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THE VETERINARY CLINICS OF NORTH AMERICA SMALL ANIMAL PRACTICE

Clinical Theriogenology AUTUMN P. DAVIDSON, DVM,

V I ,UME 3l

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NUMBER 2

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GUEST EDITOR

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MARCH 2001

W.B. SAUNDERS COMPANY A Harcourt Health Sciences Company

CLINICAL THERIOGENOLOGY

The Curtis Center' Independence Square West· Philadelphia, I cJ1nsylvania 19106 http://www.wbsaunders.com

THE VETERINARY CLINICS OF NORTH AMERICA: SMALL ANIMAL PRACTICE March 2001 Editor: John Vassallo

Volume 31, Number 2 ISSN 0195- 5616

Copyright © 2001 by W.B. Saunders Company. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information retrieval system, without written permission from the Publisher. The appearance of the code at the top of the first page of an article in this periodical indicates the consent of the W.B. Saunders Company that copies of the article may be made for personal or internal use, or for the personal or internal use of specific clients, for those registered with the Copyright Clearance Center, Inc. (222 Rosewood Drive, Danvers, MA 01923: (978) 750-8400; www.copyright.com).This consent is given on the condition that the copier pay the stated per-copy fee for that article through the Copyright Clearance Center, Inc. for copying beyond that permitted by Sections 107 or 108 of the US Copyright Law. This consent does not extend to other kinds of copying, such as copying for general distribution, for advertising or promotional purposes, for creating new collective works, or for resale. Absence of the code indicates that the material may not be processed through the Copyright Clearance Center, Inc. The ideas and opinions expressed in The Veterinanj Clinics of North America: Small Animal Practice do not necessarily reflect those of the Publisher. The Publisher does not assume any responsibility for any injury and/or damage to persons or property ariSing out of or related to any use of the material contained in this periodical. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physiCian or other health care professional, relying on independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. Mention of any product in this issue should not be construed as endorsement by the contributors, editors, or the Publisher of the product or manufacturers' Claims.

The Veterinary Clinics of North America: Small Animal Practice (ISSN 0195-5616) is published bimonthly by w.E. Saunders Company. Corporate and editorial offices: The Curtis Center, Independence Square West, Philadelphia, PA 19106--3399. Accounting and circulation offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at Orlando, FL 32862, and additional mailing offices. Subscription prices are $145.00 per year (U.S. indiViduals), $195.00 per year (U.S. institutions), $177.00 per year (Canadian individuals), $249.00 per year (Canadian institutions), $199.00 per year (foreign individuals), and $249.00 per year (foreign institutions). Foreign air speed delivery is included in all Clinics subscription prices. All prices are subject to change without notice. POSTMASTER Send addr . changes to The Veterinary Clinics of North America: Small An.imal Practice, W.B. Sa Llnd cl' Company, Periodicals Fulfillment, Orlando, FL 32887-4800. Customer Servi ce: '1-800-65112452 (US). From outside of the US, call 1-407-345-4000. The Veterinary Clin.ics of North America: SlIInll Anillloll melicl! iNniNO pllhli Hh\'d III 11 11i L,n h Antonio Delfino Editore, Vi a Udin 32/ ~O,O()'I(i l ROl1w, 11111 ; 11 1,(/ In 11'1 "1111'°" h), t:llkll sosha Company Ltd ., 2- 16- 28 Nishiknlll, 1l"I1/"yO kll , '!i ,k)" , II I, III JlIl II , Th e Vel'erillnry lillie,'; (It' NOl'JlI 1111'1 " 'II ' .'ill lll ll /\ III/ IIIJi I'III/I I,,' I, ' " '" ",I I, I '/11 /1 '111 I 1111/ 1'/ 11' I I1 gril 'IIIIIII'I', .')l'il·/I /'/' ( 'IIIIJI/l1I 111/ /1' \ 1,'1 , ' I I"d, \ 11 11'"'' 1/ / 1/111/11///1111/ / 11 1'11 1111/11"/1111/ '''/'' 11 11'0 1;\'1"'1/ 1/11 Nil 'dlm, 111111 /I/( 1' ''.'' 1', 1,11, ,11

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GUEST EDITOR AUTUMN P. DAVIDSON, DVM, Diplomate, American College of Veterinary Internal Medicine; Associate Clinical Professor, Departments of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California; ,and. Director, Veterinary Clinic, Guide Dogs for the Blind, Inc., San Rafael, Califorma

