Blackwells's Five-Minute Veterinary Consult Canine anda Feline - Larry P Tilley Francis W K Smith, Jr

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SPONTANEOUS ABORTION AND PREGNANCY LOSS IN CATS
 BASICS
OVERVIEW
 “Abortion” is the delivery of one or more fetuses before it is (they are) capable of surviving outside of the uterus
 “Pregnancy loss” is the death of the embryo, reabsorption of early fetuses, mummification (shriveling or drying up of the fetus, like a
mummy), abortion, stillbirths, and outcomes of difficult birth (known as “dystocia”)
 T he “queen” is a female cat
GENETICS
 Nonspecific; inbred lines experience higher levels of pregnancy failure than seen in other cats 
SIGNALMENT/DESCRIPTION of ANIMAL
Species
 Cats
Breed Predilections
 Persians and Himalayans—difficult birth (dystocia)
M ean Age and Range
 Noninfectious causes—more common at the birth following the first pregnancy and in queens greater than 6 years of age
 Infectious causes—all ages
Predominant Sex
 Females
SIGNS/OBSERVED CHANGES in the ANIMAL
 May have no clinical signs, especially early in pregnancy or gestation 
 Failure to litter on time 
 Decrease in abdominal size
 Weight loss
 Delivery of recognizable fetuses or placental tissue
 Lack of appetite (known as “anorexia”)
 Vomiting, diarrhea
 Behavioral changes
 Discharge from the vulva that contains blood or pus—frequently unnoticed in fastidious queens (that is, queens that groom or clean
themselves with meticulous attention) or with early pregnancy or gestational losses; the “vulva” is the external genitalia of females
 Disappearance of fetuses previously documented by physical examination (palpation), ultrasound examination, or X-rays
 Abdominal straining, discomfort
 Depression
 Dehydration
 Fever 
CAUSES
Infectious Disease
 Viruses—feline panleukopenia virus; feline herpesvirus; feline calicivirus; feline leukemia virus (FeLV); feline immunodeficiency virus
(FIV)
 Bacteria—Escherichia coli; Streptococcus; Staphylococcus; Salmonella; Mycoplasma; Mycobacterium 
 Coxiella burnetii (Q fever)
 Toxoplasma gondii (probably uncommon)
Noninfectious—Reproductive Causes
 Early loss of the embryo
 Difficult birth (dystocia) 
 Disease of the lining of the uterus (known as “endometrial disease”)—cystic endometrial hyperplasia (CEH), a condition in which the
lining of the uterus thickens abnormally and contains fluid-filled sacs or cysts; very common 
 Hormonal disorders
 Inadequate placenta
 Fetal defects—genetic or developmental (anatomic, metabolic, and chromosomal abnormalities)
 Excessive or poorly planned inbreeding and/or poor choices of breeding stock—indirect evidence; difficult diagnoses without thorough
family history and test matings
 Effects of social hierarchy in group setting; behavioral disorders in individuals
 Agents that induce abortion (known as “abortifacient drugs”)—luteolytics (such as the prostaglandin, PGF2α); estrogens; prolactin
inhibitors (such as cabergoline); steroids; tamoxifen citrate (dogs); mifepristone (dogs); epostane (dogs)
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Noninfectious—Nonreproductive Causes
 Nutrition— low taurine intake (taurine is an amino acid [protein] that is an important component of the diet of cats; cats cannot
produce enough taurine in their bodies and so, must obtain taurine from their food to maintain health); nutritional fads; some
nutraceuticals 
 Severe stress—environmental; physiological; psychosocial
 T rauma
 Some medications
 Consequence of severe, generalized (systemic) disease involving systems other than the reproductive system
RISK FACTORS
 Prior history of pregnancy loss or poor reproductive performance (may be history of individual queen or the cattery)
 Coexistent, severe sudden (acute) or long-term (chronic) disease 
 Excessive inbreeding
 Birth following the first pregnancy or queen greater than 6 years of age
 Environmental stress—crowding, poor sanitation, noise, temperature or humidity extremes
 Social order in cattery
 Exotic breeds—often reproduce poorly in large catteries or high-density environments
 Obesity or inappropriate nutrition
 TREATMENT
HEALTH CARE
 Outpatient medical management—medically stable patients; suspected hormonal disorders; disease of the lining of the uterus
(endometrial disease); noninfectious/nonreproductive pregnancy loss
 Inpatient medical management—abortion imminent or taking place; clinical illness; potential zoonoses—diseases that can be passed
from animals to people (unless safe and effective outpatient treatment can be assured); patients being treated with the prostaglandin,
PGF2α 
 Aborted fetus or discharge may be infectious; isolate patient
 Practice strict sanitation for inpatient or outpatient treatment
 Correct dehydration—administer fluids (such as Normosol® or lactated Ringer’s solution)
ACTIVITY
 No limitations, unless an infectious agent is suspected or documented for outpatients 
 Isolate infectious patients (preferred)
DIET
 No special dietary considerations for uncomplicated cases
 Persistent diarrhea or other causes of fluid loss—veterinary diet and fluid therapy
SURGERY
 Surgical management—spay or ovariohysterectomy (surgical removal of the ovaries and uterus) for stable patients with no breeding
value or if necessary to preserve queen’s life
 MEDICATIONS
Medications presented in this section are intended to provide general information about possible treatment. T he treatment for a
particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive. 
 Depend on underlying causes
 Antibiotics—amoxicillin, pending results of bacterial culture and sensitivity testing 
 Prostaglandin (PGF2α)—may be used to stimulate and evacuate the uterus in cases with non-viable fetuses or significant uterine
contents noted on ultrasound examination; discuss risks and benefits of prostaglandin treatment with your cat’s veterinarian
 Progesterone/progestogens—safe and effective doses for pregnancy maintenance not established; may cause or worsen cystic
endometrial hyperplasia (CEH), a condition in which the lining of the uterus thickens abnormally and contains fluid-filled sacs or cysts
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 FOLLOW-UP CARE
PATIENT MONITORING
 Re-evaluate 7 to 14 days after completion of prostaglandin (PGF2α) treatment 
 Repeat ultrasound examination—evaluate uterine evacuation or fetal viability
PREVENTIONS AND AVOIDANCE
 Genetic problems require attention to breeding program 
 Infectious causes require surveillance and control measures 
 Spay or ovariohysterectomy for cats with no breeding value
POSSIBLE COMPLICATIONS
 Generalized bacterial infection (known as “ sepsis”)
 Shock
 Uterine rupture
 Inflammation of the lining of the abdomen (known as “peritonitis”)
 Inflammation of the lining of the uterus (known as “metritis”)
 Inflammation with accumulation of pus in the uterus (known as “pyometra”)
 Bleeding
 Infertility
 Obesity following spay or ovariohysterectomy in mid-life queens
 Cystic endometrial hyperplasia (CEH, a condition in which the lining of the uterus thickens abnormally and contains fluid-filled sacs or
cysts) following progestogen therapy; progestogen is any substance capable of producing the effects of the female hormone,
progesterone
EXPECTED COURSE AND PROGNOSIS
 Symptomatic retrovirus infection—poor prognosis 
 Long-term (chronic) infertility—common after 6 years of age
 Queens not bred prior to 3 to 4 years of age experience higher infertility
 Severe cystic endometrial hyperplasia (CEH, a condition in which the lining of the uterus thickens abnormally and contains fluid-filled
sacs or cysts)—recovery of fertility unlikely; inflammation with accumulation of pus in the uterus (pyometra) is a common
complication 
 Genetic abnormalities causing difficult birth (dystocia) or loss of most or all of litter—guarded to poorprognosis for further
reproduction
 Repeated difficult births (dystocias)—recurrence depends on cause; guarded prognosis if cause not ascertained
 Hormonal disorders—often manageable; consider genetic aspects
 KEY POINTS
 Zoonoses (diseases that can be passed from animals to people) can be causes of abortion or pregnancy loss in cats; discuss the potential
of a zoonosis causing your cat’s abortion or pregnancy loss with your pet’s veterinarian
 Maintain careful records of reproductive performance for each queen and for the cattery
 Establish disease surveillance and control measures; may require significant changes in cattery management and breeding stock
selection 
 For breeding cats—consider risks and possible side effects associated with non-surgical solutions, particularly with infectious or genetic
causes of pregnancy loss
 Infertility—may result despite successful treatment; may be secondary to conditions pre-existing the pregnancy loss
 Prostaglandin treatment—consider risks and possible side-effects
 Spay or ovariohysterectomy—indicated for primary disease of the uterus for queens with no breeding value
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ANAL SAC/PERIANAL ADENOCARCINOMA
(CANCER INVOLVING THE ANAL SAC OR AREA AROUND THE ANUS)
 BASICS
OVERVIEW
 Uncommon cancerous tumor (malignant neoplasm) that developed from glands of the anal sac
 Locally spreading (invasive) cancer
 High rate of spread to other areas of the body (metastasis), often to the lymph nodes under the lumbar spine (sublumbar lymph nodes)
 Frequently associated with high blood calcium levels (hypercalcemia)
SIGNALMENT/DESCRIPTION of ANIMAL
 Older dogs; extremely rare in cats
 Females have had higher rates of anal sac/perianal adenocarcinoma is some studies
 No breed has been proven to have increased likelihood of developing anal sac/perianal adenocarcinoma
SIGNS/OBSERVED CHANGES in the ANIMAL
 Mass associated with anal sac, straining to defecate, and/or constipation 
 May have lack of appetite (anorexia), excessive thirst (polydipsia), excessive urination (polyuria), and sluggishness (lethargy)
 Mass associated with anal sac may be quite small despite massive metastatic disease
CAUSES
 A hormonal cause is hypothesized
 TREATMENT
HEALTH CARE
 Surgery is the treatment of choice for the primary tumor
 Surgical removal of the primary tumor and enlarged lymph nodes may prolong survival
 Radiation may be helpful, but acute and chronic radiation side effects can be moderate to severe
 Consult a veterinary oncologist for current recommendations
 Monitor blood calcium levels and manage high levels (hypercalcemia), if present
DIET
 Normal diet or as recommended by your pet’s veterinarian
SURGERY
 Surgical removal (resection) of the tumor 
 Partial surgical removal to decrease the size (debulking) of the tumor in cases where the tumor cannot be totally removed
 Surgical removal or decrease in size of lymph nodes with evidence of metastasis
 MEDICATIONS
Medications presented in this section are intended to provide general information about possible treatment. T he treatment for a
particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.
