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## Feline Diabetes Mellitus

Diabetes mellitus is a common problem in cats. Caring for a diabetic animal requires some effort, but most pets remain happy and comfortable. Successful patient management requires a team effort between you and our veterinary care team.

## What is diabetes mellitus?

Diabetes mellitus is a disease caused by a deficiency of (or lack of response to) insulin. Insulin is a hormone that is produced by the pancreas. The cells of the body require blood sugar (glucose) for food and they depend on the bloodstream to bring glucose to them. The cells cannot, however, absorb and utilize glucose without insulin. Insulin is necessary for the movement of glucose from the blood into the cells of the body.

#### What are the signs of diabetes?

Excessive thirst, frequent urination, increased hunger, sudden weight loss and weakness are seen in cats with diabetes. Without insulin, glucose remains in the bloodstream and eventually passes into the urine. This causes increased urination, which then leads to an increase in thirst. Hunger increases because the body cannot use the glucose in the blood, which results in the body destroying muscle and fat to use as energy sources. If left untreated, this disease sets off a series of events which results in weight loss, major organ system failure, and eventually coma and death.

#### Why is my cat diabetic?

Feline diabetes is a complex disease, and most likely genetic and environmental factors both play a role. Many cats with diabetes have a history of chronic pancreatitis, or a disease which affects the body’s response to insulin. We do know that obesity is commonly associated with feline diabetes, along with the use of certain medications, such as steroids.

#### Is there a cure for diabetes?

Although there is currently no cure for cats with diabetes, some cats undergo remission a few months after diagnosis. This means that the diabetes goes away temporarily, and the cat is once again able to control his or her blood glucose levels. There is evidence to suggest that remission is most likely if the diabetes is treated effectively when first diagnosed.

#### How is diabetes treated?

Treatment generally requires an injection of insulin under the skin twice daily. Successful treatment also involves a high protein, low carbohydrate diet, generally Hill’s m/d or Purina DM.

#### What does the insulin do?

Insulin moves glucose from the blood into the cells. Glucose is an essential fuel for most of the tissues in the body, and without insulin, cell metabolism is severely compromised. Providing insulin in the form of an injection allows your cat to be able to utilize its glucose and maintain relatively normal glucose levels.

#### How do I give insulin?

Our veterinary team will show you exactly how to give insulin injections, but it’s really very simple. The insulin dose it pulled up into a special syringe, and injected under the skin. It is often easiest to inject between the shoulder blades or along the neck.

#### Do the insulin injections hurt?

Insulin syringes have very small needles, and most cats do not notice the injection. It is often easiest to administer the injection while your cat is distracted with food, a treat, or a toy. Most people are surprised at how easy insulin injections are to give.

#### How do I dispose of my used supply of needles and syringes?

Used needles and syringes need to be properly disposed of for both your safety and ours. You will be required to purchase a “SHARPS” container for a fee. This fee covers the container purchase, plus the proper disposal of the used/full container.

We will not accept used needles and syringes that are stored in containers other than the approved “SHARPS” container. Once the “SHARPS” container is full, simply return it to our office. We will dispose of it and you can purchase a replacement container.

#### What follow-up is involved with treating diabetes in cats?

In the non-diabetic cat, adequate amounts of insulin are produced continually (or as needed) by the pancreas to maintain normal blood sugar levels. When we give insulin injections, we administer a fixed amount at one time and that insulin is slowly released over several hours. A blood glucose curve is needed to determine how fast the injected insulin gets into the bloodstream and how long it lasts. Based on these results, we can determine if the correct type of insulin is being used and if the dose needs to be adjusted. Blood glucose curves are needed periodically to insure that the proper amount of insulin is being used. Blood glucose curves are performed by obtaining a blood glucose level every 2-4 hours over a 12 hour period. Generally, if your cat’s blood glucose is elevated throughout the curve, their insulin dose needs to be increased. If your cat’s blood glucose level is too low throughout or at any point during the curve, the insulin dose needs to be decreased.

#### What are the possible complications associated with treating my cat with insulin?

The most serious complication involved in treatment of diabetes is administration of too much insulin, which can trigger a dramatic drop in blood sugar leading to weakness, nausea, incoordination, seizures, and even death. Immediate feeding of a sugary food (honey, syrup, etc.) usually helps reverse this reaction. Other difficulties encountered generally revolve around finding the correct amount, timing and type of insulin given. While this is not often the case, “problem diabetics” do exist and have a higher incidence of concurrent disease such as lower urinary tract infections, kidney disease and liver disease.

#### Can I monitor my cat’s blood sugar (glucose) at home?

Learning to measure your cat’s glucose levels is very worthwhile. Firstly, information collected at home is a reflection of what’s happening day to day in your cat’s normal living environment. Cats in particular can become very stressed in the clinic, and their blood sugar levels can become markedly increased. Home glucose monitoring would allow you to be able to perform your cat’s glucose curves at home. Our veterinary team can use the values you obtain at home to adjust insulin therapy more appropriately and accurately. Secondly, if your cat seems unwell, you can quickly determine if blood sugar levels are dangerously high or low. It is very important to always consult our veterinary team prior to making any insulin adjustments.

The thought of glucose home monitoring may seem overwhelming at first, but it is an option to consider and can be started at any time during your cat’s diabetic treatment. Our veterinary team would be happy to demonstrate proper and easy blood sampling techniques and provide a home glucose monitoring kit.

#### What are the costs associated with treating my diabetic cat?

The major costs associated with treatment of diabetes include insulin, syringes and the cost of the glucose curves to regulate insulin requirements. We can give you more accurate estimation of treatment cost at your consultation appointment.

Our veterinary care team has reviewed the following websites on feline diabetes and find them to be an accurate source of valuable information.

www.veterinarypartner.com

www.alphatrakmeter.com

Making the decision to care for your cat with diabetes is a big commitment, but many owners of diabetic cats have found treatment to be a very rewarding and enriching experience. There is a lot to learn and it is important to be patient with yourself and your cat during the learning process. Diabetes is a serious disease, but it can usually be well-controlled, enabling your pet to lead a happy and comfortable life.

## Laryngeal Paralysis

The larynx (or voice box) is a structure located in the throat that helps direct air into the lungs and food into the esophagus. Its function is important in preventing food/water from entering the lower airways when swallowing. The larynx opening and closing is controlled by two small flaps called the arytenoids – these arytenoids close when we swallow food/water and open when we take a breath.