CONTRIBUTORS JANICE 1. CAIN, DVM, Diplomate, American College of Vet~rina? Internal Medicine; Staff Internist and Consultant in Small Animal ReproductIon, BIshop Ranch Veterinary Center, San Ramon, California AUTUMN P. DAVIDSON, DVM, Diplomate, American College of Veterinary Internal Medicine; Associate Clinical Professor, Departments of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California; ,and. Director, Veterinary Clinic, Guide Dogs for the Blind, Inc" San Rafael, Califorma JONI 1. FRESHMAN, DVM, MS, Diplomate, American College of Veterinary Internal Medicine; Director, Canine Consultations, Colorado Springs, Colorado MELISSA GOODMAN, DVM, Veterinary Referral Center, Frazer, Pennsylvania DEBORAH S. GRECO, DVM, PhD, Diplomate, American College of Veterinary Internal Medicine; Associate Professor, Department of Clinical Sciences, College of Veterinary Medicine and Biological Sciences, Colorado State University, Fort Collins, Colorado CLAUDIA A. KIRK, DVM, PhD, Diplomate, American College of Veterinary Nutrition; Diplomate, American College of Veterinary Internal Medicine; Veterinary Clinical Nutritionist, Advanced Research Department, Hill's Science and Technology Center, Topeka, Kansas BRUNO J. MASSAT, DVM, Diplomate, American College of Veterinary Surgeons; Ithaca, New York KYL E G. MATHEWS, DVM, MS, Diplomate, American College of Veterinary Surgeons; Assistant Pro fessol~ Department of Clinical Sciences, College of Veterinary Medicine, North " rolin. tat Uni vcrsity, Raleigh, North molina

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PAULA F. MOON, DVM, Diplomate, American College of Veterinary Anesthesiologists; Assistant Professor, Section of Anesthesiology, College of Veterinary Medicine, Cornell University, Ithaca, New York

CLINICAL THERIOGENOLOGY

PETER J. PASCOE, BVSc, Diplomate, American College of Veterinary Anesthesiologists; and Professor of Anesthesiology, Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California MARGARET V. ROOT KUSTRITZ, DVM, PhD, Diplomate, American College of Theriogenologists; and Assistant Clinical Specialist, Department of Small Animal Reproduction, University of Minnesota College of Veterinary Medicine, S1. Paul, Minnesota

CONTENTS

MARION S. WILSON, BVMS, MVSc, MRCVS, Director, Glenbred Artificial Breeding Services Ltd., Feilding, New Zealand

Preface Autumn P. Davidson

xi

An Overview of Canine Reproductive Services: Getting Started Janice L. Cain

209

A veterinarian desiring to increase proficiency in canine reproduction needs to become proficient in a variety of reproductive procedures. This article describes commonly performed procedures and gives an overview of how to develop a practice in canine reproduction. Once a veterinarian develops expertise in this area, the base in breeder clients in the practice will rapidly grow.

Ovulation Timing: Concepts and Controversies Melissa Goodman

219

While the luteinizing hormone (LH) surge has long been accepted as the key event in the estrous cycle of the bitch, historically, there has been no practical way to identify it. In the past, the veterinary practitioner had to rely on general and/or subjective information received from vaginal cytology, physical examination , and observations. With the recent development of in-clinic pro" sterone and LH assays, and the wider availability of laborat ry quantitative progesterone assays, the LH surge can either be id ntified directly or estimated by the detection of changes in I rOt-; '::i t ron co A s a r ' ult, ovulation time can now be predicted wil'l1 hi gh n lira in a I riv ot p ra ti ctting.

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A Logical Approach to Infertility in the Bitch Janice L. Cain

237

This approach to infertility in the bitch describes what diagnostic methods to perfurm and what thought processes to consider at different phases of the estrous cycle,

Disorders of the Canine Penis Margaret V. Root Kustritz

247

Uterine and Fetal Monitoring in the Bitch Autumn P. Davidson

Function and anatomy of the canine penis are reviewed, Functional abnormalities of the penis described include lack of erection and lack of ejaculation, Physical abnormalities of the penis also are described, including paraphimosis, Diagnosis and treatment options are described,

Clinical Management of the Sub fertile Stud Dog Freshman

259

Jani L.

Breeders invest a great deal of time and money in developing a stud dog; successful breeding is important in making that investment worthwhile. Sub fertility in the stud dog can occur because of lack of libido, inability to breed, or poor semen quality. A detailed history, complete physical examination, and semen evaluation, along with other selected diagnostics can result in successful treatment or management of the subfertile stud dog.

Surgery of the Canine Vagina and Vulva Kyle G. Mathews Accurate diagnosis of canine vaginal abnormalities often requires gene~al anesthesia, vaginoscopy, and contrast radiography. Abdommal ultrasonography, thoracic radiography, computed tomography, and histopathology may also be advised for the workup of mass lesions prior to surgery. Many procedures such as episioplasty and resection of pedunculated vaginal masses or ede~atous tissue are easily performed with proper planning and eqUIpment (e.g., electrocautery). Consideration should be given to referring more complicated procedures, such as resection of large vaginal masses or vaginal stenoses, to a board certified surgeon, Finally, preoperative placement of a fentanyl patch and pre- or postoperative epidural anal~esia are highly recommended for any vulvo-vaginal surgical procedure.

305

The use of uterine and fetal monitoring improves the outcome of canine obstetrics, Much of the guesswork of managing whelping can be eliminated, At normal term, absolute indications for cesarean section are detected with monitoring, before multiple fetal deaths or any serious maternal compromise occurs. Bitches with previous history of cesarean section may be able to whelp vaginally successfully, having medical intervention based on monitoring. The anxiety level of owners during whelping is diminished, and the level of participation of the veterinarian improves.

