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Lymphoma in Dogs

by admin on November 1st, 2017

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What is lymphoma?

 
Lymphoma is a cancer of the lymphatic system. The lymphatic system is, amongst other things, involved in immunity and fighting infections. Lymphoma arises from cells in the lymphatic system called lymphocytes which normally travel around the body, so this form of cancer is usually widespread. Lymph nodes (sometimes called lymph glands) are part of the lymphatic system and are located all over the body. Lymphoma can affect some or all of the lymph nodes at the same time. It may be possible to feel or see affected lymph nodes that are near the body surface (as shown in the picture) – they usually feel big and firm. Lymph nodes deeper inside the body are also often involved, as well as internal organs such as the liver, spleen, and bone marrow. This widespread involvement is not like tumour spread in other types of cancer.

 
Lymph nodes you can feel:
1 Submandibular: under the jaw
2 Prescapular: in front of the shoulder
3 Axillary: in the armpit
4 Inguinal: in the groin
5 Popliteal: behind the knee

 

What tests will my dog have?

The diagnosis of lymphoma is usually confirmed by taking a sample from a lymph node, either by fine needle aspirate or biopsy. Fine needle aspirate of a superficial lymph node is a quick, simple procedure using a needle (similar to those used for booster injections) to collect cells from the node. It causes minimal discomfort and is normally carried out while a patient is awake or under mild sedation. In some cases we need to take a biopsy, involving the removal of a larger sample of tissue – this may be carried out under a general anaesthetic. These tests allow a very accurate assessment of the tumour by a specialist looking at the samples under a microscope.

To allow evaluation of internal lymph nodes and organs, patients usually have X-rays and an ultrasound scan. Mild sedation is usually required for these procedures, as we need our patients to be very still. Blood sampling is also performed to assess a patient’s general health status.

In some cases we will recommend taking samples of bone marrow to investigate whether or not cancer cells are present in the bone marrow. This procedure is carried out under a short general anaesthetic.

All the diagnostic information we obtain allows us to give an accurate prognosis and to discuss appropriate treatment options.

 

Can lymphoma be treated?

The simple answer is yes. It is very uncommon for lymphoma to be cured, but treatment can make your dog feel well again for a period of time, with minimal side effects. This is called disease remission, when the lymphoma is not completely eliminated but is not present at detectable levels.

Without treatment, survival times for dogs with lymphoma are variable, depending on the tumour type and extent of the disease, but for the most common type of lymphoma the average survival time without treatment is 4 to 6 weeks. With current chemotherapy regimes such as the so-called Madison Wisconsin protocol, the average survival time is approximately 12 months.

Treatment options will be discussed in detail on an individual patient basis. Options include:
 
Steroid treatment (Prednisolone):
By itself, this increases average survival times to 1 to 3 months, but it does not work in all cases. It will also make subsequent treatment with chemotherapy less successful.

 
Chemotherapy:
using medications to stop or hinder cancer cells in the process of growth and division.

 

What does chemotherapy involve?

 
On each treatment day, before receiving chemotherapy, your pet’s progress is discussed, together with us performing a full physical examination and blood tests. Following this assessment, chemotherapy doses are calculated and the drugs are administered either subcutaneously (under the skin), intravenously (into a vein) via a catheter, or orally.

Chemotherapy with the Madison Wisconsin protocol involves your pet having chemotherapy treatments weekly for nine weeks (with a one week break), then fortnightly up until 6 months (i.e. 25 weeks in total). At 6 months, if your dog is in remission, therapy will be discontinued. Chemotherapy can be restarted when a patient relapses i.e. when lymphoma comes back. Patients are individuals, so the response varies from case to case, and because of this, all patients receiving chemotherapy are carefully monitored and protocols adjusted to suit the individual.

 

What are the potential side effects of chemotherapy and how can they be minimised?

Side effects can be seen because chemotherapy agents damage both cancer and normal rapidly dividing cells. Normal tissues that are typically affected include the cells of the intestine, bone marrow (which makes the red blood cells, white blood cells and cell fragments involved in blood clotting called platelets) and hair follicles. Hair loss is uncommon in dogs having chemotherapy, but it can be seen in certain breeds that have a continuously growing coat, such as Poodles and Old English Sheepdogs (cats rarely develop hair loss, but may lose their whiskers). Hair usually grows back once chemotherapy is discontinued. Damage to the cells of the intestines can result in changes in appetite or stool consistency and occasionally vomiting. Damage to the bone marrow reduces blood cell production, particularly infection fighting white blood cells (neutrophils).

