POSSIBLE HEALTH PROBLEMS THAT HAVE BEEN FOUND IN THE MINIATURE PINSCHER The Tell-Tale Heart Murmur Causes and controls of cardiac disease by Kim Campbell Thornton © First published in "YOUR DOG", Tafts University School of Veterinary Medicine., Aug 2000. Reprinted w/ permission of the Author. Lup-dup, lup-dup, lup-dup. That's the sound of a normal heartbeat. As most of us learned in school, the heart operates with a pumplike action. Divided into four chambers-right atrium, right ventricle, left atrium, left ventricle-the heart has four valves that work to keep blood flowing in one direction. The valves open and close, letting blood in and then pumping it out. That lup-dup sound is created from the movement of the valves and the flowing of the blood. But what happens when valves become diseased or worn? Often, they fail to close completely with each heartbeat, resulting in a backwash of blood. The effect is an abnormal sound called a heart murmur. The sound a murmur makes depends on when it occurs in the cardiac cycle. A murmur that occurs when the ventricles are beating is called a systolic murmur. A murmur that occurs when the ventricles are relaxed-a period called cardiac diastole-is called a diastolic murmur. Instead of going lup-dup, lup-dup, the heart with a systolic murmur goes lup-shh-dup; a heart with a diastolic murmur makes the sound lup-dup-shh. LISTENING TO LEARN Murmurs are graded in severity from 1 to 6, with 1 being the softest murmur that can be heard and 6 being loud enough that it's evident before the stethoscope even touches the chest. Murmurs graded at 4 to 6 can often be felt if the hand is placed at the right spot on the chest. Most murmurs are diagnosed by auscultation, which simply means that the veterinarian listens to the heart with a stethoscope. Although auscultation can indicate the presence of a murmur, further tests are needed to determine its cause and severity. Your veterinarian is likely to refer you to a veterinary cardiologist for these tests. Depending on the breed, age, and predispositions of your dog, the cardiologist will want to take thoracic radiographs (chest X rays), if the referring veterinarian hasn't already taken them, and run an electrocardiogram and an echocardiogram (ultrasound). The radiography indicate overall heart size and enable the cardiologist to see the pulmonary vessels in the lung. This allows him to judge the degree of normalcy or abnormalcy resulting from the heart disease. An electrocardiogram shows the heart's rate and rhythm and is useful if abnormal rhythms are detected through auscultation. An echocardiogram provides a precise measure of the thickness of the various chamber walls of the heart and a look at each of the cardiac valves. This test allows the cardiologist to determine the state of the valves and to calculate overall cardiac performance, which is helpful in deciding whether therapy is necessary. Follow-up echocardiograms tell the veterinarian whether or not the therapy is working. The cardiologist may also check your dog's kidney function. "Renal disease is the most frequent cause of high blood pressure in dogs and cats," says James Ross, DVM, professor of cardiology at Tufts University School of Veterinary Medicine. "The presence of renal disease adds a greater workload onto the heart and can make some cardiac conditions much worse much quicker unless the hypertension is brought under control. "So it's often advisable to do some screening of blood for buildup of waste products, take a look at some urine, and make sure there's nothing going on there-and maybe check some enzymes that are associated with liver disease and congestion that sometimes develops as the heart falls." For more info, please check out: http://www.k9addisons.com/heart.shtml DENTAL HYGIENE Oral hygiene is as important to dogs as it is to humans. Statistical studies indicate 80 percent of all dogs show signs of dental disease by the age of 3. Most frequently, the problems begin with tartar buildup, which in turn can lead to gum infection, bone infection and tumors. Left untreated, such dental problems can lead to serious diseases of the heart, lung and kidneys. Brushing a dog's teeth can be a chore, and many owners fail to learn the process or give up the practice after a few unsuccessful attempts. They choose instead to set an annual appointment with the vet who performs an examination, cleaning, polishing and necessary treatment. Unfortunately, annual examinations aren't always enough. Puppies and aging dogs should be examined more frequently to ensure that they retain healthy gums and teeth. A puppy's first set of teeth will fall out between 4 and 6 months of age. Quite often in the Min Pins, the upper and/or lower 'canines' will be retained longer than all the rest of his teeth. Should this happen, it may be necessary to have a dentist extract the baby canines in order to allow the adult canines to grow in properly. If they are NOT extracted, it may cause a problem in that the lower adult teeth are pushed inward toward the roof of the mouth. If left untouched, these teeth can only grow into the palette of the dog's mouth. It will also cause 'crowding' with in the mouth. As a pet owner, you can recognize the warning signs and treat the problem early. The typical bad oral odor that may be accompanied by drooling is a warning. Your pet may also show discomfort biting dried food or his lower jaw may quiver. If you examine the mouth, you may find red, inflamed areas around the gums or in the hard palate area or near the tongue. Any unusual swelling or lumps in the mouth or on the lips can also be indications of progressive dental problems or oral cancer. Any of these indications should be cause to contact your veterinarian. An early response to dental problems is vital.  