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Topics - Jo CIMDA

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General chat - absolutely anything goes! / Happy Christmas
« on: December 23, 2021, 06:14:10 PM »
Wishing you  and your dogs a very Merry Christmas and a happy and healthy New Year.

Stay safe!

All the best



The Royal Veterinary College (RVC) is calling for owners of dogs in the UK with autoimmune diseases to take part in a vital piece of new research, which aims to gather data and insight into the diagnosis, treatment response and outcomes of these dogs. This information will then be shared with local veterinary practices and specialist hospitals to help owners and vets make well-informed decisions when dogs are diagnosed with one of these conditions.


Please consider taking part if your dog is newly diagnosed with one of the specified AI diseases, and also inform your vet of this study because the more dogs that take part the more the veterinary specialists will learn about autoimmune disease.

Thank you


More information from the RVC website:

Autoimmune diseases are encountered frequently in dogs, often causing severe illnesses that require intensive hospital care and prolonged treatment with immunosuppressive medications. The RVC alone sees between 50-100 dogs with immune-mediated diseases each year, with many more never being referred for treatment at specialist hospitals. In some cases, however, treatment causes side effects that can have a negative effect on quality of life. To address the current shortage of information and aid the veterinary community, researchers at the RVC have developed a new observational study, named ImmunoRegistry.

The registry will gather information about dogs that have been recently diagnosed with an autoimmune disease, following them in real-time over a one-year period to find out how they respond to treatment. Once enrolled, owners and vets will be contacted at regular intervals using emailed questionnaires to ask for detailed updates about their dog

Hi all

What a terrible year it has been for so many people around the world.  Despite this, with or without your loved ones present, I do wish you and your dogs a very happy Christmas and we can only hope that next Christmas will be much improved.

Best wishes to you all, and to your beloved dogs.


In loving memory... / In memory of Professor Michael J Day
« on: May 25, 2020, 09:23:00 AM »
Hello Everyone

I have just heard the very sad news that Prof Michael J Day has recently passed away. 

Some of you may not know of this amazing gentleman's achievements, but the links below will give you some idea of the impact that he made on the veterinary world.



Personally, I am truly saddened because Prof Day's immunosuppressive drug protocol has helped so many dogs with autoimmune disease, when their own vet had no previous knowledge of such treatments, and there is no doubt that his protocol has saved many, many lives that would have been lost.  It is the best immunosuppressive protocol that I have come across.  Many years ago, I emailed Prof Day to ask if I could pass on his protocol to those who may need it, and he replied straight away giving his permission but stressing that the protocol has to be tailored to the individual.  Now, I have no veterinary qualifications and yet this amazing man acknowledged that there was a need to get this specific treatment regimen out 'there' and he gave his permission with no hesitation.  I, and many, many others, will always  be truly grateful to him.

Prof Day, along with his colleagues at the WSAVA, is also the person who brought to the attention of the veterinary world that annual vaccination was not necessary and although it was important to vaccinate, to over vaccinate is potentially doing more harm than good.   

He has achieved so much more in his short life and you can read about him in the links, but I would like to say, Thank you Professor Day for all that you have done during your career and for going over and beyond to help individuals with your knowledge,  and the veterinary profession to understand more about immunology and these terrible diseases, and most importantly how to treat theses dreadful diseases and achieve remission, so that these dogs may have the chance of a happy and healthy life. 

Rest in Peace Michael J Day, and thank you from us all.  Your loss, to us in this world, is huge.




Hi  Everyone

I just thought I should let you know about recent warnings of a carcinogenic substance that has been detected in Zantac (Ranitidine) and many countries have withdrawn the product. 

Many dogs on immunosuppressive therapy have to use a gastroprotectant and up until now Ranitidine has been very widely used.

  It may be that the Ranitidine you use for your dog  is not affected.   If you have been buying over the counter tablets, then they say these are a not a problem.  It is only the prescription tablets that may have this carcinogen.   

