Case of the Month – April 2012


The Truth About Heartworm Disease
by Melissa Rotella, DVM

Andrew is a sweet ten year old Golden Retriever who came into Route 516 Animal Hospital for his annual wellness exam and vaccinations. Andrew was an apparently healthy senior who did occasionally cough and had suffered from arthritis in his hind legs. A heartworm test was performed on Andrew, as it is recommended to test annually in our office. This test is performed using a small amount of blood and the results are obtained within minutes. The test will also notify the doctors of any exposure to Lyme’s disease and two other tick born diseases. This year, Andrew was found to be positive for Heartworm disease.

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Heartworm disease is actually an infection from the parasite Dirofilaria immitis which is transmitted to dogs and cats from mosquitoes. Heartworm disease is most prevalent in warm areas, especially along the Gulf of Mexico, Atlantic coastline, and along the Mississippi River. Many people falsely assume that NJ is not a risk factor area. Andrew is proof that this assumption is not true, having never left the state.

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The immature heartworm parasite, or larva stage, is transmitted through a bite of a female mosquito. The parasite then makes its way through the bloodstream to the heart where it develops into an adult worm. This process can take up to seven months to complete. It is the presence of the worms in the heart that causes inflammation and damage to the pulmonary arteries. A number of factors contribute to the severity of the disease including the duration of infection, number of heartworms present, the animals response to the worms, and how active the dog is. There is a wide range of clinical signs ranging from no outward signs, cough, weight loss, exercise intolerance, collapse, heart failure, and death.

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It is possible to treat an active heartworm infection but it is also expensive and sometimes dangerous. It can take weeks for an infected animal to recover. Patients must be on strict cage rest following treatment for 4 to 6 weeks and reactions to the drug are possible. After a thorough work up, Andrew was started on a medication called Immiticide and was able to make a full recovery.

Heartworm disease is 100% preventable. There are a number of effective products on the market that will prevent infection. Medications such as Heartgard or Interceptor will kill the immature state of the parasite so that it can never develop into an adult worm. The American Heartworm Society (http://www.heartwormsociety.org) recommends year round preventative.

Case of the Month-March 2012


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A Beautiful Evil
by Melissa Rotella, DVM

Charlie is a seven year old domestic short hair cat that was recently seen at Route 516 Animal Hospital. Charlie’s owners had noticed that he had been more lethargic lately and started to vomit. The owners had received a floral arrangement that contained lilies and with closer inspection the owners noticed some bite marks in the leaves. As the owners had some knowledge of the danger of lilies, they made a wise decision in bringing Charlie in for an exam.

Despite being a very common and seasonal household flower, lilies can be quite dangerous to cats. These flowers are known to cause acute kidney disease in cats. In dogs, however, only mild gastrointestinal upset is expected. There is a range of different species of lilies that are considered toxic including Daylilies, Easter lilies, Japanese lilies, Stargazer lilies and Tiger lilies. Lily toxicosis is most prevalent during the Christmas and Easter holiday season, as they are a popular decoration. Despite their name, Lilies of the Valley and Peace lilies are not true lilies and therefore, do not cause kidney disease.

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All parts of the lily are considered toxic, including pollen. It is a common myth that removing the stamens from the flowers renders them nontoxic. The most toxin is found in the flower but even drinking the water in the

> vase can cause clinical signs in cats. Owner’s usually first notice vomiting in affected animals, with signs starting within 2 hours to 5 days of ingestion. Increased thirst, frequent urination, and kidney disease develop within 36 to 72 hours. There is no definitive test to confirm exposure to lilies and the diagnosis is made based on clinical signs and known exposure to the plant. Often plant material can be seen in the vomit.

The basis of treatment is decontamination. This is achieved by inducing vomiting, followed by activated charcoal to bind the remaining toxins from the gastrointestinal tract and limit absorption. This procedure is best achieved prior to any clinical signs developing in the patient. The second phase of treatment is to try and slow or prevent kidney failure. IV fluid therapy for a minimum of 48 to 72 hours is needed. Fluid therapy can be longer in situations where kidney values are already elevated. Additional treatments such as anti-nausea and pain medications are added in on a case by case basis. Blood work is repeated at 24, 48 and 72 hours and then as needed to monitor kidney values.

