We had several of our breeding stock evaluated for eye diseases at the Red Bank Veterinary Hospital on earlier this month. This final round of exams will complete their health testing needed for awarding of a CHIC number by OFA. We brought Kian (Ch Rysan's Road to Deythur), Tigg (Ch Ky-Bryn's As Requested for Rysan) and Eliza (Ch Limberlost My Fair Lady). The dogs were examined by Dr. Michael Ringle, a well known and respected ACVO specialist who I have known professionally for more than 20 years. He examined all three dogs for functional eye conditions (entropian, distichiasis, PRA, cataracts, PPM, etc.) and also performed gonioscopy to evaluate the iridocorneal angle in all three dogs. In addition, we had a discussion regarding the value of gonioscopy to dog owners and breeders, its reliability in diagnosis of narrowed angles, the professional ability and reliability of vets performing the exam, and lastly, how the gonioscopy exam information could be used to improve the eye health of the breed.

In preparation for the gonioscopy exam, anesthetic drops were administered, and the exam has a thick contact lens placed on the cornea of each eye. The procedure was extremely well tolerated by all our dogs, with no objections to placement of the lens or examination by the vet with a strong light. The vet was using the lens to visualize the iridocorneal angle (see larger picture). This is where the base of the iris attaches to the peripheral cornea and sclera. It is important to examine this part of the anatomy of the eye, because it is where fluid drains from the eye's anterior chamber. If the angle is so narrow that it prevents drainage of fluid from the anterior chamber of the eye, the dog could be at risk to develop glaucoma. 

Dr. Ringle classifies the status of the iridocorneal angle as being normal, slightly narrowed, moderately narrowed, or severely narrowed. His recommendation for treatment was for none for a normal angle, optional (i.e. at the owner's discretion) for dogs with a slightly narrowed angle, but strongly recommended use of eye drops to reduce intraocular pressure for dogs with moderately or severely narrowed angles. 

We discussed breeding recommendations with him based on particular findings, and he was reluctant to say that all dogs with a narrowed iridocorneal angle should automatically be excluded from breeding programs. His reason for this is that a) there is no good information on the prevalence of narrowed angles in our breed at this time and b) the incidence of glaucoma in Welshies is very low. Not enough breeders and owners are obtaining gonioscopic evaluations of their dogs and publishing this information, and it is entirely possible that there are significant numbers of dogs with narrowed angles being used in breeding programs even now. In fact, he mentioned that it was possible that some degree of narrowed angles may actually be the norm in the breed, since so few dogs are being examined for the status of the iridocorneal angle and there is no preventive breeding program in place except after the fact when glaucoma is identified in bloodlines.

We asked Dr. Ringle about how reliable the test was and how readily it could be performed by other ACVO-certified veterinarians. He was emphatic that all ACVO-certified vets are trained on performing this exam and they are equally competent in interpreting the findings of the exam. He essentially minimized any 'intra-operator' differences between vets in the performance of this test, and felt that was an excuse used to dismiss the value of the test results. Based on my reading of available information, the test itself has some limitations, but for first-level examination it certainly provides useful information. There are new imaging modalities available now should owners wish to pursue further studies, including High Resolution Ultrasound. More information about other imaging studies and the current state of breed specific research about glaucoma can be found in the article Glaucoma in the Bassett Hound.

The current OFA eye examination forms do not have a place to list the status of the iridocorneal angles or results of gonioscopy. I asked Dr. Ringle to use the COMMENTS section of the form to specify the status of the angle that he identified. I will check if this information shows up on the OFA website when the forms are submitted. 

Bottom line-folks, it's time to wake up and smell the coffee. There is a need to determine if the WSS gene pool has predominantly normal or narrowed iridocorneal angles. Perhaps we should recommend that gonioscopy become a standard for awarding a CHIC?  Remember, when instances of glaucoma are documented it can require huge modifications to a breeding program. But, with testing and evaluation of information, all breeders gain valuable information that can be used to make wise choices. The test itself is not costly or dangerous, and it increases the level of understanding of our dogs and their genetic predisposition to disease. I don't really see a difference between this test and the TGAA testing we all routinely perform.

So, what do you think-is it time to recommend that we add gonioscopy to the CHIC testing requirements? Or at least add it to the list of things we should check for routinely, the way thyroid testing has become ubiquitous? I look forward to your comments!