Steroids are often used in combination with chemotherapy. These medications can make patients feel that they want to eat and drink more (especially during the first week of therapy when doses are usually higher and given every day). Patients should not have their access to drinking water restricted, but it is important not to increase their food intake, as excess weight gain can be problematic. The increased thirst is associated with increased urination, so patients may also need to go out to pass urine more often.

Cyclophosphamide, one of the commonly used chemotherapy agents, can cause irritation to the lining of the bladder, producing cystitis-like signs, so it’s important to bring urine samples when requested and to monitor your pet’s urination very carefully, and to promptly report any signs of problems.

Epirubicin, another chemotherapy agent, can cause damage to the heart muscle over time. The more doses your dog has, the greater the risk. For this reason, we will carry out checks on the heart before the drug is given for the first time and at various points during the treatment course. Heart complications are extremely uncommon and your dog is at much greater risk if the lymphoma is not treated.

We prescribe medications to help to prevent complications, and we will advise you on which signs to monitor. Compared to human patients who receive chemotherapy, pets experience fewer and less severe side effects, and these can usually be managed at home. This is because we use lower drug doses and do not combine as many drugs as in human medicine. Your pet’s quality of life is really important to us and to you.

 

What precautions do I need to take at home, with my pet having chemotherapy?

Chemotherapy agents can be excreted in the urine and faeces, and care must be taken when handling your pet’s waste. You will be advised of appropriate precautions, and it is important to note explicitly that pregnant women should avoid contact with the pet’s waste following chemotherapy.

 

What should I look out for?

Signs of gastrointestinal upset: if your pet has vomiting or diarrhoea for more than 24 hours please contact us or your usual vet. Also watch for any dark coloured faeces.

Signs of bone marrow suppression: Neutrophils (infection fighting white blood cells) are at their lowest point usually 5 to 7 days after treatment. If your pet is depressed, off its food, panting excessively or is hot to the touch at this time, please contact us.

Signs of bladder problems: you should alert us if your dog is urinating more frequently than he or she has been, is straining or having difficulty passing urine, or if you see blood in the urine.

 

What will happen in the future?

Unfortunately, chemotherapy for lymphoma is very unlikely to cure your pet, but will allow a good quality of life to be enjoyed for some time.

Inevitably, the cancer cells become resistant to the drugs we use, and the cancer will come back. At this stage, it is often possible to get the cancer back under control for a while with alternative agents (this is known as a ‘rescue’ treatment). Eventually, the tumour cells will become resistant again and it is likely that your pet will have to be put to sleep when his or her quality of life deteriorates.

Hopefully, this will be after many happy months of good quality life for your pet and you to enjoy together.

 

Lymphoma in Dogs

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Canine Mast Cell Tumours

by admin on October 4th, 2017

Category: News, Tags:

Mast cells are normal cells found in most organs and tissues of the body, and are present in highest numbers in locations that interface with the outside world, such as the skin, the lungs and the gastrointestinal tract (stomach and bowels). They contain granules of a chemical called histamine which is important in the normal response of inflammation. When mast cells undergo malignant transformation (become cancerous), mast cell tumours (MCTs) are formed. Mast cell tumours range from being relatively benign and readily cured by surgery, through to showing aggressive and much more serious spread through the body. Ongoing improvements in the understanding of this common disease will hopefully result in better outcomes in dogs with MCTs.
 

Why do dogs get Mast Cell Tumours (MCTs)?

This is unknown, but as with most cancers is probably due to a number of factors. Some breeds of dog are predisposed to the condition, and this probably suggests an underlying genetic component. Up to 50% of dogs also have a genetic mutation in a protein (a so-called receptor tyrosine kinase protein) which inappropriately drives the progression of mast cell cancer cells.
The role of these receptor tyrosine kinases in canine MCTs is very interesting and also important in understanding the role and mechanisms of the newer drugs available for treating canine MCTs: the tyrosine kinase inhibitors (see Treatment Options).
 

Where in the body do MCTs occur?

The vast majority of canine MCTs occur in the skin (cutaneous) or just underneath the skin (subcutaneous). In addition, they are occasionally reported in other sites, including the conjunctiva (which lines the eyeball and eyelids), the salivary glands, the lining of the mouth and throat, the gastrointestinal tract, the urethra (the tube from the bladder), the eye socket and the spine.
 