315

Periparturient and Neonatal Anesthesia Peter J. Pascoe and Paula F. Moon

271

Transcervical Insemination Techniqu es in th e Bitch Marion S. Wilson

insemination enables intrauterine deposition of semen, to be achieved without the risks, time, and costs associated with anesthesia and surgery The results achieved with this method of insemination are on a par with the best results recorded following the use of frozen semen, Endoscopic transcervical catheterization has many other applications that make it a valuable technique in canine theriogenology, The overwhelmingly positive reaction from clients makes this a technique well worth learning,

Small animal patients may need to be anesthetized in the periparturient period for emergency, nonobstetric reasons, elective ovariohysterectomy, or cesarean section. In each case, the physiologic changes in the dam must be accounted for in designing an anesthetic protocol, but the requirements of the fetuses will be different. Subsequent to birth, the neonatal animal may need to be anesthetized, and the unique physiology and pharmacology at this age is described.

Neonatal Critical Care Paula F. Moon, Bruno J. Massat, and Peter

343

J. Pascoe

The quality of the first few minutes of a newborn's life has important and lasting consequences on its entire life. Hence, the care a newborn receives is critical. Recommendations for po tdelivery resuscitation techniques are reviewed. The remainder of the article focuses on the critically ill neonate, possible lInd erlying diseases, and methods of supportive therapy.

29'1

fntra lll'l' l'iIW inHI'lIlillilli o l\ 11IIfl lll" '11 IIIIIV" 11 11" , 1)11" \I I 11 11' 11111, Ii rn('lol'l1 i,l Iii, ' II I " ',"'/ilri ,rI 11111' 111111 111'11 ' IlI d ,Il ' 11 '11 11 '11 '1'11 111111 1'11/' II I

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N('w C OIl C pi N In 1'(1(1/ llri c Nutrition ( '11111111 11 1\ , I 11'1

369

II,rl ld /'I I', 1/ 11' 1"" 11, 111 11' ''11", 111, ,1(0"/', Iwnll'h and rnaximallongevIl y 11 11 " , IriI I111 ,11,' I'"" d Iii 1l1I111i 1, 1l11l 11l1.11I1 )', (·nw nl· of the neonate. 1 1111 1111 1'

vii

Nutritional considerations must therefore begin before conception with optimal feeding of the dam. This article reviews key nutritional considerations for reproduction in the queen and bitch and discusses the impact of common nutritional deficiencies and excesses throughout perinatal growth. Factors important in maternal milk for optimal development of the neonate as well as functional foods that show promise toward enhancing the health of growing puppies and kittens are discussed.

Congenital and Inherited Renal Disease of Small Animals Deborah S. Greco

393

Congenital renal diseases are present at birth and may be determined genetically; familial renal disorders occur in related animals with a higher frequency than would be expected by chance, and frequently are inherited. The most common familial disorders in c~ts ~d dogs include renal amylOidosiS, renal dysplaSia, polycyshc kidneys, basement membrane disorders, and tubular dysfunction (Fanconi's syndrome). This article alerts the veterinarian to commonly observed congenital and hereditary conditions of the kidneys in small animals.

Diagnosis and Treatment of Juvenile Endocrine Disorders in Puppies and Kittens Deborah S. Greco

Inherited diseases are common among dogs. Recent advances in molecular genetics provide the groundwork for the development of genetic tests for the diagnosis and prevention of inherited diseases. As a result of this progress, genetics should become an integral part of veterinary medicine. DNA tests are safe, easy to perform, and reliable if interpreted correctly. Genetic tests only need to be performed once in a dog's lifetime, because the results of DNA testing never change. Veterinarians should be prepared to understand genetic testing and counseling because they are becoming increasingly important to veterinary medicine.

Index Subscription Information

401

Endocrine and metabolic disorders affecting puppies and kittens from birth until 6 months of age may manifest as clinical problems related to growth, water metabolism (polydipsia or polyuria), or as episodic weakness. Endocrine and metabolic disorders that affect stature, such as pituitary or hypothyroid dwarfism, present to the veterinarian for assessment of delayed or aberrant growth. Conversely, juvenile-onset diabetes mellitus and diabetes insipidus cause excessive thirst, urination, and difficulty in housebreaking.

Frustrating Case Presentations in Canine Theriogenology Autunm P. Davidson

411

The practice of small animal theriogenology is rewarding, but frustrations exist concerning teclmologic advan as ornp nrcd with other species. Reproductive linicia n ' Siri v in g lo prn Ii 'l' good quality m edicine r ad ily id nlify to pi H of (0 111111 0 11 ' On t\' m : causes that ar not id nli ficd or I'il l'rlll1l'lIli" fl li1 ,ll lll'" Jlol IIVl1 iI.111 11· or appli ab l . Imprnv('" , 'o ll ,llllll'l! l llI l\ 11111111'11', liJ" I'I(1)',I' ,\,Ii(l) ',1 1I 11 sp' i ;:di /; il1 )~ 111 IlI ll,ill 111\ 111 1111 1'1'1 1, '1 "" I ,'v lll" I)( '1'1i Ily ,', 11'1'\1 11 1', , Il l'llli 111 1', ' 1\1 1\1 \1 11111111 111111 11111'1 11 1111 11 111 11 Iii Il'liI II, 11 11'1 ' 1111 )'" I II \' 1'1'11/ 11'11 1\ ' " 111 1 \ 11I d" 1 111 1'l l lrl , 111 \11