This AM I received my daily 'Dr. Becker newsletter' and there was an article that caught my eye because I hadn't heard of the topic before. The article discussed treatment with Extracorporeal Shockwave Therapy (ESWT) for conditions where the dog has pain or non-healing fractures. The treatment itself has been used with humans for over 25 years-it's the same as the lithotripsy procedure now routinely used for treating kidney stones. It is also used for treating painful plantar fasciitis and for promoting healing in bones that refuse to knit together. The same treatment is now being offered to horses, cats and dogs to treat a variety of conditions.

In dogs, ESWT has been used to relieve pain associated with osteoarthritis, degenerative joint disease, hip/elbow dysplasia, tendon and ligament injuries, even lick granulomas and non-healing tissue conditions and bone fractures. It is thought that the high-powered shock waves work within the dog's body to promote new blood vessel development, reduction of inflammation, and stimulation of collagen production. All these factors contribute to promoting accelerated healing and reducing pain in the affected areas.

I have seen conflicting information about the need for anesthesia prior to an ESWT procedure due to the noise and possible pain associated with treating an already painful injury. I could not always tell if the dogs in photos I found in association with articles about the treatment were anesthetized or sedated. Perhaps it depends upon the type of ESWT device used to generate the shock waves and where the device is placed and the injury that the animal is being treated. So, if you are interested in this procedure, that's an important question to ask, since the anesthesia/sedation certainly has its own expenses and risks.

As far as how often the treatment is given, it depends on what conditions are being treated and what the specific device manufacturer protocols recommend. For example:
Musculoskeletal conditions: every 2-3 weeks for 1-3 treatments until resolution
Wounds: once per week for a treatment, but more than three treatments may be needed if wound is large
Osteoarthritis management: every 1-1.5 weeks for up to 3 treatments, and then repeated at 6-12 months for treatment intervals since CHD is a chronic condition that is not cured by the ESWT.

There can be side effects of the ESWT procedure, including swelling, red or purple discoloration at the site of the shockwave focus, or short term aggravation of the condition. And pain relief may not be noticeable for up to four weeks after the last ESWT session. The literature indicated that side effects are short lived and usually gone within 1-2 days. Some dogs may require standard NSAID's like Rimadyl or Deramax temporarily.

I reviewed professional journal articles about ESWT available through ivis.org, and there have been presentations at veterinary proceedings in Europe since 2004 promoting the use of ESWT, first in equines, followed by canine research. A few canine discussions of veterinary uses for ESWT in both research articles and articles for veterinary professionals are listed below. They may not be available to you without registration at the ivis.org site or the Clinician Briefs site. Both are free registrations, though. If you cannot access these links, the Dr. Becker article is highlighted above and is an excellent overview of the treatment.
-Extracorporeal Shock Wave Therapy (ESWT) for Hip Osteoarthritis
-Effect of extracorporeal shock wave therapy on elbow osteoarthritis in dogs
-Mobility; a multi-disciplined approach (Iams Proceedings)
-August 2013 Clinicians Brief-Shockwave Therapy as a Treatment Option
-July 2012 Clinicians Brief-Nonsurgical Management of CHD
-September 2012 Clinicians Brief-Treating Patellar Ligament Desmitis

So, if your dog has pain due to an injury or a chronic condition that is not getting better, you may want to discuss the use of ESWT with your veterinarian. If your vet practice is not currently authorized to perform the treatment, they should be able to refer you to a veterinary orthopedic specialist who has the training and equipment to provide the treatments your dog needs.

If you and your dog have undergone ESWT, leave a comment and share your experiences with us! 


A future topic will review very new stem cell therapy for canines for treatment of injuries and various conditions...

OK, I admit it...we have been feeding a dry dog food brand almost continuously for the past 34 years that does not ever appear on lists of top tier dog foods people strive to feed their pets. We feed it because the dogs like it, it's relatively cheap (I use relatively because I remember paying $18 for a 40-pound bag in the early '80s, but now it's $35 for 38.5 pounds), and because it has always been a consistent, reliable and available product. However, there seems to be a lot of pressure lately to look at other formulations of dog foods that are somehow 'better' for my dogs. I hear about grain-free foods, breed specific foods (there's apparently one offered for Spaniels by several companies) and organic and wilderness or evolutionary foods-although I have no idea what those really mean! So, I spent the better part of Sunday perusing various websites for information about whose higher quality dog foods that I should be serving up to my dogs twice daily. I should say upfront that I don't really have any overwhelming reason to change their food. Maybe some of the itchy-scratchy behavior that the dogs routinely go through would lessen, but that was really all I could come up with. Their coats are fine, their stools are fine, their weight is fine, their appetites are great (this is SPANIELS we're talking about, after all)...I don't really have any major issues with the current feeding regimen-just a kind of vague guilty feeling that I'm supposed to be doing something BETTER for them.