If you wait too long, there may be serious consequences. Take your pet to the vet, and if he or she is not trained in advanced veterinary dental techniques, ask for a referral. The toxins from dental maladies can get into the bloodstream to infect major organs such as the heart, liver and kidneys and in turn adversely affect the health of the whole animal. SKIN DISORDERS 1) DEMODEX MANGE 2) HAIR LOSS 3) SKIN INFECTION 1) Demodex is the result of a compromised/weakened immune system, which allows the mites to manifest themselves. Many breeders use Ivermectin very successfully, but it is very easy to overdose any dog, especially a min pin puppy, and Ivermectin can do harm to the kidney's and liver if the dosage is not correct. Some dogs have even been known to seizure from it. It is also not labeled for use as a cure for Demodex. Demodectic mange in a puppy is a lot different than demodectic mange in an older adult dog. It is found that using antibiotics in dogs that itch when they have demodectic mange is very helpful in relieving this syndrome. The demodectic mange itself is not usually very itchy so most itchiness comes from secondary infections. Fungal infections can itch, so that is also a possible cause. Most dogs with immune system disorders that allow demodecosis to occur develop it at a younger age, usually less than one year of age. In dogs in which demodecosis occurs later, there is often something causing significant compromise of the immune system. Cushing's disease, liver disease, diabetes, high doses of prednisone or other cortisones, cancer and other strong suppressors of immune function can lead to adult onset demodecosis. It is worthwhile to put a good effort into eliminating as many of these causes as is possible through lab work and physical exam. Demodex mites can be spread from one dog to another but it takes an immune system deficiency for the mites to cause problems, so demodecosis is not considered to be a contagious disease. If there is a disease or environmental problem stressing both dogs at once it is conceivable that they might both develop demodecosis but this is really unlikely. 2) HAIR LOSS that occurs on the top of the dog and forms a triangle of hair loss, with the widest part of the triangle at the base of the tail and the point somewhere between the base of the tail and the shoulder blades, is usually due to flea bite or mosquito bite hypersensitivity. There are also times when the hair loss occurs due to hormonal disease. These disorders are more common in older dogs, usually six years of age or older. Hypothyroidism is the most common hormonal disorder leading to skin problems so it makes sense to check for that first. The next most common problem is hyperadrenocorticism (Cushing's disease, HAC). 3) SKIN INFECTION - There are several conditions which can lead to skin infections. Allergies can lead to secondary bacterial infections or fungal infections. Immune deficiency problems can lead to secondary bacterial infections. Long term control of allergies is best accomplished with hyposensitization (allergy shots). If the allergy is food related it may be possible to do food trials and find the problem. Then eliminating that food ingredient from the diet will control the problem. Also, undiscovered parasitic infections such as sarcoptic mange may lead to skin infection. Skin crusting and ulcerative skin lesions (especially on the face, legs and feet) that occur due to underlying liver disease, pancreatic tumors and possibly diabetes is known as necrolytic dermatitis, hepatocutaneous syndrome and necrolytic migratory erythema. The prognosis for this condition is usually poor because the underlying liver and pancreas disorders are often difficult to treat and that makes resolving the skin disease difficult as well. GLAUCOMA A LEADING CAUSE OF BLINDNESS IN DOGS "Glaucoma is a painful, often blinding and more common than is essentially known eye disorder" says Dr. Kerry Ketring, a Cincinnati-based veterinary opthamologist and public relations chairperson of the American College of  Veterinary Opthamologist. The eye  maintains its turgid, spherical shape because natural processes within it produce a fluid called 'aqueous' which nourishes ocular tissues, absorbs waste products and then drains off, creating a relatively constant innocular pressure (IOP). When metabolic and mechanical processes interfere with its drainage, that pressure can rise, causing extreme pain, damaging the retina and optic nerve, and causing blindness. Signs of glaucoma include sudden blindness, a cloudy cornea which obscures the iris, dilated and non-responsive pupils, inflammation of the sclera with large elevated vessels, and frequently, a visibly enlarged eye. Animals suffering from glaucoma will likely squint or hold the eye closed, and behave lethargically because of the discomfort associated with