Wednesday, January 29, 2020

CERTIFED ORAL PAIN FREE~Demystifying Root Canal Strategies-Number #47




Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
SilverSandsVeterinary.com
SilverSandsVeterinary.blogspot.com
P- 1-800-838-3368
F- 203-877-8301
DonDeForge100@gmail.com
Number 47 Jan 2020


       X-ray showing a Completed Root Canal in a Canine Tooth After Debridement and Obturation


Image result for Picture of an endo file in a dog's canine tooth

Root Canal Strategies

demystifying endodontic myths

Root canals preserve the function of the tooth. They involve little to no discomfort to your pet, and are less traumatic than extraction which involves incising soft tissue and removal of bone. 

The main objectives of root canal treatment:

  • The Cleaning and Shaping of the complete pulp space
  • Obturating the canal to assure a bacterial tight seal
  • Placement of a perfect coronal restoration
  • Pre- and post digital oral x-rays
  • Follow up Endodontic X-rays in 12 months under general inhalation anesthesia
  • Antibiotic are indicated when fever or malaise are present; if there is a spreading infection; or cellulitis is present
  • Unsupported use of antibiotics contributes to the development of antibiotic-resistant bacteria
  • The choice to use antibiotics is based on a sound diagnosis and clear clinical indicators
  • General Practitioners should only perform root canal therapy by their skill; comfort level; and endodontic training with continuing education
  • Referral to an Animal Dentist is recommended in cases which are outside of the LDVM's comfort level or with lack of experience


Myths v. Truth in Root Canal Care


The root canal has become a recognized standard of care in veterinary dentistry and should always be conisdered prior to exodontia [tooth removal].  It allows patients to retain teeth that were once untreatable.

Technological advancements have contributed to the improved performance of root canal treatment.

Root canal success is not centered only on new devices and technology advancement alone.  It is based on knowledge and application of basic mechanical and biological standards.

Medical and dental history of the patient along with Comprehensive Oral Radiology Evaluation and Treatment [CORET] are the keys to endodontic treatment success. 

In some instances, endodontic disease does not show up radiographically.  It must be emphasized that hard tissues are visible with dental x-ray; soft tissues such as the pulp are not visible. 

In the dog and cat, a patient with irreversible pulpitis may have normal dental x-rays while the pet advocate describes what they consider a patient in pain at home.

As the pulp disease advances and inflammation progresses, bone resorption on x-ray becomes evident and a radiolucent area may develop periapically.

Some Oral Pain Signs in Pets that may be indicators for Endodontic Treatment:
Not eating as usual
Avoiding dry food
Flipping food to the back of the mouth and not chewing
Hypersalivation
Changes in mood or activity
Teeth grinding
Avoiding toys
Sleeping more
Conversely-hyperactivity is now being noted
Avoiding treets
Eating canned but not dry food 

After the Root Canal-Crown or Cap?
Once a root canal is completed, the tooth needs to be restored.  There are many excellent restorative materials available in animal dentistry that are being used in human dentistry. It must be emphasized in humans or animals no composite-resin restoration is considered permanent.  

All dogs have very strong chewing force and can dislodge the most perfectly placed restoration.  If the patient dislodges the restoration, it must be immediatley replaced.  

If the dislodgment is more than twice a full jacket crown or cap is always the best alternative to prevent further visits to the animal dentist.

The discussion of crowns or caps being utilized is based on the evaluation of the tooth structure by the animal dentist performing the root canal with a detailed consultation with the pet advocate.  

There are enamel colored ceramic caps; porcelain fused to metal caps; Inceram caps, and titanium alloy caps.....all available for restorative care by animal dentists after root canal therapy.

A crown or cap is designed to help minimize the risk of fracture recurrence in any patient! 

Guard dogs; police dogs; and military dogs should absolutely receive a crown in order to protect their precious and strategic dental structures after root canal therapy! 

Working dogs, hunting dogs, and large and giant breed dogs that are particularly hard on their teeth should also be considered for crown/cap restorative care. 

