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Interview with Dr. Tobin, DVM

Dr. Stephen Tobin is a holistic veterinarian who providestreatment using homeopathic herbs and nutrition. He speaks with us about hisphilosophy of animal care, pet nutrition, and his experience with the LonglifeProgram in the treatment of his patients.

Read the interview

The Canine Immune System

The immune system is a complex defense network of white blood cells, antibodies,and other substances that fight off infections and reject foreign proteins. Itis a force patrolling the body, designed to distinguish one'ss own cells fromoutside cells by trace markers found on the surface of every cell in the body.It is this ability that causes the bodies of human beings and animals to rejectskin grafts, blood transfusions, and organ transplants. Like anything else inlife, the immune system can fail, either by not doing enough or by doing toomuch.

Such is the natural process by which the body responds to so many harmfuloutside agencies that a breakdown in a dog’s immune system is so destructive.A collapse of the immune system leaves the body open to attack by an opportunisticinfection from outside elements. In these situations, lacking the body's naturaldefense mechanisms, a dog might suffer terribly from the most ordinary of injuries.

AnAuto-Immune Disease, on the other hand, is a different kind of immune systemfailure. In this situation, the immune system fails to recognize itself, andit begins to attack and reject the body's own tissue as foreign. One specifictissue type, such as red blood cells, may be affected, or a generalized illness,such as systemic lupus (see below), may result.


Causes of Auto-Immune Disease in Dogs

What causes the immune system to short-circuit and start rejecting normalbody tissue? Many theories exist, but the ultimate answer is that no one quiteknows. Jean Dodds, a veterinarian who specializes in immunology, believes thatmultivalent modified-live vaccines overstimulate the immune system. Others blameenvironmental pollutants or food preservatives such as ethoxyquin, an antioxidantfound in most dog foods. There is strong evidence for a genetic factor in thedevelopment of auto-immune disease in many species. Finally, some cases occurspontaneously, causing damage to kidneys, lungs, or the thyroid gland.


Symptoms of Auto-Immune Diseases

Canine auto-immune disease can be signaled by a multiplicity of symptoms,any of which might signal an onset. Chief among these is an intense sorenessin certain parts of the body, often demonstrated by a "protecting," duringwhich the dog behaves as if keeping a certain body part untouched is a matterof life and death. For instance, a protecting of the pancreas (a pale pink glandularorgan that nestles just under the stomach) might signal the onset of auto-immunedisease. A soreness of the thyroid (a butterfly-shaped gland in the throat) mightbe cause for concern, as might an irritated or swollen rear quarter, illustratedby a licking or dragging of the left hind paw.

Other symptoms, which otherwise might be overlooked in the larger pictureof a dog's health, include itchy, flaky skin, inflamed ears, excessive lickingof the front paws, and swelling of the toes. If any of these symptoms are present,a dog may suffer from Canine auto-immune disease, and should see a veterinarianimmediately.


Testing for Auto-Immune Disease / Thyroid Tests

Veterinarians may suggest a thyroid test if a pet has gained weight or ishaving chronic skin infections, or if an elite breeding dog is experiencing reproductivedifficulties, especially if the animal lacks energy or has a scruffy or dullcoat. The veterinarian draws the blood and sends it to one of several laboratorieswith the equipment for conducting the test. The blood sample should be takenwhen the dog is otherwise healthy, is not approaching a heat cycle, and is nottaking pharmaceuticals such as steroids, non-steroidal anti-inflammatories, oranti-seizure drugs. The latest tests include measurement of two forms of thethyroid hormones T3 (triodothyronine) and T4 (levothyroxine) and a search forantibodies that could indicate auto-immune thyroiditis, the genetic form of thedisease. Interpretation of the numbers recorded is as important as the numbersthemselves, for the relationship between the hormones is complex. In addition,normal ranges of hormones vary somewhat with the breed or mix.


Hypothyroidism in Dogs

When a dog suffers from an auto-immune disease, he or she is at risk for severalailments, most commonly Hypothyroidism. Hypothyroidism is a common disorder inmiddle-aged to older dogs, characterized by thyroid hormone production.