the disorder. Animals suffer from two broad categories of glaucoma, primary and secondary, and successful management depends upon the proper differentiation of these two categories. Primary glaucoma, the most common, is an inherited disorder which occurs when the 'drainage angle' becomes clogged and fails to drain the eye properly. Primary glaucoma often affects both eyes, but usually not at the same time or to the same extent. Using special examination techniques, veterinary opthamologists can further classify primary glaucoma into narrow, closed and open-angle glaucoma. Secondary glaucoma is an increase in pressure which occurs as a result of another abnormality of the eye such as a tumor, severe trauma, an uncontrolled inflammation, or a shifting of the lens that blocks the outflow of aqueous. "Differentiating between primary and secondary glaucoma is critically important since the treatments for each are almost opposite," says Dr. Ketring. "A mistake at this point can result in irreversible blindness." Most vets diagnose glaucoma on the basis of observing the 'cardinal signs', but since many of these signs are also associated with other eye disorders, it is frequently mis-diagnosed or missed. The only way to accurately diagnose glaucoma is by demonstrating an increase in intraocular pressure. Veterinary opthamologists measure that pressure with an instrument called an electronic tonometer. When a dog's pressure exceeds the normal range of 15-25 mm of mercury, it is time to act - sustained pressures of 60 or greater for a day or longer can result in irreversible blindness. With the exception of some procedures, glaucoma is treated the same in animals as in humans. Treatments are formulated based on the animals prognosis for vision and the proper classification of the glaucoma. And, Dr. Ketring says, treatments always seek to reduce the extreme pain associated with the disorder. "The success of medical and surgical treatments depends upon when the disorder is diagnosed. If you diagnose it early enough, treatment can be very successful. If you catch it late, the chances for success are reduced." Medical treatments include the administrations of oral drugs intended to reduce the amount of aqueous produced by the eye; and in some cases, may reduce the production of aqueous. An animal with glaucoma must take medication for the rest of its life. Surgical treatments are also useful. Veterinary opthamologists may perform cyclocryosurgery, which freezes the aqueous-producing tissues; filtering procedures, which improve fluid drainage; or in cases of secondary glaucoma, correct the displaced lens or other abnormality causing the drainage problem. A new technique which involves implanting a device to aid in the drainage of aqueous is still in the developmental stages, according to Dr. Ketring. Because the disease is frequently undetected, many animals are often in advanced stages by the time they are referred to a board certified veterinary opthamologist. In these cases removing the irreversibly blind eye to eliminate the pain and carefully evaluating the other eye for signs of glaucoma may be the best treatment. Many vet ophthalmologists elect to implant intraocular prostheses. While these 'artificial eyes' do not restore vision, they are popular with clients for cosmetic reasons. Dogs adapt more easily to blindness than people, according to Dr. Ketring; eliminating the pain often creates a happier, more lively animal. People don't realize that their dog has been suffering from chronic pain. Many can't believe how active the dog becomes after the surgery. New techniques for treating glaucoma in people may eventually prove useful in dogs. But for now, Ketring says, early detection and prompt referral to a board-certified veterinary ophthalmologist is the best response to glaucoma. LEGG-CALVE-PERTHES HISTORY - Legg, Calve, and Perthes, in 1910, simultaneously and independently described a disease of the hip joint that affected young children and was characterized radiographically by flattening of the femoral head. They speculated that the lesion was a non-inflammatory, aseptic necrosis, possibly caused by trauma. The disease soon became known as Legg-Calve-Perthes disease (LCPD). Earlier, Waldenstrom mistakenly thought the disease was a tuberculous lesion. He used the term 'coxa plana' to describe the flattened femoral head. Other common synonyms are  aseptic necrosis, -avascular necrosis,- and osteochondrosis of the femoral head. LCP disease and coxa plana are the terms most commonly used today. Schnelle and Moltzen-Nielsen are given credit for describing the first cases of LCPD in dogs having described 12 cases, all in Wirehaired Fox Terriers. Since the early reports, the disease has been in dogs of miniature and toy stature found between three and ten months of age. Some larger breeds are now known to have it but it is more rare Clinical Findings Affected dogs are presented during the first year of life, usually between 5 and 8 months of age. Lameness in one rear leg, with an insidious onset over several weeks, is the usual history. In some dogs, however, the onset may be sudden. Six to eight weeks may pass before lameness progresses from intermittent limping to continuous carrying of the leg. Pain is easily elicited in the hip joint when the leg is abducted. Mild to severe muscle atrophy, (as in smaller muscle) shortening of the affected leg, and restricted joint movement, especially on abduction of the leg, are common physical findings. The diagnosis must be confirmed by x-ray of the joint. The age range for the disability was 3 to 13 months with a peak at about seven months from the onset of clinical signs. All the dogs tested were of small breeds  usually less than 20 pounds with the following being over represented (for the clinic at the time of testing)  Miniature Pinschers, Poodles, Lakeland Terriers, West Highland Terriers, and Cairn Terriers.  