The first thing I did was read the Dog Food Reviews written by Mike Sagman. He's a dentist who decided to get into dog food reviews about 6 years ago. He has a standard methodology and a templated format that makes it pretty easy to figure out how he rates various foods on a scale from 1 star to 5 stars. The only objection I have is that he will sometimes use one type of food to represent all the lines of food of a particular dog food brand. If he selects a Large Breed formula to review, it is not necessarily going to jive with the info I need for evaluating a puppy food or an adult food from the same manufacturer for the Welshies. Nevertheless, it gave me the information I needed to determine why some foods were rated higher than others, and why my current food was downgraded by his methodology.

First, I decided to evaluate all the brands of dog food marketed by my current manufacturer-they have several lines, including a basic and a premium line. I'm not unhappy with the manufacturer, and I'm pretty sure that with all their foods there's one that would meet my needs without having to go outside to a strange new brand. They have grain-free and breed specific foods, and activity and life-stage specific foods also. The biggest issue I had was that it appears the marketing is in flux-some products are available on the product web site but not sold in any stores that I could find. Some labels have changed their looks, or some foods been moved from one line into another rebranded product line. It was all very confusing, so I had to set up a spreadsheet to tabulate all the variables and try to link them to the reviews. I started documenting a bunch of details that I thought would help me decide whether I really needed to (or could AFFORD to) change my dog food. Here's what I started listing:
-brand of food
-category of food (i.e. activity, life stage, breed specific)
-first three ingredients on the label
-nutrient analysis of Protein/Fat
-rating given by the review site, if available, from 1 to 5 stars
-largest available bag size
-cost per bag of the largest size
-cost per pound

One of the main requirements that we have for a dog food is that it is available readily-that means it has to be sold at big name pet stores like PetSmart or Petco. I don't do deliveries and I don't want to pay a gas premium to drive around finding the food. Nothing like going to feed the dogs after dinner, when you realize you emptied the last bag of food into the bin a week ago and there's no more left in the storage closet. At least PetSmart is open until 9 PM and you can run over for a quick bag.

The next thing I started looking at was ingredients-I figured if I was going to make any change at all to the dog's diet, it was going to be to reduce or remove cheap corn meal from the food, or go grain-free. I reviewed the first three ingredients in all the foods, and discovered only some of the more premium and natural ones had products that didn't use cornmeal or corn at all. Some of the 'better' foods dropped cornmeal to the third ingredient, some even had it as the 4th to 6th ingredient-but it was still there. Only the grain-free ones didn't list corn at all as part of the ingredients.

Then I started looking at cost per pound, and that's where I nearly fell off my chair. The cost of being better to my dogs was going to run me about 35% to 155% more than I was already paying. And with 9 dogs to feed, we go through a bag of food every week. So any increase in the costs were going to be pure profit for the dog food company and probably not really reflect any change to me OR the dogs.

I did also calculate what it would cost to go from my perfectly well tolerated 'economy' food to the Petsmart house brand of Authority Grain-free Chicken and Potato. It is a well-regarded diet and it would move the mealtime feeding program from a 2.5 star to a 4-star event for the dogs. It would cost me about 28% more to go to that level, or roughly an additional 36 bucks per 100 pounds of dog food. I'll allow that this is a very reasonable alternative, and I'm fine with making it if there was a big reason to move to grain-free. I evaluated their standard adult dog food product and found it contained corn products at the 4th and 6th spots on the ingredient list, and the price was comparable to what I was paying now with m. But, I just don't know that making the change to a new brand is justified for the same cost and not really getting rid of the corn. I'm still feeling that we're in 'It ain't broke so don't fix it' mode, and after all the research, maybe we'll just wait a bit and see if a real need to change presents itself...

I almost wish dog food selection was like pulling up to the pump with your car-you get Regular, Plus and Premium, and that's it. And as long as your engine is running fine on the 87-octane, there's no point in putting the High-Test gasoline in the tank.