Laryngeal paralysis is when the nerves to one or both of the arytenoids become weakened or stop working entirely. This results in one or both of the flaps controlling the larynx to become paralyzed causing them to become slack. This causes louder raspy noise while breathing caused by the slackened arytenoids vibrating as air flows past them. Because of this weakening dogs can inadvertently swallow food or water into the lower airways resulting in coughing or even pneumonia.

The exact cause of laryngeal paralysis is yet unknown. It has been found that dogs with hypothyroidism are more prone to laryngeal paralysis. One study suggests that laryngeal paralysis may be part of a more widespread nerve degeneration; often times dogs with laryngeal paralysis also have weakness in the hind limbs.

Diagnosis of laryngeal paralysis is made by observation of the movement of the arytenoids as deep breaths are taken. This type of exam requires sedation. If one or both of the arytenoids appear slack the diagnosis is made. Occasionally chest x rays and bloodwork are also needed to better understand the situation.

Treatment of laryngeal paralysis is a surgical procedure called a laryngeal tie back or lateralization surgery. This surgery involves placing sutures to help reposition one of the arytenoids to open the airway. Unfortunately this surgery can present risks. Approximately 30% of dogs receiving this surgery will experience a complication called aspiration pneumonia in which food or water is swallowed into the lungs causing infection. Acute respiratory distress is another common complication of the surgery in which a patient will have difficulty breathing and may require an emergency tracheostomy to be placed (this is when a small hole is cut into the trachea below the surgery site to place a breathing tube).

If laryngeal paralysis is not treated the risk of respiratory crisis can occur. If a dog with laryngeal paralysis gets excited or is exposed to warm temperatures, they will begin to pant. Panting will cause the slackened arytenoids to hit each other repeatedly resulting in potentially life threatening swelling of the throat that could result in overheating, lack of oxygen to the brain, and/or death.

#### Helpful tips for dogs with laryngeal paralysis:

• Avoid stress to prevent excess panting
• Keep pet in a temperature controlled, cool environment avoiding extreme heat
• Use a harness instead of a collar to reduce pressure on the neck
• Pursue surgical correction in a timely fashion to reduce risk of respiratory crisis

## Vestibular Disease

The vestibular system is a combination of sensing receptors in the middle ear which help us determine our orientation and movement. These receptors then send signals via nerves to parts of the brain that help us maintain balance and coordinate our movements. If any part of this intricate system is disrupted it can result in “vestibular disease”.

Symptoms of vestibular disease include: head tilt, ataxia or uncoordinated movements, walking in circles, falling over, motion sickness or nausea, and nystagmus (rapid eye movements side to side or rotational).

#### Causes of Vestibular Disease

• Middle ear infections can affect the vestibular organs which reside in the ear. Diagnosis can occasionally be made by external ear exam and microscopic evaluation of debris, but may require x rays of the bulla (bones of the inner ear). Treatment will involve topical and/or oral antibiotics. In severe cases, anesthesia for a deep ear flush may be warranted.
• Brain lesions such as cancer, bleeding or blood clots in or around the brain can be an important but less likely cause of vestibular symptoms. Diagnosis of this would require referral for CT scan or MRI.
• Idiopathic or “old dog vestibular disease” is the most common cause. Idiopathic disease has no known cause, but it occurs acutely and resolves quickly. Often dogs with this form will be back to normal in 7-14 days. Treatment involves treating for motion sickness and nausea. Physical therapy can also be helpful in assisting in recovery.

## Transitional Cell Carcinoma (TCC)

Transitional Cell Carcinoma (TCC) is a cancer of the urinary bladder. Transitional cells are the cells that line the bladder wall, TCC is a cancer that arises from these cells. The exact cause is unknown, however, an increased risk of this cancer is found in certain breeds of dogs. Shetland sheepdogs, West highland terriers, Scottish terriers and Beagles are breeds predisposed to TCC.

#### Symptoms include:

• Blood in the urine
• Straining to urinate
• Frequent or unexplained bladder infections

The diagnosis of TCC is often made after ruling out more common causes of the above list of symptoms (such as bladder stones, infections or other benign causes of blood in the urine and straining to urinate). Several diagnostic tests will be needed to confirm the diagnosis of TCC.

• Urinalysis – will reveal blood and sometimes abnormal cancer cells can be seen.
• Urine culture – allows for infection secondary to the tumors to be treated with appropriate antibiotics.
• Ultrasound – will show abnormal masses in the bladder wall, but can also show us crystals, stones or polyps in the bladder
• Cystoscopy – A tiny flexible camera that can be inserted like a catheter through the urethra into the bladder to help visualize and biopsy bladder masses
• Catheterization – in some cases a urinary catheter can be placed in male dogs that helps collect a small sample of cells for cytology
• Cytology — evaluation of cells by a pathologist

#### Treatment

• Chemotherapy – available through veterinary oncologists.
• Surgical removal – possible only if mass is in a location favorable for surgery.
• Conservative/palliative care – piroxicam is an oral medication often used due to its anti-inflammatory properties and possible anti-tumor activity.

Your veterinarian will help formulate a diagnosis and treatment plan best suited for your pet’s needs.

## Keratoconjucntivitis Sicca (KCS)

Keratoconjunctivitis sicca, otherwise known as KCS or Dry Eye is a condition in which tear production is abnormally low.

#### Symptoms may include one or more of the following:

• Dry appearance to the eye
• Increased thick ocular discharge
• Conjunctivitis – red/inflamed eyes
• Corneal edema (hazy white appearance to outer eye)
• Corneal pigmentation (brown discoloration to the outer eye)

Corneal ulcers or damage to outer eye can occur secondary to KCS

Diagnosis is made by performing a test to measure tear production called a Schirmer Tear Test.  A fluorescein stain may be performed to help rule out corneal damage or ulceration secondary to KCS.

Treatment of KCS is life long and involves using a combination of therapies to help stimulate natural tear production, provide lubrication to the eye and control secondary bacterial infections.  The most common medication used is an ophthalmic ointment called Optimmune (or other cyclosporine eye medications) – this treatment can stimulate tear production as well as decrease inflammation.    Prognosis is good for patients with KCS, however treatment is lifelong.

## Flea Control Guide

#### How to Look for Fleas on Your Pet

Examine your pet’s coat carefully. Using a fine-toothed comb (flea comb), look for adult fleas, or for specks that look like pepper (flea dirt). The most common areas to find fleas/flea dirt are the groin, armpits, tailhead, and the neck area. Transfer the black specks onto a white paper towel, and moisten it with water. If the specks leave a red stain, these are definatley flea droppings.