The indicators for a crown or cap are based on each individual pet; damage to the affected tooth; the pet’s behavior regarding oral play; rough chewing habits; and how the fracture originally occurred. 

The decision for a cap or crown is a joint decison based on patient chew history; separation anxiety problems; and/or pet advocate input.  

Board Certified Animal Behaviorists should be consulted in dogs that have aggressive separation anxiety to avoid or prevent damage to other dentition. 

Questions about this blog?
Write to DonDeForge100@gmail.com

Tuesday, January 28, 2020

CERTIFED ORAL PAIN FREE-A Rhinoceros in Your Operatory~~Comprehensive Oral Radiology Evaluation and Treatment~~#46

Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentisry
SilverSandsVeterinary.com
AnimalDentistrySolutions.blogspot.com
P- 1-800-838-3368
E-mail- DonDeForge100@gmail.com
Jan 2020 #46


Image result for picture of a rhinoceros




A Rhinoceros in Your Operatory
In Search of a New Vision

A Buddhist Monk is visited by a young man seeking enlightenment.  The Monk blindfolds the boy and takes him to a village.  The Monk tells the boy to become enlightened you must be able to see that which you cannot see.  The cover on your eyes makes you blind to the world around you.  I will bring you forward and have you touch objects and you must let me know what you think you are touching.

There was only one object and it was a very old Rhinoceros that had been in a sancturary for years.  The monk would walk the boy around the field and then bring him back to touch a different part of the Rhino.  

First, he had him touch the horn........the boy stated..... this is the handle of a hunting ax.........next he had the boy touch the ear........the boy said this is a purse to hold valuables within......

Then the Monk put the boy's hand on the leg of the Rhino....this is the easiest so far the boy exclaimed.......I am touching the trunk of a tree.

The Master took off the blindfold and let the boy see the Rhinoceros.  The boy could not believe that without his eyes he could be so wrong.

The Wise sage said to the boy you are not wrong.  Without vision, you had only a perception of the real world.  Those without vision must use all of their senses to see the truth.

This story illustrates the imporance of how veterinary dentistry has become revolutionized with the advent of Oral X-ray.  Living without oral X-ray is similar to doing surgery with the lights out in your operatory. 

Dental X-ray lets your veterinarian see pathology that you never new was present.

It allows the veterinarian to make the CORRECT treatment or referral decisions.  

Comprehensive Oral Radiology Evaluation and Treatment [CORET] is the key to oral diagnostics and all that is performed daily in animal dentistry.

Our clients, as Pet Advocates of the Animal Kingdom, demand more that blind extractions. They seek a pain free quality of life for the pets they love.  They request modern imaging tools to verify the need for oral surgery.  

All oral care, exodontal patients, should have oral x-ray prior to extraction and post-etraction. Follow-up radiology in 3/6/ or 12 months is very important.  The return x-ray periodicity is based on the procedure performed and isolated as a reminder to the client by the veterinary nurse-dental technician.  

If you have just introduced oral digital x-ray into your practice and are unsure of a diagnosis, you can send these digital x-rays to a radiologist or an animal dentist for review for a correct diagnosis. [One such service is eVETDiagnostics.com]

What are the Primary Reasons for Dental X-ray:

Treatment Planning in:
Advanced Periodontal Disease
Worn teeth that may need Endodontics
Fractured teeth that may need Extraction or Endodontics
Embedded and Impacted teeth
For caries or cavities-repair in the dog
Fractures of teeth
Oral Tumor or Mass surgical planning
Maxillofacial fracture repair
Stomatitis Care in cats-[see AnimalDentistrySolutions.blogspot.com -Number #41and #48]
Difficult Extractions
Orthodontia
Root Canal Therapy
Restorative Dentistry of all types
Oral Oncology
Pathologies of Deciduous Dentition


The New Hand Dental X-ray Generator

The Nomad Pro 2 Veterinary HAND HELD X-ray generator is an example of the new vision in animal oral health care.  

No longer is the veterinarian trapped with a wall mounted x-ray generator or a dental x-ray generator on a tripod base that everyone trips over.  