I thought you might like to look into this and if you are unsure, please contact your vet.


If your dog needs a gastroprotectant then there are others, such as Pepcid and Omeprazole. etc


P.S.  This is also relevant to any human users of Zantac or Ranitidine.

Vaccination / Vaccines - leptospirosis Vaccine
« on: August 04, 2019, 04:58:36 PM »
If anyone had any doubts about whether or not to vaccinate their dog for leptospirosis, take a read of this very interesting article.

Subject: The Problem With Leptospirosis vaccines:



If a dog has a serious autoimmune disease, then the sooner treatment commences the better chance the dog has of survival.  The main delay to starting treatment is obtaining a diagnosis or at least your vet being sure that he hasn’t missed anything that could be made worse by giving high doses of steroids.  Achieving a diagnosis can be a fight against time. 

If your vet has decided that in all probabilities your dog has an autoimmune disease, then to a certain extent, which autoimmune disease your dog has, as far as treatment is concerned, is irrelevant because with the exception of a few diseases, they are all treated the same, that is, with immunosuppressive drugs.  The main objective is to ‘knock out’ the immune system and virtually stop it from working (or near enough) so the destruction will cease and give the body a chance to recover.  As previously stated, this treatment regime works in most cases, that is, if it has been given early enough and the dosage is correct.  All dogs are different and some can tolerate the drugs better than others. In proportion to their size, small dogs seem more able to tolerate higher doses of steroids than large ones. Some diseases are more serious than others and carry a poorer prognosis. So the initial crisis is a crucial time, however anecdotal evidence shows that many more dogs survive than die if correct treatment is administered in good time.
It is hoped that a positive response can be seen within 4-6 hours of starting treatment (depending on the disease), but in a serious, life threatening situation, the first 2-7-14 days can be a very worrying time.  Assuming the dog has stabilised he will quickly feel much better, and if he is in hospital may be allowed home within a week.

When he comes home he will probably have a ‘goody bag’ full of drugs.  He will be on a high dose of steroid, usually prednisolone, and he may also be on another immunosuppressive drug, such as Azathioprine.  Your dog will be weaned off in a controlled manner according to his wellness and clinical observations. 

Note: High doses of steroids must not be stopped abruptly.  Your dog could go into an adrenal crisis if the medication is withdrawn too quickly.
In addition to immunosuppressive drugs he should have something to protect his stomach from excess acid.  The last thing your dog needs when he is feeling poorly is a bleeding stomach ulcer caused by the drugs.  Sometimes, Antepsin is given to coat and protect the stomach (but this must not be given within two hours of other medication otherwise it will stop the drugs from being absorbed).  Zantac (Ranitidine) may also be prescribed to take away the excess acid. Another gastroprotectant used is Omeprazole. To minimise irritation to the stomach it is usual for the daily dose of steroid to be split into two doses and given with food, one dose in the morning with breakfast and the other dose with his evening meal. I have known several dogs, who did not receive a gastroprotectant as a part of their treatment regime, and went on to develop anaemia. This is not autoimmune haemolytic anaemia but iron deficiency anaemia caused by bleeding stomach ulcers. Using a gastroprotectant is a good preventative measure. When the steroids have been significantly reduced to a low dose, a gastroprotectant may not be necessary.

Excess acid, produced because of the drugs, may make a dog prone to developing pancreatitis. A dog with pancreatitis will appear in pain and his back may be arched as if he can’t straighten up.  He may be lethargic, seem bloated and have a tender abdomen. Dogs usually go off food and water, may vomit and look depressed.  If you suspect that your dog has pancreatitis, don’t try to feed him because it will make the condition worse. Take him to the vet as soon as possible as he may require treatment or need to go on an intravenous drip to stop him dehydrating.  Again, the risk of pancreatitis should be minimal once the dog is on a lower dose of steroids.   A low fat diet is best when your dog is on high dose steroids or prone to pancreatitis. 
As your dog‘s immune system is being significantly suppressed, he will be more likely to pick up infections, and will not have the ability to fight against them.  As a precaution a broad spectrum antibiotic is often prescribed. Also it is sensible not to exercise him in areas where he is more likely to encounter infections, for example, a park or a popular dog walking area. 