#### Flea Allergy Dermatitis

Many dogs and cats are allergic to flea saliva, and even a few bites cause these pets to be intensely ithcy. For these pets, flea prevention is critical. The skin irritation associated with flea bites can be treated with anti-inflammatories, and skin infections can be controlled with antibiotics.

#### Successful Flea Control

An effective flea control program requires treatment of all:

• Pets in the household
• Stages of fleas
• Areas of the environment

It is very important to use a flea control product that controls the larva and egg stages, as these stages comprise 95% of the flea population. Look for house treatments that contain insect growth regulators (IGRs) for effective control of all stages. Adult fleas spend a majority of their lives on a dog or cat, and are easily killed with an effective adulticide product.

Fleas complete their life cycles best in carpet/upholstry fibers, cracks or crevices on the floor, and in shady areas of yards. Concentrate control efforts in these areas. Prevention is easier and less costly than treating a flea infestation.

#### A. Treat the pet.

Adult fleas that are living on the pet must be killed. Effective topical products will not only treat an active infestation, they will prevent future infestations. It is recommended to use monthly.

These topical products include:

• Parastar Plus (dogs only)
• Easy Spot (cats only)
• Frontline Plus
• Revolution

For pets with a significant amounts of flea dirt, we recommend applying the topical product, wait two (2) days, then bathe with an aloe/oatmeal shampoo. It is not recommended to use medicated shampoos or flea shampoos in conjunction with topical products. These shampoos will strip, or remove, the topical products.

#### B. Treat the house/outdoor environment.

Remember that only 5% of the flea populations are adult fleas on the pet. The remaining 95% of the population are eggs, larvae, and pupae living in carpet and upholstery.

The recommended home treatment is a product called Knockout Spray (with IGR). One (1) can treats approximately 1200 – 1500 square feet.

##### Pre-treatment:
1. Vacuum all carpets, upholstered furniture, baseboards, and under furniture. Discard vacuum cleaner bag immediately.
2. Mop floors with warm, soapy water.
3. Change all linens, blankets, and replace (or wash in hot water) pet bedding.
##### Treatment:
1. Follow the directions on the can. All pets and humans must be out of the treated areas as directed on the can.
2. Spray all carpeted areas and upholstery with the house treatment spray. Be sure to treat under furniture, and to treat all rooms in the house.
3. If you pet spends a lot of time outside or in a kennel, these areas must be treated for fleas as well. Concentrate on shady, protected areas, and dog houses. Treat the areas according to label directions.
##### Follow-up treatment:

Repeating home treatment is very important. Fleas in the pupal stage are protected by the cocoon, therefore retreat in two (2) weeks to kill fleas that emerge.

#### C. Prevention

If your pet is exposed to other animals or are outside, they may become infested with fleas repeatedly. Consistent use of monthly preventatives is advised yearround to keep your pet protected from re-infestation.

• Parastar Plus (dogs only): Apply topically once a month for control of fleas and ticks in dogs. Water resistant
• Easy Spot (cats only): Apply topically once a month for flea and tick control in cats.
• Frontline: Long-lasting spray OR topcial application for dogs and cats. Apply once a month for control of fleas and ticks. Water resistant.
• Revolution: This product prevents heartworm disease, ear mites, sarcoptic mange, roundworms and hookworms, as well as fleas and ticks.

## Equine Euthanasia and What Comes Next

Making the decision to euthanize an equine companion is never easy. Even if the time may be right for our horse, it may not feel like the right time for us to be saying goodbye to our friend. The end of a beloved horse’s life can be a very difficult time. Not only are we faced with the loss of a companion, but decisions must be made regarding care of the body.

Beginning in late spring of 2018, most livestock removal and rendering services in our area began no longer accepting horses euthanized with the drug that had previously been used. The reason for this is to increase the safety of animal feed products, but as a result our livestock removal options have changed and may continue to do so as new regulations evolve. Please check with our office about current changes if you have any questions or concerns.

### Some disposal options currently available include:

Burial: If you own land, you may want to have your horse buried on your property. To do so, you should research the laws for your location. Some counties prohibit burial, or if they allow it, there may be specifications about the depth and size of the hole, its location in relation to water sources, and how the body should be handled. Please look up local ordinances prior to burial. (Cost: $0-300) Landfill: Horses may be taken to a local landfill (certain landfills only). This requires a special trailer and winching system for loading and unloading the body. Each landfill has its own regulations and limits on size and number of horse(s), and drop off times and days. Please call ahead. (Cost varies by weight) Cremation: You can arrange to have your horse cremated with or without the cremains returned to you. There are two companies that service our area: Midwest Cremation Service and Brier Hill Livestock Removal. Both companies provide a pick-up service that will take your horse’s body directly to the crematorium. Brier Hill Livestock Removal 847-652-4839 brierhilllivestock@gmail.com ($395-500 for group cremation or additional for individual cremation with ashes returned)

Midwest Cremation Service:
608-635-7270
www.mcsofwi.com
($1100-1600) Livestock Removal: This used to be the most utilized option until laws about chemical euthanasia changed in May 2018. At the present time these services will only pick up if your horse is euthanized by gunshot or captive bolt or died of natural causes. Gunshot and captive bolt euthanasias are approved by the American Veterinary Medical Association as an acceptable route of euthanasia. These services do occasionally offer Saturday pickup. Marshall Stock Removal 608-655-3439 ($250-300)

Granite Stock Removal
920-566-2563
(\$250-300)

The doctors and staff at Lodi Veterinary Care understand how difficult the loss of an equine companion can be. We are available to discuss any questions, emotions, or concerns that you may have so please feel free to contact us. Here you will find a wealth of support and a group of concerned, loving individuals who understand the depth of the human-animal bond.

## Hay Analysis

Hay is a crucial part of an equine diet in the Midwest, and its nutrition content can play a big role in what grain and supplements your horse may or may not need. When creating a nutrition plan for your horse(s), we recommend a hay analysis. A hay analysis is easy to obtain and can tell you a lot about the forage your horses are eating.

## What information can a hay analysis provide?

#### Sugar content

• The sugar content is key for horses with metabolic conditions such as Pituitary Pars Intermedia Dysfunction (PPID, or “Cushings”) as these horses should ideally be limited to hay which is less than 10% NSC, the non-structural carbohydrates.
• When limited hay is not an option, we often recommend soaking hay in cold water, which can decrease the NSC level by approximately 30%

#### Digestibility and consumability

• Are your horses wasting a large amount of the hay you provide? The consumability may be low if so.
• Poor digestibility can lead to “hay belly” appearance.