Thyroid hormones affect almost every organ in the body and thus many signsof this disease are common. These include lethargy, depression, obesity (despitenormal feeding amounts), hair loss, skin and ear infections, and weak or tornknee ligaments. Should this disease be suspected, initial screening blood workis performed. Dogs that are hypothyroid have thyroid levels that are almost alwaysbelow the normal range.

Puppies with severe forms of congenital hypothyroidism are said to have Cretinism.These usually have developmental defects of the pituitary gland and are stuntedmentally, and, with time, are malformed physically.

Breeds Commonly Affected by Hypothyroidism

Many breeds are commonly affected by this disease: Boxers, Cocker Spaniels,Golden Retrievers, Labs, Poodles, Dachshunds, and Miniature Schnauzers. It islikely that some breeds are genetically predisposed. There is no difference infrequency of occurrence between males and females.

Additional Symptoms of Hypothyroidism in Dogs

In addition to the symptoms listed above, some of the other signs of Hypothyroidisminclude lethargy, mental dullness or behavioral changes, increased weight gain/obesity,cold intolerance (seeking of warm places), poor wound healing, poor skin andhair coat (including hair loss or abnormal hair turnover, or dull or brittlehair), altered pigmentation, oily or dry skin, thickened skin with a "sad" facialexpression, odiferous skin that may be pruritic (itchy) because of secondarybacteria, and/or yeast dermatitis/pyoderma (superficial infections) with or withoutconcurrent demodecosis (skin parasite). The last group of symptoms includes seizures,cranial nerve deficits (blind and/or droopy eyelids, or dry irritated red eyesdue to paralysis of eyelids), and decreased tear production, which causes eyesurfaces to be dry and irritated. In rare cases, the dog might act "drunk",endure swallowing problems, or endure general weakness.


Pemphigus Disease in Dogs

Three other major potential diseases may result from canine auto-immune disease:
The first is Pemphigus. Clinically, dogs with pemphigus will present with ulcersthat affect the oral cavity and skin areas bordering the mouth, nose, eyes, anus,and genitalia. The lesions often progress to involve the skin, especially inareas of friction, such as the groin and armpits. In rare dogs, the lesions arerestricted to the skin, to the nose, or to the borders of the nails. Ulceratedskin and mucosal lesions generally are painful; the pets thus are reluctant toeat, and they will begin to lose weight. Deep skin lesions commonly become infectedwith skin bacteria.

Pemphigus Disease Symptoms

The more common forms of pemphigus produce scaling skin, scabbiness, and sometimespus-filled sores that look like pimples. Early in pemphigus foliaceus, the diseasemay be confined to the head and feet, making it hard to distinguish from pemphiguserythematosus. Later it spreads to more of the body. Careful examination of theskin may reveal the presence of blisters, which are very indicative of thesediseases. The blisters rupture quickly and may not be seen.

There are several skin disorders within the pemphigus complex. They all haveone thing in common, in that the body produces harmful antibodies, this timeagainst the outer layer of the skin.

Breeds Commonly Affected by Pemphigus

Pemphigus foliaceus is the most common of these diseases in the dog. It isseen more often in Akitas, Chow Chows, Dachshunds, Bearded Collies, DobermanPinschers, Finnish Spitzes, and Newfoundland dogs. Pemphigus erythematosus issecond most common and may just be a milder form of pemphigus foliaceus. It isseen more commonly in Collies, Shetland Sheepdogs, and German Shepherds.

Pemphigus Vulgaris Symptoms

Pemphigus vulgaris is the most severe form of the disease. In this disorder,there is severe ulceration of the skin, usually where "normal" skinmeets "specialized" skin, around the mouth, anus, prepuce, nose, andvagina. The mouth is almost always affected. Secondary complications are morecommon with pemphigus vulgaris than other forms of Pemphigus, and can be verysevere.

