Chronic Conditions

Allergies are one of the most common and most frustrating diseases we treat at Intracoastal West. We frequently see pets who never had signs of allergies until moving to north Florida, or pets who have developed allergies as they’ve grown up. Both dogs and cats can experience allergies, and some individuals may be more sensitive than others. Allergies, whether seasonal or year-round, are often life-long, and untreated allergies can increase your pet’s inflammation, itching, and risk of chronic infection. Addressing your pet’s allergies as soon as they show signs is important for maintaining their quality of life.

Unfortunately, allergies work through a different signaling pathway in dogs and cats than in humans so antihistamines like Benadryl and Zyrtec are often ineffective at controlling pet allergies. During your pet’s exam and consultation, our veterinarians can discuss the common causes of allergies and recommend specific management strategies for your pet’s allergies.

We will also identify skin infections that can commonly occur as a result of allergies. Healthy skin may naturally have small amounts of yeast and bacteria, but a pet without allergies will have normal skin defenses that keep these organisms in check. In pets with allergies, their normal skin defenses are weakened, so these yeast and bacteria take advantage and can exacerbate itching by causing secondary infections that can make your pet miserable. We will discuss ways to prevent these infections from occurring, and strategies to support your pet’s normal skin barrier.

What could my pet be allergic to?

​There are many things a pet can be allergic to. It can be difficult to determine what your pet is specifically allergic to, and many allergens are impossible to avoid. We can discuss allergy testing including blood tests and intradermal allergy testing during your pet’s exam and consultation, but more importantly, we will discuss management strategies, which can include a combination of topical therapy (including medicated shampoos, sprays, mousses, wipes, and powders) and allergy medications to control their itching. Allergies are frustrating because they typically need ongoing management and there isn’t a simple cure. Our veterinarians will work together with you to come up with a realistic plan to help control your pet’s allergies and help you all live without the stress and discomfort of constant itching.

Flea Saliva

The most common allergy for dogs and cats is flea saliva so it is important for every pet (including indoor-only cats) to be on appropriate flea prevention. We can discuss different options for flea prevention, but beware many over-the-counter topical flea preventives are ineffective against the tough fleas we have here in Jacksonville. Even without direct evidence of fleas, flea prevention is still especially important for allergic pets since even just one bite can cause a flare-up.

Environmental Allergies

The next most common cause of allergies is environmental allergies. These can be caused by outdoor allergens such as grass, pollen, trees, or indoor allergens such as dust mites and mold, which can be a problem even in clean households. It can be helpful to reduce exposure to some of the outdoor allergens by wiping your pet’s feet with a baby wipe when they come in from outside. Additional management tools can include dog-specific allergy medications that include a medication your dog can take daily as needed or an injection that lasts for 1-2 months. While steroids have commonly been used in the past, they come with side effects that make them less than ideal for chronic conditions like allergies, so our veterinarians prefer cutting-edge medications that are safe for long-term use.

Pet Food

Although the marketing around pet food will have you believing otherwise, food allergies are actually one of the least common causes of allergies in pets, with only about 10% of cases caused by diet. Of those pets with food allergies, approximately half of them also have an environmental component to their allergies as well, so true and isolated food allergies are fairly rare. Pets with food allergies often exhibit signs of gastrointestinal upset in addition to their skin problems, but some may only have gastrointestinal or skin issues alone. The most common food allergens are the protein sources in the foods; grains are much less likely to cause an allergy (again, despite common marketing by pet food companies). Properly determining whether your pet has a true food allergy can be difficult but important for managing their allergies. Pets with food allergies often will have only a mild improvement with environmental allergy management strategies, but if their allergies can be controlled with diet, they can return to a normal, high quality of life.

Food allergies can only be diagnosed through a diet trial; blood tests are unreliable for diagnosing food allergies. We will discuss in further detail during your pet’s consultation, but a diet trial consists of feeding strictly a hydrolyzed protein diet for 8-12 weeks. If your pet has responded well during the diet trial, we can plan for a diet challenge, during which you will methodically introduce whole food ingredients or commercial diets to narrow down which foods your pet is specifically allergic to. Based on the results of this diet trial and challenge, we can determine what kind of diet your pet should be on long term, and which foods to avoid.

Click here to schedule an exam and consultation if you believe your pet is suffering from allergies.

Arthritis is a common condition in both dogs and cats. For both species, it can result from injury, poor conformation (abnormal physical shape or structure of their joints, such as from normal breed standards or congenital issues like hip dysplasia), immune dysfunction, or most commonly obesity.