#### Calcium content

• Calcium can indicate the amount of alfalfa in the hay (more calcium = more alfalfa)

#### Digestible energy

• How much energy can be extracted from the hay

#### The Relative Feed Value (RFV)

• RFV is the overall quality of the hay, graded out of 200
• An average hay is typically between 95-115.
• Keep in mind that not every horse (in fact many horses!) don’t need the highest quality hay!

#### Moisture content

• High moisture can lead to spoilage more easily

#### Crude protein

• Especially important for horses with impaired kidney function, as they can’t balance their protein as effectively

Another key reason to have your hay analyzed is to better determine how much grain (if any) is needed based on the horses’ demands and requirements. In other words, a hay analysis is crucial to properly balance a ration.

## Testing the Hay

It’s ideal if we can sample a random assortment of 8-10 bales to get an idea of the overall quality of the hay. From each of those bales we obtain a cross-sectional “core” sample across a large area of the bale.

Lodi Veterinary Care provides hay sampling services as well as diet/nutrition analysis recommendations. If you’d like to schedule a time for us to pick up a sample or if you have any other questions, please give us a call at (608) 592-7755.

## How-To: Giving Subcutaneous (SQ) Vitamin B12 Injection

• Take a new syringe from the package (syringes are single use only, call or visit us to get refills on syringes when needed)
• Draw up 0.25ml of the red Vitamin B12 solution (measure from the top of the black plunger).​
• Pull up the skin between the shoulder blades to create a skin “tent”
• Insert the whole needle into the skin (pointing downward towards the body), make sure the needle has not exited the skin on the other size of the skin “tent”.
• Inject the total volume of Vitamin B12 under the skin.
• Discard the used needle into a Sharps container, syringes are single use only. When Sharps container is full, it can be returned to Lodi Veterinary Care for proper disposal.

## How-To: Giving a Pill to a Cat

One thing to keep in mind is that cats will do their best to make pilling difficult. Cats are not too fond of having their mouths pried open, let alone allowing you to insert a pill in their mouth. Some cats will salivate excessively, so it is very important that you learn how to pill a cat quickly and efficiently.

#### STEP 1: Restraint

There are three ways to restrain a cat:

• Restraint 1: Kneel on ground. Place the cat between your legs with its face near your knees. Squeeze slightly with your legs just enough so the cat won’t escape.
• Restraint 2: Use a towel to restrain if the cat is too wiggly. Wrap the cat up like you would if you were wrapping a burrito/taco. Be careful not to wrap too tight. If needed, this can go with step 1.
• Restraint 3: If you have someone available to help, have them hold the cat on a table cradled next to their body. Have the person hold the front legs and chest tight so the cat can’t get away. You can then concentrate on giving the pill, not chasing the cat.

#### STEP 2: The actual pilling

• Put your “off-hand” on top of cat’s head. Place thumb and forefinger on the side ridges of face, just behind jaw. Gently raise the head until it points to the ceiling in an upward position.
• As the mouth opens, use your other hand to hold the pill and press down on lower jaw, dropping or pushing the pill as far back on the tongue as possible. If this is not easy to do, you may use a piller, which is a device designed to make pilling easier to do.

#### STEP 3: Making sure the pill has been swallowed.

• Once the pill is placed in the mouth, close the mouth making sure you or your partner still have a firm hold on the cat. Rub the throat and nose, or blow into the cat’s face softly to get the cat to swallow the pill. The desired result is to get the cat to lick its nose, which forces the swallowing action. When the cat has swallowed the pill, you may offer a small amount of water to wash the pill down.
• When finished give lots of praise to your cat. If these techniques do not work, please call Lodi Veterinary Care and we can assist you with any problems.

#### Alternatives/Suggestions:

• It is not ideal to crush the medication and mix with food. Most often your cat will detect the medication and refuse to eat it. You will also not know if the entire dose of medication was ingested.
• Coat the pill with butter. This will allow the medication to slide down easier.
• Greenies Pill Pockets for Cats are available at Lodi Veterinary Care. These meaty pockets provide you with a means to hide the medication in a tasty treat most cats will like.
• If you do not like the idea of putting your fingers inside your cat’s mouth, there are cat pillers available at Lodi Veterinary Care. These pillers allow you to safely bring the medication to the back of your cat’s mouth for ease of administration.
• If your cat has been prescribed antibiotics and you are having difficulty giving the medication, you might be in luck. In most cases there is an injectable antibiotic available. This injectable will give 10-14 days of antibiotic coverage without the hassle.

# The way it used to be:

### What is Strategic Deworming?

Strategic Deworming involves determining a Fecal Egg Count (FEC) by counting the number of parasite eggs, and using that number, along with the specific identification of which types of parasites are present, to better select a dewormer. Only about 20% of horses harbor about 80% of parasites, so the same deworming program shouldn’t be used for all horses.

### Goals of Strategic Deworming:

• Tailor deworming to the individual horse, time of year, geographic location, and exposure level. This means using the right dewormer, at an effective dose, at the best times.

• Limit overuse of dewormers to prevent resistance. Resistance can be present regionally or more locally on specific farms.

• Evaluate a dewormer’s effectiveness on a certain farm by checking a fecal before and after deworming.

• The goal is NOT to eradicate all the parasites or to make every horse into a “low shedder”.

### Manure management:

Parasites are part of the normal intestinal fauna of grazing animals: horses and parasites evolved together. Actively managing horses (fences etc) causes an imbalance to this relationship.

• By far the best parasite management practice is to remove manure frequently from pastures and pens

• Compost manure before spreading on grazing areas.

• Pay particular attention to remove manure from feeding areas.

• Avoid overcrowding

• Deworm new horses prior to introduction, and keep visitors separated.

• Mowing and harrowing pastures: this exposes eggs and larvae to the killing effects of air and sunlight.  Works best when temperatures are at least 85°F.

• Rotational grazing: allows larval stages to die before horses are exposed. Ideally combine rotational grazing with mowing/harrowing.

### General recommendations for adult horses:

Discuss with your veterinarian if the below protocol is a good fit for your horses. Many factors influence a deworming program including manure management, animal density, and general health of the horses. Please wait at least 4 weeks after most recent deworming to submit a sample for a fecal egg count.

#### SPRING: Check a fecal egg count

• Low shedder (<200 epg): deworm with ivermectin

• Moderate shedder (200-500 epg): deworm with ivermectin and recheck fecal in 4 weeks

• High shedder (>500 epg): deworm with ivermectin now and repeat in 4 weeks, then recheck fecal 4 weeks after second deworming.