Usually if treatment is started within 18 hours of exposure, before the onset of kidney disease, the prognosis is good. After kidney disease has developed, the prognosis become guarded to poor. Therefore, any known exposure to lilies requires immediate attention by your veterinarian.

In Charlie’s case, his initial lab work revealed elevated kidney values and he stayed in the hospital for 7 days before the values came back down. Due to the lily ingestion, he has suffered permanent kidney damage. He is currently doing well at home, however he is now on a kidney friendly prescription diet and requires subcutaneous fluids two times a week to help manages his mild disease.

The take home message for this case of the month is: With Easter and Spring approaching, if you are a pet owner, take special care in making sure any holiday decorations or floral arrangements do not contain lilies.

Case of the Month-October 2011


A Sweet Escape

Chloe is an adorable six year old female French bulldog who presented to our hospital on October 13, 2011 for celebrating Halloween a little early! Her owner came home after work to find Chloe had gotten out of her crate and escaped to the kitchen where she consumed 1 1/2 pounds of chocolate, wrappers and all!! She enjoyed Mr. Goodbars, Kit Kats and Peppermint Patties! Chloe’s owner was not sure exactly when she ingested the chocolate, but knew it had not been more than six hours and that she was quite bloated.

Chocolate and its by-products contain theobromine and caffeine which can cause side effects to dogs. Severity and the onset of signs depend on the amount and type of chocolate ingested. The higher the amount of theobromine and caffeine, the more toxic the type of chocolate. The high amounts of sugar and fat, while not toxic, can lead to gastrointestinal upset.

Most toxic to least toxic

  • Cocoa powder

  • Baker’s chocolate

  • Semisweet chocolate

  • Instant cocoa mix powder

  • Milk chocolate

  • White chocolate

Clinical signs usually begin around six to twelve hours after ingestion so Chloe could have been in definite danger. Signs include increased thirst and urination, bloating, vomiting, diarrhea, and restlessness. In severe cases, signs can progress to heart arrhythmias, tremors, seizures, collapse, and coma.

When a dog ingests chocolate, it is important to always contact your local veterinarian or animal poison control so that calculations can be made based on body size of the dog and type of chocolate ingested. In most cases, it is recommended to induce vomiting. This is done so that any chocolate not yet absorbed by the intestines can be removed from the body. Following vomiting, activated charcoal is then given orally to the patient. Activated charcoal can then bind the toxins that have already moved into the intestinal tract to help minimize potential side effects. Additional procedures and medications may need to be administered depending on clinical signs. This includes medication for seizures and hear arrthymias, monitoring body temperature and controlling vomiting. Prognosis for chocolate toxicity is generally good with prompt and thorough care. Clinical signs should usually resolve in 12 to 72 hours.

In Chloe’s case, X-Rays were immediately taken and her stomach was found to be extremely full. Even the metallic wrappers could be seen. Vomiting was induced while Animal Poison Control was contacted. It was determined that Chloe ate enough candy to potentially have severe side effects. Everyone was amazed at the amount of chocolate and candy wrappers that came out of such a little dog and how good it smelled! Chloe actually had a thin waist and a real girlish figure. Enough candy was vomited that she was no longer in severe danger from toxicity. Activated charcoal was given orally as a protective measure. She was then given fluids to help replace those lost from vomiting and gastroprotectants (pepcid) to help settle her stomach. Chloe did great and was able to make a full recovery!

Make sure to keep candy, especially chocolate, in a safe location away from pets. If you feel that your pet may have gotten into chocolate, please make sure to contact your local veterinarian.

Have a Safe and Happy Halloween!

May 2011


Ringworm
by Melissa Rotella, DVM

Alden is a one year old male cat from a local animal shelter that presented to Route 516 Animal Hospital for an upper respiratory infection. While treating the infection, the staff noticed an area of hair loss on his left front foot. The lesion was grey with some scaling and crusting where the hair was missing. Based on the appearance and fungal culture results, Alden was diagnosed with ringworm and treatment started immediately.

