Swollen Testicles--Getting the Right Diagnosis

Look outside the normal. Consider abnormal or atypical illness patterns

We’ve been discussing how difficult it is to get the right diagnosis for a pet’s illness and have identified 5 problem areas:
1. Working with incomplete or misleading information
2. Being presented with a pattern of illness that isn’t normal or typical
3. Grabbing onto a major symptom and thinking that’s where the focus should be
4. Considering the problem only in light of what local pets develop
5. Using stereotypes such as breed or age

We discussed the first problem in detail, and now let’s cover the second problem: being presented with a pattern of illness that isn’t normal or typical.

Let’s look at an achingly painful problem, swollen testicles.

Cancer is a common cause of swollen testicles
When an older male dog that has never been used for breeding develops swollen testicles, veterinarians usually suspect cancer and we put Sertoli cell tumors, seminomas, interstitial cell (Leydig) tumors, and mast cell tumors high on our list of potential problems.

Cancer affects half of all dogs
We think cancer is the most likely diagnosis because neoplasia affects half the canine population. That’s right. Our senior dogs have a 1 in 2 chance of developing cancer. In addition, 75% of tumors affecting the male urogenital tract occur in the testicles.

Veterinarians also think of cancer as a potential diagnosis because we tell every family with a male puppy: “We should neuter your dog because if your dog doesn’t have testicles, it won’t get cancer of the testicles.” Then, whenever we see an adult dog with testicles, we think: cancer.

Brucella can also cause swollen testicles
With swollen testicles in an unneutered male, we also want to know whether the dog has been used for breeding or whether it has lived in a breeding kennel. Breeding allows transmission of brucella, a bacteria that causes brucellosis. In males, brucellosis causes achingly painful testicular swelling. Historians think Napoleon had brucellosis and that’s why he looked so uncomfortable sitting on a horse.

Disregarding brucella as a diagnosis because it doesn't fit the pattern
If the family tells us that the dog was never used for breeding and has never been resident in a breeding kennel, we take brucella infection right off our list of potential diseases causing this dogs swollen testicles. What a mistake that can be: we’d be missing the atypical or abnormal case of brucellosis caused by food. Although food-borne brucellosis is uncommon in the United States, it is common in the Mediterranean and can occur when pets are fed unpasteurized sheep or goat cheese imported from this area. Who would have thought….

Swollen penis (balanitis) caused by Lyme disease
Another infection that has an atypical presentation as swollen penis (balanitis) is Lyme disease. Lyme disease usually causes joint problems, but it also causes balanitis in humans and should be considered in the differential list of diseases for dogs presenting with a swollen penis.
If we want to make the correct diagnosis for pets, we can’t get stuck on finding a diagnosis that fits the normal or typical pattern of illness. We should consider the atypical and abnormal, too.

What's coming: Focusing on one major symptom
In the past few Caring for Pets blog entries, we’ve discussed two major problems leading to misdiagnosis (Working with incomplete or misleading information and Being presented with a pattern of illness that isn’t normal or typical). In the next blog, we’ll cover another major problem leading to misdiagnosis: Grabbing onto one major symptom and thinking that’s where the focus should be.

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Keeping a Pet Diary--Getting the Right Diagnosis

Don't work with incomplete or misleading information

We’ve been discussing how difficult it is to get the right diagnosis for a pet’s illness and have identified 5 problem areas:
1. Working with incomplete or misleading information
2. Being presented with a pattern of illness that isn’t normal or typical
3. Grabbing onto a major symptom and thinking that’s where the focus should be
4. Considering the problem only in light of what local pets develop
5. Using stereotypes such as breed or age

Today, we’re going to discuss how keeping a pet diary will help so that we don't misdiagnose a pet's illness because of the first problem: Working With Incomplete or Misleading Information

Poor Memory
One reason we may have incomplete or misleading information is that the family cannot remember the pet’s history. For example, if we’re trying to figure out why a diabetic cat cannot be regulated to maintain normal blood sugar levels, and the family cannot remember whether the cat is always fed before she’s given insulin, we have incomplete information with which to try and diagnose the unregulated sugar levels.