• In cats,it can also occur due to normal wear and tear on the joints over time, similar to arthritis in people.
  In dogs,however, because of the other factors that contribute to arthritis, it is fairly common for us to see young or middle-aged pets already showing signs of arthritis.

What is Arthritis?
Arthritis is inflammation of the joints that causes a breakdown in the cartilage that protects and cushions joints. It is a chronic, progressive condition that causes pain and decreased mobility and can have a huge impact on a pet’s quality of life.

What are the signs & symptoms?
The signs of arthritis can be subtle, especially in the early stages. A pet may seem less playful, act stiff when they first get up in the morning, sleep more throughout the day, hesitate when jumping onto furniture, take more time going up or down stairs, etc. Cats with arthritis may avoid the litter box if it is difficult to get in and out of, and dogs may have accidents inside the home if they are too uncomfortable to get up in time to ask to go out. Many pet owners will dismiss these signs as a pet simply “getting older” and they will fail to recognize the quiet suffering their pet is experiencing. Recognizing arthritis can be difficult since pets with arthritis generally don’t limp or cry out to express their discomfort. Fortunately, when you and our veterinarians are able to detect arthritis early, we can develop a management strategy.

What can I do to help my pet’s Arthritis?

Since arthritis is a progressive condition, it is important to be proactive about this disease to prevent or reduce further damage to the joints. Chronic pain can be more difficult to treat the longer it goes untreated because the nerves can become hyper-sensitized to pain signals over time. Dr. Marsigliano and Dr. Green have extra experience and special interest in the management of arthritis and can offer multiple management strategies to help you keep your pet comfortable. These strategies can include nutriceuticals (joint supplements), physical therapy exercises, pain medication, and environmental modification.

Weight Management

Because obesity is one of the leading risk factors for arthritis and because it can increase a pet’s risk for other chronic diseases, one of the first things Dr. Marsigliano will discuss with you is weight management. Diet plays a very important role in weight management, and our veterinarians can offer over-the-counter diet recommendations as well as prescription diets that support weight loss and can improve joint comfort and mobility.

Joint Supplements

In addition to diet, nutriceuticals are generally safe for long-term use and can slow down the progression of arthritis by providing support to the cartilage in the joint. At Intracoastal West we offer several different joint supplements, including daily tasty chews and oils, as well as monthly injections under the skin. These nutriceuticals are generally very well tolerated with minimal side effects. However, it is important to note that the supplement industry is unregulated, and many companies offer products that are untested and may either not contain what is reported on their label or may contain impurities or other contaminants that may make your pet sick. The supplements we carry and recommend have scientific data supporting their use and are regularly tested to confirm purity and accurate dosing. Our veterinarians can work together with you to determine which joint supplement (or multiple) would be right for your pet.

Physical Therapy

Physical therapy exercises can increase blood flow and strengthen the muscles that help support the joints, improving your pet’s mobility and comfort. Depending on the affected joint(s), our veterinarians will work with you to develop an exercise regimen for your pet to help maintain or improve their strength. These exercises can also serve as good bonding opportunities for you and your pet, and can help older pets keep their mind active as well.

Pain Medication

Dr. Marsigliano can also offer pain relief medications, which can be used intermittently when a pet is having a rough day (which can sometimes happen if a pet is feeling well and plays too roughly, then regrets it the next day), or even long-term if they are experiencing advanced stages of arthritis. These medications may carry side effects or require blood monitoring to ensure your pet’s organs are able to handle these medications. We will discuss the risks and benefits of these different medications.

Environmental Adjustments

Finally, there may be things you can place around your home to help your pet get around more easily if they are having mobility issues. These tools can include carpet runners in slick hallways, stairs, or ramps to help your pet onto and off of furniture, and orthopedic beds to help your pet rest more soundly. Our veterinarians may even recommend things like the Help ‘Em Up harness or Dr. Buzby’s Toe Grips if your pet needs additional help getting around the house.

​Our goal at Intracoastal West Veterinary Hospital is always to optimize your pet’s quality of life. Because arthritis is so common in pets, our veterinarians can tailor a treatment plan that fits your pet’s level of disease, severity of discomfort, and lifestyle. Book an appointment today to take the first step towards improving your pet’s mobility, comfort, and quality of life.

Identifying endocrine problems as early as possible is important in dogs and cats. These serious, potentially life-threatening conditions are much more manageable when caught early, allowing us to begin proper treatment.