Pemphigus vegetans may be a less severe form of pemphigus vulgaris, but itdoes look different. In this form of pemphigus there are warty growths that mayulcerate. Many diseases can look like pemphigus disorders.

Testing and Treatment of Pemphigus

Diagnosis of pemphigus is best done by skin biopsy. Sometimes specializedtesting must be done on the biopsy samples—often by doing them again. Treatmentof pemphigus vulgaris and pemphigus foliaceus can be pretty frustrating. Treatmentof pemphigus erythematosus and pemphigus vegetans may not be necessary or isusually possible with topical corticosteroids or low to medium dosages of prednisone.Due to the serious immunosuppressive tendencies of the medications used to treatpemphigus diseases, it is usually necessary to closely monitor the health ofpets under treatment. To succeed in keeping a dog comfortable when affected bythe more severe pemphigus diseases, the client and veterinarian must cooperateclosely. Teamwork is important in treating pemphigus.


Canine Lupus

Canine Lupus: In Latin, "Lupus" means wolf, and the diseaseLupus is aptly named; Lupus, in both humans and canines, is the disease in whichthe body literally attacks itself. The disease takes two forms, Systemic LupusErythmatosus and Discoid Lupus.

Systemic Lupus Erythmatosus

Systemic Lupus Erythmatosus (SLE, or often referred to as simple canine lupus)is a rare autoimmune-mediated disease specific to dogs. Dogs with lupus haveunusual antibodies in their blood that are targeted against their own body tissues.Lupus can cause widespread systemic disease of the skin, heart, lungs, kidneys,joints, and nervous system, as well as blood (anemia and/or decreased plateletnumbers). Multiple organs are usually affected.

Symptoms of Systemic Lupus Erythmatosus

The condition tends to wax and wane, so your dog will have periods of remissionand of flare-up. The kinds of problems you may notice include shifting lameness(varies depending on which joint is affected at any time), weakness and palegums (due to anemia), and/or increased drinking and urination (kidney disease).The face and the feet are the areas of the skin most often affected, with ulcersand loss of pigment on the nose, and ulceration and thickening of the footpads.

From the above paragraph, one might conclude (correctly) that one of the problemswith SLE is that it causes such a wide variety of symptoms that it can be confusedwith a number of different diseases. The signs of SLE may be acute (sudden onsetand short duration) or chronic (of long duration and recurring) and are usuallycyclic (recurring in a specific pattern or cycle). Some of the symptoms may includea fluctuating fever, shifting lameness, arthritis affecting multiple joints withoutany evidence of cartilage erosion, multiple painful muscles, anemia, a low whiteblood count, oral ulcers, symmetrical skin lesions including alopecia (hair loss),skin crusting, lesions, ulceration and scar formation, thyroiditis, (inflammationof the thyroid gland), and splenomegaly (enlargement of the spleen). Pyelonephritis(generalized infections of the kidney), renal failure (kidney failure), septicarthritis (serious infection of the joints), or septicemia (infections of thebloodstream) are signs that the disease is in an advanced state.


Diagnosis of Systemic Lupus Erythmatosus

Because SLE can affect many different body systems, diagnosis is challenging.In fact, it is sometimes called "the great imitator". Once suspected,diagnosis is confirmed by specific blood tests and biopsy for examination bya veterinary pathologist.

Veterinarians should know that the list of rule-outs with SLE is extensive,due to the varied and changeable cutaneous and systemic manifestations of thisdisorder. Diagnosis is based on signs of multisystem involvement (most commonlyanemia, thrombocytopenia, glomerulonephritis, polyarthritis, nasal and footpaddermatitis, fever of undetermined origin), a positive antinuclear antibody test,and histopathologic and immunopathologic evaluation.

Discoid Lupus

Discoid Lupus is an immune-mediated skin disease that is probably relatedto SLE, but instead of affecting the whole body, as SLE does, it primarily affectsthe nose and face. There is no known cause of this problem, but it does seemmore common in dogs of the German Shepherd, Collie, Brittany Spaniel, ShetlandSheepdog, Siberian Husky, and German Shorthaired Pointer breeds.
Discoid Lupus is also called Cutaneous Lupus Erythematosus (CLE).