Breed predisposition

Some breeds of dog are predisposed to getting mast cell tumours, amongst them are:

  • Australian Cattle Dog
  • Beagle
  • Boston Terrier
  • Boxer
  • Bull Terrier
  • Bullmastiff
  • Cocker Spaniel
  • Dachshund
  • English Bulldog
  • Fox Terrier
  • Golden Retriever
  • Labrador Retriever
  • Pug
  • Rhodesian Ridgeback
  • Schnauzer
  • Shar-Pei
  • Staffordshire Terrier
  • Weimaraner
  •  
    Some breeds tend to get MCTs more commonly in certain locations, but more importantly MCTs sometimes behave in a certain way in certain breeds. For example, Pugs are renowned for getting large numbers of low-grade (less aggressive) tumours, and Golden Retrievers commonly get multiple tumours. Boxers with MCTs are generally younger than other breeds, and more commonly have lower-grade MCTs with a more favourable prognosis. In contrast, Shar-Pei’s usually get aggressive high-grade and metastatic (spread to other sites) tumours, often at quite a young age. MCTs in Labrador Retrievers are also frequently more aggressive than in other breeds.

    Age
    The average age of dogs at presentation is between 7.5 and 9 years, although MCTs can occur at any age.

    Paraneoplastic syndromes and complications of granule release
    Cancerous mast cells contain 25 to 50 times more histamine than normal mast cells. Histamine is a very inflammatory chemical, and therefore explains why some MCTs wax and wane or suddenly increase in size due to inflammation – especially after they have undergone biopsy/needle aspiration (see diagnosis). Histamine also causes the stomach lining to produce more acid – this can result in stomach ulcers, causing signs such as vomiting or black, tarry stools (this appearance is due to the presence of digested blood coming from the ulcer).

    The outlook (prognosis) –
    Can we predict whether a dog will do well or not do well due to their MCT? No single factor accurately predicts the biological behaviour or response to treatment in dogs affected by MCTs. Various clinical factors can influence the outcome, such as whether it has spread, potentially the breed and also the tumour location. Tumours in the nail bed, inside the mouth, on the muzzle, in the groin area and in those sites where the skin meets mucus membranes (mucocutaneous junctions), are often correlated with a worse prognosis than those in other parts of the body, although this is not always the case.The single most valuable factor in predicting the outcome for most patients is the grade of the tumour when assessed under a microscope (the histological grade).
     

    How is MCT diagnosed?

    Cytology – This means looking at the cells under a microscope, and the sample for this is usually obtained by ‘fine-needle aspirate’. Fine-needle aspirates of MCTs involve taking a small sample of the tumour with a thin needle. This is generally a straightforward procedure which can be done conscious and without sedation in most patients. It should be performed prior to any surgery, because a pre-operative diagnosis of MCT influences the type and extent of surgical intervention required.

    Biopsy - This involves taking a larger piece of tumour tissue and sending it away to a pathologist for analysis. This can be performed to help decide on the best treatment, or it can be performed when the tumour has been removed to find out the grade of the tumour.The pathologist looks at the sample of the tumour under the microscope and performs grading to indicate how aggressive the tumour is.

    MCT grade and outlook (prognosis)

    Low grade (grade 1) tumours and around 75% of intermediate (grade 2) tumours are cured with complete surgical excision. Unfortunately, most high grade (grade 3) tumours and around 25% of intermediate grade tumours have already spread by the time they are diagnosed (even if this spread cannot be detected on scans at the time of diagnosis). These cases benefit from chemotherapy treatment. In some dogs, further analysis of the biopsy samples is useful in determining the best management options. The tumour grade is very important in determining the appropriate therapy for dogs with MCTs.

    Further investigations – ‘staging’ of the MCT

    As well as performing fine needle aspiration and biopsies of the MCT to determine its grade, additional tests may be required to determine the stage of the tumour i.e. whether or not it has already spread. These further tests can include sampling of nearby lymph nodes, chest X-rays and abdominal ultrasound scanning. Which tests are performed will depend on a number if factors, and these will be discussed with you by the specialist.