#### FALL: Check a fecal egg count

• Low shedder (<200 epg): deworm with ivermectin and praziquantel combination

• Moderate shedder (200-500): deworm with ivermectin and praziquantel combination and recheck fecal in 4 weeks

• High shedder (>500 epg): deworm with ivermectin and praziquantel combination then deworm with ivermectin (no praziquantel). Recheck fecal in 4 weeks. If continues to be high, deworm with moxidectin.

• If a horse is showing overt symptoms of intestinal parasitic disease, perform a fecal egg count and discuss a deworming protocol with your veterinarian. Moxidectin may be recommended to kill encysted larvae in these horses.

## Tapeworms:

Praziquantel is used to treat for tapeworms. Tapeworms do not show well on a standard fecal; however, in this area deworming with praziquantel once yearly is typically adequate. Praziquantel is included with ivermectin in EquiMax (recommended) and Zimectrin Gold. Praziquantel is included with moxidectin in QuestPlus.

### For horses less than three years old:

• If you acquired a horse less than 3 years old and it has no deworming history, please consult a veterinarian prior to deworming them for the first time. These horses should have an individualized plan for deworming. If a young horse contains a large number of parasites, they may be at risk for a severe impaction colic caused by die-off of ascarid parasites. This could require surgery and can even cause death.

• Foals should receive at least 4 deworming treatments within their first year of life.

• @ 2-3 months old, deworm with oxibendazole

• @ 4-6 months old, deworm with oxibendazole

• @ 9 months, deworm with an ivermectin and praziquantel combination

• @ 12 months, check a fecal and deworm with either ivermectin or oxibendazole depending on the predominant parasite type seen.

## How do I submit a manure sample for a fecal egg count?

It’s easy! All we need is 1-2 fresh fecal balls per horse. If possible, try to collect from the center of a manure pile so they are not dried out or covered in bedding, sand, or dirt. Place into a clean zip-lock bag and label with your first and last name, horse’s name, and date of collection. If you have a rough idea of when the horse was last dewormed and what product was used, that is helpful information for formulating a deworming program best suited to your horse. Keep the sample in the fridge or in a cooler with ice packs until it gets to us. You can drop off samples at any of our three locations (Lodi, DeForest, or Portage); give it to us at your next appointment; or call to arrange pick-up.

Please don’t hesitate to call with any questions or to discuss a deworming protocol specific to your horse!

## What is a Coggins Test?

A coggins is a test for equine infectious anemia (EIA) which is a viral disease.

EIA is spread by blood-feeding insects such as horseflies, stable flies , and deer flies. It can also be transferred in utero, or via equipment or blood products (ex. blood transfusion).

Once infected, horses may show fever, swelling of lower legs, weakness, or petecchia (small bruises on gums). Horses that survive this phase usually become carriers and can spread the disease without even showing any signs.

There is no treatment for this disease; positive horses can be quarantined for the rest of their lives but are typically euthanized. In just one week, 3 horses in Georgia were confirmed positive for Equine Infectious Anemia and were euthanized.

Preventative measures focus on eliminating vectors, such as: using insect repellents, reducing standing water, managing manure waste, and cleaning pastures.

## When is a Coggins Test Needed?

• Most equine events/shows require a negative coggins test performed within the past twelve months

• Out-of-state health certificate

• Sales

• Some boarding facilities require a negative coggins test

## What is conjunctivitis and how do I recognize it?

Conjunctivitis is where the tissues surrounding the horse’s eyes become irritated by allergens, excessive dust, flies, injury, or a combination of irritants. The eyes appear red and watery and often the nasolacrimal (tear) duct becomes inflamed and swollen as well and no longer drains the eye normally.

### Symptoms include:

• Inflammation of the mucous membrane or pink lining that surrounds the eyeball
• Redness of eye tissues
• Swelling and watering of eyes, sticky
• Yellowish discharge
• Often times refusal of horse to open the eyes or repeated clenching of eyelids

Conjunctivitis may be caused by any number of irritants, including dust, pollen, insect bites, flies, allergens, or it may also be the result of injury to the eye.

Unfortunately it is impossible to determine whether it is a simple form of conjunctivitis or if the conjunctivitis is accompanying a more serious condition such as a corneal ulcer so it should always be given immediate attention.

### How can we treat it?

Removing known irritants from the environment is the first step in preventing conjunctivitis. Keeping dust of all kinds at a minimum, having an insect control plan in place, and taking care to prevent injuries to the horse’s eyes will help lessen the problem.  In the case of ongoing or repeated cases of conjunctivitis a fly mask may be a large help in managing the problem.

In cases of simple conjunctivitis, merely removing the offending irritant can help solve the problem.

However in cases of more serious conjunctivitis it will be necessary to perform an examination of the cornea to be sure there are no corneal ulcers and then start the horse on an ophthalmic ointment with a steroid.  The steroid works to decrease inflammation and calm down the irritated tissues.  Since steroids decrease the eye’s ability to heal, it is imperative to be sure that there is no corneal ulcer present when you begin to administer the medication.

Equine ophthalmic issues can evolve from simple to serious very quickly so please do not hesitate to call your veterinarian if you have any questions or concerns regarding your horse’s eyes. We are open 24/7 for emergencies (608) 592-7755.

## The Buzz About EEE and WNV

There has been a recent resurgence in mosquito-borne diseases in Wisconsin over the last few years, and it has become even more vital that horse owners vaccinate against both Encephalitis and West Nile Virus. Last year, there were 24 cases of West Nile Virus (only 1 had been vaccinated) and 24 cases of Eastern Equine Encephalitis (only 1 horse had been vaccinated) in Wisconsin. Typically, when a horse contracts one of these diseases, it is due to not being vaccinated or being under vaccinated; thus, the goal of most equine practitioners is to ensure all horses are vaccinated and protected against these diseases.

Fun Fact: According to The Historical Medical Library of The College of Physicians of Philadelphia, horses and other animals were used to produce antitoxins in a variety of diseases, such as diphtheria, tetanus, and scarlet fever.

### Recommended Vaccinations

The core vaccines recommended by AAEP are Eastern Equine Encephalitis (EEE),  Western Equine Encephalitis (WEE), Tetanus, Rabies, and West Nile Virus. These vaccinations protect against diseases that occur year after year – by way of soil, insects or local wildlife; every horse is at risk, regardless of location or lifestyle. These vaccinations are safe, effective, widely available, and they prevent diseases that have a high mortality rate and/or no effective treatment. Additionally, the rabies vaccination helps protect human health and lives. Other vaccines may be recommended by your veterinarian depending on your horse’s specific needs/situation.