Symptoms of Discoid Lupus

The disease normally starts as a loss of pigment around the nose. There maybe scabby sores or just scaling of the nasal tissue. The surface of the nosemay change from its typical "cobbletoned" appearance to a smooth surface.As this disease progresses it can cause deep sores on the borders of the nose,where it meets normal skin. Eventually, the sores start to progress up the bridgeof the nose.

(Note: Nasal scarring is common with both SLE and CLE. Exposure to ultravioletlight is a factor (especially in CLE), so the condition is seen more often andis more severe in the summer and in sunny parts of the world.)

Ultraviolet light seems to make the sores worse, so the disease may appearto be seasonal. It is more common in areas in which exposure to ultraviolet lightis increased, such as high altitudes. If the depigmentation leads to sunburn,squamous cell carcinoma becomes more likely than in other dogs. Topical sunscreenscan be very beneficial, although it is hard to get dogs to leave them on. Keepingthe dog indoors during peak sunlight hours is probably the most effective wayto prevent excessive exposure to UV light.

CLE is diagnosed through examination of biopsy samples, and by histopathologicand immunopathologic evaluation.

Exposure to ultraviolet radiation worsens the skin lesions in both conditions,so sunscreen is advisable and dogs should be sheltered from peak sunlight (approximately10:00 am to 3:00 pm).

One should note that for many breeds and many disorders, the studies to determinethe mode of inheritance or the frequency in the breed have not been carried out,or are inconclusive. Listed here are breeds for which there is a consensus amongthose investigating in this field and among veterinary practitioners that thecondition is significant in this breed.

This, too, is important: Although the mode of inheritance is not known foreither discoid or SLE, these conditions run in families. Affected animals shouldnot be bred, and it is prudent to avoid breeding their close relatives as well.


Auto-Immune Hemolytic Anemia

The third and last ailment resulting from auto-immune syndrome is Auto-ImmuneHemolytic Anemia (AIHA), a disease in which the body attacks its own red bloodcells (RBC). A pet suffering with AIHA will have a lower-than-normal number ofred blood cells within the blood. This is termed anemia.

The exact mechanisms which trigger the dog's immune system to attack and destroyits own red blood cells are unknown. However, the disease process is believedto occur when antibodies coat the surface of the red blood cells, tagging themfor destruction by the white blood cells. When the body is invaded by an infectiousmicroorganism or agent, it produces a number of antibodies that range in specificityfor that particular invading antigen. Some of the antibodies are highly specific,while others bind with less specificity. In the normal immune system, suppressorT-cells ensure that these non-specific antibodies do not react with normal hosttissues. However, it is believed that some dogs may have poorly regulated T-cellsuppression that allows these non-specific antibodies to attack their own cells.

Breeds Commonly Affected by AIHA and Other Factors

Such a genetic predisposition for AIHA has been suspected in several breedsof dogs, including Old English Sheep Dogs, Cocker Spaniels, Poodles, Lhasa Apsos,and Shih Tzus. Alternatively, some clinical studies exploring potential causativemechanisms have identified several non-genetic factors that may play a role inthe development of this disease. For example, the observation that dogs afflictedwith AIHA also demonstrate increased antibody titers to viral antigens for canineparvovirus and distemper virus suggests that certain viral infections may triggeran autoimmune reaction. Under such circumstances it is believed that there isadsorption of the virus to the red blood cell. When the immune system launchesantiviral antibodies to destroy the virus, these antibodies target and destroynot only the virus, but the red blood cell as well. Similarly, some drugs (suchas antibiotics, analgesics, and cardiovascular drugs) as well as viral antigenscomposing modified-live vaccines are also believed to induce AIHA through thistype of mechanism.