Despite the name, ringworm is not an actual worm or parasite. In fact, ringworm is a fungal disease known as dermatophytosis. There are several species of dermatophyte fungi. Microsporum canis is the most common species of ringworm and dogs and cats are the normal host. Microsporum gypseum, which is found in the soil and trichophyton mentagrophytes which has a rodent host are the two other species of ringworm. The fungus lives on skin and feeds on dead cells in the skin, nails, and hair leading to skin infections in mammals, including humans. The term “ringworm” is derived from the way the lesion appears on the skin of humans. The classic appearance in people is a red, irritated area of skin with a ring of scaling around the edge of the lesion.

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Ringworm can be seen in all our household pets, but tends to be more common in young cats and kittens. There are even some pets that can be a carrier of ringworm. A carrier animal does not show lesions but is still infected and able to pass the disease to other animals and people. Carrier animals, along with the fact that ringworm can survive in the environment (soil) for up to 18 months, make treatment and resolution difficult at times.

A diagnosis of ringworm starts with a physical exam and a suspicion by the doctor. The appearance of lesions can vary between animals but a typical lesion is a circular path of hair loss with inflammation, scaling, and crusting. Some owners will notice their pets scratching or chewing at the lesions, but the pet may not always be itchy. One species of the fungus will fluoresce an apple green color when the lesion is placed under a black light in approximately 50% of cases. A fungal culture is usually needed to confirm a diagnosis of ringworm. It takes at least 10 days for the fungus to grow and therefore many times topical treatment will be initiated prior to confirmation to prevent further spread of the fungus.

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Medial management and disinfection of the home environment are the two main approaches of treatment. The affected hair should be clipped and topical anti fungal creams applied daily. In addition, oral antifungal medications and antibiotics (to treat secondary infections) are added to the treatment plan. Oral antifungal medications can be relatively expensive and have the potential for side effects. It is important that any pet started on oral antifungal be closely monitored for side effects. In the home, affected animals should be confined to one room, away from other pets. Prognosis for most animals is good; however treatment may need to be continued for several weeks to months.

Alden was started on clavamox (an antibiotic) and itraconozle (an antifungal) along with topical medication and weekly bathing. After a month of treatment, Alden was found to be free of ringworm and adopted to a new loving home. His new owners report that he is doing wonderful!

March 2011


NO BONES ABOUT IT!
Written by Melissa Rotella, DVM

Reeses, a two year old mixed breed dog, presented to Route 516 Animal Hospital for a unique emergency. Reeses had been playing outside and chewing on a bone marrow bone; something that had always been a favorite pasttime for her. It wasn’t until Reeses’ owner called her to come inside that a problem arose. Reeses would not drop the bone marrow bone that she had been chewing on despite repeated requests to do so by her owner. After a few minutes, Reeses’ owner realized the problem. The bone was stuck around her lower jaw! Her family could not remove the bone and soon brought her into our hospital.

Reeses strolled into the hospital wagging her tail and acting extremely friendly. She didn’t seem too bothered by the bone stuck on her lower jaw. Her physical exam was otherwise normal and she was found to be in good health. Reeses needed to be given a sedative so that a better oral exam could be performed and a plan made to remove the bone. Once she was sedated, it was observed that a piece of the bone marrow bone had lodged behind her canine teeth causing the bone to be stuck. An instrument called a rongeur, typically used during extraction procedures, was used to cut the wedge of bone stuck behind the tooth. The bone could then be removed from Reeses’ mouth with ease.

While Reeses’ situation was unique, it is not uncommon to see a variety of foreign material getting stuck in the mouth of dogs and cats. The common culprit for dogs tends to be sticks or bone material that gets lodged behind teeth or across the roof of the mouth. Cats have been known to get objects stuck under their tongue, especially sewing needles and thread. Overall these animals tend to drool, lick their tongues, paw at their face, or even cough. Sometimes the only clinical sign can be a foul odor coming from the mouth due to infection. More serious complications can develop if the foreign object is swallowed and becomes stuck in the esophagus, stomach, or intestines. If you have a pet that likes to chew, it is important to regularly examine the bones and chew toys in your house. Look for sharp edges, splintering, or pieces falling off. Throw away the toy if any of this is noted. Also if your pet is tolerant, it is a good habit to examine your pets mouth on a regular basis. Any problems or concerns can then be addressed with your
veterinarian.