 Limited reports of partial responses to platinum-containing chemotherapeutic compounds in dogs—cisplatin, carboplatin
 Possible role for melphalan after debulking surgery
 FOLLOW-UP CARE
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PATIENT MONITORING
 Complete surgical tumor removal—physical examination, chest X-rays, abdominal ultrasonography, and blood work (serum
biochemistry tests) as scheduled by your pet’s veterinarian
 Partial surgical tumor removal—monitor tumor size and blood calcium levels and kidney tests (blood work, urinalysis)
EXPECTED COURSE AND PROGNOSIS
 Prognosis guarded to poor
 Surgery often reduces the severity of signs (known as “palliative” treatment), but is not curative
 May see both local progression of the tumor and metastasis occurring
 Growth of the tumor may be slow and debulking lymph-node metastatic disease may significantly prolong survival
 Presence of high blood calcium levels and metastasis were poor prognostic factors in one study
 Median survival time (the time between diagnosis and death) ranges from about 8 to 19 months, depending on individual clinical status
 Ultimately, dogs succumb to complications related to high blood calcium levels or from effects of the primary tumor or metastases
 KEY POINTS
 Uncommon cancerous tumor (malignant neoplasm) that developed from glands of the anal sac
 High rate of spread to other areas of the body (metastasis)
 Frequently associated with high blood calcium levels (hypercalcemia)
 Surgical removal of the primary tumor and enlarged lymph nodes may prolong survival
 Prognosis guarded to poor
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SPONTANEOUS ABORTION AND PREGNANCY LOSS IN DOGS
 BASICS
OVERVIEW
 “Abortion” is the delivery of one or more fetuses before it is (they are) capable of surviving outside of the uterus
 “Pregnancy loss” is the death of the embryo, reabsorption of early fetuses, mummification (shriveling or drying up of the fetus, like a
mummy), abortion, stillbirths, and outcomes of difficult birth (known as “dystocia”)
 T he “bitch” is a female dog
GENETICS
 No genetic basis for most causes of abortion
 Low levels of thyroid hormone due to infiltration of lymphocytes into the thyroid gland resulting in destruction of thyroid tissue
(known as “ lymphocytic hypothyroidism”); lymphocytes are a type of white-blood cell that are formed in lymphatic tissues throughout
the body; lymphocytes are involved in the immune process—single-gene recessive trait in borzois
SIGNALMENT/DESCRIPTION of ANIMAL
Species
 Dogs
Breed Predilections
 Familial (runs in certain families or lines of animals) low levels of thyroid hormone due to infiltration of lymphocytes into the thyroid
gland resulting in destruction of thyroid tissue (lymphocytic hypothyroidism) reported in borzois—prolonged interval between “heat”
or “estrous” cycles, poor conception rates, abortion mid-pregnancy or gestation, stillbirths
 Many breeds considered at risk for familial (runs in certain families or lines of animals) low levels of thyroid hormone (known as “
hypothyroidism”)
M ean Age and Range
 Infectious causes, medications causing abortion, fetal defects—seen in all ages
 Cystic endometrial hyperplasia (CEH), a condition in which the lining of the uterus thickens abnormally and contains fluid-filled sacs
or cysts—bitch usually is greater than 6 years of age
Predominant Sex
 Females
SIGNS/OBSERVED CHANGES in the ANIMAL
 Failure to deliver or whelp on time
 Delivery of recognizable fetuses or placental tissues
 Decrease in abdominal size; weight loss
 Lack of appetite (known as “anorexia”)
 Vomiting, diarrhea
 Behavioral changes
 Discharge from the vulva that contains blood or pus; the “vulva” is the external genitalia of females
 Disappearance of fetuses previously documented by physical examination (palpation), ultrasound examination, or X-rays
 Abdominal straining, discomfort
 Depression
 Dehydration
 Fever in some patients
CAUSES
Infectious Disease
 Brucella canis—bacteria that causes reproductive problems in female and male dogs; disease called “brucellosis”
 Canine herpesvirus
 Toxoplasma gondii, Neospora caninum
 Mycoplasma and Ureaplasma
 Miscellaneous bacteria—E. coli, Streptococcus, Campylobacter, Salmonella
 Miscellaneous viruses—canine distemper virus, parvovirus
Uterine
 Cystic endometrial hyperplasia (CEH, a condition in which the lining of the uterus thickens abnormally and contains fluid-filled sacs or
cysts)and inflammation with accumulation of pus in the uterus (known as “pyometra”)
 T rauma
 T umors or cancer
 Medications that are toxic to the developing embryo
 Chemotherapeutic agents
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 Estrogens
 Steroids—high dosages
Ovarian
 Prostaglandins—substances that have many effects on the female reproductive tract, one of which is the breakdown of the “corpora
luteum” or “yellow body” that develops at the site of ovulation in the ovary and produces the female hormone, progesterone, which
supports and maintains the pregnancy; breakdown or lysis of the corpora luteum decreases levels of progesterone and disrupts support of
pregnancy
 Dopamine agonists—medications that mimic dopamine (a nervous system “messenger”) that leads to a decrease in the hormone,
prolactin, and to lysis of the “corpora luteum” or “yellow body” via suppression of prolactin; drugs include bromocriptine and
cabergoline
 Insufficient secretion of progesterone by the “corpora luteum” or “yellow body” during pregnancy, leading to pregnancy loss (known
as “hypoluteoidism”)—abnormal function of the corpora luteum in the absence of fetal, uterine, or placental disease: progesterone
concentrations less than 1 to 2 ng/ml
Hormonal Dysfunction
 Low levels of thyroid hormone (hypothyroidism)
 Excessive levels of steroids produced by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s disease”)
 Environmental factors—hormone or endocrine-disrupting contaminants have been documented in people and wildlife with fetal loss
Fetal Defects
 Lethal genetic or chromosomal abnormality
 Lethal organ defects
RISK FACTORS
 Exposure of the brood bitch to animals carrying disease
 Old age
 Genetic factors
 TREATMENT
HEALTH CARE
 Most bitches should be confined and isolated pending diagnosis
 Hospitalization of infectious patients preferred
 Brucella canis—highly infective to dogs; bacteria shed in high numbers during abortion; suspected cases should be isolated
 Outpatient medical management—medically stable patients with noninfectious causes of pregnancy loss, hormonal disorders, or disease
of the lining of the uterus (known as “endometrial disease”)
 Partial abortion—may attempt to salvage any remaining live fetuses; administer antibiotics if a bacterial component is identified
 Dehydration—use replacement fluids, supplemented with electrolytes if imbalances are identified by serum biochemistry blood tests
ACTIVITY
 Partial abortion—cage rest
DIET
 No special dietary considerations for uncomplicated cases
SURGERY
 Spay or ovariohysterectomy—preferred for stable patients with no breeding value
 MEDICATIONS
Medications presented in this section are intended to provide general information about possible treatment. T he treatment for a
particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive. 