    Treatment options

    Surgery is the cornerstone of management of MCTs, and complete surgical removal is often curative in dogs with low or intermediate grade MCTs. However, to achieve a cure, in some circumstances a significant amount of tissue surrounding the tumour must be excised to ensure that all the tumour cells are removed. This can require a high level of surgical experience and expertise, in order to perform complex reconstructive surgical techniques and may require referral to a specialist.

    If complete removal is not possible, or where the tumour appears to be more aggressive (e.g. high-grade) then radiation therapy and chemotherapy treatments become more useful. The optimum treatment depends on the tumour grade, stage and other factors unique to the individual dog.

    Chemotherapy can be used:

  • before surgery to shrink a tumour down
  • after surgery if the tumour appears more aggressive on analysis of a biopsy
  • as palliative treatment if a tumour cannot be removed, has already spread or if an owner does not want to pursue surgical intervention.
  •  
    Fortunately, the drugs used for chemotherapy in MCTs are extremely well tolerated and most owners are very happy with their dog’s quality of life on treatment. A new group of drugs called tyrosine kinase inhibitors is also available – these block proteins (called tyrosine kinases) which are found on the surface of cancerous mast cells. They can be used where tumours cannot be surgically removed or have recurred despite previous treatments. They can have some side effects, but most dogs tolerate these drugs well.

    In some instances referral may be recommended to an RCVS Recognised Specialist in the fields of both medical and surgical oncology. The expertise provided by a combination of medical and surgical cancer specialists has particular advantages in MCT treatment.
     

    Summary

    Dogs have a unique risk to develop MCTs in the skin, and they can be frustrating to manage, even for specialist oncologists.

    Knowing what the best treatment is for an individual dog depends on knowing the grade of the MCT and whether or not it has already spread.

    It is important to recognise that most dogs can survive for a long time with mast cell cancer and can be cured. However, some dogs have a more aggressive type of MCT and treatment in these cases is of a more palliative nature, trying to improve patient comfort and life expectancy, but without being able to achieve a cure.

    If you have any queries or concerns, please do not hesitate to contact us.

    MCT Dog Nose'

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    Glaucoma

    by admin on August 31st, 2017

    Category: News, Tags:

    What is glaucoma?

    Glaucoma is an increased pressure inside the eye, caused by an obstruction to the drainage of the fluid from within the eye. In order to keep the eye inflated, fluid is normally produced and cleared away from the eye all the time. The fluid inside the eye is not related to the tear fluid (which is on the surface of the eye).

    The blockage of fluid drainage within the eye can be due to an inborn defect (primary glaucoma) or due to another eye disease that interferes with drainage of the fluid inside the eye (secondary glaucoma). Common causes of secondary glaucoma are inflammation inside the eye or a shift of the position of the lens within the eye.

     

    Is my dog at risk?

    Many cases of primary glaucoma are inherited and due to an abnormally formed drainage passage within the eye. Affected breeds include the Basset Hound, Welsh Springer Spaniel, Cocker Spaniel, Siberian Husky, Great Dane, the Flat Coated Retriever and many others. Often one eye is affected initially but there is a high risk that the other eye will follow at some point in the future.
    A test (gonioscopy) is available to determine the predisposition of your dog to develop glaucoma. In this test, a special contact lens is applied to the eye to allow assessment of the structure concerned with drainage of fluid from the inside of the eye.

     

    What are the signs of glaucoma?

    In most cases, the disease develops very rapidly. The patient is often depressed and reluctant to exercise. The eye becomes blind and appears red, painful and sore with a bluish tinge over the cornea. Less commonly, the pressure increase is slow and the clinical signs are not as pronounced. However, a gradual reduction in vision is often noticed.

     

    How is glaucoma diagnosed?

    A special instrument called a tonometer is used to measure the pressure inside the eye. Local anesthetic is applied to the eye for this test which is usually very well tolerated.

     

    Is treatment possible?

    The aim of treatment in glaucoma is to preserve vision and to relieve the pain caused by the pressure increase. In order to reduce the pressure within the eye, drugs are given to reduce fluid production within the eye and to improve removal of fluid from the eye. In some cases of secondary glaucoma (see previously mentioned), treatment of the underlying cause, such as anti-inflammatory medication or removal of a dislocated lens, can lead to the pressure decreasing.

    Patients with primary glaucoma are more difficult to treat and it is important to realise that no cure for the disease exists. In some patients, pressure control can be achieved with medical treatment only. However, with time, most patients become less responsive to the treatment and surgical alternatives may have to be considered. These include laser therapy or the surgical placement of a drainage implant into the affected eye.