To help prevent incomplete information from contributing to a misdiagnosis, keep a pet diary and write down what’s important in your pet’s life. Diary information should include:

• When it gets fed


• What it eats


• What stools and urine are like


• When and what medications are given


• When and what type of exercise it receives


• When it gets sick


• What you see that tells you the pet is sick: fever, lethargy, vomiting

Pet diaries help with every medical condition
If your pet is healthy, there’s not much work for you to keeping this diary, but if your pet has a chronic illness, such as epilepsy, diabetes, or feline urinary tract disease (FLUTD), there will be lots of useful information that you can list. Take your diary along when your pet needs a medical review, and it will help your pet get the right diagnosis and therapy.

Blood and diagnostic tests prevent misdiagnosis
Allow your veterinarian to take the blood and diagnostic tests necessary to identify the problem. Ask to have tests reviewed by pathologists and radiologists to ensure your pet gets the help of experts. And, realize that no test is perfect, so expect that 1 of 14 tests will be inaccurate.

What's coming?
We’ve discussed the first problem that leads to misdiagnosis (Working With Incomplete or Misleading Information), and in the next Caring for Pets blog entry, we’ll cover the second problem: Being Presented With A Pattern Of Illness That Isn’t Normal or Typical.

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Getting the Right Diagnosis for Your Dog & Cat—5 Problem Areas

When pets are ill, the first thing we want to know is what caused the problem. This sounds simple, but getting the diagnosis is so complex that it takes veterinarians 4 years of schooling to learn how to begin. That many years? Yup. And only to begin getting the diagnosis right? Yup. It’s hard to get the right diagnosis.

Here are 5 problems that make it difficult to get the right diagnosis:
1. Working with incomplete or misleading information
2. Being presented with a pattern of illness that isn’t normal or typical
3. Grabbing onto one major symptom and thinking that’s where the focus should be
4. Considering the problem only in light of what local pets develop
5. Using stereotypes such as breed or age

What can pet families do to ensure their pet gets the correct diagnosis? Let’s consider each of these 5 problems and in more detail over the next few Caring for Pets entries.

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Diagnosing Arthritis, Limping and Pain in Pets That Are Sitting Still

Would you like to be able to tell if your pet has arthritis, bone, muscle or nerve problems? We’ve already discussed what to look for while your pet is moving—head bobbing, bunny hopping, hip hiking—and where the lameness problem occurs based on these signs—but we can also look at your pet while it’s sitting and diagnose some joint problems:

• Sits with legs off to one side—hip pain


• Can’t bend the knee or sit squarely—knee problems, especially with the ligaments within the knee called the anterior cruciate ligament or ACL.


• Leans onto one limb—protects the limb on the other side


• Can’t extend the elbow—either the elbow is out of joint (luxated) or the triceps muscles along the back of the arm are torn


• Holds front leg up and slightly out—the shoulder is dislocated (luxated)


• Holds rear leg up and slightly out—the hip is dislocated (luxated)

If you see any of these behaviors in your pet, ask your veterinarian to evaluate it for pain, arthritis, or nerve problems.

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Arthritis, Limping and Pain in Pets

Would you like to be able to tell if your pet has arthritis, bone, muscle or nerve problems?

Here are some signs your pet has a problem and needs help:

• Head bobs up and down—the shoulder, knee or forefoot has a problem
  
• The foreleg swings out or paddles—the shoulder, elbow or infraspinatus muscles under the scapula are a problem
  
• Hula sway to the rear end—both rear legs or hips have a problem


• Bunny hopping—both rear legs or the hips have a problem


• Hip hiking or tail winging—rear leg has a problem


• The one leg takes a short step (short stride)—the other leg has a problem


• The nails drag while walking—pain or problems with the nerves


• The foot swings so high while walking that the foot pads are visible—that leg or foot have a problem

If you see any of these behaviors in your pet, ask your vet to evaluate it for pain, arthritis, or nerve problems.