 Prostaglandin (PGF2α—Lutalyse®)—stimulates and evacuates the uterus; also may consider Estrumate® (cloprostenol)—not approved
for use in dogs; discuss the risks and benefits of treatment with your dog’s veterinarian
 Antibiotics—for bacterial disease; initially institute broad-spectrum antibiotic; specific antibiotic depends on bacterial culture and
sensitivity testing of vaginal tissue or postmortem examination of fetus(es)
 Progesterone (Regu-Mate®) or progesterone in oil—for documented cases of insufficient secretion of progesterone (female hormone
necessary to support pregnancy) by the “corpora luteum” or “yellow body” (hypoluteodism) only
 Oxytocin (hormone that stimulates uterine contractions)—for uterine evacuation; most effective in the first 24 to 48 hours after
abortion
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 FOLLOW-UP CARE
PATIENT MONITORING
 Partial abortion—monitor remaining fetuses with ultrasound examination to determine if they are continuing to live and develop;
monitor general (systemic) health of the bitch for remainder of pregnancy
 Vulvar discharges—check daily; for decreasing amount, odor, and inflammatory component; for consistency (increasing mucoid
content is good prognostically)
 Prostaglandin (PGF2α)—continued for 5 days or until most of the discharge ceases (usually 3 to 15 days)
 Brucella canis—monitor after spaying and antibiotic therapy; yearly serum testing to identify reappearance of bacteria (extremely
difficult to eliminate infection successfully, even if combined with spaying or ovariohysterectomy)
 Low levels of thyroid hormone (hypothyroidism)—treat appropriately; spaying recommended (possible genetic nature of
hypothyroidism should be considered)
PREVENTIONS AND AVOIDANCE
 Brucellosis (disease caused by Brucella canis) and other infectious agents—surveillance programs to prevent introduction to kennel
 Spay or ovariohysterectomy—for bitches with no breeding value
POSSIBLE COMPLICATIONS
 Untreated inflammation with accumulation of pus in the uterus (pyometra)—generalized disease caused by the spread of bacteria in the
blood (known as “ septicemia” or “blood poisoning”), presence of poisons or toxins in the blood (known as “ toxemia”), death
 Brucellosis (disease caused by Brucella canis)—infection and inflammation in other organs of the body, such as the vertebrae
(diskospondylitis) and eye (endophthalmitis, recurrent uveitis)
EXPECTED COURSE AND PROGNOSIS
 Inflammation with accumulation of pus in the uterus (pyometra)—recurrence rate during subsequent cycle is high (up to 70%) unless
pregnancy is established
 Cystic endometrial hyperplasia (CEH, a condition in which the lining of the uterus thickens abnormally and contains fluid-filled sacs or
cysts)—recovery of fertility unlikely; and inflammation with accumulation of pus in the uterus (pyometra) is a common complication
 Hormonal dysfunction—often manageable; familial (runs in certain families or lines of animals) aspects should be considered
 Brucellosis (disease caused by Brucella canis)—guarded prognosis; extremely difficult to eliminate infection successfully, even if
combined with spaying or ovariohysterectomy
 KEY POINTS
 If brucellosis (disease caused by Brucella canis) is confirmed as the cause of pregnancy loss, euthanasia is recommended owing to lack
of successful treatment and to prevent spread of infection; may try spay or ovariohysterectomy and long-term antibiotics with
long-term monitoring
 If brucellosis (disease caused by Brucella canis) is confirmed as the cause of pregnancy loss, a surveillance program for kennel
situations should be developed and implemented 
 If brucellosis (disease caused by Brucella canis) is confirmed as the cause of pregnancy loss, zoonotic potential should be considered; a
“zoonosis” is a disease that can be passed from animals to people
 Primary uterine disease—spay or ovariohysterectomy is indicated in patients with no breeding value; cystic endometrial hyperplasia
(CEH, a condition in which the lining of the uterus thickens abnormally and contains fluid-filled sacs or cysts) is an irreversible change
 Infertility or pregnancy loss—may recur in subsequent “heat” or “estrous” cycles despite successful immediate treatment
 Prostaglandin treatment—discuss possible side effects of prostaglandins with your pet’s veterinarian
 Infectious diseases—establish surveillance and control measures
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AGGRESSION BY DOGS TOWARD FAMILIAR PEOPLE
 BASICS
OVERVIEW
 Aggression (such as growling, lip-lifting, barking, snapping, lunging, biting), usually directed toward household members or familiar
people in situations involving access to preferred resources (such as food or toys) 
 Also referred to as “dominance aggression,” “ status-related aggression,”“conflict aggression,” or “competitive aggression”
GENETICS
 Breed bias or predilections exist and pedigree analyses have shown that it may occur more commonly within related dogs 
 Mode of inheritance is unknown
SIGNALMENT/DESCRIPTION of ANIMAL
Species
 Dog
Breed Bias or Predilections
 Spaniels (English springer and cocker), terriers, Lhasa apso, and rottweiler, but may be exhibited by any breed
M ean Age And Range
 Usually manifested at the onset of social maturity (12–36 months of age); may be seen in young dogs
Predominant Sex
 Male dogs (castrated and intact) more commonly are presented with aggression toward familiar people than are female dogs
SIGNS/OBSERVED CHANGES in the ANIMAL
 Aggression often seen around resting areas, food, toys, handling (including petting) and reaching toward favorite possessions, including
people
 Aggression usually is directed toward household members or persons that have an established relationship with the dog
 Aggressive behaviors may be seen in other contexts, including (but not limited to) defense of territory, when dogs are reprimanded or
denied access to items or activities, toward other dogs, and toward unfamiliar people
 Aggression may not be seen every time dog is in a certain situation and may not be directed uniformly toward each person within the
household
 Stiff body posture, staring, head up, ears up and forward, or tail up usually accompanies aggressive behavior; a combination of these
postures may be seen with more submissive postures (for example, tail is up but ears are tucked, eyes averted), which may represent an
element of conflict, anxiety, or fear in the dog’s motivation
 Dog may seem to be “moody” and this behavior may be a key to judging when the dog is likely to be aggressive in a given situation 
 Dog may show fearful behaviors (such as eye aversion, tail tucked, and avoidance) in early episodes; these fearful behaviors may
diminish as the dog becomes more confident that aggression will change the outcome of the situation
 Anxiety may be noted in pet-owner interactions and other situations, such as owner departure or novel situations 
 Some dogs control their environment using aggression only because it is effective, but are anxious about every encounter, while other
dogs appear confident and secure
 Generally the dog does not have any physical abnormalities related to the aggressive behavior; however, medical conditions, especially
painful ones, may contribute to the expression of aggression 
CAUSES
 May be part of a normal canine social behavioral repertoire, but its expression is influenced by environment, learning, and genetics
 T he manifestation of aggression may be influenced by underlying medical conditions, early experiences (learning that aggression works
to control situations), inconsistent or lack of clear rules and routine within the household and within human-pet interactions
 Rarely a sign of a medical condition, but contributory medical conditions must be ruled out, since illness and/or pain may influence a
tendency for aggressive behaviors
RISK FACTORS
 Inconsistent or inappropriate punishment and inconsistent owner interactions may contribute to the development of conflicted and/or
aggressive behavior
 Medical conditions, especially painful ones, may contribute to the expression of aggression; extreme caution should be taken when the
veterinarian examines dogs that show aggression—including the use of muzzles or other humane restraint devices
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 TREATMENT
HEALTH CARE
 Outpatient behavior modification and possibly medical management
 Avoid situations that might evoke aggression; identify specific situations to avoid—do not allow the dog on furniture; do not give
valuable treats or toys (such as rawhides); pick up toys and control playtime and activity; limit physical contact with the dog, including
petting
 Do not physically punish or reprimand the dog
 T each the dog to comfortably and safely wear a head halter (such as a Gentle Leader®) and/or basket muzzle; have the dog wear the
head halter with a lightweight 8–10 foot leash attached whenever in contact with people 
 Use a long leash to move the dog from situations that may elicit aggression; do not reach for dog directly
 Behavior modification—use non-confrontational methods to teach the dog to view people as leaders; use reward-based training
techniques to teach the dog to obey commands from people without the dog experiencing conflict or becoming aggressive
 Affection control—make the dog follow a command before getting anything it desires from people (also known as “Nothing in life is
free” or “Learn to earn”)—for example, the dog must sit or lie down before feeding, petting, play, or going for a walk
 For initial 2–3 week period, owners should give the dog attention only during brief, structured (for example,
command-response-reward) periods; at other times, they must ignore the dog, especially if it is soliciting attention
 Counter commanding—using positive reinforcement (such as food, toys, play, petting) to teach behaviors that are counter to those
that have resulted in aggression in the past—for example, teach an “off” command to move off furniture or “drop it” command to
release toys
 Desensitization and counterconditioning—technique used to decrease responsiveness to situations that have resulted in aggression in
the past (dog may need to be muzzled for safety); should not begin until the owner has assumed a greater level of control over the dog
through affection control and reward-based training
ACTIVITY
 Appropriate physical activity may help decrease incidences of aggression
DIET
 Low protein/high tryptophan diets may help reduce aggression, but are unlikely to make a significant difference without behavior
modification
SURGERY
 Neuter intact males
 Females that start to show dominance aggression at less than 6 months of age may be less aggressive when mature if not spayed
 MEDICATIONS
Medications presented in this section are intended to provide general information about possible treatment. T he treatment for a
particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive. 