The right and left legs appeared to be involved equally often and in only 12% to 16% of the dogs were both hips simultaneously affected. Pathophysiology A compromise of the blood supply to the femoral capital epiphysis leads to the necrotic changes that occur with LCPD. Infection, trauma, metabolic and hormonal imbalances, and vascular abnormalities have all been suggested as possible causes for the ischemia. A genetic predisposition must also be considered a factor in the pathogenesis because of the exclusive occurrence in miniature and toy breeds. ORTHOPEDIC FOUNDATION FOR ANIMALS writes: Legg-Calve-Perthes Disease (LCP) is a disorder of hip joint conformation occurring in both humans and dogs. In dogs, it is most often seen in the miniature and toy breeds between the ages of 4 months to a year. LCP results when the blood supply to the femoral head is interrupted resulting in avascular necrosis, or the death of the bone cells. Followed by a period of revascularization, the femoral head is subject to remodeling and/or collapse creating an irregular fit in the acetabulum, or socket. This process of bone cells dying and fracturing followed by new bone growth and remodeling of the femoral head and neck, can lead to stiffness and pain. LCP is believed to be an inherited disease, although the mode of inheritance is not known. Because there is a genetic component, it is recommended that dogs affected with LCP not be used in breeding programs. Breeds at risk for Legg-Calve-Perthes: Affenpinscher   Australian Terrier      Bichon Frise Border Terrier        Boston Terrier    Cairn Terrier Chihuahua   Cocker Spaniel         Dachshund Fox Terrier      Jack Russell Terrier   Lakeland Terrier Manchester Terrier  Miniature Schnauzer   Miniature Pinscher Pomeranian   Pekingese    Poodle   Pug             Schipperke    Scottish Terrier Shetland Sheepdog  Silky Terrier    Welsh Terrier West Highland White Terrier       Yorkshire Terrier Legg-Calve-Perthes Treatment Options The degree of clinical severity of LCP varies, and treatment can vary accordingly. In mild cases, the dog may occasionally resist bearing weight on the affected leg or may exhibit periodic lameness. In these cases, limited activity and treatment with non-steroidal anti-inflammatory drugs (NSAIDs) may be sufficient. In more severe cases as the pain and discomfort experienced increase, the dog may become totally lame and avoid all use of the affected leg. Furthermore, the leg muscles may begin to atrophy after extended periods of non-use. In severe cases, treatment often resorts to excision of the femoral head and neck. By removing the femoral head and neck, the bone on bone contact that is the source of the pain and discomfort is eliminated. Later, through the healing process and with therapy, a new false joint is formed by muscle and tissue, and the dog may have a complete recovery. MORE INFO AT: http://www.offa.org/lcptreat.html General Patellar Luxation What is Patellar Luxation? The patella, or kneecap, is part of the stifle joint (knee). In patellar luxation, the kneecap luxates, or pops out of place, either in a medial or lateral position. Bilateral involvement is most common, but unilateral is not uncommon. Animals can be affected by the time they are 8 weeks of age. The most notable finding is a knock-knee (genu valgum) stance. The patella is usually reducible, and laxity of the medial collateral ligament may be evident. The medial retinacular tissues of the stifle joint are often thickened, and the foot can be seen to twist laterally as weight is placed on the limb. -------------------------------------------------------------------------------- Patellar Luxation Categories Patellar luxations fall into several categories: Medial luxation; toy, miniature, and large breeds Lateral luxation; toy and miniature breeds Lateral luxation; large and giant breeds. Luxation resulting from trauma; various breeds, of no importance to the certification process. Numbers 1, 2 and 3 are either known to be heritable or strongly suspected. -------------------------------------------------------------------------------- Medial Luxation in Toy, Miniature, and Large Breeds Although the luxation may not be present at birth, the anatomical deformities that cause these luxations are present at that time and are responsible for subsequent recurrent patellar luxation. Patellar luxation should be considered an inherited disease. Clinical Signs Three classes of patients are identifiable: Neonates and older puppies often show clinical signs of abnormal hind-leg carriage and function from the time they start walking; these present grades 3 and 4 generally. Young to mature animals with grade 2 to 3 luxations usually have exhibited abnormal or