### Who Can Vaccinate?

Vaccinations are available for over the counter purchase by anyone. However, it is strongly recommended that a veterinarian administer vaccines. If your horse was an adverse reaction associate with the vaccination or develops the disease while up-to-date on vaccines, the vaccine company will cover the cost of diagnostics and treatment when those vaccines were administered by a licensed veterinarian.

### Vaccinating for Disease Prevention

Vaccination easily ranks as one of the single most important things you do to protect your horse’s health. Effectiveness of vaccines can be seen in human health history. Human diseases such as Smallpox and Polio have been almost 100% eradicated due to the use of vaccines; the last endemic case of Smallpox in the world occurred in Somalia in October 1977. While not all vaccines are as effective as these examples, most have significantly decreased the amount of disease.

## Eastern Equine Encephalitis

#### A Brief History

The virus Eastern Equine Encephalomyelitis is thought to have been the case of EEE in North America since 1831. It did not receive its name until a major outbreak occurred in horses  \in the coastal areas of Delaware, Maryland, New Jersey, and Virginia in 1933. Additional outbreaks occurred in Virginia and North Carolina in 1934 and 1935, respectively. Mosquitoes were first determined to be the carriers of EEE in 1934, and in 1950 it was discovered that birds can be a reservoir host for the virus.

#### Transmission

• Transmitted by mosquitoes or other biting insects
• Birds act as reservoirs for the virus; mosquitoes and other biting insects then carry the pathogen from infected birds and transmit it to horses when they bite
• The majority of wild birds infected with the virus will exhibit no clinical signs
•  A horse affected with EEE is not contagious and poses no risk to other horses, humans or birds.

#### Incubation Period: 3-7 days

Carrier Status: Infected horses CANNOT transmit the disease to other horses, horses do not replicate enough virus to pass on to another mosquito

Severity: High; morbidity rate in horses infected with EEE is 75-95%

#### Clinical Signs

• Depression and anorexia without fever when initially infected
• Moderate to high fever 102.5-104.5F
• Lack of appetite, lethargy/drowsiness
• Neurologic signs- Onset of neurologic disease is frequently sudden and progressive
• Periods of hyperexcitability, apprehension and/or drowsiness
• Fine tremors and fasciculations of the face and neck muscle
• Convulsions
• Cranial nerve paralysis– facial paralysis and weakness of the tongue are very common
• Head tilt, droopy lip, muzzle deviation
• Weakness, ataxia, and dysmetria (incoordination) in one or all limbs o
• Complete paralysis of one or more limbs
• Colic
• Recumbency (inability to stand)
• Death

Diagnosis: Made by a veterinarian using combination of clinical signs, history and bloodwork

#### Treatment

• There is no cure for EEE
• Supportive care is administered in horses which show clinical signs

#### Prognosis

• Poor. Horses infected with EEE do not often survive
• Morbidity rate is 75-95% and death usually occurs within 2-3 days of onset of signs

#### Prevention

• Keep all horses up to date on vaccinations!
• Initial vaccination with booster, followed by yearly revaccination
• More frequent boosters (i.e. twice yearly) are recommended in areas with year-round mosquito seasons and in endemic areas
• Practice vector control management on your facility to reduce risk of transmission from insects.
• Use insect repellents frequently; re-apply after rain
• Keep horses in at night when possible, and apply insect repellent
• Eliminate or minimize standing water, eliminate brush piles, gutters, old tires and litter
• Remove all equipment in which standing water can collect
• Biosecurity: There are no recommended biosecurity protocols nor do restrictions need to be placed on affected or recovered animals as they pose no risk of infection to other horses.

## West Nile Virus

WNV is a mosquito-borne virus that can cause encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain and spinal cord) in humans and horses. Mosquitoes acquire the virus from infected birds and transmit it to the dead end host In 1999, WNV was seen for the first time in New York. Since then, over 25,000 cases of WNV encephalitis have been reported in U.S. horses. Horses represent 96.9% of all reported non-human mammalian cases of WNV disease.

#### Transmission

• Transmitted by mosquitoes or other biting insects
• Birds act as reservoirs for the virus; mosquitoes and other biting insects then carry the pathogen from infected birds and transmit it to horses when they bite
• A horse affected with WNV encephalitis is not contagious and poses no risk to other horses, or birds

#### Incubation Period: 7-10 days

Carrier Status

• Infected horses CANNOT transmit the disease to other horses.
• The virus can only be transmitted to a horse via an insect vector

Severity: Medium. Up to 40% of infected horses are euthanized or die as a result of infection

#### Clinical Signs and Symptoms

• Depression and anorexia without fever when initially infected
• Lack of appetite, lethargy/drowsiness
• Neurologic signs
• Paralysis
• Facial paralysis and weakness of the tongue are very common
• Recumbency (inability to stand)
• Incoordinationin one or more limbs
• Weakness
• Colic
• Death

#### Diagnosis

• Use a combo of clinical signs, history and bloodwork

#### Treatment

• There is no cure for West Nile Virus
• Supportive care is administered in cases which show clinical signs

#### Prognosis

• Horses showing clinical signs of the disease develop in up to 39% of horses infected
• Some infected horses never show clinical signs of the disease and horses who survive usually make a full recovery
• Approximately 40% of horses will have residual neurologic deficits after recovering
• However, up to 40% of infected horses are euthanized or die if they become recumbent

## References

• https://equusmagazine.com/management/core-vaccines-25417
• https://www.aphis.usda.gov/publications/animal_health/content/printable_version/fs_eastern_equine_enceph.pdf
• https://cwhl.ahdc.vet.cornell.edu/disease/eastern-equine-encephalitis#collapse3
• https://extension.psu.edu/west-nile-virus-a-threat-to-horses
• https://www.vet.k-state.edu/vhc/services/equine/timely-topics/wnv-fact-sheet.pdf
• https://www.historyofvaccines.org/content/horse-serum
• http://www.equinediseasecc.org/disease-information
• https://aaep.org/guidelines/vaccination-guidelines

## Toxic Plants to Horses

There are many poisonous plants in Wisconsin that could be a potential hazard to horses. These plants may cause symptoms such as:

• Colic
• Muscle weakness
• Incoordination
• Depression
• Paralysis
• Death

Undesired plants can be eliminated in pastures by several methods, however, hand pulling is often most effective. When eliminating these plants, be sure to:

• Wear gloves
• Pull plants up by the root (this is easier when the ground is wet)
• Dispose of the plants far from the horse’s reach
• Read instructions on any chemical herbicides thoroughly
• Keep animals off the area as directed after using herbicides

Below is a non-exhaustive list of commonly found plants that can be toxic to horses:

#### Black Locust

This tree can be found in almost every environment and soil. The bark, leaves, and seeds are all toxic.