 No medications are approved by the FDA for the treatment of canine aggression
 Owners must be aware that the use of a medication is off-label and be informed of potential risks and potential side effects
 Signed informed consent forms are prudent
 Before prescribing medication be sure that owners understand the risks involved in owning an aggressive dog and will follow safety
procedures and not rely on medication to keep others safe
 Never use medications without behavior modification
 Medication may not be appropriate in some family situations, such as those with small children, family members with disabilities, or
immunocompromised individuals, who are unable to develop a normal immune response
 Drugs that have been used in treating canine aggression include Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine,
paroxetine, sertraline; T ricyclic Antidepressants (T CAs), such as clomipramine; and progestins, such as DepoProvera
 FOLLOW-UP CARE
PATIENT MONITORING
 Owners often need ongoing assistance with behavior cases, especially aggression 
 At least one follow-up call within the first 1–3 weeks after the consultation is advisable; provisions for further follow-up either by
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phone or in person should be made at that time
PREVENTIONS AND AVOIDANCE
 Continued avoidance of situations that lead to aggression (known as “aggression triggers”) may be necessary
POSSIBLE COMPLICATIONS
 Human injuries; surrender of dog to animal control or animal shelter; euthanasia of dog
EXPECTEDCOURSE AND PROGNOSIS
 No cure exists; prognosis for improvement is better if aggression is at a low intensity and in relatively few predictable situations;
prognosis is highly dependent on owner compliance
 T reatment recommendations are lifelong
 Owners may see recurrence of aggression with treatment lapses
 KEY POINTS
 Successful treatment, as measured by a decrease in aggressive incidents, depends upon the owner’s understanding of basic canine social
behavior, the risks involved in living with an aggressive dog, and how to implement safety and management recommendations
 Preventing human injuries must be the first concern
 T reatment is aimed at controlling the problem, not at achieving a “cure”
 Owners must be aware that the only way to prevent future injuries is euthanasia
 It is very important that owners are educated about the risks of using physical punishment and training techniques that rely upon
owners learning to “dominate” their dogs; the improper use of physical punishments/dominance techniques ranging from corrections
with choke chains to so-called “alpha rolls” to setting up situations to provoke and then correct aggression can lead to human injury,
increased aggression, an increase in underlying anxiety and a disruption of the human-animal bond
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ABORTION, TERMINATION OF PREGNANCY in DOGS
 BASICS
OVERVIEW
 Intentional medical or surgical termination of an unwanted pregnancy in a dog; may be accomplished by using drugs that prevent
fertilization of the egg or prevent implantation of the embryo in the uterus or by using drugs or surgery to terminate an established
pregnancy
SIGNALMENT/DESCRIPTION of ANIMAL
Species
 Dogs
Breed Predilections
 Unwanted pregnancy in any breed
Predominant Sex
 Female
SIGNS/OBSERVED CHANGES in the ANIMAL
 Depend on the stage of the pregnancy (gestation)
 May have no visible signs of pregnancy
 Discharge of fluid or developing fetus(es) from female genital canal (vagina)
CAUSES
 Medically stopping development of the “corpus luteum” or “yellow body” in the ovary that produces the female hormone
progesterone, which supports and maintains the pregnancy
 Inhibiting the production of progesterone, the female hormone that supports pregnancy
 Using a drug to block the effects of progesterone, the female hormone that supports pregnancy
RISK FACTORS
 Drugs used to terminate a pregnancy may have undesirable side effects 
 Medical treatment may require a great deal of time and effort
 Anesthesia and surgical risks if ovariohysterectomy (surgical removal of the ovaries and uterus, also known as a “spay”) is performed
 TREATMENT
HEALTH CARE
 Inpatient care is preferred to allow for monitoring of the patient; the patient should be monitored for at least 1 hour prior to
discharge if the owner wishes to take the patient home
 Many accidentally mated dogs do not become pregnant; therefore, treatment may not be necessary
 Determining pregnancy status in the early stages is difficult because ultrasound confirmation of pregnancy is not possible until 4–5
weeks after breeding
 Medical treatment is generally done early in the pregnancy as later treatment may lead to more discharge and possible visually detected
passage of fetuses
ACTIVITY
 No need to change the patient’s activity following medical treatment
 Activity and exercise is restricted for several days following surgery if ovariohysterectomy (spay) is performed
DIET
 Delay feedings for at least 1–2 hours after medical treatments—reduces nausea and vomiting
 Follow feeding instructions before and after surgery if ovariohysterectomy (spay) is performed
SURGERY
 If breeding is not a consideration, ovariohysterectomy (spay) may be the best alternative treatment
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 MEDICATIONS
Medications presented in this section are intended to provide general information about possible treatment. T he treatment for a
particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive. 
 Prostaglandin F2α or PGF2α (Lutalyse)—causes breakdown of the corpus luteum and causes cervical dilation and uterine contractions
 Bromocriptine mesylate (Parlodel)—causes abortion and inhibits hormone, prolactin, that stimulates milk production
 Cabergoline (Dostinex)— inhibits hormone, prolactin, that stimulates milk production
 Prostaglandin F2α or PGF2α combined with bromocriptine or cabergoline
 Dexamethasone—mode of action not known
 Mifepristone (blocks the effects of progesterone) and epostane (prevents production of progesterone) are potentially useful; not
currently available to veterinarians in North America
 FOLLOW-UP CARE
PATIENT MONITORING
 Examination of uterus using ultrasound to confirm emptying of uterine contents
PREVENTIONS AND AVOIDANCE
 Surgical sterilization (ovariohysterectomy or spay) for dogs not intended for breeding
 Confine dogs intended for breeding during heat cycle, walk on leash, and observe carefully to avoid accidental breeding
POSSIBLE COMPLICATIONS
 Medical treatment may shorten time until next heat cycle
 Estrogen compounds should not be used as treatment to cause abortion
 Bleeding, infection, and incision problems may occur following ovariohysterectomy or spay
EXPECTED COURSE AND PROGNOSIS
 Fertility may be preserved with medical treatment
 Ovariohysterectomy (spay) will eliminate heat cycles and fertility 
 KEY POINTS
 If breeding is not a consideration, ovariohysterectomy (spay) may be the best alternative
 Discuss all treatment options with the veterinarian, and come to a mutually agreeable treatment plan
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AGGRESSION IN CATS: OVERVIEW
 BASICS
OVERVIEW
 Aggression can be an appropriate behavior that allows the cat to protect itself (known as an “adaptive behavior”) and its resources
(such as food)
 Behavioral medicine—concerned with recognizing when aggressive behavior is abnormal or inappropriate (known as “maladaptive
behavior”)
 Numerous types of aggression have been identified in cats, including the following:
1. Aggression owing to lack of socialization
o No human contact before 3 months of age—cat misses sensitive period important for development of normal
approach responses to people; if not handled until 14 weeks of age, it usually is fearful and aggressive to people; if
handled for only 5 min/day until 7 weeks of age, it interacts with people, approaches inanimate objects, and plays
with toys.