Whilst your dog is on high dose steroids he will want to eat and drink excessively. However, this also means that he will want to urinate more and this can sometimes cause temporary incontinence.  You may have to get up to let him out during the night and if you leave the garden door open during the day, it may save some mopping up!  He cannot help it and won’t like it either, so don’t be too hard on him, it’s only temporary. You will notice as he is weaned off the drugs the unwanted side effects will subside and he should return to normal habits and behaviour.  Urinary tract infections and/or bacterial skin pustules are not uncommon when a dog’s immune system is suppressed, and this is often the reason for a dog to be off colour during this time.  Note: Always consider a urine infection if your dog seems under par.  A course of antibiotics will usually sort this out quickly.

Depending on what autoimmune disease your dog has, he will probably need to have regular blood tests.  Biochemical blood tests will also keep an eye on other body functions, such as those of the liver and kidneys, which is important at this stage.
Assuming good progress is being made, the clinical signs of his illness are diminishing and positive signs of improvement are apparent, your vet will want to start weaning him down from the high doses of steroid.  This process can take 3-6 months or more, and usually begins any time after 10 - 28 days from the start of treatment, depending on the results of his blood tests and his clinical signs.
Relapses are not uncommon, especially in diseases that are difficult to control, for example SLE.  A relapse may mean that initially, your dog needed to be on a higher dose of immunosuppressive drugs for a longer period of time, or your dog may have been weaned off a little too quickly and then the dose withdrawn too soon.
If a relapse occurs he will probably show similar clinical signs to his initial crisis.  He will have to go back on an immunosuppressive dose of prednisolone, but it may not have to be quite as high as before. A combination drug may need to be added at this stage. The weaning process will then have to start all over again. Returning to an immunosuppressive dose will mean that he has to go back on a gastroprotectant.

Side Effects of the Drugs – Iatrogenic Cushing’s Syndrome
Iatrogenic Cushing’s syndrome is a side effect of high dose steroids and is caused by too much corticosteroid in the body. To a lesser extent, the immediate side effects observed when the dog initially goes on steroids eg., drinking, eating and urinating excessively is a mild example of Cushing’s syndrome.  Personally I like to see dogs responding to high doses of prednisolone in this way, as it means that they are responding to the drugs as they should.

Usually, Cushing’s syndrome only becomes a real problem when exceptionally high doses, or prolonged high doses of steroids are administered, maybe due to a relapse, or in some cases where the vet is inexperienced in reducing steroid doses and keeps the dog on a high dose for longer than necessary; or when the dog is not responding to treatment and higher doses are necessary to control the disease.  This is where the cytotoxic drug Azathioprine is very useful. 

All drugs carry side effects and Azathioprine is no exception, but it does not carry the same side effects as prednisolone, therefore by using this drug in combination with prednisolone it reduces the risk of iatrogenic Cushing’s syndrome.  As Azathioprine takes at least 10 days to take effect, starting the ‘combination’ therapy at the beginning of treatment may enable the prednisolone to be lowered within the 10-28 day band and still maintain a good level of immunosuppression. If your dog is not responding to treatment then your vet may consider changing his treatment to other immunosuppressive drugs.

How Can I Tell if My Dog Develops Iatrogenic Cushing’s Syndrome?
Iatrogenic means ‘drug induced’.  Clinical signs of Iatrogenic Cushing’s syndrome are the same as primary Cushing’s syndrome but can present with acute clinical signs. It reflects the level of corticosteroid in the body.

