itself with a vengeance last fall. Portions of southern Ontario were hit pretty hard with K9 cases as well…and for both regions new cases were being diagnosed well into December 2017. That’s unusual since we don’t tend to think of lepto as a bug that does particularly well in colder climes (i.e. how we traditionally think of the Canadian winter), but times ‘they are a changin’ and at the risk of using 2 song choruses at one go, we (veterinarians) may need to ‘change, change, change’ our thinking on what vaccines are indicated for our specific geographic risk regions. 

 These days, if you live in (or plan to travel to) eastern or Atlantic Canada (and potentially coastal B.C) with your dog, leptospirosis vaccination (i.e. containing the 4 K9 lepto serovars I mentioned in the prior blog (http://www.canadian-k9.com/puppy-tales-blog/) is something you’ll want to consider in order to protect dogs year-round. Particularly as we slide into fall and hope to avoid further outbreaks of severe canine illness. 

 On that note and to help raise awareness, here’s a draft map provided by Scott Weese and our collaborative research team (Universities of Guelph and PEI) on Canadian canine lepto test positive incidence (PCR, ELISA). Data source from December 2008 to May 2018, provided courtesy of IDEXX Laboratories.

Autumn is coming. And lepto may be more likely...

As a native of the Canadian prairies, for much of my life I was oblivious to the glory of fall, and the wonder of cooler nights, warm (but not hot) days AND brilliant red, orange and yellow foliage. However, now that I live in a part of Canada with a fall season > 1.5 weeks, my thoughts turn to the colour yellow for a more sinister reason than 5-star Atlantic Canada leaf-peeping. 

Yellow is the colour I associate with leptospirosis, and it’s a rather nasty bug (bacterium) that can infect and cause a range of illness in dogs. Vets typically diagnose leptospirosis as kidney (urine) and/or liver (jaundice) disease...which is why (for me), lepto = yellow. The bacterium is formally known as Leptospira interrogans, and in dogs we usually think about 4 serovars (strains of the bug) as key: L. canicola, icterohaemorrhagiae, pomona and grippotyphosa.

Typically, lepto is shed in the urine of animals like raccoons, rats and other rodents. These wildlife hosts also frequently populate urban (city and suburbs) environments, (e.g. Toronto where I think a raccoon is running for mayor), and then urinate into puddles or other water sources that dogs splash or wander through, thus becoming infected.

Lepto’s also a bug we tend to find in geographic ‘hot spots’ in N. America, and there’s been a few publications (from the U.S.A.) indicating these higher risk lepto locations (links below). A number of articles also show an increased risk during specific seasons, such as in northern climes, where we tend to see more lepto in late summer/fall…hence the title of this post and my hope to increase awareness and reduce dogs getting sick. 

Lepto links:

Spatial and spatio-temporal clustering of overall and serovars-specific Leptospira microscopic agglutination test (MAT) seropositivity among dogs in the United States from 2000 through 2007. Gautam, et al. https://www.sciencedirect.com/science/article/pii/S0167587710001649?via%3Dihub

Hotspots of canine leptospirosis in the United States of America. White, et al. 

https://www.sciencedirect.com/science/article/pii/S109002331730059X

Seasonality of canine leptospirosis in the United States and Canada and its association with rainfall. Ward, et al. 

https://www.sciencedirect.com/science/article/pii/S0167587702001836?via%3Dihub

Lungworm 'step-dance' to your door

Lungworm 'step-dance' to your door

A Cape Breton ceilidh is a fabulous way to spend a summer evening- and we were lucky enough to take in a few on our recent trip around the trail. The step dancing at the ceilidh (and my 2 girls trying to replicate it) made me think of wiggly worms…and the group of those I frequently consider when on clinics seeing K9 and feline patients are lungworms. 