o Lack of social interaction with other cats—may result in lack of normal inquisitive response to other cats
o T hese cats are usually not normal, cuddly pets; they may eventually attach to one person or a small group of
people; if forced into a situation involving restraint, confinement, or intimate contact, they may become
extremely aggressive
2. Play aggression
o Weaned early and hand-raised by humans—cat may never learn to temper its play responses; if not taught as a
kitten to modulate responses, it may not learn to sheathe claws or inhibit bite; bottle-fed cats may be over
represented
3. Fearful or fear-induced aggression
o Fearful—cat may hiss, spit, arch the back, and hair may stand up if flight is not possible; combinations of offensive
and defensive postures and overt and covert aggressive behaviors are usually involved
o Flight—virtually always a component of fearful aggression if the cat can escape
o Pursued—if cornered, cat will stop, draw its head in, crouch, growl, roll on its back when approached (not submissive
but overtly defensive), and paw at the approacher; if pursuit is continued, cat will strike, then hold the approacher
with its forepaws whilekicking with the back feet and biting
o If threatened, cat will defend itself; any cat can become fearfully aggressive
4. Pain aggression
o Pain may cause aggression; with extended painful treatment, cat may exhibit fearful aggression
5. Cat-to-cat (intercat) aggression
o Male cat-to-male cat aggression associated with mating or hierarchical status within the social group; mating also
may involve social hierarchy issues
o Maturity—in peaceful multi-cat households, problems may occur, regardless of sexes in the household, when a cat
reaches social maturity (2–4 years of age)
6. Maternal aggression
o May occur during the period surrounding the birth of kittens (known as the “periparturient period”)
o Protection—queens may guard nesting areas and kittens by threatening with long approach distances, rather than
attack; usually directed toward unfamiliar individuals; may inappropriately be directed toward known individuals; as
kittens mature, aggression resolves
o Unknown if kittens learn aggressive behavior from an aggressive mother
7. Predatory behavior
o Occurs under different behavioral circumstances
o Normal predatory behavior develops at 5–7 weeks of age; kitten may be a proficient hunter by 14 weeks of age;
commonly displayed with field voles, house mice, and birds at feeders; may be learned from mother; more common
in cats that have to fend for themselves; if well fed, cat may kill prey without feeding on it 
o Aggression—stealth, silence, heightened attentiveness, body posture associated with hunting (slinking, head
lowering, tail twitching, and pounce postures), lunging or springing at prey, exhibiting sudden movement after a
quiet period
o In free-ranging groups of cats, when a new male enters, he may kill kittens to encourage queen to come into heat
(estrus)
o Inappropriate context distinctions about prey—potentially dangerous if “prey” is a foot, hand, or infant; cats
exhibiting pre-pounce behaviors in these contexts are at risk of displaying inappropriate predatory behavior
8. T erritorial aggression
o May be exhibited toward other cats, dogs, or people; owing to transitive nature of social hierarchies, a cat aggressive
to one housemate may not be to another if its turf is not contested
o T urf may be delineated by patrol, chin rubbing, spraying, or non-spraying marking; threats and/or fights may occur
if a perceived offender enters the area; if the struggle involves social hierarchy, the challenger may be sought out
and attacked after the territory is invaded
o May be difficult to treat, particularly if the cat is marking its territory; marking problems suggest a possible
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underlying aggression
9. Redirected aggression
o Difficult to recognize and may be reported as incidental to another form of aggression
o Occurs when a aggressive behavior pattern appropriate for a specific motivational state is redirected to an accessible
target because the primary target is unavailable (e.g., cat sees a bird outside the window and is demonstrating
predatory behavior; person walks behind cat and cat pounces the person, possibly biting the person); cat may
remain reactive for some time after being thwarted in an aggressive interaction
o Often precipitated by another inappropriate behavior or event; important to treat that behavior as well
10. Assertion or status-related aggression
o If unprovoked, most frequently occurs when cat is being petted; a need to control all interactions with humans and
when attention starts and ceases; cat may bite and leave or may take hand in teeth but not bite
o May be accompanied by true territorial aggression where specific areas are patrolled
o May best be called impulse control/dyscontrol aggression
o Exact syndrome is not well defined or recognized
11. Idiopathic aggression
o Rare; poorly understood and poorly defined; unprovoked, unpredictable, “ toggle-switch” (turned on and off)
aggression
SIGNALMENT/DESCRIPTION of ANIMAL
 Any breed of cat
 Some types of aggression appear at onset of social maturity (2–4 years)
 Males—may be more prone to cat-to-cat aggression (known as “ intercat” aggression)
SIGNS/OBSERVED CHANGES in the ANIMAL
 Aggressive behavior
 Physical examination findings are generally secondary to aggression, such as injuries, lacerations, or damage to teeth or claws
 Continuous anxiety—decreased or increased grooming
CAUSES
 Aggression is part of normal feline behavior; greatly influenced by the early social history and exposure to humans and other animals,
sex, social context, handling, and many other variables
RISK FACTORS
 Abuse—cat may learn aggression as a pre-emptive strategy to protect itself
 TREATMENT
HEALTH CARE
 Desensitization, counterconditioning, flooding, and habituation—if subtleties of social systems and communication are understood
 MEDICATIONS
Medications presented in this section are intended to provide general information about possible treatment. T he treatment for a
particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive.
No drugs are approved by the FDA for the treatment of aggression in cats; your veterinarian will discuss the risks and benefits of medical
treatment
 Antianxiety medications that increase levels of serotonin in the central nervous system, such as tricyclic antidepressants (T CAs) and
selective serotonin reuptake inhibitors (SSRIs)
 Amitriptyline (T CA)
 Imipramine
 TBuspirone; may make some cats more assertive; thus may work well for the victim in anxiety-associated aggression
 TClomipramine (T CA)
 TFluoxetine or paroxetine (SSRI)
 Buspirone, clomipramine, paroxetine and fluoxetine—may take 3–5 weeks to be fully effective; early effects in cats are seen within 1
week, best for active, overt aggressions
 Nortriptyline—active intermediate metabolite of amitriptyline
 Anxious and fearful aggression combined with elimination disorders (behavioral problems involving urination and/or defecation)—
diazepam or other benzodiazepine; use with caution because benzodiazepines can worsen inhibited aggressions; may facilitate some
behavior modification if food treats used
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 FOLLOW-UP CARE
PATIENT MONITORING
 Blood work (complete blood count, serum biochemistry) and urinalysis should be performed before treatment; semiannually in older
patients; yearly in younger patients if treatment is continuous; adjust dosages accordingly
 As warranted by clinical signs—vomiting; gastrointestinal distress; rapid heart rate (tachycardia), and rapid breathing (tachypnea)
PREVENTIONS AND AVOIDANCE
 Ensure appropriate socialization of kittens with humans and other cats
 Avoid provocation of the cat
 Observe signs of aggression (such as tail flicking, ears flat, pupils dilated, head hunched, claws possibly unsheathed, stillness or
tenseness, low growl) and safely interrupt the behavior; leave cat alone and refuse to interact until appropriate behavior is displayed; if
the cat is in the person’s lap, let the cat drop from his or her lap
 Discourage direct physical correction; may intensify aggression
 If possible, safely separate cats; keep the active aggressor in a less favored area to passively reinforce more desirable behavior
 Remember that a cat displaying aggressive or predatory behavior can bite or scratch any person or another animal--always be careful
to ensure that you do not get injured; the best approach in some situations is to leave the cat alone in a quiet area until it calms down
POSSIBLE COMPLICATIONS
 Human injuries; surrender of cat to animal control or animal shelter; euthanasia of cat
 Left untreated, these disorders always progress
 KEY POINTS
 Aggression can be an appropriate behavior that allows the cat to protect itself(known as an “adaptive behavior”) and its resources
(such as food)
 Behavioral medicine is concerned with recognizing and identifying abnormal or inappropriate aggressive behavior
 Numerous types of aggression have been identified in cats
 Early treatment using both behavioral modification and pharmacological intervention is crucial
 Left untreated, these disorders always progress
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OVERVIEW OF AGGRESSION IN DOGS
 BASICS
OVERVIEW
 Action taken by one dog directed against a person or another animal, with the result of harming, limiting, or depriving that person or
animal; aggression may be offensive, defensive, or predatory (that is, hunting behavior)
 Offensive aggression—unprovoked attempt to gain some resource (such as food or toys) at the expense of another; includes social
status/dominance, inter-male (that is, between two males), and inter-female (that is, between two females) aggression
 Defensive aggression—aggression by a “victim dog” toward a person or another animal that is perceived as an instigator or threat;