421

Canine Molecular Genetic Testing Danika L. Metallinos

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433

Inside back cover

FORTHCOMING ISSUES May 2001 VACCINES AND VACCINATIONS

Richard B. Ford, DVM, MS, Guest Editor

PREFACE

July 2001 ENDOSCOPY

Lynda Melendez, DVM, MS, Guest Editor September 2001 ENDOCRINOLOGY

Ellen Behrend, VMD, MS, and Robert Kemppainen, DVM, PhD, Guest Editors

AUTUMN P. DAVIDSON, DVM

Guest Editor

Organizing this volume of The Veterinary Clinics of North America: Small Animal Practice has been a rewarding experience, and I look forward to its

RECENT ISSUES January 2001 LAMENESS

Walter C. Renberg, DVM, MS, and James K. Roush, DVM, MS, Guest Editors November 2000 RESPIRATORY MEDICINE AND SURGERY

Philip Padrid, RN, DVM, Guest Editor September 2000 INFECTIOUS DISEASE AND THE EYE

Jean Stiles, DVM, MS, Guest Editor

VISIT OUR WEB SITE For more information about Clinic : http://www.wbsaunders.com/porlodlcnh-l/cllnic /lnd!x.htm

publication. Managing the voice mail system for small animal reproduction consult calls at the School of Veterinary Medicine, Davis, California, has given me insight to practitioners' areas of interest and concern. It was easy to identify clinicians within the field of small animal theriogenology with expertise in these areas, having worked in concert with them for many years. To my amazement, they all agreed to take time out of their very busy schedules to contribute to this volume. I wholeheartedly thank each one. We all look forward to referring p ractitioners to this well recognized text. The field of small animal theriogenology is uniquely diverse, encompassing board certified theriogenologists, internists, surgeons, anesthesiologists, and nutritionists, as well as doctorates of genetics; all have participated in this volume. Additionally, general practitioners with a special interest in and practice limited to theriogenology contributed their excellent knowledge to the effort. These authors illustrate the exciting diversity present in our practice of small animal reproduction. Collaboration among veterinarians practicing small animal reproduction, both nationally and internationally, is increasing. Attendance at scientific meetings devoted to small animal theriogenology reflects this growing interest. Veterinary students and residents in theriogenology and internal medicine seek additional time on small animal reproduction rotations, anticipating future caseloads. The demand for knowledgeable reproductive clinicians is familiar to anyone in small animal practice. While contemplating this preface, I reviewed the comments of Drs. Shirley Jolmston and Stefano Romagnoli p refacing The Veterinary Clinics of North America: SInaI! Anirl'/a/ Practice 21 (3): Canine Reproduction, 1991. They enthusiastically a ll d fo r fu rth'r 8tu d i in th ar a of early chemical p regnancy diagnosis, nn il (" I'yol rl,!l-lc rvn linl\ ('Cl

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exceed two to six times the RER. The discrepancy in the timing of peak lactation and peak energy demand is a result of combined food consumption by the dam and offspring. Neonates begin eating the dam's food in increasing amounts from 3 weeks of age until weaning. Even though there are several useful guides to estimate the energy requirement of lactating dams, it is preferable to feed free choice. A wide variation in energy needs makes accurate prediction difficult, and free access to food encourages early food exploration and consumption by the neonate. If controlled intake is required to avoid excessive weight gain, two to three daily feedings are recommended.

100

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5

Gestation

7

9

1

3

7

• +--Lactation---+ Weeks

Figure 2. Comparison of the pattern of energy intake and body weight (BW) gain during gestation and lactation in the dog and the cat. A, The queen gains 'weight in a linear fashion throughout gestation and then draws on body stores to maintain lactation . Weight loss during lactation is substantial despite an energy intake 2-3 times above maintenance levels. B, The b itch gains weight in the last trimester at which time food intake will increase by 30- 60%. At parturition she should weigh 5-10% above the premating weight and gradually return to this weight by weaning. RER = resting energy requirement. (Adapted from Debraekeleer J, Gross KL, Zicker SC: Normal dogs. In Hand MS, Thatcher CD, Remillard RL et al (eds): Small Animal Clinical Nutrition, ed 4. Marceline, MO , Walsworth Publishing Co, 2000, p 235; and Kirk CA, Debraekeleer J, Armstrong PJ : Normal cats. In Hand MS, Thatcher CD, Remillard RL et al (eds) : Small Animal Clinical Nutrition, ed 4. Marceline, MO, Walsworth Publishing Co, 2000, p 321.)

prebreeding weight. Queens failing to gain ad qu at w ig hl' durill ); gestation have suboptimal lactation p erform, n ('. Lactation is the most ener y-d m a ndin l'l f lll)',I ' o r li rv. Pl'liI IIdll production typically oc urs nt ~ I;() II. w( I(II /4 ()I 1.11'l.llillll , '1'lli 'I)('l'I i!' di y, peak energy d m, nd ~ hll i dd l'pill 85%) are best suited for reproduction. The benefits of highly digestible foods include (1) improved nutrient availability to meet the increased nutrient needs, (2) reduced required food volume and subsequent abdominal fullness, and (3) avoidance of large amounts of undigested nutrients entering the colon, which can lead to diarrhea. Urinary pH

Highly acidified foods should be avoided during gestation, as they may impair bone mineralization in the developing fetus. Anecdotal reports have implicated certain highly acidified semi-moist foods in poor reproductive performance in queens. Foods designed to produce average urinary pH values at or above 6.2 seem to be safe during reproduction.