With handheld dental x-ray the operator is fully mobile.  Read about the Nomad Pro-2 Veterinary unit and how safe it is to operate on the Nomad website.

Along with a Hand Held X-ray Generator you will also need to purchase a Dental Digital X-ray processing system with veterinary oral diagnostics software.  

There are many such systems available for DR Processing. DR processing is fast and convenient choice.  Veteriarians are always looking for excellent technology to save time.  

"DR" imaging has excellent image quality, speed, and simplicity.  These characteristics are important in my work and are also important to the veterinarian in general practice.



veterinary dental X-ray generator / analog / digital / hand-held


The picture above illustrates the Nomad-Pro 2 Veterinary hand held dental x-ray generator.  There are other hand held x-ray generators in the veterinary dentistry marketplace.  Ask for an in-service demonstration of the x-ray generator, of your choice, and a veterinary digital DR x-ray processing system!

Today is the day to remove the blind fold of oral care and move into the vision of the New Millennium.

Questions:
E-Mail DonDeForge100@gmail.com

Monday, January 20, 2020

CERTIFIED ORAL PAIN FREE #45-Obstacles in Oral Surgery-Removing the OUCH!

Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Advanced Veterinary Dentistry

www.SilverSandsVeterinary.com
AnimalDentistrySolutions.blogspot.com
SilverSandsVeterinary.blogspot.com

P-203-877-3221 and 1-800-838-3368
Fax-203-877-8301
E-Mail DonDeForge100@gmail.com~ Web Log #45


Image result for Photo a bad tooth in a dog

CERTIFIED ORAL PAIN FREE

Obstacles in Oral Surgery
Removing the OUCH!

Oral Surgery is indicated for many reasons in the companions we love. This surgery results in a pain-free quality of life!

Below is a list of common reasons for Oral Surgery in Dogs and Cats:


#1] Fractured Teeth

#2] Hopeless teeth affected by long term Periodontal Disease

#3] TRRR-Tooth Resorption and Root Resorption in Cats

#4]  Advanced Cavities in dogs where root canal and restorative dentistry are not         
       possible

#5] The treatment of the painful cat Stomatitis patient-[See Blog #41]

#6]  Non-Vital tooth extraction if root canal therapy is not possible

#7]  Cyst and Mass Removal

#8]  Oral Trauma Repair

#9]  Oral Oncology Diagnostics and Treatment

#10] Oronasal and Oroantral Fistula Repair

#11] Removal of Deciduous-Primary Teeth~~Trauma Care or Interceptive Orthodontia

#12]  A malocclusion resulting in pain or poor quality of life

#13]  Enamel Hypocalcification: when endodontics with restorative dentistry 
         are not possible

#14]  Complications in Gingival Hyperplasia from advanced Periodontal Disease

#15]  Impacted and Embedded teeth: A tooth which has fully formed but has broken through the gum into the mouth is either impacted or embedded – they are also known as un-erupted teeth. Instead or erupting through the gum tissue into their correct partition they remain under the surface of either the gum or bone.

Impacted teeth occur where one tooth is prevented from erupting due to being wedged up against a neighboring tooth. It is always necessary to extract impacted teeth to prevent further problems.

If a tooth is not breaking through the gum because of being under bone it is classed as being embedded. In the majority of the cases where the tooth is being blocked by the gum it may lack the force necessary to break through the gum.

A bony impaction is when a tooth is impacted entirely within bone and a soft-tissue impaction is when the tooth has broken through the bony cortex and is also partly or entirely covered by the gums.


Certifed Oral Pain Free~
How to Avoid the OUCH in Oral Surgery!

A]  Be proactive....examine your dog or cat's mouth frequently

B]  Observe for pain when looking into the mouth; redness of the gums; bleeding of          gums; masses in the mouth; broken teeth....call your Local Doctor of Veterinary          Medicine [LDVM] for a check-up if any of the above are noted!