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Common Liver Toxins

Dogs and cats are exposed to many toxic substances that harm the liver. Because a healthy liver is essential for life, pets should avoid liver toxins. This list details some common liver toxins and describes how pets might be exposed to them.

Acetaminophen or Tylenol
Pain & arthritis medication frequently used in humans. Some folks give this medication to pets to help their pain. It kills cats and harms dogs.

Aflatoxin
Aflatoxin is a toxin produced by Aspergillus mold. Because Aspergillus is present in the soil, crops are often infected. Although minute quantities of aflatoxin are allowed in crops, the molds grow to produce toxic amounts of aflatoxin when crops are stressed by bad weather. Plants commonly infected with Aspergillus mold that produces aflatoxin include: corn, maize, sorghum, millet, rice wheat, peanuts, soybeans, sunflower, cotton, almonds, and walnuts.

Aflatoxin is unrecognizable in the food because it doesn’t have an odor or an appearance that we recognize as moldy. For example, the FDA finds that aflatoxin is present in minute quantities in all commercial peanut butter. Aflatoxin is also present in packaged food containing grains and oils, such as dog kibble. Although we cannot recognize the toxin, many dogs and cats know it’s in the dog food and are reluctant to eat it.

Blue-green algae
Blue - green alga produces cyanotoxins and can be found in abandoned swimming pools and ponds full of nitrate fertilizer run-off. This is different than the algae we use to keep pets healthy, such as Spirulina.

Clay pigeons
Clay pigeons that are used for skeet and trap shooting are toxic to pets. Shooters don’t go out into the fields and pick up the busted clay pigeons, so they litter fields and can impact soil, wildlife, and pets used for hunting. Poisoning is caused by pitch that contains cresol and phenol. Pitch serves as a binder in clay pigeons, but non-toxic clay pigeons made without pitch are available.

Creosote
Roofing tar, tar paper, and wood preservatives contain creosote as a preservative. Pets that sleep on treated decks, in treated dog houses, or that crawl over tar paper rooms are affected. Creosote causes liver disease.

Copper
Pet supplements are often fortified with copper. For some dogs this is not a problem, but for others, even small amounts of copper are toxic. This occurs because these dogs have genetic predisposition that allows them to store copper but not to move it out of the liver. Thus, toxic levels of copper build up although the pet is receiving only a small amount of copper in the supplement. We cannot always tell a pet has a copper overload because blood tests don’t tell us what is stored in the liver, only what is carried in the blood. Some dogs prone to develop copper toxicosis are Bedlington Terriers, West Highland White Terriers, Labrador Retrievers, and Doberman Pinschers.)

Cycad palms
Cycads are palm plants with large seeds that grow where it’s warm, either in the sun or in the shade. The cycad palm nut contains a toxin that animals eat. Wild animals then become poisoned and carry the toxic substance in their fat. Dogs and cats that eat wild cycad-poisoned wild animals may also be poisoned. Some indigenous tribes use cycad nuts for food, but they soak the nuts so that much of the toxin is stripped from the nut.

Iron
Pet supplements are often fortified with iron, and iron is also present in some fertilizers and pesticides. Some dogs have genetic predisposition that allows them to store iron but not to move it out of the liver. Thus, toxic levels of iron build up although the dogs are ingesting only a small amount of iron in the supplement. We cannot always tell this is happening because the blood tests don’t tell us what is stored in the liver or bone marrow, only what is carried in the blood.

Lantana
Lantana is a flowering shrub that is so highly toxic that it is considered one of the ten most noxious weeds in the world. Usually, Lantana poisons grazing ruminants such as cattle and sheep, but it can be grown as a flower in shady, moist residential areas where it would be toxic to dogs and cats.

Mushrooms
Amanita and psilocybin mushrooms contain toxins that harm the liver and can cause death. Humans may use these mushrooms for mystical religious experiences because they cause profound central nervous system changes and hallucinations. Pets are already mystical. No mushrooms necessary.