Monitoring

One of the early indicators of successful breeding and conception in the queen is a steady gain in body weight (see Fig. 2). In the queen, w ight gain increases linearly from conception to parturition. This patt I'll is different from that of dogs, which experience small increases in hody wi g ht until the last third of gestation, when weight gain and (' Iw rg in t. I ' g r otly in I' a ' . Wight gain in early pregnancy is not dHHocinlt'd w ilh Hignifi c< nt g row th of I' productive tissues or the concepIU N bill '("' 1111'1 10 lw slo t', 'd in ,' nl' rgy d po ts (PI' sum ably as fat) to /1I IPIHli'l Illl'I ltlil lll , )(11 ,, ' 11/1 IIIld " t' WI,jl', ill ,II pnrlurili Ol1 o f I: n xp ri nce 1'(lIH ' IlI d ,tl i'"1 1)('1'1111'11111111 '" 111 11 1 ",, !>l llly III IIll1 illll ili hi lt! ,'(lllliilio)') , MI 'I III WI' )',111 )',1 1 II 11111 II )', ),,"111,11 11 11 II ' 1"" "1111 I I ,qll' I'Il \ IIII III " ly \o() % ll f 111" 1" "1 111 11111 )" \\I1'1)', It! (' Hili I '(11 ) ),, 1111 ,1\" '101 )',1' 1111 ,'1 I ' ) ' '1\' 111 1'1111 Ill ,' I, li ll ,llIlIilti 1111 11'1111, 111 '1 111111 \ \ " 1),,111 I.\, .1,"" il l \\, 11, ,11 11 11)', \ 1 Iii 11111 1 I

378

KIRK

NEW CONCEPTS IN PEDIATRIC NUTRITION

tion, the queen loses only 40% of the weight gained during gestation. The remaining 60% of prepartum weight gain is used during lactation to sustain milk production. Unlike the queen, the bitch enters lactation at only 5% to 10% above prebreeding weight.s The mammary glands should be closely evaluated to ensure health and ready access. Expressing milk from each gland does not ensure adequate milk production. Continuous weight gain by the offspring is the best indicator of lactation performance.

379

beyond a supply of nutrients. Enzymes, immune factors, hormones, and digestive factors serve important functions in the developing neonate. Although it sometimes becomes necessary to hand-feed puppies and kittens less than 4 weeks of age, it is probably better to foster or supplement feed than to completely deprive the neonate of maternal milk. Neonatal Assessment

GROWING PUPPIES AND KITIENS: NEONATAL PERIOD

The neonatal p eriod encompasses the time from parturition to completion of weaning. During the nursing period, the neonate relies on colostrum and milk to supply its nutritional needs. The nutrient profile of maternal milk is thought to provide optimal nutrition for the neonate even though larger growth rates have been observed in puppies and kittens fed milk replacers. 36 Nutrient recommendations for neonates have been derived from the composition of maternal milk (Table 2) and growth studies in weaned puppies and kittens. Milk provides benefits

Table 2. NUTRIENT COMPARISON AMONG MILK OF VARIOUS SPECIES Nutrients

Moisture (g/100 g) Dry m atter (g/lOO g) Crude p rotein (g/100 g) Arginine (mg/100 g) Taurine (mg / 100 g) ' Methionine (mg/ 100 g) Crude fat (g/ 100 g) Lactose (g / 100 g) Minerals Calcium (mg/100 g) Phosphorus (mg/100 g) Potassium (mg / 100 g) M agnesium (mg/ 100 g) Copper (mg/lOO g) Iron (mg /100 g) Metabolizable energy (kcal/100 g) Metabolizable energy (kJ/100 g)

Queen Milk'

Bitch Milkt

Cow Milk:!:

Goat Milk:!:

79 21 7.5 347 27 188 8.5 4.0

77.3 22.7 7.5 420

87.7 12.3 3.3 119 0.13 82 3.6 4.7

87.0 13 3.6 119

180 162 103 9 0.11 0.35 121 506

240 180 120 11 0.33 0.70 146 610

119 93 150 14

133 111 204 14

9.5 3.3

0.05 64 268

80 4.1 4.0

0. 05 69

2H8

' Data from Adkins Y, Z icker Sc, Lepine A, et al: Changes in nu[!'i ('nl fll1d I 1'01" ill (,(" " pn"i I iOl1 01 cat milk during lactation. A m J Vet Res 58 :370-375, 1997; and Zollmnn il, I )"h" I1 I'l"kt 'I' il, l 80% and protein digestibility> 85%). The small stomach capacity and relatively high energy demands of young a~in:als limit food intake capacity. Providing highly digestible foods maXimizes use of the nutrients consumed and helps to avoid diarrhea. Functional Foods and Nutraceuticals