• Symptoms: irregular heart rate, shallow breath, abdominal pain, and death
• Treatment: supportive care and detoxification

#### Black Walnut

While the tree itself is not toxic, shavings made from it and should not be used as horse bedding. Wilted or dry leaves can also be toxic for 4 weeks after falling from the tree.

• Symptoms: laminitis
• Treatment: treatment for laminitis

#### Bracken Fern

This plant is also known as Eastern Bracken. It is a perennial fern, and symptoms are slow to develop.

• Symptoms: depression, tremors, appetite loss, weakness, paralysis, staggering, loss of flesh
• Treatment: if caught in time, injections of thiamine can help reverse damage

#### Chokecherry

Chokecherry can be extremely lethal in small doses; as little as 2 pounds of leaves can kill an 800 pound animal in 30 minutes.

• Symptoms: convulsions, rapid breathing, frothing of the mouth, and dilated pupils
• Treatment: if caught in time, immediate supportive care and IV fluids, with an antidote of sodium nitrate and sodium thiosulfate

#### Cocklebur

Cockleburs are toxic when ingested. As little as 6 lbs. can be lethal to an 800 lbs. horse

• Symptoms: convulsions, depression, blindness, reluctance to move, hunched back, death
• Treatment: supportive care

#### Dried Maple Tree Leaves

While fresh leaves and twigs will not harm horses, wilted or dried leaves can be toxic.

• Symptoms: weakness, anemia, and increased respiratory rate
• Treatment: supportive care, IV fluids, blood transfusions and activated charcoal

This plant is also known as Deadly Nightshade, Horse Nettle, or Belladonna. It grows in hedges, pastures and in fence rows. It is a vine with purple flowers and green and red berries.

• Symptoms: depression, decreased heart and respiratory rate, muscle weakness, watery diarrhea, paralysis of hind legs
• Treatment: supportive care

#### Jimson Weed

This plant is also known as Devil’s Trumpet and Thorn Apple. As little as 1 lb. can cause symptoms and more can be fatal.

• Symptoms: dilated pupils, decreased respiratory rate, and muscle weakness
• Treatment: if caught in time, activated charcoal, supportive care, and IV fluids

#### Lawn Clippings

Lawn clippings become toxic as the grass ferments and releases a gas.

• Symptoms: gas colic
• Treatment: same as colic treatment

#### Oak Tree

The acorns, buds, leaves, and blossoms are toxic to horses and livestock.

• Symptoms: anorexia, colic, bloody diarrhea and edema
• Treatment: supportive care and IV fluids to flush out kidneys

#### Ornamental Yew

This plant is also known as Japanese Yew and is commonly used as a landscaping shrub. They are extremely toxic and as little as 6-8 ounces can kill a horse.

• Symptoms: weakness, labored breathing, collapse, trembling
• Treatment: if caught in time, treatment can include activated charcoal and assisted respiratory support

#### Rhododendron

This plant is also known as Mountain Laurel. It is extremely toxic to horses and as little as 0.2% of the body weight may be lethal.

• Symptoms: depression, weakness, impaired vision, difficulty breathing, collapse
• Treatment: if caught in time, treatment can include activated charcoal

#### Spotted Poison Hemlock

Also called Water Hemlock Cowbane, this plant is often found near creeks and streams in damp areas. As little as 2 pounds can cause death.

• Symptoms: incoordination, salivation, and colic
• Treatment: supportive care

#### White Snakeroot

This plant is often found along fence rows and woodlines.

• Symptoms: difficulty swallowing, muscle tremors, and wide stance
• Treatment: if caught in time, activated charcoal can be used

#### Images:

• https://wagwalking.com/horse/condition/black-locust-tree-poisoning
• https://csuvth.colostate.edu/poisonous_plants/Plants/Details/69
• http://noosasnativeplants.com.au/plants/414/pteridium-esculentum
• http://poisonousplants.ansci.cornell.edu/php/plants.php?action=indiv&byname=common&keynum=68
• https://www.fireflyforest.com/flowers/2542/xanthium-strumarium-rough-cocklebur/
• http://www.horsedvm.com/poisonous/red-maple/
• https://fyi.uwex.edu/weedsci/1993/10/04/1187/
• https://wagwalking.com/horse/condition/jimson-weed-poisoning
• http://www.herbalsafety.utep.edu/herbal-fact-sheets/jimsonweed/
• http://nwdistrict.ifas.ufl.edu/hort/2013/08/19/disposing-of-grass-clippings-can-be-a-pain-but-alternatives-exist/
• http://www.equestrianandhorse.com/care/pasture-grazing.html/poisonous-plants.html
• https://csuvth.colostate.edu/poisonous_plants/Plants/Details/111
• http://joshfecteau.com/poisonous-plants-spotted-water-hemlock/
• https://www.mnn.com/your-home/organic-farming-gardening/photos/13-plants-that-could-kill-you/white-snakeroot

## Senior Pet Care

There are many changes that can occur in our pets as they age. These changes may require us to care for them differently than we may have when they were younger. This guide is intended to help you recognize the signs or symptoms common in our senior pets and ways to help them stay comfortable, safe and happy.

#### Decreased mobility

Mobility will decrease with time due to a combination of factors. Arthritis resulting in pain or decreased range of motion of the joints may cause difficulty in rising or laying down, or difficulty getting around. Muscle and nerve weakness can also lead to difficulty lifting the legs properly to walk — this may result in dragging or scuffing of the nails on the ground, or difficulty walking on slippery floors. Decreased mobility may result in your pet laying down most of the day — this can result in bed sores and infection or possibly swollen legs from decreased circulation from lack of movement.