The endocrine system is made up of a group of tissues (mostly glands) that release hormones into the bloodstream. These hormones regulate metabolism, growth, development, and reproduction and are dispersed to different areas of the body, depending on the hormone’s function. When a hormonal balance is disturbed (by a tumor or autoimmune disease, for instance), an endocrine disorder can develop. “Hyper” refers to an excess of a hormone, and “hypo” refers to a deficiency in a hormone. Treatment varies depending on the disease.

There are several common endocrine disorders we see in pets include:

Dogs

• Diabetes – caused by a deficiency in or resistance to the hormone insulin.
• Cushings disease (Hyperadrenocorticism) – increased levels of the stress hormone (cortisol)
• Hypothyroidism – indicates that the animal has low levels of thyroid hormone.
• Addison’s disease (Hypoadrenocorticism) – lack of production of the stress hormones

Cats

• Hyperthyroidism – which frequently affects cats, indicates that the animal has high levels of thyroid hormones.
• Diabetes – caused by a deficiency in or resistance to the hormone insulin.

​Contact us if your pet begins panting excessively, develops any skin issues (such as hair loss or dull coat), or shows any changes in behavior, energy levels, appetite, weight, water consumption, or urination.

Chronic renal insufficiency (kidney disease) can occur in dogs or cats of any age, but is a relatively common cause of illness in senior cats. There are many factors that contribute to kidney disease, including genetics as well as blood pressure abnormalities, excessive mineral intake, and inflammation.

The kidneys serve several roles in the body, including concentrating urine, eliminating toxins that the body produces through normal daily functioning, and even signaling for the bone marrow to make more oxygen-carrying red blood cells. When these functions are disrupted due to kidney disease, pets can become ill, experiencing progressive symptoms as their disease worsens.

In early stages of kidney disease, pets may urinate more due to decreased urine concentrating abilities, and as a result will drink more water to replace what was lost through urination. As the disease progresses, pets simply cannot drink enough to replace what they lose, so supplementation through oral hydration supplements like Purina Hydracare or subcutaneous injections of fluid may be needed. Pets may also experience anemia as well as discomfort, fatigue, decreased appetite, and vomiting or diarrhea due to the buildup of normal cellular byproducts (toxins). They can also experience muscle wasting as their body breaks down tissues due to cachexia.

Treatment is tailored to slow the progression of the disease as well as manage the patient’s symptoms, and may include fluid supplementation, blood pressure medication, therapeutic veterinary diets that take some of the strain off the kidneys, anti-nausea medications, appetite stimulants, and other medications as needed to maintain the pet’s quality of life.

Through annual (or for senior pets, twice-annual) screening panels, we can detect early kidney disease and other factors that may contribute to chronic kidney disease before pets start showing signs. Cats are unfortunately especially good at hiding signs of chronic disease like renal insufficiency until very late in the disease.

Book an appointment now for a physical exam and screening laboratory panel to check if your pet is at risk for kidney disease.

Diarrhea is no fun for pets or their family members that have to clean up after accidents or wake up in the middle of the night to let them out. Chronic diarrhea is diarrhea that has been occurring for three or more weeks. (Diarrhea lasting shorter than this duration is acute diarrhea and may require a different workup and treatment plan.)

Chronic diarrhea can result from many different causes including:

• chronic infection, especially from parasites
• an imbalance of good vs. bad bacteria in the intestines known as dysbiosis
• maldigestion/malabsorption issues relating to other organs besides the intestines
• food allergies
• inflammatory bowel disease

To narrow down this variety of causes, our veterinary team will start by collecting a thorough history including diet history, so it will be important to let us know what diets your pet has been on including treats while the diarrhea has been occurring. Then our veterinarian will examine your pet to rule out some other concurrent diseases. They may recommend diagnostic testing including a fecal exam to look for parasites, bloodwork to look for evidence of concurrent diseases or test gastrointestinal function, and/or advanced diagnostics like an abdominal ultrasound to look for evidence of swelling in the intestinal walls. Some diseases may need surgical biopsy or referral to an internal medicine specialist for definitive diagnosis, but we can diagnose and manage most causes of chronic diarrhea here at Intracoastal West.

Eye Issues

Glaucoma

It is crucial for your pet’s vision and comfort that we detect and treat glaucoma and other problems with intraocular pressure (pressure within the eye) as quickly as possible. We can test your dog or cat’s eyes for excess pressure easily and safely. The test, performed with a device called a tonometer, is not painful and does not require sedation.