Phenolics
Phenolics are chemical compounds that harm the liver and are found in everything from mouthwash to coal tar:
· creosol wood preserver
· coal tar,
· BHT food preserver,
· thymol in mouthwash,
· xylenol in antiseptics and disinfectants,
· cannabis found in marijuana,
· propofol an anesthetic,
· methyl salicylate found in oil of wintergreen.

Pyrrolizidine plants
Pyrrolizidine is toxic to the liver. Groundsel, rattlebox, and comfrey are plants containing pyrrolizidine. For pets, exposure to pyrrolidine is most often through comfrey used in wound and joint salves. Comfrey salves are OK for external use but are not OK if the pet licks the salve off.

Protect your pet
Unfortunately, liver disease is too common. Sometimes the effects of disease are subtle and difficult for us to detect, and other times, such as when exposed to high levels of aflatoxin in dog food, the effects are sudden and profound. Help protect your pet’s liver by avoiding toxins.

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Liver disease in dogs & cats

Did you know that the liver is as essential to pet health as the heart is? The liver is so important for dogs and cats that we routinely ask for blood tests when pets are ill. The blood tests show us the liver enzymes (ALP, ALT), bile acids, clotting factors, blood sugar stabilizers (glucagon), and jaundice factors (bilirubin).

Swollen liver (hepatomegaly)
We can also assess the liver by palpating the abdomen. A normal liver rests above the stomach and is protected by the ribs, but when a liver is swollen (hepatomegaly, hepato=liver, megaly=large or swollen), we palpate the edge swelling beyond the ribs.

Jaundice
Another way to tell a pet has a liver problem is that the body turns yellow (jaundice) because the liver isn’t processing bilirubin. It’s easiest to see jaundice when bilirubin tints the white part of the eye (the sclera) a pale or deep yellow. The skin and gums in the mouth can also have a jaundiced color. Just press the gum for a second to make the blood move out of the way and look at the color of the gums when not flushed with red. Yellow gums suggest liver problems.

Nasty pets
One way nature has of ensuring that we don’t miss signs of liver disease is that dogs and cats with sick livers become nasty. They hiss, snarl, and bite. Often, pets with liver disease are so nasty that we can’t get medications into them. These little terrors would benefit from herbs or supplements, but nobody with sense tries to put a pill into the mouth of a dog or cat with liver-disease . Instead, we choose to begin treatment with a homeopathic medication in the water.

Good pets
Some pets with liver disease cannot be mean no matter how sick their organs are. These pets are a delight to treat because we can use supplements and herbs that strengthen the liver. Our friend Jiggy, Chiclet’s buddy, is an example of a pet who remains wonderful despite liver disease.

Liver regeneration
The liver has the ability to regenerate so we’re rewarded when we treat these pets—whether they’re hostile or happy —because they respond and return to health. Among the holistic therapies that benefit the liver are acupuncture, homeopathy, SAMe, herbs and feeding organic liver.

Toxins prevent recovery
Supplements, herbs, and medications will not return pets to health if they are exposed to toxic materials and exposure continues during and after treatment. Although the immune system is trying to help protect the liver from toxins, it actually responds in such a way that the liver swells and becomes sicker. A swollen liver (hepatomegaly) doesn’t work well and can cause abdominal pain. A swollen liver also presses on the gallbladder and interferes with the flow of digestive bile into the small intestine. Thus, many pets whose immune systems are responding to liver toxins or liver insults cannot digest their food . Many are nauseated and have no desire to eat.

Liver toxins
The following are some of the liver toxins that dogs and cats are exposed to:
· Acetaminophen
· Aflatoxins
· Blue-green algae clay pigeons
· Copper
· Coal tar
· Iron
· Mushrooms
· Phenolics
· Plants, such as cycad palms & lantana
· Pyrrolizidine plants

We’ll go over this list in greater detail in a future Caring for Pets blog.

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