The provision of specific nutrients or ingredients with functional properties beyond that of meeting basic nutrient needs is currently generating much interest. Recent findings establish th~ pos~ibility of altering body composition, immune competence, gastromtestmal function, and joint health in the growing animal through nutritional manipulation. Although few studies are specific to the growing dog or cat, the potential benefits provide exciting opportunities for enhancing the overall health of dogs and cats. In livestock, ingredients such as carnitine, chromium, and conjugated linoleic acid repartition energy stores and promote accretion of lean tissue over fat during the growth period. In a recent study, puppies supplemented with carnitine were larger with more muscle and greater bone mass and density than unsupplemented dogsY Chromium supplementation of Beagle dams d':lring gestat~on and lactation resulted in slight increases in the body weight of nursmg puppies but no specific benefit to the reproductive efficiency of the dam. 2s Chondroprotectives

Chondroprotective ingredients such as glucosamine and' chondroitin sulfate are popular dietary supplements and food additives for the support of joint health. Studies in adult dogs have shown mild to moderate benefits with chronic supplementation. In puppies, intramuscular administration of glycosaminoglycan polysulfate from 6 weeks to 8 months improved coxofemoral joint congruity and reduced the occurrence of coxofemoral subluxation in treated pUpS.28 Controversy remains over the bioavailability efficacy and mechanism of action of the various glycosaminoglycans. Nonetheless, glycosaminoglycan therapy h as resulted in positive outcomes in dogs with certain orthopedic disorder . The long-term benefit to growing puppies and kittens is yet to b' determined. Probiotics

Probiotics are microorgani sm Sli h ,Ii-! IlIlIIPdll llll',I'I )i, ' IlI lI 'I"1 ,I Ill ' yeasts fed to animals for th I uq ()K~' or l'q ',ld lll lll l'. II \! , 11\1, '/1 11111 11 11111' I ,Ii the host. Th y hel ve' ht'('1) II Hi'd Ilwl'I II li' III II ' dl ~1 11 111 1 IIlll lril \,IIII II"II II v II

NEW CONCEPTS IN PEDIATRIC NUTRITION

389

human beings and livestock to correct or normalize the microbial population within the gut. More recently, probiotics have been found to aid nutrient digestion and stimulate the immune system. Common organisms supplied as probiotics include Lactobacillus sp, Bifidobacter sp, Streptococcus thermophilus, and certain yeasts. The health-promoting effect of Lactobacillus includes improved food digestion as a result of microfloral enzymes that breakdown fiber, stimulation of antibacterial activity of Peyer's patches, enhanced IgA secretion, and a potential protective effect against allergies via modulation of the Thl and Th2 lymphocyte ratio. 2 Lactobacillus can also stimulate macrophage function and increase the rate of apoptosis, a possible benefit in cancer protection. 2 One study has reported alteration of gut microflora in response to probiotic therapy in puppies. 3 The changes were short-lived, and specific health benefits were not determined in that study. Anecdotally, probiotics seem useful in managing diarrhea in response to antibiotic use in puppies and kittens. Probiotics may also prove to be beneficial in intensive breeding operations or large kennels, where stress, overcrowding, or unfavorable husbandry practices increase the likelihood of transmission of intestinal p athogens. For most puppies and kittens, however, good husbandry and sound nutritional practices are better options. Prebiotics

Prebiotics are indigestible substances that provide substrate for the growth of healthful bacteria in the intestinal tract. Examples include a variety of oligo saccharides (e.g., inulin, fructooligosaccharides, mannin oligosaccharides), resistant starches, and fermentable fibers. In addition to selectively supporting the growth of nonpathogenic bacteria, fermentation of prebiotics can help to reduce proliferation of gut pathogens, increase calcium bioavailability, and increase levels of short-chain fatty acids that serve as a major energy source for the gut muscosa. Certain prebiotics are thought to have a direct immunomodulatory effect as well as the ability to reduce hypertriglyceridemia and hyperinsulinemia. Negative side effects are rarely reported, with most involving mild gastrointestinal distress (i.e., flatulence, bloating, laxation).2,37 Data are limited on the benefit of prebiotics in companion animals. Although some studies have reported increased levels of Bifidobacterium and LactobaciLl.us in dogs and cats after the feeding of lactosucrose,19 two other :> tu d i reported negligible changes after the addition of fructooligosac'hari d s in either dogs or cats. 41 ,43 Regardless of any alterations in gut mi 'l"oflon1 or int stin a l 111 rphol.ogy, studies demonstrating a functional he n ' fil on il111THl nC 'ta tu l:l, gnstroin t tina l h ealth, or disease resistance il) pllPpil \ 11I Id I illl 'Ii, 111'( ' I(\cl ing. II 114 111'1'11111111'" Iii 11 11 11 ,' II jll','lrI ,' 1"'I'Ollllll t' lld Cl l'ions fo r th u se of III'li'l tll l, lI 1()(ltl lI ill 111 1'/11'111 l'I'I·III Ii II )I' II ll1d il'H II IIVI' d l' lll()n s lrat( ~rl 111'1IlI il lI llI)', 11111111'111 '" 1111 1'1'1\ ,1111 II\I Y 111\1 11',11 ' 1(II WIIIlIl/ """ 111 1'. 1',I'(lW lhi 11,I W" Vil l, 11 11'1 ·111'11 111 11,\ ''1 111111 ''1 11111 d l ll'IHII' 1111 '\"' 111 1111, IIIIIII II II I', I'V Iy '111 '1"" 1,1 III ' .1 ,,11'1111111""