The most notable side effects are, heavy panting, some hair loss, and an increase in drinking and urinating, excessive pigmentation.  This is something everyone seems to be aware of and accepts as normal when a dog is on high dose steroids. Very often the dog will be weaned down to a low dose before any major problems arise. 

Acute Cushing’s syndrome due to overdosing of cortiocoid steroids can be very serious.  Blood results will reflect this, especially the liver enzymes which may be extremely high. Red blood cells and blood platelets may also be high and blood clotting may be a risk.
So when should you alert your vet to suspected, unacceptable level of corticosteroid?  The owner should take note when other clinical signs occur, such as: Depression, anorexia, muscle wasting and extreme weakness, continuous panting, lethargy - unwillingness to exercise, skin lesions and thinning of the skin, excessive hair loss, pot-bellied appearance and sagging back, behavioural changes (aggression).

If your dog is showing these signs it will probably mean that the dose of steroids needs to be lowered. It is important that it is not confused with a relapse of the dog’s condition or an infection. The dilemma is that steroids must not be withdrawn too quickly otherwise the dog may go into an adrenal insufficiency crisis.  If the clinical signs of iatrogenic Cushing’s syndrome is intolerable, it is hoped that the high dose of steroids that he has been on will have already done their job and that his autoimmune disease will be stable. As long as the steroids are lowered in a controlled manner and in time, all the symptoms of Cushing’s will subside and your dog will return to normal, but extreme signs must not be ignored.

How Do I Know if My Dog Will Relapse?
Until you have attempted to wean your dog off of the tablets for the first time you will not know if he is likely to relapse or not.  Sometimes during the weaning off process, before you even get down to an every other day dose, he may relapse.  If this happens then the drug dosage has to be raised, probably up to the last dose before the relapse (maybe a little higher, depending on the severity of the relapse) and then start the weaning process again.  If this happens again, then you and your vet may have to settle for keeping him on a low maintenance dose to achieve a good quality of life. A low, every other day maintenance dose of prednisolone is preferred to enable the dog’s liver to rest in between doses. There are many autoimmune diseases that carry a good, drug free prognosis.  The more common, serious autoimmune diseases that may not need long term steroid therapy are: primary immune-mediated polyarthritis, autoimmune haemolytic anaemia and thrombocytopenia. However, as previously stated, all dogs are different and it very much depends on the individual dog, the severity of the disease, the experience of the vet and the vigilance and compliance of its owner.

If a relapse occurs whilst the dog is still being treated then true remission has not been achieved.  If the dog has achieved remission and has enjoyed a period without drugs or is on EOD maintenance drugs, when a relapse occurs or he develops another autoimmune disease, he has encountered a ‘trigger factor’ which has induced this change.

General chat - absolutely anything goes! / Happy New Year
« on: January 03, 2019, 11:05:54 AM »
Wishing you and your dogs a very happy and healthy New year.

All the best


General doggy chat / Merry Christmas!
« on: December 25, 2018, 09:05:02 AM »
Christmas greetings to you all.

Wishing you and your dogs a merry Christmas and a happy and healthy New Year.


Focal GME  or  Granulomatous Meningo-Encephalitis (GME) or MUO (MENINGO-ENCEPHALO-MYELITIS of Unknown Origin)

There are several different of MUO which tend to be breed related. The main types are:
• Granulomatous Meningo-Encephalitis (GME)
• Necrotising Meningo-Encephalomyelitis (NME)
• Necrotising Leuco-Encephalitis (NLE)
• Idiopathic Tremor Syndrome (ITS)

Case history of  Focal GME

24 Feb a totally normal dog and had just started agility 

26 February woke up not responding to voice or touching, eyes wide open no response straight to the vets, bloods taken only thing they found was a very high fat in the blood he started to look a bit normal and sent home no injection just advices to put him on a low fat diet and treatment him like a normal dog, a bit odd but it was the advice

28 February another episode this time he woke up looking out off it and wobbled down the stairs and stopped in the kitchen non responsive staring at nothing and not hearing me or even being touched luckily I took a video of this as how could I explain it to the vets as he was also when I got him to move he was walking into things door frame kitchen bin... off to the vets

On examination he was walking in circles, bumping into things and a head tilt, more bloods again nothing abnormal Just high fat.  The vet scratched his head went off and called the vet who we saw days before.