Additional Risks of Auto-Immune Hemolytic Anemia

AIHA makes a dog vulnerable to another disease, immune-mediated hemolyticanemia (IMHA). IMHA refers to all anemias that occur when the immune system mistakenlydestroys its own blood cells secondary to an immune attack directed against anunderlying condition such as cancer, endocarditis, or heartworm, or by unidentifiablecauses, as in AIHA.

A veterinarian can diagnose AIHA. The clinical signs of AIHA are usually gradualand progressive, but occasionally an apparently healthy pet suddenly collapsesin an acute hemolytic crisis. The signs are usually related to lack of oxygensupply. The hemoglobin in RBC is the primary carrier of oxygen in the blood.


The Role of Blood

Blood is considered an organ. It has its own complex and diverse development,structure and functions. Its unique form, cellular tissue suspended in fluidplasma, allows it to serve as a main distribution system throughout the body.Cellular tissues composing the blood include: the red blood cells, which provideoxygen to tissues of the body; the white blood cells, which prevent invasionof microorganisms or other foreign substances; the lymphocytes, which carry outimmune surveillance; and the platelets, which are involved in keeping the componentsof the blood in balance. Remarkably, all of these cellular components originatefrom a common source, called stem cells, located in the bone marrow. These stemcells give rise to a mature colony of cells which as they continue to divideand mature undergo a series of changes, a process known as differentiation, andeventually develop into the specialized blood cells indicated above.
Anemia is a condition brought on by abnormalities which lead to a deficiencyin the number of red blood cells. Although the average life span of a circulatingred blood cell is brief in most organisms (approximately 4 months), under normalcircumstances the red blood cell mass is maintained at a constant level becausenew red blood cells are made as old red blood cells are destroyed and removedfrom circulation by the white blood cells. When this balance is disturbed andthe level of red blood cells decreases to a point at which demand exceeds thecapacity of the bone marrow to produce them, anemia develops. Because integrityand function of other organs in the body are dependent upon red blood cells todeliver oxygen to their tissues, if the red blood cell number decreases to apoint at which the body is unable to compensate for the decrease in oxygen transport,serious and irreparable tissue and organ damage may occur. Conditions which maycause a decrease in the circulation of red blood cells include excessive bloodloss (hemorrhage), impaired ability of the bone marrow to produce new red bloodcells, or increased rate of red blood cell destruction.

When a large percentage of red blood cells (RBC) are affected, and they areremoved faster then they can be replaced, the animal shows external signs ofthe disease. To the untrained eye, signs include weakness, lethargy, anorexia,and an increase in heart rate and respiration. Heart murmurs, pale mucous membranes(gums, eyelids, etc.), and discoloration in the urine and/or stool may also bepresent. More severe cases also have a fever and icterus (jaundice), which isa yellow discoloration of the gums, eyes, and skin. This is due to a buildupof bilirubin, one of the breakdown products of hemoglobin.

Causes of AHIA and IMHA

Unfortunately, as of now, the veterinary medical field has not discoveredwhy an individual dog gets AIHA/IMHA. Certain breeds, such as Cocker Spanielsand Poodles, are at a higher risk than other breeds. Middle-aged female dogsare also at a higher risk. However, immune-mediated hemolytic anemia may occurin any breed at anytime.

Evidence suggests that recent vaccinations (DHLPP), along with the administrationof certain medications like sulfa-trimethoprim antibiotics, may be associatedwith a higher incidence of IMHA. Dogs with serious infections or cancers in theirbody may also develop IMHA. The thought for the underlying cause is that something(e.g., vaccine, cancer cells) triggers the immune system to react and to createantibodies. Accidentally, the antibodies also destroy the red blood cells andsometimes also the platelets (idiopathic thrombocytopenic purpura), and therefore,the first sign of illness may be anemia.

Summary

In summary, AIHA/IMHA is a life-threatening immune disease that can causedamage to vital organs through the lack of oxygen supply associated with theresultant anemia. Owners of pets with AIHA/IMHA face a guarded to poor prognosisfor the pet at the time of diagnosis. If an underlying disease such as canceris discovered, the prognosis becomes complicated by the limitations associatedwith the underlying cause as well.