Addressing lack of mobility will vary case to case depending on the severity and each pet’s particular needs. The following list are things that may help our pets with decreased mobility:

• Placing non-slip rugs, bath mats or yoga mats on slippery floors to provide traction.
• Trim excess hair that may be between toes that could reduce your pets natural traction.
• Move food and water bowls to a location where they can be easily accessed. For cats this means having the food on ground level so they do not have to jump up onto a counter, or walk down stairs to get to it.
• Use a litter box with lower edges to prevent need to climb or jump into the box
• Harnesses or slings can be used to help dogs stand from a laying position, or help them walk with our assistance. The Help Em Up Harness (www.helpemup.com) is a comfortable harness worn daily that has handles over the shoulders and hips that caretakers can use to help lift dogs into a standing position, or help them walk out to potty. Even a beach towel used like a sling could be helpful if your pet isn’t amenable to wearing a harness.
• Toe Grips – (www.toegrips.com) are non-slip nail grips that fit on a dog’s toenails to provide traction on slippery floors. They can be worn continuously, but will need to be replaced every 1-3 months.
• Use ramps to minimize number of steps a pet has to maneuver to go outside or into the car
• Medications — there are many safe and effective medications to treat arthritis pain.
• Acupuncture can be helpful in supporting nerve function and strength.
• Use of baby gates to protect pets from accidentally falling down stairs
• Comfortable bedding in a variety of areas to choose from
• Keep active — take small walks if tolerated to maintain muscle mass

#### Pain

Pain can come from many sources: arthritis, certain disease processes, decreased mobility. Speak with your veterinarian about signs of pain to watch for such as: heavy panting, pacing, whining, laying or sitting in an abnormal posture or location, or lack of appetite. There are safe and effective medications to treat the different types of pain our geriatric pets may experience. Laser therapy and acupuncture can be combined with traditional medications to help treat and control pain.

#### Hearing loss

By 8-10 years of age most of our pets will have some degree of hearing loss. This can pose safety concerns if they should become lost or if we need to call them away from a dangerous situation.

• Monitor your senior pet closely when outside, do not allow them outside alone if they are not contained in a fenced yard.
• Early on training your pets with both verbal and hand signals.
• It has been suggested that acupuncture can be helpful for age related hearing loss.

#### Decreased vision or blindness

Decreased vision or ability to see fine details is a common aging change. You may notice them missing treats on the floor or not being able to catch toys like they used to. Being able to see clearly at night is also a common complaint. Not all of our pets will completely lose their vision. If your pet suddenly becomes blind, a veterinary visit to evaluate vision and the eyes will be important in formulating a treatment plan. Ways to help our pets with decreased vision:

• Blocking off stairways using baby gates to prevent accidental falls
• Using night lights can help with decreased vision in poor lighting
• Not allowing pets with decreased vision outside alone to prevent accidents
• Use verbal commands or gentle touch to help guide them
• For pets who are blind the book “Living with Blind Dogs” by Caroline D. Levin can be very helpful

#### Incontinence

As muscles and nerves weaken with age, just as we see weakness in the hind legs, we can also see weakness in the muscles that control the bladder or rectum. This can result in urinary and/or fecal incontinence. Older pets may also have the urge to urinate or defecate more frequently. Hygiene can become an issue if they are urinating/defecating where they lay — this can lead to sores and infection. Depending on the severity of their incontinence, a variety of treatments are available:

• Medications can be used to help with urinary incontinence.
• Acupuncture may help improve continence
• Trimming hair near the urinary opening and anus and gently cleaning these areas with warm water on a rag to prevent sores/infection
• Use of Aquaphor ointment after cleaning near the urinary opening can reduce urine scald
• Sanitary napkins, belly bands and diapers can be used – these may increase risk of urinary tract infection.
• Covering their bedding with disposable absorbent pads (like puppy training pads or hospital chux)
• Working with your veterinarian to frequently monitor for urinary tract infections which become very common in our geriatric patients with incontinence.
• Having litter boxes with lower walls and in a variety of locations on every floor of the home for easy access
• Creating an indoor potty area for dogs to use “in an emergency” when you are away (using puppy pads, dog size litter pans, artificial turf, etc)
• Letting dogs outside to potty more frequently to reduce accidents inside

#### Appetite

Medical conditions that our geriatric pets may have can contribute to a decreased appetite. Nutrition is important for energy and maintaining weight.

• Appetite stimulants are available in a variety of forms
• Anti-nausea medications can be used in patients with diseases that may cause nausea (kidney disease, liver disease, pancreatitis, intestinal disease, etc.)
• Vitamin B12 injections are a natural appetite stimulant that may be of benefit
• Encourage appetite by feeding foods that are both enticing, but unlikely to cause gastrointestinal upset such as: cooked white rice, cooked noodles, boiled skinless potato, lean cooked protein, protein based baby food purees. Your veterinarian may have other recommendations based on your pets specific medical needs.

#### Hydration

Just as with food, some of our pets will become disinterested in drinking water. Hydration is very important for our pets, especially as they get older. Maintaining normal hydration can improve how our pets feel.

• Have multiple bowls of water around the house in easily accessible locations
• Use a pet water fountain — fresh running water can be more enticing
• Use low sodium chicken broth
• Try making low sodium chicken broth with gelatin added to create a “treat”
• Your veterinary team can teach you how to give fluid under the skin

#### Cognitive dysfunction

Behavioral changes can be some of the more concerning changes that occur in our older pets. Signs can include: aimlessly wandering or pacing the house, altered sleep/wake cycles, acting confused, getting lost in the house, not recognising familiar people or pets, regression in potty training or personality changes. It can be natural to want to scold them for making mistakes, or waking us at night, but we need to remember that these actions are usually not on purpose. Unfortunately there is no cure for cognitive dysfunction, several modalities have been tried with variable success rates. The following have been found to be helpful in some cases.

• Feeding a diet fortified with antioxidants
• Hill’s Prescription diet B/D (canine only)
• Purina ProPlan Veterinary Diets Neurocare (canine only)
• Anipryl (selegiline HCL) is a daily oral medication that can help reduce symptoms of cognitive dysfunction (can take up to 4 weeks to see a response) (canine only)
• S-Adenylmethionine is a daily chewable tablet that contains a powerful antioxidant which can be helpful in reduction in symptoms (canine and feline)
• Environmental enrichment such as regular exercise and introduction of new toys or rotation of toys can help stimulate the brain and slow progression of cognitive dysfunction
• Studies have shown that dogs that were given both dietary and environmental enrichment had the greatest improvement in cognitive dysfunction when compared to dogs who did not have enrichment.

#### Happiness

Of course this is the most important, but often overlooked, key to helping our geriatric pets. We love them unconditionally and because of this we, as pet owners, are the most important judge of their happiness. Keep in mind the things that make them special to you, what they love best, what gives them joy. Remember that even as the burden of caring for them increases with age we also need to keep in mind and provide them the things that bring them joy — whether it be car rides, walks (or trips outside in a wagon or stroller), a nap in the perfect sun spot, a visit with a special friend, beloved toys, favorite snacks, snuggles and cuddles with you.Caring for our pets as they age and develop medical conditions can be difficult. But we, at Lodi Veterinary Care understand the loving bond that connects us with our fur-children. If you have questions or concerns of the best ways or options to treat and help your pet, do not hesitate calling at any time.