Reeses was lucky that she did not have any complications. Her mouth, tongue, and teeth were unaffected from the incident and she left the hospital wagging her tail like when she walked in.

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May


“Slip of the Tongue”

written by
Melissa A. Rotella, DVM

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Sebastian is a two year old male neutered Chihuahua that was recently seen here at Route 516 Animal Hospital. For a few months prior to presentation, Sebastian had been crying out in what his owner assumed was pain when petting his head. He also had not been eating as much and had lost almost 14% of his body weight. Sebastian had also developed an occasional cough. All of these signs were inconsistent, but becoming worse over time.

On physical exam, Sebastian appeared happy and healthy. He was, however, very resistant to opening his mouth and a foul smelling odor was noted. The cause of most oral odor is usually from infected gums or tooth decay. However, Sebastian’s teeth were pearly white! Since Sebastian wouldn’t allow a full oral exam be performed, it was necessary to sedate him for a thorough exam.

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Once Sebastian was sedated, a fairly large, ulcerative and infected growth was detected underneath the tongue. We had found the source of the odor and pain! Upon further evaluation of the oral cavity, a string was seen wrapped around the base of the tongue and extending down the throat. The proliferate tissue growth seen under the tongue was in response to the string foreign body. Every time Sebastian swallowed, he was most likely in pain.

Foreign bodies lodged or embedded in the oral cavity are not extremely common, but can be a real source of pain and infection for both dogs and cats. Signs of oral discomfort are usually noted (pawing at the mouth, decreased appetite, and reluctance to eat hard food). Other clinical signs can be facial swelling, odor, drooling, oral discharge (blood or pus); or more nonspecific signs such as depression or vomiting. Once the foreign body is detected and removed, treatment consists of antibiotics and pain medication. It is a good idea to avoid situations that could lead to foreign body injuries (i.e. chewing on sticks, fishing line, bones, yarn, etc). Foreign bodies that are fully ingested and not limited to the oral cavity usually cause some other clinical signs such as vomiting and/or diarrhea. Gastrointestinal surgery is usually required to remove foreign bodies of the intestinal tract.

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It has been over a month since Sebastian had the string removed from around the base of his tongue and he is doing great!. Sebastian has gained weight and is back to his usually happy self!

April


Obesity in Animals
written by Dr. Melissa Rotella, DVM

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Innis is a 7 year old male Golden Retriever. He is neutered. Innis currently weighs 88 pounds. However, a few short years ago, he was approaching 120 pounds. Innis was obese!!

Obesity is defined as an increase in body weight beyond the limitation of skeletal and physical requirements. As in the human population, animals of any age, breed, or sex can become overweight. However, there are some breeds that seem to be at an increased risk: Labradors, Dachshunds, Beagles, Basset Hounds, and Golden Retrievers, just to mention a few.

There are serious health risks for overweight animals. Overall, they have a reduced life expectancy and are at increased risk for diabetes, joint problems, tracheal collapse, skin and heart disease. Therefore, routine wellness blood work and urinalysis are always important diagnostics in any overweight patient. It is also important to note that there are some diseases and medications that can make weight gain more likely. Hypothyroid disease is a common endocrine disease that can lead to weight gain. Once the underlying illness is treated, weight loss becomes an easier task.

One major way to decrease the chance of pet obesity in your household is to know what to look for. A body condition score (BCS) is a measurement scale that most veterinarians use to classify the degree of obesity. The BCS is a five point system with 3 being the ideal weight to body type ratio. A body condition score of 5 (obese) is classified as: difficulty feeling ribs under thick fat cover and no waist evident when viewed from the side or above.