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Feeding Plan

A food that is complete and balanced for growth as demonstrated by AAFCO or similar animal feeding trials should be fed until puppies and kittens reach adulthood (10-12 months). Unmoistened dry foods and moist foods are appropriate. Semimoist foods that excessively acidify the urine (i.e., p rocl u li on, cd . I. Philadelphia, WB Saunders, 1987, pp 55- 90 7. Fisher DA: Medical management of sllsp ec t d aSCH of l'OI1)\I 'lIi I'll I Ii I (l lh roi d l 111 , 11/ Burrow GN (ed) : Neona t@l Thy ro"icl S p 'ning. NI'w (11'1, 1{.lVI'1I l'I"'IiH, 19BO, pp 2:1'1 244 8. Greco DS, h iJ~tn i n C H: I ':n(l 1)(' 1'1 1) 1' di HOI'd,'! 'H, II/ 11 ' 11 11, 11111 II ) (, ·d): V,'I",'I," " Y I'"dllll , I, tl, d . 2, Phil acl \' lphi ll, W II :;, 11 11 11 1,' 1'11, 11)%, 1'1' \'1'/ 111'/

Deborah S. Greco, DVM, PhD Department of Clinical Sciences College of Veterinary Medicine and Biological Sciences 300 W. Drake Colorado State University Fort Collins, CO 80523-1601 e-mail: [email protected]

CLINICAL THERlOGENOLOGY

0195-5616/01 $15.00

+ .00

FRUSTRATING CASE PRESENTATIONS IN CANINE THERIOGENOLOGY Autumn P. Davidson, DVM

Generally, small animal theriogenology is a rewarding subspecialty in veterinary medicine. Although demanding of the clinician's time and expertise, the breeder client tends to be loyal and compliant. A good reproductive practice generates its own referrals, and usually is busy. Obstetrics and pediatrics are undeniably rewarding parts of the specialty. Theriogenology incorporates the interesting fields of reproductive physiology, endocrinology, embryology, genetics, metabolism, nutrition, critical care, anesthesia, pharmacology, and anatomy. The theriogenologist's practice is uniquely medical and surgical. Frustrations do exist in the small animal theriogenologist's practice. Technology in the small animal theriogenology practice has not kept pace with that in the equine or bovine field and even less so with the practice of human reproduction. The primary reason is a lack of funding supporting the development of technical expertise in a field in which anticipated financial returns are poor. The Westminster Kennel Club Best of Breed stud dog will never match the financial expectations of the Triple Crown winner. The value of such dogs (and cats) is more personal, but even the most motivated dog or cat owner cannot afford to develop a technique permitting intracytoplasmic insemination or embryo transplant in his or her pet. Technology developed for equine and bovine patients may not be applicable or effective in the canine or feline. Reli able induction of fertile estrus in the bitch remains technically chal-

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lenging. Male subfertility in the stud dog has few options. Pediatric critical care in canine and feline practice is exacerbated by small patient size and financial constraints. Fortunately, the development of advanced reproductive technology in endangered canine and feline species may apply to dogs and cats. The ~atural fecun~ity of dogs and ~ats and the consequent pet overpopulation problem Inject further ethIcal concerns into the small animal theriogenologist's practice. Clinicians should guide their clients through the myriad genetic screenings advised for the particular breed, and shoul~ discuss proper puppy placement and neutering. Some dogs and cats sImply should not be bred (aggressive or genetically defective individuals), despite their inherent value to the client. s Unsolved and controversial clinical problems are not uncommon to the reproductive practitioner. Progress in understanding the cause, pathophysiology, and proper therapeutics of such problems is hampered by anecdotal information abounding among the breeder clientele and often among veterinarians. University residencies and postdoctorate programs limited to OL even emphasizing small animal theriogenology are uncommon. Collaborat~on a~ong small animal theriogenologists is developing slowly. This article dIscusses some of the clinical problems familiar to the small animal reproduction specialist. PUPPY VAGINITIS Chief Complaint

An apparently healthy female puppy presents with mucoid vulvar discharge, usually white to yellow and sometimes copious. The dis~harge c~ be accompanied by mild perivulvar dermatitis. The puppy ' IS not typIcally attentive to the discharge, and there is not. any associated change in urinary behavior. The age of onset ranges from 6 weeks to puberty, the duration is days to months, and the disorder is often intermi ttent. Diagnostics

Cytologic examination of the discharge finds suppurative inflammation. Vagi~al cultures .(aerobic) generally fail to grow anything but normal flora In small, mIxed numbers. A urinalysis (culture "if"), a quired by cystocentesis, is characteristically normal (a decrea durin specific gravity is typical for pediatric dogs). Cause