A referral to Andersonmoore for the next day as they thought it wasn’t an emergency.

Arrived at Andersonmoore and met the vet from Internal Medicine show the videos and history given, they then mentioned his blindness in his left eye news to me.. now feeling worried after more tests they suspect Liver Shunt!

He gets admitted for more bloods etc etc

Next day get a call it’s not Liver Shunt and hes transferred to Neurology for MRI and CSF.. now feeling very sick myself.

Next day the MRI scan comes back abnormal changes and CSF sent away results came back 6 days later.

He was started on antibiotics and prednicare 30 mg per day as a starter till the CSF results arrive. Go and collect him 2 days later and he’s ok just very sleepy. Results back they mentioned Atopica for life or a course of chemotherapy 4 in total, which meant a 2 night stay and every 4 weeks and 4 injections.

I opted for tablets thinking easy option, 75 mg twice a day, this medication was very regimented around an empty stomach and given 12 hrs apart long with 30 mg steroids. But we just got on with it. He to be honest didn’t do much just sleep and being made to being walked.

Next chapter

23 March, back the vets as he’s now being sick and had diarrhoea more antibiotics and sent home

5 April, back to the vets not drinking sent home with a vit b injection and don’t worry he’s just hot but what about the blood in his urine as I thankfully got a sample from him, other advice if hes not better by Monday call Andersonmoore

6 April not drinking or eating called Andersonmoore spoke to his specialist and was advised to rush him back to the vets.... It’s nothing to do with his MUO

Arrive with only what I can describe as a very ill dog showing signs of jaundice admitted and put on a drip and a referral back to Andersonmoore luckily they are only 45 mins away and off we go back this time with Pancreatitis and a 6 night stay and they found a grade 2 heart murmur after his heart scan just to be on the safe side before starting chemotherapy

Everyone put there thinking chaps on scratched their heads and argue over reduce his Atopica start chemotherapy ,

10 April his 1st chemo

12 April came home and drop down to 75 mg Atopica per day

15 April steroids drop to 15mg per day

1 May 2nd chemo and drop down to 10 mg steroids per day

16 May Atopica stopped thank god

29 May last chemotherapy

So far the vet bill is £6500 for the MUO and have £1000 left till next Jan and the chemotherapy on average is £550 per go hence only having 3

His pancreatitis bill was £3750

Happy days 27 June back to Andersonmoore they are over the moon with him and in remission and another drop 5 mg steroids per day

Back on the 9th August and fingers crossed another steroids drop.

They have said because the pancreatitis got involved the treatment plan is “bespoke” and as he is young poor boy is only 20 months and fit in his body they thought it was worth trying.
They have given us the provisional diagnoses of Focial GME (as they can never be for sure unless a brain biopsy is done which can’t be) as he hasn’t had another episode in for months and they say it’s the best of the worst condition

I’m happy with that and thank god he’s insured I thought £7500 was a lot of money and have only £1000 left but with fingers crossed we won’t need it.


Keeper the crazy cocker spaniel X

Note from Jo:  For further reading:  http://www.wear-referrals.co.uk/factsheets/GME&Meningitis.pdf

Vaccination / Vaccination
« on: February 22, 2018, 10:13:04 AM »

I have just joined the CIMDA forum. I hope you can advise me please. I have two toy poodles. Coco is 10 and Candy is 8. Coco is well . Last summer Candy was diagnosed with SLO but the treatment almost killed her. She was on a drip for 2 days. I ceased all meds and she is fine now except for deformed nails.
She is now due annual vaccinations but I am very worried that she may react as she has this autoimmune disease.
The vet advised that she has the Leptospirosis vaccine as this only lasts a year and I  live in the middle of the Norfolk Broads. Apparently the teter  test does  not reveal the lepto situation in a dog.
I am struggling to know what to do.
What do you think?
Regards Glynis

At the moment there seems to be a problem authorising people who want to join the forum.  I apologise for the inconvenience and hope this will be resolved very soon.