If not treated immediately (within hours to days), glaucoma can cause permanent vision loss or even blindness. Pets that have suffered eye injuries should have this test performed. In addition, we recommend that breeds that are prone to developing glaucoma come in for regular measurements so we can monitor eye pressure and begin treatment before any problem becomes irreversible. Please call us to discuss whether your pet may be at higher risk for glaucoma.

Call us right away if you notice any of the following problems in either or both of your pet’s eyes:

• dilated (enlarged) pupils
• clouding of the cornea (the normally clear outer layer of the eye)
• red or bloodshot eyes
• one eye protruding or appearing larger than the other
• squinting
• tearing

Because glaucoma is painful, your pet may react by rubbing or pawing at the eyes or rubbing his or her head against the floor or furniture more than normal.
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Cataracts

A cataract is an opacity in the lens, which is a structure in the middle of the eye that focuses light and is important in vision. Over time, the lens can become mildly cloudy, a condition called nuclear sclerosis, which is fairly common especially in dogs over 7 years old. Nuclear sclerosis is different from cataracts because it doesn’t affect your pet’s vision and is a normal, age-related change, not a disease. In contrast, cataracts can block light from penetrating into the back of the eye and can obstruct vision. An ophthalmic exam by one of our veterinarians can distinguish between these two similar conditions.

​Cataracts can occur over time as the lens ages and undergoes structural changes. Cataracts can also be genetic and occur in younger dogs, or may occur as a result of diabetes. Cataracts can cause blindness, and may cause complications such as glaucoma (increased pressure inside the eye, which can cause pain and blindness) or uveitis (inflammation in the front chamber of the eye). Our veterinarians can diagnose cataracts and underlying causes such as diabetes, and discuss potential treatment or management options with you.
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Dry Eye

Dry eye (keratoconjunctivitis sicca or KCS) is a fairly common problem in dogs that can cause discomfort and eventually lead to blindness if left untreated. It is a condition that results from decreased tear production but actually presents as increased discharge from the eyes. Normal tear film that coats everyone’s eyes consists of 3 components: an aqueous or water component, a mucous component, and an oil component. When a dog’s tear glands produce less of the water component of the tears, the other components will increase secretions, causing thick, goopy eye discharge that looks like boogers. However, because of the lack of water component, the eye will feel dry and may have a burning sensation, such as when you hold your eyes open and don’t blink for an excessive period. Over time, this chronic burning can cause inflammation, which results in hyperpigmentation to the cornea (the clear outer coating of the eyeball, creating a dark haze that can eventually obstruct a dog’s vision.

​Rarely, KCS can be a result of a drug reaction, especially to a specific antibiotic. But more commonly, it is an autoimmune condition in which a dog’s immune system attacks their tear glands. Some breeds are more prone to this condition, especially brachycephalic (smushy-faced) breeds like bulldogs, pugs, and shih tzus.

​Diagnosing this condition requires a Schirmer tear test, which quantifies the water component to the tears. The test is painless and takes 1 minute to perform. Dogs with KCS typically require lifelong eye medication to stimulate tear production and control their immune system around their eyes. In end-stage KCS when the eyes have been diseased for so long that vision has been compromised, surgery to remove the painful, nonfunctioning eye(s) may be recommended.
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Cheery Eye

Cherry eye is the common term for a prolapsed nictitating membrane gland. It occurs when the gland of the third eyelid (the pink or gray eyelid at the inner corner of dog and cat eyes) pops out of its normal position and appears like a swollen mass at the inner corner of the eye. This gland is important for normal tear production, which can be obstructed if it remains out of place chronically. Surgical correction to replace the gland into its normal position is recommended.

Although heart problems are found more often in older pets, these conditions can affect pets at any age. Heart disease is usually a life-threatening condition, but early diagnosis and appropriate therapy can extend your pet’s life. If caught soon enough, some forms of heart disease can be cured.

Heart disease can lead to congestive heart failure (CHF), which occurs when the heart can no longer pump blood effectively. If an animal is suffering from CHF, fluid usually accumulates in and around the lungs and sometimes in the abdomen. Congenital heart disease (animals born with a heart problem), valvular heart disease (abnormalities of the heart valves), arrhythmias (rhythm disturbances), and heartworm disease can all lead to CHF.

Call us if your pet starts:

• breathing rapidly or coughing
• loses their appetite
• tires easily
• seems weak
• has trouble exercising

We can discover many heart problems during a physical exam. Additional tests, such as an electrocardiogram (ECG), radiographs (x-rays), and ultrasounds, are usually needed to accurately identify the cause of the heart disease or failure.