includes fear-motivated, territorial, protective, irritable (pain-associated or frustration-related), and maternal aggression
 Predatory aggression—rare; the dog’s aggression may be triggered by “prey” behavior by the victim (person or another animal), such
as running or squealing
SIGNALMENT/DESCRIPTION of ANIMAL
Species
 Dogs
Breed Predilections
 Any breed may show aggression
 Pit bulls, rottweilers, German shepherd dogs—associated with fatal dog bites
M ean Age and Range
 Any age puppy or dog may show aggression
 Social status/dominance-related offensive aggression—escalates near the time the dog reaches social maturity (1 to 2 years of age)
Predominant Sex
 Any sex dog may show aggression
 Males—intact or castrated
 Females—intact; maternal aggression
SIGNS/OBSERVED CHANGES in the ANIMAL
 Behavioral warning signs include being motionless (immobility), growling, snarling, or snapping at air; offensive aggression warning
signs include head up, tail up, direct stare, face-on immobility; defensive aggression warning signs include head lowered, tail down, and
body withdrawn
 Physical examination usually unremarkable
 Dominance-related aggression, fear-related aggression, or irritable aggression may be evident during the examination
 Nervous system examination—abnormalities may suggest a disease process (such as rabies) as the cause of aggression
 Signs vary, according to the situation and the type of aggression
Social Status/Dominance Aggression
 Directed toward household members
 Head up; tail up; staring; stiff gait
 T riggers that stimulate aggression include reaching for pet, patting on head, pushing off sleeping sites, approaching food or stolen
objects 
 Also called “conflict aggression”
Inter-male (between two males) and Inter-female (between two females) Aggression
 Directed toward other dogs, usually same sex 
 Human injury, when person interferes with fights
 Head up; tail up; staring; stiff gait
Fear-M otivated Aggression
 Directed to people or dogs who approach, stand over, or reach for the dog
 Certain familiar people may be exempt
 No gender bias
 Head down; eyes wide; tail tucked, spine in “C” curve
Territorial Aggression
 Directed toward strangers approaching home, yard, or car
 May be increased in intensity, if the dog is restrained 
 Agitation, barking; lunging; baring teeth
 Approach/avoidance behavior is common; “approach/avoidance” behavior consists of the dog approaching the stranger and then
moving back away from the stranger
Protective Aggression
 Directed toward stranger approaching owner
 Escalates with decreasing distance between the stranger and the dog and owner
Irritable (Pain, Frustration) Aggression
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 Restricted to specific context associated with pain (for example, nail trim, injection) or conflict associated with being restrained
 Other forms of aggression (social status/dominance and fear-induced aggression) should be considered as possible causes of signs
M aternal Aggression
 Directed toward individuals approaching the whelping area or puppies
 Intensity usually related to age of puppies; the intensity of aggression is greater the younger the puppies
CAUSES
 Part of the normal range of dog behavior; strongly influenced by breed, sex, early socialization, handling, and individual temperament
 May be caused by a medical condition—possible but rare; medical causes of aggression should be considered in all cases
RISK FACTORS
 Poor socialization to certain types of stimuli (such as children)—adult dog may display fear-related aggression 
 Environmental conditions may lead to aggression or may increase the level of aggression—such as associating with other dogs in a
pack; barrier frustration or tethering; cruel handling and abuse; and dog baiting and fighting
 TREATMENT
HEALTH CARE
 T he first tenet of management is to prevent injury to people
 Overtly aggressive dogs are never cured, occasionally they may be managed successfully 
 Euthanasia—appropriate solution in cases of vicious dogs; may be the only safe solution
 Board the dog until an outcome decision or implementation of a safe management plan is made
 Use physical barriers, to reduce risk of injury to people, until the owner obtains treatment
 Identify specific situations that have led to aggression in the past; use a specific plan to avoid these situations 
 Improve physical control of the dog using reliable barriers (such as fences, baby gates), muzzles, leashes, and head halters 
 Calmly and safely remove dog from aggressive-provoking situations 
 Avoid punishment and confrontation; punishment and confrontation promote defensive (fear) responses and escalate aggression
 Management success—combination of environmental control, behavior modification, and medication
Social Status/Dominance Aggression
 Environmental—use barriers and restraint to prevent injury to people
 Devices—train the dog to accept a muzzle and head halter
 Behavior modification, step 1—withdraw all attention from the dog for 2 weeks; list situations in which aggression occurs; devise a
method of avoiding each situation; daily, list all aggressive incidents and circumstances to avoid in the future—do not punish the dog
 Behavior modification, step 2—use non-confrontational means to establish the owner’s leadership; teach the dog to reliably “ sit/stay”
on command in gradually more challenging situations (dog must comply without causing any problems to the owner before getting
attention and other benefits); no “ free” benefits (dog must “ sit/stay” before eating, being petted, going for walk, and any other
attention; the owner initiates all interactions)
 Behavior modification, step 3—gain greater control; situations that previously elicited aggression are introduced gradually with the dog
controlled in a “ sit/stay” position (muzzle if necessary)
 Surgery—neuter males; unless aggression is associated with the heat cycle, spaying (ovariohysterectomy) of female will not improve
behavior
Inter-male and Inter-female Aggression
 Environmental—use barriers to prevent contact between the dogs, unless they can be well supervised; note dominance order between
dogs; if apparent, comply with dogs’ rules (for example, dominant dog is fed first, travels through doorways first)
 Devices—train the dog to accept a head halter and muzzle
 A reduced protein diet may be helpful
 Behavior modification, step 1—owner must withdraw all attention to both dogs; teach “ sit/stay” program (as for dominance-related
aggression)
 Behavior modification, step 2—desensitize or countercondition by gradually decreasing distance between dogs while they are under
leash control; reinforce acceptable behavior; “desensitization”is the repeated, controlled exposure to the stimulus [in this case, another
dog] that usually causes an aggressive response, in such a way that the dog does not respond with aggression; with repeated efforts, the
goal is to decrease the dog’s aggressive response; “counterconditioning” is training the dog to perform a positive behavior in place of the
negative behavior (in this case aggression)—for example, teaching “sit/stay” and when performed, the dog is rewarded; then when the
dog is placed in a situation where it might show aggression, have it “ sit/stay” 
 Surgery—neuter males; spay (ovariohysterectomy) of females recommended only if aggression is associated with heat cycle (otherwise
it will not improve behavior)
Fear-M otivated Aggression
 Environmental—barriers and restraint to prevent injury to people
 Devices—muzzle
 A reduced protein diet may be helpful
 Behavior modification, step 1—list all situations in which the dog appears fearful or exhibits aggression; avoid situations initially;
teach dog basic obedience commands and reinforce under non-fearful conditions (generalize by training in many locations)
 Behavior modification, step 2—desensitize and countercondition; subject the dog to mildly fearful conditions with the stimulus (for
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example, a stranger) far away; keep the dog attentive and performing obedience commands; gradually decrease the distance of the
stranger; if the dog exhibits fear, the stranger should withdraw and work should continue at an easier level, then gradually progress;
desensitize or countercondition by gradually decreasing distance between the dog and the stimulus while the dog is under leash control;
reinforce acceptable behavior; “desensitization” is the repeated, controlled exposure to the stimulus that usually causes an aggressive
response, in such a way that the dog does not respond with aggression; with repeated efforts, the goal is to decrease the dog’s aggressive
response; “counterconditioning” is training the dog to perform a positive behavior in place of the negative behavior (in this case
aggression)—for example, teaching “sit/stay” and when performed, the dog is rewarded; then when the dog is placed in a situation where
it might show aggression, have it “ sit/stay” 
 Surgery—neutering males or spaying female probably will not improve the behavior
Territorial Aggression
 Environmental—barriers and restraint to prevent injury to people; initially, when visitors come, isolate the dog to prevent it from
exhibiting the behavior
 Devices—head halter, muzzle
 Behavior modification, step 1—teach the dog “sit/stay,” first at neutral locations, then near the door and at other sites of territorial
aggression; later, control the dog while a familiar person approaches; reward the dog for calm, obedient behavior
 Behavior modification, step 2—gradually introduce strangers; increase the difficulty as the dog learns control; move the exercises to
the door; add ringing the door bell and entering the door
 Surgery— neutering males or spaying female probably will not improve the behavior
DIET
 A reduced protein diet may be helpful in controlling some forms of aggression
 MEDICATIONS
Medications presented in this section are intended to provide general information about possible treatment. T he treatment for a
particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive. 