General doggy chat / Forthcoming Health Seminar notice 25th Nov 2017
« on: November 10, 2017, 10:08:23 AM »


for The East of England Afghan Club.

To be held at:      Dick White Referral Specialists, Six Mile Bottom, Newmarket.

Saturday 25th November, 2017

These topics are not breed specific, so could be of interest any breed owner.

Tickets cost £15 & can be booked through the club secretary Lynn Hewson at  rekaylahn@hotmail.com. telephone 01536 267892.


10.00 – 10.15   Arrival, Registration and Coffee

10.15 – 10.30  Welcome - Who we are and what Dick White Referral Specialists do  by Rob Foale
10.30 – 11.15  Soft tissue surgery  -  Laryngeal paralysis by Georga T Karba
11.15 – 11:30  Coffee break

11:30 – 12.15   Neurology  -  Investigation and treatment of seizures  by  Giunio Bruto Cherubini
12.15 – 13.00  Respiratory medicine  -  Lung lobe torsion and chylothorax  by  Chiara de Gennaro,  Jon Wray
13.00 - 14:00  Lunch and DWR Tour  by Rob Foale
14:00 – 14:35  Cardiology:  Diagnosis and treatment of canine cardiomyopathy  by Ruth Willis
14.35 -  15.15  Soft Tissue Surgery -  Current thoughts on canine GDV by Fransisco Silviera
15:15 – 15:30  Coffee break

15.30 – 16.15  Internal Medicine - Diagnosis and treatment of hypothyroidism  by Simon Tappin
16:15 – 16:45  Internal Medicine  - Diagnosis and management of insulinomas by  Rob Foale
16.45  - Closing Comments  by Rob Foale