C]  After pre-anesthesia evaluation ask your doctor to take DENTAL X-RAYS prior to 
      any treatment of the mouth

D]  If your LDVM is uncertain of how to treat the problem have them consult with  
      an animal dentist

E]  Animal Dentists perform Comprehensive Oral Radiology Evaluation with 
     Treatment [CORET}.  Their training and expertise is an important adjunct as a                consultant to your LDVM

F]  The lower jaw [i.e. mandible] is the area where inadvertent fractures can occur 
      during extractions in the front of the mouth or in the molar area in the back of
      the pet's mouth.  Animal dentists, using oral surgery principles, can treat the 
      oral surgery problem while avoiding the encumbrance of an inadvertent jaw 
      fracture.

G]  Many pets need Guided Bone Regeneration-at the extraction site- to preserve the
      alveolar ridge and strengthen the jaw.

H]  Some patients can avoid major extractions with Root Canal Therapy by an animal        dentist!  Root Canal Therapy, if applicable, is considered standard of care and in          many cases is less expensive than a major oral surgery with tooth extraction.

I]   Any oral treatment without the back of dental x-ray can lead to problems.  Dental 
     x-ray allows a diagnosis to be made.  In many instances dental x-ray
     must be complemented with histopathology [sending oral tissues to a laboratory]       for a definitive diagnosis.

J]  Ask your LDVM for a referral to an animal dentist if dental x-ray is not available
     in their hospital or the extraction or major oral surgery is a difficult procedure  
     that needs referral.

Conclusions:
The advancements in companion animal oral care continue to bring a pain-free
quality of life to the pets we love.  

A Certified Oral Pain Free condition should be available to all companions.  

Animal dentists help minimize oral pain and completely remove the "OUCH" in oral care by understanding and recognizing possible oral complications [before they occur]! 

Initiating appropriate treatment methodology based on knowledge and experience is the key to pain-free care.

Questions about this blog?
Write to DonDeForge100@gmail.com
Dental X-rays for Evaluation: Contact E-VetDiagnostics.com
A Telemedicine Radiology Service


Saturday, January 18, 2020

CERTIFIED ORAL PAIN FREE #44-Treating Tooth Resorption-Root Resorption [TRRR] in the Cat~#44




Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
P-1-800-838-3368
E-Mail: DonDeForge100@gmail.com
AnimalDentistrySolutions.blogspot.com
Number #44

Resorptive Lesions in Cats  [FORL]

Tooth Resorption-Root Resorption [TRRR]

Image result for Picture of Tooth resorption dental x-ray in the cat


The Pain Hunt 


Tooth Resorption and Root Resorption [TRRR] in the Cat

Comprehensive Oral Radiology Evaluation and Treatment [CORET] 


The term Feline Odontoclastic-Osteoclastic Root Resorptive Lesion [FORL] has been commonly used to describe cavities/caries in cats.

A more acceptable term is ~
Tooth Resorption and Root Resorption-TRRR

Facts: 
No one knows the cause of TRRR in cats; the term cavities or caries in not utilized by animal dentists~~~Typical caries in dogs and people are actually passive inorganic demineralization of enamel which can be restored with advanced dental materials.  

TRRR in cats occurs as an active progressive destruction of the dental tissues by clastic cells.  These teeth cannot be restored because of their progressive nature.

A dental explorer with the patient awake should never be used to detect TRRR. If the explorer is inserted peri-pulp or intra-pulp, it can cause severe pain.  This type of exam must only be performed under General Inhalation Anesthesia.

TRRR is one of the most under-reported; poorly understood; and non-diagnosed painful oral conditions in the cat.  The affected teeth will become painful as soon as resorption results in pulp exposure.

General Out-Patient Oral Exams are important and can point to TRRR; only dental x-ray with the patient under General Inhalation Anesthesia after~~~ appropriate pre-anesthesia testing~~~ will definitively recognize all pathology.

Many cats with TRRR have sub-gingival [below the gum-line] pathology.  that is why dental x-ray is so important.

Suspicious TRRR teeth may evidence~~ above the gum line~~ a loss of tooth structure [i.e.  a concavity] where the crown of the tooth meets the root-i.e. Cemento-Enamel Junction-CEJ.  