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413

is reported to resolve with puberty or ovariohysterectomy (two different events endocrinologic ally, neither likely to be truly therapeutic). Puppy vaginitis diminishes with maturity in most cases. Important differentials include urinary tract infection, urinary incontinence, the onset of the initial estrous cycle, vaginal foreign bodies (i.e., foxtails), and vaginal anatomic anomalies causing pooling of urine or secretions. 2 Therapeutics

Cleansing the perivulvar area with a gentle solution (nonalcoholic otic preparations or baby wipes) and benign neglect are advised if other maladies are not evident. CHRONIC VAGINITIS Chief Complaint

The dog presents with variable vulvar discharge that is mucoid to hemorrhagic or purulent, which is accompanied by signs of discomfort (e.g., licking, scooting, pollakiuria). Perivulvar dermatitis also may be present.n The condition usually is noted in ovariectomized bitches, of any age, and in variable times from the spay procedure. The history usually includes multiple therapeutic efforts without resolution, although transient improvement can occur. The duration is generally chronic, from weeks to months and sometimes years. Diagnostics

A minimum data base (complete blood count [CBC] and serum chemistries), including a urinalysis (preferably acquired by cystocentesis) and culture or culture "if," is advised. A careful perivulvar and vaginal examination, preferably with the dog under sedation or anesthesia, with endoscopic equipment allowing evaluation of the entire vaginal vault, should be p erformed. Radiography (e.g., vaginogram, urethrogram, cystogram, intravenous pyelogram [IVPl) and ultrasound of the lower genitourinary tract may be indicated. Vaginal cytology, aerobic ondm y opla ma cranial guarded vaginal cultures, and pinch biopsy of (Iff ted vag inal mucosa are helpful. Identification of any contributory (1 \1 , torn ic nb no rrn a liti s iimportant (e.g., significant strictures, mass ivli i()I1S, rvtiunliant lo rs'" I vLdvar fold, pelvic bladder, anomalous ure1III'il i 11 111i1 III1) y), II is h \11 (ul to v;) luntc I'll bitch in a normal standing IH II 1IIll11 Itl II/ It'HI ,\\ 1, '1'11,11 Il l1 l1 tOIll fll ' (, lI I'll Ivl nnd to I' peat the exami11 ,11 1(111 11 111 '1' I I II' 11.11 11 1'i 11.II I,d ,'Illi .I )'"ti ll ti'1t'1'1'1'('111111)('n . Th PI' n e Iii 1111111 ' 1"lIdlll )'1 III 1111' V1)',1 11 d vi lldl , 11I111 ,1i WIIl '11 IIII' hil t' h i. ' lInti l' 1' dll ,111I 111'11I1 1 ' 111\ II" Ild fl l,'j\d II )'., 111111 11 \1 ' 1111 ' (\111 '1' II I 1'I·dlll\1I 11111 vll lv,I I'

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folds can be difficult to ascertain when the bitch is positioned for vaginoscopy.

FRUSTRATING CASE PRESENTATIONS IN CANINE THERIOGENOLOGY

415

SHORTENED INTERESTROUS INTERVAL Chief Complaint

Cause

The cause of chronic vaginitis is usually multifactorial, and the primary cause often is masked and exacerbated by previous therapies, including long-term antimicrobial use, self-mutilation, and topical irrigations. Vaginal mucosal biopsy frequently shows lymphoplasmacytic inflammation, but sometimes suppurative (neutrophilic) or eosinophilic inflammation is predominant. Cranial vaginal cultures can show overgrowth of an atypical bacterial species (pure gram-negative cultures, resistant organisms, Pseudomonas species) or pure culture of Mycoplasma species if antibiotics have been used extensively. Occasionally, a yeast (Malessezia) overgrowth is identified. Extensive perivulvar dermatitis can perpetuate chronic vaginitis. Urinary tract infection with urethritis and cystitis also can contribute to vaginitis. Vaginal foreign bodies and neoplasia can cause symptoms of chronic vaginitis. 2

Therapeutics

The discontinuation of topical irrigations, prevention of self-mutilation with Elizabethan collars, and initiation of antimicrobial therapy only when indicated by proper interpretation of culture and sensitivity testing should be undertaken. Antimicrobial therapy should be limited , to those cases in which pathogens have been identified as displacing normal flora. Topical estrogen therapy is helpful in establishing normal mucosal integrity in postmenopausal women with idiopathic vaginitis; oral diethylstilbesterol therapy can be evaluated in the ovariectomized bitch. The dose is empiric and usually the same as used for urinary incontinence caused by sphincter incompetence (0.5- 1.0 mg orally given one to two times weekly). Several weeks of therapy with estrogen may be required before improvement is recognized. A short anti-inflammatory course of corticosteroids can be useful in diminishing vaginal pathology, but the subsequent propensity for urinary tract in f cti on m Li st be kept in mind. Nonsteroidal anti-inflammatories m ay be us f Lil. urg i, cal correction with careful postoperative control of If-Ill uti la tion iH indicated if anatomic abnormalities have contributed to Or hilv ' Ca liI' ,d the condition. 6 Redundant dorsal vulvar folds a r mol" om lll oni inlpli cated than vaginal strictures. Obviotl 'Iy, 1"1 (' id