 

Lungworms are a broad category of parasite which can settle in the lungs (hence the name) of various hosts (e.g. dogs, cats), or for the very unlucky- migrate to other body systems. There are a lot of different kinds of lungworms to be aware of, and while some are found globally, varieties of lungworm can vary regionally. That’s important information dependent on where you happen to live or are travelling to- with or without your pet.

 

Since I spend much of my time in eastern or Atlantic Canada, my ‘Top 5 K9 and feline lungworms’ to consider as: 1) a cause of a disease, 2) to raise awareness for vets and owners, and 3) where possible- take steps toward prevention, includes:

 

1.   Fox lungworm (Crenosoma vulpis)- This worm used to be just in Atlantic Canada; however, in recent years cases have been found in Ontario. The main host (you guessed it) is the fox, which are plentiful here on PEI. Since fox are not that different from dogs, they can be infested, and disease can manifest as coughing. Dependent on where you live, prevalence can be high. In one study of coughing dogs up to 27% were infected: https://www.researchgate.net/publication/11370175_Lungworm_Crenosoma_vulpis_infection_in_dogs_on_Prince_Edward_Island

 

2.   French heartworm (Angiostrongylus vasorum)- This worm really likes to settle in specific spots within countries or geographic locations, e.g. Newfoundland, southern England, France. Clinical disease in dogs can be severe- fatal (e.g. effort to breathe, blood loss) or milder (e.g. cough, exercise intolerance). It’s a nasty one that’s been predicted to spread to other parts of N. America. https://www.ncbi.nlm.nih.gov/pubmed/21310537

 

 

3.   Cat lungworm (aleurostrongylosis)- Unsurprisingly, we think about this wiggler in cats or wild cats, especially those that hunt and eat snails, slugs, frogs, birds or rodents carrying the parasitic larvae. 

 

Here’s a nice review from parasites and vectors that gives some info on what to consider if your cat is acting off or shows any respiratory signs, e.g. cough, wheeze, or working to breathe. https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-016-1671-6

 

 

4.    Eucoleus aerophilus/Capillaria aerophilla- This nematode (worm) is a globe-trotter i.e. found worldwide. Both dogs and cats can be infested, and the eggs are very difficult to kill once shed into the environment. Once again- cough is the concern in your pet, and the disease (and worm) looks to be emerging in various countries it’s not been seen before: https://www.researchgate.net/publication/24212877_Infection_by_Eucoleus_aerophilus_in_dogs_and_cats_Is_another_extra-intestinal_parasitic_nematode_of_pets_emerging_in_Italy

 

 

5.   Finally, rat lungworm…which is (or should be) a bit of an oddball worm to cause disease outside of rats. However, I couldn’t resist including 2 recent reports of disease due to this worm from a traveler-beware standpoint.

 

In China or the Pacific islands, be alert that centipedes may be infested with rat lungworm (Angiostrongylus cantonensis) which if consumed accidentally (or intentionally) can lead to meningitis in humans. http://www.ajtmh.org/content/journals/10.4269/ajtmh.18-0151

 

 

Another report from Hawaii has identified this worm as a cause of neurologic disease in humans (big and little versions) related to consuming raw or unwashed veggies contaminated with tiny slugs or snails infested with the worm: (http://www.promedmail.org/direct.php?id=20180818.5973796

 

 

Rat lungworm might be something to think about for those humans already planning travel far far away from the frigidity of the canuck winter and wanting a novel eating experience- or for those tempted to buy local and not washing the veggies (or anything potentially contaminated with slug or snail trails) thoroughly.

 

 

Parasites are fiddlin’ about everywhere, and while some (like many of the worms listed above) prefer to stick close to their geographic home-base… travel, pet importation and lack of awareness (and prevention where possible) can translate into worm wigglers establishing residence within your own pet- or you. As ever, upping awareness of what worms (and other germs) live where you do (or where you and your pet travel) and practicing simple hygiene dictums (wash your hands, wash your food, don’t eat poop) can reduce risk.