 No medications are approved by the federal Food and Drug Administration (FDA) for the treatment of aggression in dogs; discuss the
risks and benefits of using medications with your pet’s veterinarian
 Medication should be used only in conjunction with a safe management plan
 Medications that increase serotonin (chemical messenger in the brain that affects mood and behavior) may be helpful to reduce
anxiety, arousal, and impulsivity
 T reatment duration: 4 months to life
 Medications that have been tried include amitriptyline, fluoxetine, and L-tryptophan
 Clomipramine (Clomicalm®) has a warning on the label that it is not designed to treat aggression; therefore, it should not be used to
treat canine aggression
 Megestrol acetate has been used successfully with dominance-related and inter-male aggression; however, it does have side effects that
should be considered
 FOLLOW-UP CARE
PATIENT MONITORING
 Weekly to biweekly contact—recommended in the initial phases
 Clients need feedback and assistance with behavior modification plans and medication management
PREVENTIONS AND AVOIDANCE
 Avoid situations that lead to aggression
 Use extreme care when handling aggressive dogs; use muzzles and other restraints to prevent injury to people and other animals
POSSIBLE COMPLICATIONS
 Injury to people and/or other animals
 Social status/dominance aggression—can be directed toward owners
 Interdog aggression—people often seriously injured when interfering with fighting dogs, either by accident or by redirected or irritable
aggression; owners should not reach for fighting dogs; pull apart with leashes
EXPECTED COURSE AND PROGNOSIS
 Aggressive dogs are never cured, some may be managed successfully
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 KEY POINTS
 Aggressive dogs are never cured, some may be managed successfully
 Behavioral warning signs include being motionless (immobility), growling, snarling, or snapping at air; offensive aggression warning
signs include head up, tail up, direct stare, face-on immobility; defensive aggression warning signs include head lowered, tail down, and
body withdrawn
 Avoid situations that lead to aggression
 Use extreme care when handling aggressive dogs; use muzzles and other restraints to prevent injury to people and other animals
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HAIR LOSS (ALOPECIA) IN CATS
 BASICS
OVERVIEW
 “Alopecia” is the medical term for hair loss
 Hair loss is a common problem in cats
 Characterized by a complete or partial lack of hair in areas where it is present normally
 Pattern of hair loss—varied or symmetrical
SIGNALMENT/DESCRIPTION of ANIMAL
Species
 Cats
M ean Age and Range
 Cancer-related hair loss (alopecia)—generally recognized in old cats
SIGNS/OBSERVED CHANGES in the ANIMAL
 Hair loss; pattern of hair loss varies—may be localized or widespread
 Skin itself may appear normal or may be abnormal (such as redness; multiple, pinpoint bumps or scabs; or loss of superficial layers of
the skin [known as ulceration])
 Other signs depend on the underlying cause of hair loss
CAUSES
 Nervous system or behavioral disorders—obsessive-compulsive disorder, in which the cat over grooms, with resulting hair loss
 Hormonal disorders—sex hormone hair loss (alopecia); excessive levels of thyroid hormone (known as “hyperthyroidism”); increased
levels of steroids produced by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s disease”); diabetes mellitus (“ sugar
diabetes”)
 Immune-mediated disorders—skin allergies (known as “allergic dermatitis”); specific condition characterized by multiple patches of
hair loss (known as “alopecia areata”)
 Parasites—demodectic mange (known as “demodicosis”)
 Fungal infection—ringworm (known as “dermatophytosis”)
 Physiologic disorder—condition characterized by multiple areas of hair loss with reddened skin, scales (accumulations of surface skin
cells, such as seen in dandruff), and signs of itchiness (known as “pruritus”) with inflammation of the sebaceous glands, the glands that
produce oils in the hair coat (condition known as “ sebaceous adenitis”)
 Cancer or cancer-related hair loss
 Unknown cause (so called “ idiopathic disease”)
 Inherited hair loss
RISK FACTORS
 Felineleukemia virus (FeLV) infection and feline immunodeficiency virus (FIV) infection—for demodectic mange (demodicosis)
 TREATMENT
HEALTH CARE
 T reatment is limited for many of the disorders that cause hair loss (alopecia)
 Behavioral modification or use of a “T -shirt” on the cat may help prevent excessive self-grooming
 Shampoo and treatment applied directly to the skin may help secondary problems, such as increased thickness of the outer, keratinized
layer of the skin (known as “hyperkeratosis”) in sebaceous adenitis (condition with hair loss, reddened skin, scales and inflammation of
the oil-secreting sebaceous glands); dried discharge on the surface of the skin lesion (known as a “crust”) in demodectic mange
(demodicosis); secondary bacterial infections; and malodor for greasy conditions
DIET
 Removal of an offending dietary item may alleviate signs of food allergy (such as hair loss, scratching at skin)
SURGERY
 Biopsy of a tumor or the skin may be indicated in the diagnostic work-up for some causes of hair loss (alopecia)
 Excessive levels of steroids produced by the adrenal glands (hyperadrenocorticism or Cushing’s disease)—surgical removal of the
adrenal gland
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 Surgical removal of skin cancer or tumors
 MEDICATIONS
Medications presented in this section are intended to provide general information about possible treatment. T he treatment for a
particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive. 
 Obsessive-compulsive disorder—amitriptyline
 Hormonal hair loss (alopecia) in males—testosterone supplementation
 Skin allergy (allergic dermatitis)—antihistamines, steroids, “allergy shots” (known as “hyposensitization vaccine”)
 Excessive levels of thyroid hormone (hyperthyroidism)—medications given by mouth, such as methimazole (T apazole®), or
radioactive iodine therapy
 Diabetes mellitus (“ sugar diabetes”)—regulation of glucose levels with insulin
 Excessive levels of steroids produced by the adrenal glands (hyperadrenocorticism or Cushing’s disease)—surgery; no known effective
medical therapy
 Cancer-related hair loss (alopecia)—no therapy for many types of cancer-related hair loss; disease often fatal
 Epidermotropic lymphoma (type of cancer in the skin characterized by the presence of abnormal lymphocytes; a lymphocyte is a
type of white-blood cell, formed in lymphatic tissue throughout the body)—retinoids (isotretinoin), steroids, interferon, cyclosporine,
lomustine
 Sebaceous adenitis (condition with hair loss, reddened skin, scales and inflammation of the oil-secreting sebaceous glands)—retinoids,
steroids, cyclosporine
 Squamous cell carcinoma (type of skin cancer)—retinoids (applied to skin directly [topical] and administered by mouth [oral]), topical
imiquimod cream
 Alopecia areata (specific condition involving multiple patches of hair loss)—no therapy; possibly counterirritants
 Demodectic mange (demodicosis)—lime sulfur dips at weekly intervals for 4 to 6 dips; Mitaban® and ivermectin have been tried with
variable success
 Ringworm (dermatophytosis)—griseofulvin, ketoconazole, itraconazole (best choice), lufenuron
 FOLLOW-UP CARE
PATIENT MONITORING
 Depends on specific diagnosis
PREVENTIONS AND AVOIDANCE
 Depend on specific diagnosis
POSSIBLE COMPLICATIONS
 Depend on specific diagnosis
EXPECTED COURSE AND PROGNOSIS
 Depend on specific diagnosis
 KEY POINTS
 “Alopecia” is the medical term for hair loss
 Hair loss is a common problem in cats
 Pattern of hair loss varies—may be localized or widespread
 Skin itself may appear normal or may be abnormal
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HAIR LOSS (ALOPECIA) IN DOGS
 BASICS
OVERVIEW
 “Alopecia” is the medical term for hair loss
 Hair loss is a common disorder in dogs
 Characterized by a complete or partial lack of hair in areas where it is present normally
 Pattern of hair loss—varied or symmetrical
 May be the primary problem or a secondary phenomenon
SIGNALMENT/DESCRIPTION of ANIMAL
Species
 Dogs
SIGNS/OBSERVED CHANGES in the ANIMAL
 May be sudden (acute) in onset or slowly progressive
 Multiple patches of circular hair loss (alopecia)—most frequently associated with inflammation of the hair follicles (known as “
folliculitis”) from bacterial infection and/or demodectic mange (known as “demodicosis”)
 Large, more widespread areas of hair loss (alopecia)—may indicate abnormal development of the hair follicles or hair (known as “
follicular dysplasia”) or a more generalized disease
 T he pattern and degree of hair loss are important for establishing a diagnosis
CAUSES
M ultiple Areas (M ultifocal) of Hair Loss
 Localized demodectic mange (demodicosis)—partial to complete hair loss (alopecia) with reddening of the skin (known as “erythema”)
and mild scaling; lesions may become inflamed and may have dried discharge on the surface (dried discharge known as “crusts”)
 Ringworm (known as “dermatophytosis”)—“ringworm” is a fungal infection on the surface of the skin characterized by partial to
complete hair loss (alopecia) with scaling; with or without reddening of the skin (erythema); not always “ ring-like” in appearance
 Inflammation of the hair follicles due to Staphylococcus bacterial infection (known as “ staphylococcal folliculitis”)—circular patterns
of hair loss (alopecia) bordered by scales (accumulations of surface skin cells, such as seen in dandruff) or surface peeling of the skin (the
pattern is known as an “epidermal collarette”), reddening of the skin (erythema), dried discharge on the surface of the skin lesion
(crust), and darkened areas of skin (known as “hyperpigmented macules”)