Obesity treatment is aimed at weight reduction and risk-factor avoidance. There are a wide variety of reduced fat or low calorie foods now available for pets. Your veterinarian can help choose the appropriate one for your pet. Decreasing the amount of treats your dog or cat gets, along with choosing healthy options such as baby carrots or snap peas, are just a few helpful tips. As with human health, exercise also becomes an important aspect of any diet plan. If your pet can tolerate it comfortably, your pet should be encouraged to be active for 30 minutes each day. This can range from walking, hiking, playing fetch, or even swimming. It is important to have regular follow ups with your veterinarian so that progress can be monitored and any changes to the diet or exercise adjusted. With time and dedication, weight loss is possible and your pet will lead a healthier, happier life!!

February


Dental Disease

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Murphy is a 14 year old female Bassett Hound who presented to the Rt 516 Animal Hospital for difficulty eating, severe malodor from her mouth and a large swelling on the right side of her face, near her cheek. Upon examination, Murphy’s swelling proved to be a tooth root abscess. These are pockets of infection caused by bacteria found in tartar in our pets’ mouths. As the bacteria replicate and white blood cells rush to the source of infection, the cellular build-up will cause the breakdown of tissue lying between the roots of problematic teeth and nasal cavities, sinuses, or skin. Abscesses can disintegrate these tissues and eventually result in the flow of pus into the sinuses or even externally onto the nose and face. They are extremely painful due to both the build-up of pressure from the pus and also from the stimulation of sensitive nerves that lie at the tooth’s root.

Periodontal disease can occur at any age and in any species and breed. Some risk factors which can put pets at risk for tooth root abscesses include broken teeth, lack of adequate preventative dental care, long term steroid use, Diabetes and Cushing’s disease. Murphy’s tooth root abscess was secondary to her chronic, severe dental disease. Her teeth were covered with layers of tartar, hair and grass which in turn resulted in severe tooth decay, gingivitis and periodontal disease. The bacteria caused the breakdown of the ligaments holding her teeth in place and therefore several were loose, contained deep caries (dental decay) and were extremely painful to her. Murphy was placed immediately on antibiotics and scheduled for oral surgery. Twenty-one of her teeth (half in her mouth) were extracted and the remaining teeth were ultrasonically scaled and then polished. The swelling went down immediately and Murphy was much more comfortable as her gums began the healing process.

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Dental disease is a preventable condition. You should brush your pets’ teeth at least three times weekly along the gum line with a soft toothbrush. Do not use commercial human toothpaste as it can cause an upset stomach in animals. Special pet toothpaste is available which comes in flavors such as beef and chicken to make the process more enjoyable. It is easiest to start brushing your pets’ teeth when they are young puppies and kittens. They will become accustomed to the sensation and learn to enjoy the attention (especially if is followed by a treat). Your pets’ dental health should be evaluated by your veterinarian once to twice yearly. She will determine if your pet will need to undergo anesthesia and further dental diagnostics and treatment. The degree of dental disease can be evaluated through dental radiography and by measuring the gingival recession and bone loss by using a periodontal probe.

The key to good dental health is prevention. Long standing tooth decay and gingivitis increases the likelihood of tooth root abscesses, halitosis, pain, and inevitably, extractions (see photos 1 and 2). Even more critical is preventing the spread of bacteria into the bloodstream and to major organs such as the heart, liver, and kidneys. Taking proper care of your pets’ teeth will allow for routine dental scaling and polishing without the need for extractions or oral surgery. (See photos 3 and 4). After a routine cleaning is performed, a special sealant called Oravet can be placed along the teeth, which inhibits the attachment of plaque. We can also provide you with Oravet to apply weekly at home, along with a variety of other dental products to meet your pets’ special needs.

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If you notice any odor from your pets’ mouth, difficulty chewing, weight loss, an obviously broken tooth, tartar/calculus build-up, or a painful swelling in the cheek area, make an appointment immediately with your veterinarian for a full checkup and oral exam. Proper dental care will not only help them live longer, healthier lives, it can make those pet kisses much nicer.