Acidosis – A disturbance of acid base balance leading to an excessive accumulation of acids or loss of bicarbonate.
Anaphylactic (shock) – State of collapse resulting from injection of a substance to which the animal has been sensitized can be deliberate injection or insect sting.
Anorectic/Anorexia – Having no appetite/Loss of appetite.
Ascites – Abnormal accumulation of serous fluid in the abdominal cavity due to interrupted return of blood to the heart, obstruction of the vena cava or portal vein, obstruction of lymphatic drainage or electrolyte imbalance.
Corticosteroids – Any steroid hormone from the cortex of the adrenal gland, or a synthetic drug that mimics their function such as prednisolone.
Edema – Local or generalized abnormal accumulation of fluid in tissues (oedema in the UK).
Ehrlichiosis – Infection with Ehrlichia canis (a rickettsial bacteria) carried by the brown dog tick that attacks the white blood cells (monocytes).
Endo – A prefix that means inside.
Endotoxins – A toxin confined within a bacterium and only released when the bacterial wall is breached.
Enzymes – Complex proteins that act as catalysts and are produced by living cells.  They speed up biochemical reactions without being changed in the process.  They are found most often in digestive fluids. 
Hyper – A prefix that means above hence an excess or higher than normal.
Hypo – A prefix that means under indicating less than or below normal - a deficiency.
Immune-mediated disease – Diseases that are mediated through the immune system.  Either this over-reacts to an external threat (contact dermatitis) or the immune system fails to distinguish self from non self, and attacks the animal’s own body – autoimmune disease eg., autoimmune hemolytic anemia (AIHA) or Addison’s disease.
Immune-mediated thrombocytopenia (ITP) – Autoimmune destruction of the blood platelets a.k.a as idiopathic (of unknown cause) thrombocytopenia (low platelets).
Ischemia/ischemic  - A restriction of blood supply leading to a local and temporary anemia.
Ketones – The end products of fat metabolism.  Their levels will be high when carbohydrates are scarce or not properly used – diabetes mellitus, starvation, high fat diet, pregnancy or after anesthesia.
Ketosis – Significant accumulation of ketones in the body and urine.
Lactic acid – A substance formed by the break down of carbohydrate in the body.  It accumulates in working muscles when production exceeds removal.
Leukemia – Cancer resulting in unrestrained production and growth of white cells and their precursors in the bone marrow and tissues.
Lipemia – An excess of fat in the blood.
Lymph – A normally clear, colorless fluid – becomes milky when laden with fat – similar to blood without red cells, and formed in tissue spaces throughout the body.  It flows through vessels that collect into the thoracic or right lymph ducts and enters the blood in the neck.  It passes through the lymph nodes which remove foreign particulate material especially bacteria from the lymph.  They may also filter out cancer cells.  Lymph is used to carry fat and also protein that is absorbed from the intestines.
Lymph system- Lymphatic system is a network or organs, lymph nodes, ducts and vessels that transport lymph.  Organs include tonsils, thymus gland and spleen.  Its major role is in providing immunity.
Mast cells – These are connective tissue cells containing anticoagulant heparin and histamine granules.  They are part of the normal body defense system against infection and help blood coagulation in injury.
Metabolism/Metabolic -  The sum of all the physical & chemical changes that take place in a living organism,  all the energy and material transformations that occur within living cells./Relating to metabolism.
Microbes – Bacteria, germs producing fermentation, putrefaction and disease.
Morphology – The science of structure and form without regard to function. 
Morphologically – Relating to morphology.
Myopathy – Any striated muscle disease or abnormal condition.
Myositis – Inflammation of the muscle tissue.
Necrosis – Death of tissue or bone surrounded by normal structures, or mass death of tissue as opposed to gradual destruction.  The result of insufficient blood supply, trauma, radiation, chemical agents or toxins.
Nephron – The structural and functional unit of the kidney that achieves filtration, selective secretion and reabsorption to finally produce urine.  There are about a million nephrons in a kidney.
Parvovirus – Viral infection spread by direct or indirect fecal contact.  It primarily affects dogs under a year of age and those that are immunocompromised.  Usually it produces gastrointestinal disease, and destroys the absorptive surface of the intestinal tract.  It also attacks the immune system – lymph nodes, bone marrow.  Bacteria can freely cross the damaged intestinal wall and enter the circulation leading to sepsis.  It is frequently fatal.  A rarer form of the disease attacks the heart muscle of puppies in utero and neonates.and usually results in sudden death.  Still rarer, all of the organs in the neonate or fetus can be destroyed by the virus. 
Peptide – Compounds of two or more amino acid molecules. About twenty amino acids – organic compounds containing both amino and carboxyl radicals - combine to make all the proteins found in the body.  Some amino acids can be made by the body, but some “essential” amino acids have to be consumed in the diet.   
Petechiae/petechiation – small, purplish hemorrhagic spots that appear in skin or mucus membrane due to abnormalities in blood clotting or high fevers./The presence of petechiae.
Portal blood – Blood from the capillaries in the intestinal walls drains into the portal vein and is taken first to the liver.  There nutrients are removed and processed and any toxins absorbed from the digestive system and detoxified and metabolized. 
Pyometra – Infection of the uterus, literally pus in the uterus.
Sepsis – Disease resulting from the presence of microorganisms or their poisonous products in the blood stream.  Usually results in fever.
Urease – An enzyme that catalyzes the breakdown of urea.
Uremia – Toxic condition due to insufficient kidney function and resulting in the retention of nitrogenous waste in the body that would normally be excreted.
Venipuncture – puncture of a vein for any purpose, often used synonymously for phlebotomy - the withdrawal of blood from the vein.

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