The gingiva-can be red, swollen, and ulcerated at these sites. 

In some cats, the TRRR sites can be covered with calculus [i.e. tartar] in the crown of the tooth making them impossible to identify.  

Dental x-rays are ESSENTIAL in any TRRR suspicious site.  In cats with suspected TRRR, all teeth must be x-rayed while under general inhalation anesthesia.  

Cats coming in for routine oral health treatment-i.e. cleaning- should have full mouth x-rays to eliminate occult TRRR that is below the gum-line

These lesions are painful and progressive!  


Signs of ORAL PAIN in TRRR:

Not eating well

Avoiding dry food

Forcing the food into the back of the mouth to swallow

Sleeping more 

Disinterest in playing 

Vocalizing 

Halitosis

Drooling-i.e. hypersalivation

Changed patterns of contact with the pet owner

Reduced Grooming

Chewing on one side of the mouth

Teeth Grinding

Aggression

Withdrawal and Hiding

Wanted only soft table food and canned cat foods

Refusing Hard Cat Treats

Not all signs are present in all cats! You must take a step back and look carefully for any change in behavior that could be pain-centered in nature.  Even if the signs of pain are not easily noticeable...... that does not mean that pain is not present!  

See your LDVM for oral x-rays under general inhalation anesthesia if you are unsure!

Extraction of the affected teeth is the currently recommended treatment for a cat with advanced TRRR~~~

Variable stages of root resorption result in a high risk of root fracture during exodontia. 

All cats with suspected TRRR must have pre- and post-exodontal dental X-ray!

Oral surgery techniques and principles are critical to avoid accidental fracture of the mandible or maxillary complications during tooth extraction!  

If the General Veterinary Doctor [GVD] is not trained in advanced exodontal techniques, it is best to refer the patient to an animal dentist for care~~~

Root fractures with retention of apical fragments or non-removal of bone sequestra may result in persistent pain and/or osteomyelitis of the alveolar bone[socket]~~~

The Coronectomy Procedure [i.e. tooth recontouring-odontoplasty] can be used to treat TRRR.  Coronectomy is never used on fractured teeth; in patients with  apical periodontitis; and/or other significant root pathology.  If this technique is utilized......... all patients must return in one year for follow up oral x-rays.

If the Coronectomy is not advised after dental x-ray, full tooth extraction [exodontia] is recommended!

If unsure if Coronectomy can be performed after oral radiology is completed,  consult with an Animal Radiologist or an Animal Dentist for their expert opinion.  [One such Telemedicine Radiology Consulting and Diagnostic Service is:          E-VetDiagnostics.com]


Questions:
Contact: Dr. Don DeForge
1-800-838-3368
E-Mail DonDeForge100@gmail.com



Monday, January 13, 2020

CERTIFIED ORAL PAIN FREE #43-The Pre-Anesthesia Assessment




Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
1-800-838-3368
DonDeForge100@gmail.com
www.AnimalDentistrySolutions.blogspot.com
www.SilverSandsVeternary.com
#43





Image result for Picture of a dog having chest x-rays
Heart Disease
Cardiomyopathy


Certified Oral Pain Free
The Pre-Anesthesia Assessment

Prior to any general inhalation all pets should have pre-anesthesia assessment.
The testing is different for the young pet; the middle aged pet; and the senior pet.

Helping the senior pet is very important.  Co-morbidities can be present that can be complicated by septic oral pathology [i.e. advanced oral disease]

The signs of oral disease and "bad pain"....... pain hidden by dogs and cats are many times not apparent to the pet advocate.  

Evaluation for a definitive diagnosis of oral pain sites must be under general inhalation anesthesia.  At that time, dental x-rays are taken to reveal ANY oral pathology.  

The KEY is returning the pet to a pain free quality of life.

Oral care and the further prevention of NEW oral pathology developing after oral care................................ is directly linked to follow-up professional oral care and an excellent homecare anti-plaque program.

BELOW is a list of some of the appropriate testing that your LDVM may advise before they initiate general anesthesia in your pet.  The list is a guide and is not to be a substitute for ANY additional testing recommended by the LDVM who is your primary care veterinarian.