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January


“Blowing Bubbles Can Cause Troubles”
Xylitol Ingestion
Written by Dr. Marni Cohen, DVM

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Coal is an 8 year old male Greyhound owned by Dr. Flanagan. Recently he ate a pack of her Orbit chewing gum. Coal decided that the Orbit bubble gum smelled yummy and he ate the whole pack. In the past, when an animal ate chewing gum, it was nothing to worry about. Unfortunately, manufacturers have started adding a sugar substitute called Xylitol to a lot of the gum.

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Xylitol is a white powder that looks and tastes like sugar. It is now being used as a sugar substitute. Due to the high demand for sugar free products, Xylitol is used in many more products; like candy, gums, puddings and baked goods. Xylitol has little or no effect in humans and is safe for us to ingest. However, in dogs it can have very serious side effects. Xylitol strongly promotes the release of insulin in dogs and can cause severe hypoglycemia (low blood sugar), liver damage, bleeding disorders, and possible death. These clinical signs can take up to 48 hours to develop. If ingestion is not caught early, the damage is often irreversible.

Chewing gums that are sweetened with xylitol contain about 1-2 grams per piece. This means that a small amount of gum (1 to 2 pieces) can cause hypoglycemia in an average sized dog. If the gum has already been chewed before the dog eats it, chances are that it has significantly less xylitol then a fresh piece. However, it is best to be extra cautious and call or take your pet to a veterinarian so that they initiate treatment. A full recovery is possible with early medical attention.

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Dr. Flanagan rushed Coal into the animal hospital. We induced vomiting right away. This can be done with hydrogen peroxide, apomorphine, or ipecac syrup. We also checked his blood glucose, did a blood chemistry panel, started an IV fluid drip (to restore and maintain hydration) and put him on supportive liver medications. Once he was stable, Dr. Flanagan took him to a 24 hour hospital where he was monitored throughout the night to make sure his blood glucose did not drop to low and she would not have to worry. Coal did great, had no complications and wondered what all the fuss was about!!
Remember that products safe for humans are not always safe for our pets. Make sure you keep such products in a safe place where your pets cannot get them. It can happen to any one of us

September


“LUCY”
Demodex Skin Condition
Written by Dr. Melissa Rotella, DVM

Lucy is a one year old spayed female who was came to Route 516 Animal Hospital for localized areas of hair loss and some mild crusting of the skin around some lesions. The lesions were approximately an inch in size and the skin underneath appeared healthy. Lucy’s owners did not notice her to be scratching at all. Remaining physical exam was unremarkable.

Demodicosis is a skin condition when there is an overpopulation of the mite Demodex canis (in dogs) or Demodex cati/Demodex gatoi (in cats). This can lead to furunculosis (infection of the hair follicle), hair loss and secondary bacterial infections. This mite is a normal inhabitant, in small numbers, of hair follicles and sebaceous glands on all dogs. Demodectic overgrowth is thought to be associated with a number of factors including genetics, stress, poor nutrition, endocrine diseases (including diabetes, Hypothyroidism, and Cushings) and immunosuppressive drug therapy. Demodex is diagnosed by a deep skin scrape, which is then looked at under a microscope. The disease is not considered to be contagious to other animals (except newborn cats and dogs) or people.
Demodex Mite
Localized Demodex on the face

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There are two forms of the disease: localized and generalized.

Localized lesions tend to occur in younger, otherwise healthy animals. These animals range from having 1-5 areas of hair loss (alopecia). Occasionally, localized lesions will spontaneously recover without treatment. Topical treatments, including benozyl peroxide shampoos, help flush out the hair follicles. Oral antibiotics are often prescribed to treat any secondary bacterial infections. Prognosis is usually good with most cases resolving in 4-8 weeks. However, some cases can progress to the generalized form.

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Generalized form of demodex tends to be more frustrating to owners. Generalized demodex usually starts as localized lesions that spread. Lesions can be anywhere on the body and consist of generalized areas of hair loss, crusting, red, inflamed skin. For all adult onset cases of demodex, underlying diseases should be ruled out. Your veterinarian may want to start with blood work. Treatment includes medicated baths, oral antibiotics, and medications directed at killing the mites. Prognosis is fair to good. Relapses may reoccur.

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