 Injection reactions—inflammation with hair loss (alopecia) and/or thinning of the skin (known as “cutaneous atrophy”) from scarring
 Rabies-vaccine inflammation of the blood vessels (known as “vasculitis”)—patch of hair loss (alopecia) at the location where the
rabies vaccine was administered is observed 2 to 3 months following vaccination
 Localized scleroderma (condition in which normal skin is replaced by scar tissue for some unknown cause)—well-demarcated, shiny,
smooth skin with hair loss (alopecia); lesion is a thickened, raised, flat-topped area that is slightly higher than the normal skin (known
as a “plaque”)
 Specific condition characterized by multiple patches of hair loss (known as “alopecia areata”)—noninflammatory areas of complete
hair loss (alopecia)
 Condition characterized by multiple areas of hair loss with reddened skin, scales, and signs of itchiness (known as “pruritus”) with
inflammation of the sebaceous glands, the glands that produce oils in the hair coat (condition known as “ sebaceous adenitis”) seen in
short-coated breeds—ring-like areas of hair loss (alopecia) and scaling
Symmetrical Hair Loss
 Excessive levels of steroids produced by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s disease”)—hair loss along
the sides of the body (known as “ truncal alopecia”) associated with thin skin, plugs of keratin and oil in the follicles of the skin (known
as “comedones”), and skin infection characterized by the presence of pus (known as “pyoderma”)
 Inadequate levels of thyroid hormone (known as “hypothyroidism”)—hair loss (alopecia) is an uncommon presentation
 Growth hormone–responsive skin disorder (known as “growth hormone-responsive dermatosis”)—symmetrical hair loss along the
sides of the body (truncal alopecia) associated with darkened skin (known as “hyperpigmentation”); hair loss often starts along the collar
area of the neck
 Excessive levels of estrogen (known as “hyperestrogenism”) in females—symmetrical hair loss (alopecia) of the flanks and skin
between the external genitalia and the anus (perineal skin) and between therear legs (inguinal skin) with enlarged external genitalia
(vulva) and mammary glands
 Inadequate secretion of female hormones (known as “hypogonadism”) in intact females—hair loss of the skin between the external
genitalia and the anus (perineal skin), flank, and hair loss along the sides of the body (truncal alopecia)
 T estosterone-responsive skin disorder (known as “ testosterone-responsive dermatosis”) in castrated males—slowly progressive hair
loss along the sides of the body (truncal alopecia)
 Male feminization from Sertoli cell tumor (a type of tumor in the testicles)—hair loss (alopecia) of the skin between the external
genitalia and the anus (perineal skin) and genital region with excessive development of the male mammary glands (known as “
gynecomastia”)
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 Castration-responsive skin disorder (known as “castration-responsive dermatosis”)—hair loss (alopecia) in the collar area, rump, skin
between the external genitalia and the anus (perineal skin), and flanks
 Estrogen-responsive skin disorder (known as “estrogen-responsive dermatosis”) in spayed female dogs—hair loss (alopecia) of the skin
between the external genitalia and the anus (perineal skin) and genital regions
 Seasonal flank hair loss (alopecia)—creeping hair loss involving the flanks with darkened skin (hyperpigmentation)
Patchy to Generalized (Diffuse) Hair Loss
 Demodectic mange (demodicosis)—often associated with reddening of the skin (erythema), inflammation of the hair follicles
(folliculitis), and darkened skin (hyperpigmentation)
 Bacterial infection/inflammation of the hair follicles (folliculitis)—multiple areas of circular hair loss (alopecia) that may join to form
large areas of hair loss; circular patterns of hair loss bordered by scales (accumulations of surface skin cells, such as seen in dandruff) or
surface peeling of the skin (epidermal collarette)
 Ringworm (dermatophytosis)—often accompanied by scales (accumulations of surface skin cells, such as seen in dandruff)
 Sebaceous adenitis (condition characterized by multiple areas of hair loss with reddened skin, scales, and signs of itchiness [known as “
pruritus”] with inflammation of the sebaceous glands, the glands that produce oils in the hair coat)—hair loss (alopecia) with thick,
adherent scales; predominantly along the back line of the body, including the head
 Color-mutant hair loss (alopecia)—thinning of the hair coat with secondary inflammation of the hair follicles (folliculitis) in some
blue or fawn dogs
 Abnormal development of the hair follicles or hair (known as “ follicular dysplasia”)—slowly progressive hair loss (alopecia)
 Hair loss during stages of the hair growth cycle—sudden (acute) onset of hair loss (alopecia)
 Inadequate levels of thyroid hormone (hypothyroidism)—generalized (diffuse) thinning of the hair coat
 Excessive levels of steroids produced by the adrenal glands (hyperadrenocorticism or Cushing’s disease)—hair loss along the sides of
the body (truncal alopecia) with thin skin and formation of plugs of keratin and oil in the follicles of the skin (comedones)
 Epidermotropic lymphoma (type of cancer in the skin characterized by the presence of abnormal lymphocytes; a lymphocyte is a
type of white-blood cell, formed in lymphatic tissue throughout the body)—widespread, generalized hair loss along the sides of the body
(truncal alopecia) with scales (accumulations of surface skin cells, such as seen in dandruff) and reddening of the skin (erythema); later
small, solid masses (known as “nodules”) and thickened, raised, flat-topped areas that are slightly higher than the normal skin (known as
“plaques”) may form
 Pemphigus foliaceus (a disease in which the body’s immune system attacks its own skin)—hair loss (alopecia) associated with the
formation of scales (accumulations of surface skin cells, such as seen in dandruff) and dried discharge on the skin lesions (crusts)
 Keratinization disorders (disorders in which the surface of the skin is abnormal)—hair loss (alopecia) associated with excessive scales
(accumulations of surface skin cells, such as seen in dandruff) and greasy surface texture
Specific Locations of Hair Loss
 Hair loss involving the ears (known as “pinnal alopecia”)—miniaturization of hairs and progressive hair loss (alopecia)
 T raction hair loss (alopecia)—hair loss on the top and sides of the head secondary to having barrettes or rubber bands applied to the
hair
 Postclipping hair loss (alopecia)—failure to regrow hair after clipping
 Melanoderma (hair loss [alopecia] of Yorkshire terriers)—symmetrical hair loss with darkened skin of the ears, bridge of the nose, tail,
and feet
 Seasonal flank hair loss (alopecia)—creeping hair loss of the flanks, that may connect over the back
 Abnormal development of the hair follicles or hair involving black hairs only (known as “black hair follicular dysplasia”)—hair loss
(alopecia) involving only the black-haired areas of the body
 Inherited inflammatory disorder that affects the skin and muscles of unknown cause (condition known as “ idiopathic familial canine
dermatomyositis”) in collies and Shetland sheepdogs—hair loss (alopecia) of the face, tip of ears, tail, and digits; associated with scales
(accumulations of surface skin cells, such as seen in dandruff) and dried discharge on the skin lesions (crusts), and scarring
 TREATMENT
HEALTH CARE
 Demodectic mange (demodicosis)—amitraz, ivermectin, Interceptor®
 Ringworm (dermatophytosis)—griseofulvin, ketoconazole, itraconazole, lime sulfur dips, lufenuron
 Inflammation of hair follicles due to Staphylococcus bacterial infection (staphylococcal folliculitis)—shampoo and antibiotic therapy
 Sebaceous adenitis (condition with hair loss, reddened skin, scales and inflammation of the oil-secreting sebaceous glands)—keratolytic
shampoo, essential fatty acid supplementation, retinoids
 Keratinization disorders (disorders in which the surface of the skin is abnormal)—shampoos, retinoids, vitamin D
SURGERY
 Biopsy of a tumor or the skin may be indicated in the diagnostic work-up for some causes of hair loss (alopecia)
 Hormonal disorders causing hair loss (treatment determined by specific hormonal disorder)—surgery may include removal of ovaries
and uterus (known as “ovariohysterectomy” or “ spay”), removal of testicles (known as “castration”), or removal of adrenal glands
(known as “adrenalectomy”)
 Surgical removal of skin cancer or tumors
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 MEDICATIONS
 Vary with specific cause
 Excessive levels of steroids produced by the adrenal glands (hyperadrenocorticism or Cushing’s disease)—Lysodren®
 FOLLOW-UP CARE
PATIENT MONITORING
 Varies with specific cause
PREVENTIONS AND AVOIDANCE
 Vary with specific cause
POSSIBLE COMPLICATIONS
 Vary with specific cause
EXPECTED COURSE AND PROGNOSIS
 Vary with specific cause
 KEY POINTS
 “Alopecia” is the medical term for hair loss
 Hair loss is a common problem in dogs
 Pattern of hair loss varies—may be localized or widespread
 Skin itself may appear normal or may be abnormal
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AMYLOIDOSIS
(DISORDER CAUSED BY DEPOSITION OF PROTEINS [AMYLOID] IN VARIOUS
ORGANS)
 BASICS
OVERVIEW
 A group of conditions of differing cause in which insoluble proteins (amyloid) are deposited outside the cells in various tissues and
organs, compromising the normal function of the tissues or organs
GENETICS
 No genetic involvement is established clearly; occurs in certain lines or families (known as “ familial amyloidosis”) in the following dog
breeds: Chinese shar pei, English foxhound, and beagle, and in the following cat breeds: Abyssinian, Oriental shorthair, and Siamese