Young Pets:
Physical Exam
Chemistry Profile and CBC
Urinalysis and Fecal Exam
Electrocardiogram

Middle Aged Pets
Physical Exam
Chemistry Profile and CBC
Urinalysis and Fecal Exam
Chest X-rays
Blood Pressure
Electrocardiogram

The Senior Pet
Physical Exam
Chemistry Profile and CBC
Urinalysis and Fecal Exam
Chest X-rays
Blood Profile
Screening for Thyroid Disease
Electrocardiogram
Echocardiogram-ultrasound of the heart

All dogs in all ages groups should have heartworm testing and tick serology to identify the presence of tick borne diseases

All cats should have an IFA Feline Leukemia Test; and a Western Blot Immunodeficiency Virus test and Bartonella test sent to the National Veterinary Lab to eliminate co-morbidities.
See NatVetLab.com

See below the reasons for Chest X-rays in Pre-Anesthesia Assessment

If any dog or cats experiences coughing; shortness of breath; has a heart murmur; or evidences abnormal heart/lung  x-rays................ a consultation with an Animal Cardiologist and Pulmonary Specialist is recommended.


Many pet owners bring their pets to veterinarians with a history of sneezing; gagging, or  on-and-off stressed breathing.  Others comment their pets will cough while on leash.  Some pets wake up during the night coughing and gagging.  These pets may have occult heart and or lung disease that can only be found with the testing mentioned in this web log.

The hidden cough is a diagnostic challenge.  This may be missed in many breeds because the pet has had grunting or strange respiratory sounds since a puppy.  This is especially common in Brachcephalic breeds [Bull dogs; Pugs; Boston Terrier; Bull Terriers; Boxer etc]

Cats with heart and lung disease in early stages are very difficult to diagnose without special imaging.  All cats 2 years of age and older are advised by Dr. DeForge to have an Echocardiogram to rule out occult Hypertrophic Cardiomyopathy   

In older cats, testing for hyperthyroidism must be initiated. As a co-morbidity, hyperthyroidism can affect heart function.  

The hidden cough is the reason Chest X-rays are recommended in middle aged and senior pets.


The Coughing Pet and The Hidden Cough~
The Hunt for Heart and Lung Disease in the Aged Pet Prior to Anesthesia