intermittently abnormal gaits all their lives but are presented when the problem symptomatically worsens. Older animals with grade 1 and 2 luxations may exhibit sudden signs of lameness because of further breakdown of soft tissues as result of minor trauma or because of worsening of degenerative joint disease pain. Signs vary dramatically with the degree of luxation. In grades 1 and 2, lameness is evident only when the patella is in the luxated position. The leg is carried with the stifle joint flexed but may be touched to the ground every third or fourth step at fast gaits. Grade 3 and 4 animals exhibit a crouching, bowlegged stance (genu varum) with the feet turned inward and with most of the weight transferred to the front legs. Permanent luxation renders the quadriceps ineffective in extending the stifle. Extension of the stifle will allow reduction of the luxation in grades 1 and 2. Pain is present in some cases, especially when chondromalacia of the patella and femoral condyle is present. Most animals; however, seem to show little irritation upon palpation. -------------------------------------------------------------------------------- Lateral Luxation in Toy and Miniature Breeds Lateral luxation in small breeds is most often seen late in the animal's life, from 5 to 8 years of age. The heritability is unknown. Skeletal abnormalities are relatively minor in this syndrome, which seems to represent a breakdown in soft tissue in response to, as yet, obscure skeletal derangement. Thus, most lateral luxations are grades 1 and 2, and the bony changes are similar, but opposite, to those described for medial luxation. The dog has more functional disability with lateral luxation than with medial luxation. Clinical Signs In mature animals, signs may develop rapidly and may be associated with minor trauma or strenuous activity. A knock-knee or genu valgum stance, sometimes described as seal-like, is characteristic. Sudden bilateral luxation may render the animal unable to stand and so simulate neurological disease. Physical examination is as described for medial luxation. -------------------------------------------------------------------------------- Lateral Luxation in Large and Giant Breeds Also called genu valgum, this condition is usually seen in the large and giant breeds. A genetic pattern has been noted, with Great Danes, St. Bernards, and Irish Wolfhounds being the most commonly affected. Components of hip dysplasia, such as coxa valga (increased angle of inclination of the femoral neck) and increased anteversion of the femoral neck, are related to lateral patellar luxation. These deformities cause internal rotation of the femur with lateral torsion and valgus deformity of the distal femur, which displaces the quadriceps mechanism and patella laterally. Clinical Signs Bilateral involvement is most common. Animals appear to be affected by the time they are 5 to 6 months of age. The most notable finding is a knock-knee (genu valgum) stance. The patella is usually reducible, and laxity of the medial collateral ligament may be evident. The medial retinacular tissues of the stifle joint are often thickened, and the foot can often be seen to twist laterally as weight is placed on the limb. Diagnosing Patellar Luxation Examination and Certification The dog is examined awake (chemical restraint is not recommended) and classified by the attending veterinarian according to the application and general information instructions. The veterinarian then completes the application form indicating the the results of the dog's patella evaluation. The application and fee can then be mailed to OFA. The attending veterinarian and owner is encouraged to submit all evaluations, whether normal or abnormal, for the purpose of completeness of data. There is no OFA fee for entering an abnormal evaluation of the patella in the data bank. A breed database number will be issued to all dogs found to be normal at 12 months of age or older. The breed database number will contain the age at evaluation and it is recommended that dogs be periodically reexamined as some luxations will not be evident until later in life. Information obtained with permission from OFA. http://www.offa.org/index.html PROGRESSIVE  RETINAL  ATROPHY Commonly referred to as P.R.A., progressive retinal atrophy is an inherited form of blindness which, in the dog, occurs in two forms, generalised and central. By way of explanation, the retina is the light sensitive membrane at the back of the eyeball. Atrophy infers degeneration. Hence P.R.A. leads to gradual loss of retinal sensitivity, impaired function and progressive loss of vision. Early in the disease, affected dogs are nightblind, lacking the ability to adjust their vision to dim light; later their daytime vision also fails. As their vision deteriorates, affected dogs will adapt to their handicap as long as their environment remains constant, and they are not faced with situations requiring excellent vision. At the same time the pupils of their eyes become increasingly dilated, causing a noticeable "shine" to their eyes; and the lens of their eyes may become cloudy, or opaque, resulting in a cataract. No effective method of treatment exists. However, curtailment and/or eventual elimination of the disease is possible by careful selection of blood lines used for breeding.