Washington State University-Internet
This information is not meant to be a substitute for veterinary care. Always follow the instructions provided by your veterinarian.
Cough is a common problem in dogs but occurs less frequently in cats. Cough is caused by irritation of the throat, airways or the lungs. The main airway to the lungs known as the windpipe or trachea branches into smaller airways called bronchi which branch several more times as they travel to the deeper parts of the lung. 
There are many causes of cough. A thorough history and physical examination help the veterinarian decide which causes of cough are most likely in your pet and helps him or her decide which diagnostic tests to recommend and which therapies are most likely to be effective. Cough originating from the trachea may be stimulated by lightly squeezing the trachea. Cough due to heart disease may be accompanied by a murmur or abnormal heart rate or rhythm.
Your description of the nature of the cough, when the cough occurs, and if anything brings on coughing can be very helpful in pinpointing the cause of coughing in your pet. Some causes of cough result in difficulty breathing between coughing episodes whereas with other diseases, the pet breathes normally between coughing episodes. Some types of cough occur more commonly at night when the animal (and human family members) are trying to rest. Animals with heart failure, collapsing trachea and lung edema cough more at night than during the day.
Cough caused by tracheal irritation or tracheal collapse often occurs when the pet is excited or is tugging on its collar. Cough caused by heart disease may follow exercise or excitement. Cough due to tracheal collapse may be stimulated by drinking water. Coughing that occurs during or shortly after eating may be due to disease of the larynx or esophagus. The larynx normally closes when food is swallowed to prevent food from entering the trachea. If the larynx is diseased it may not close when food is swallowed resulting in food entering the trachea. Food may pool in an abnormally dilated esophagus. The food then may pass to the mouth and down the airways into the lungs causing pneumonia and cough.
Some coughs sound moist and others are harsh and dry. Moist coughs indicate the accumulation of fluid (water, blood or pus) in the airways or lungs. The environment and habits of the pet can influence which causes of cough are more likely. Dogs that hunt or spend time outdoors may inhale grasses, seeds or other foreign materials through the nose into the airways. In addition to causing coughing, foreign materials can travel down the airways and through the lung causing an infection with a large amount of pus to develop in the space surrounding the lung. This disease is called pyothorax. Animals that have exposure to other animals in a shelter or boarding facility are more likely to have an infectious cause for coughing. The region of the country in which you live or to which you and your pet have traveled, influences the likelihood of some diseases like heartworm disease and fungal infections of the lung (histoplasmosis, coccidiomycosis and blastomycosis). Heartworm disease occurs in both dogs and cats and is most common in parts of the country that have lots of mosquitoes.
The age and breed of the pet also influences what causes of cough are most likely. Young animals are more likely to develop a cough due to infections with bacteria or viruses. Young to middle aged cats may develop wheezing and cough due to asthma. Cats with asthma have sudden episodes of wheezing and coughing but are normal in between episodes. Middle aged to older, small breed dogs are more likely to have heart disease due to leaky valves. Middle aged to older, large breed dogs are more likely to develop paralysis of the larynx.
Tracheal collapse occurs most commonly in middle to aged overweight small breed dogs . Tracheal collapse is rare in cats. The cough is often described as sounding like a goose honking. Treatment for tracheal collapse includes weight reduction and intermittent use of cough suppressants and sedatives. Surgery can be performed in dogs with severe collapse that don't respond to weight reduction and cough suppressants but often surgery is not effective.
Kennel cough or infectious tracheobronchitis is caused by several infectious organisms, including bacteria and viruses. Vaccinations are not 100% protective against the agents of kennel cough. Coughing due to kennel cough usually becomes apparent within a few weeks of exposure of your dog to other dogs in a kennel or show environment. Kennel cough usually resolves itself without any treatment. If the cough is severe enough that the pet has difficulty sleeping or people in the house have difficulty sleeping, cough suppressants can be given to suppress the frequency of cough, allowing the pet and human members of the household to get rest while the disease runs its course. If the cough does not subside in a week to ten days, your pet should be evaluated for other diseases of the lungs or airways.
Cough can be caused by heart disease, which is diagnosed by a chest x-ray, an electrocardiogram which measures the electrical activity of the heart, and often by a heart ultrasound which allows the veterinarian to view the inside of the heart, including the valves and the thickness of the walls of the heart muscle. Heart disease may cause heart enlargement that  puts pressure on the airways causing cough or the heart may fail and lead to edema of the lungs.)
Allergies to particles in the air including dust, pollens, and smoke can cause allergic lung disease and coughing.
In older patients, lung cancer has to be considered. The lungs receives a large amount of blood that flows through the rest of the body. Lung cancers in dogs and cats most often originate from other organs and are transferred from those organs through the blood to the lung. Some cancers may be controllable with anticancer medication. Single lung tumors that originate within the lung may be surgically removed in some cases.Tests that may be recommended to identify the cause of a cough include a blood profile to screen multiple organs, a stool exam to look for parasites or their eggs that are coughed up and swallowed, chest x-rays or x-rays of the trachea. The larger airways can be examined using a flexible scope called a bronchoscope in a procedure called bronchcoscopy. Sterile fluid can be flushed into the airways to collect samples for culture or microscopic exam. Large foreign bodies in the airways can be removed by bronchoscopy. Specific tests may be performed if heart worm disease  or an infectious cause for the cough are suspected.
Treatment of coughing patients depends upon the disease diagnosed and may include cough suppressants, antibiotics for bacterial infections, and steroids for allergic lung disease. Avoid self medicating your pet as the treatment for one cause of cough may be very wrong for the treatment of another type of cough.

Questions or Comments:
Contact Dr. DeForge
at DonDeForge100@gmail.com

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