    Regular check ups will also be necessary to re-assess the second eye and check its pressure.

     

    Is preventative treatment available for the second eye?

    No preventative treatment is available that can totally stop glaucoma developing in the second eye. However, there is evidence that with the help of medication, the onset of the condition in the second eye may be delayed.

     

    What happens if the pressure cannot be controlled?

    Eyes that have lost vision but continue to have an increased pressure are a cause of chronic pain for the patient. Removal of the eye must be considered in such cases to ensure the welfare and comfort of the patient. Occasionally, both eyes may, unfortunately, be lost. Should this be the case, most dogs will adapt very well to being blind and continue to lead a good quality life.

    Glaucoma

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    Syringomyelia

    by admin on August 1st, 2017

    Category: News, Tags:

    Syringomyelia is a relatively common condition, especially in breeds like the Cavalier King Charles Spaniel and the Griffon Bruxellois, in which it is suspected to be an inherited disorder. Other names that have been used to describe this condition include syringohydromyelia, Arnold-Chiari or Chiari-like malformation, and caudal occipital malformation.

     

    What is syringomyelia and what causes it?

    Syringomyelia is a neurological condition where fluid filled cavities develop within the spinal cord (the bundle of nerves that run inside the spine). The most common reason for the fluid build-up is that there is an abnormality where the skull joins onto the vertebrae (the bones of the spine) in the neck, causing fluid in the brain (called cerebrospinal fluid or CSF) to be forced down the centre of the spinal cord, where it causes the tissues to become distended and cavities to form.

     

    What are the most common signs of syringomyelia?

    Clinical signs or symptoms can vary widely between dogs and there is no relation between the size of the syringomyelia (cavity in the spinal cord) and the severity of the signs – in other words a dog with severe fluid build-up can have relatively mild symptoms, and vice versa. The most common symptom that develops is intermittent neck pain, although back pain is also possible. Affected dogs may yelp and are often reluctant to jump and climb. They may feel sensations like ‘pins and needles’ (referred to as hyperaesthesia). Another common sign is scratching of the neck and shoulder region called ‘phantom scratching’, as there is generally no contact of the foot with the skin of the neck. Occasionally dogs become weak or wobbly if there is significant damage to nerves within the spinal cord. Cavalier King Charles Spaniels will typically show clinical signs between 6 months and 3 years of age. Not all dogs with syringomyelia will show signs of pain or other clinical symptoms, so the presence of syringomyelia can be an incidental finding on an MRI scan or specialised X-rays, when neurological investigations are being performed.

    Other neurological conditions, such as slipped discs (cervical and thoracolumbar disc disease), can mimic the signs of syringomyelia and it is important for us to rule them out before concluding that your pet is suffering from syringomyelia.

     

    How can syringomyelia be diagnosed?

    The best method of diagnosing syringomyelia is an MRI scan of the brain and spine. It is necessary to perform this investigation under a general anaesthetic. The scan and anaesthetic are safe procedures. In the future it is possible there will be a genetic test to identify dogs with syringomyelia.

     

    How can syringomyelia be treated?

    Medical therapy is usually the treatment of choice in dogs suffering from syringomyelia. Several types of medication are used to manage episodes of pain, including a drug called gabapentin. This drug is safe, with few side effects apart from possible sleepiness. Other medications that may be used include anti-inflammatory drugs, corticosteroids and drugs that reduce the production of fluid in the brain and spinal cord.
    Occasionally medical management is unsuccessful and surgery needs to be considered. The aim of surgery is to improve the shape of the back of the skull and reduce the flow of fluid down the centre of the spinal cord. Many dogs will improve following surgery, although some patients will have persistent signs despite surgery, whereas others may show improvement initially but then develop recurrence of their symptoms.

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    Disc Disease in Dogs

    by admin on July 4th, 2017

    Category: News, Tags:

    Dachshunds and similar breeds such Pekingese, Lhasa Apsos and Shih Tzus, have short legs and a relatively long back. These breeds suffer from a condition called ‘chondrodystropic dwarfism’. As a result they can be prone to back problems, more specifically disc disease.

     

    What are intervertebral discs?

    The intervertebral disc is a structure that sits between the bones in the back (the vertebra) and acts as a shock absorber. The structure of a disc is a little like a jam doughnut with a tough fibrous outer layer (annulus fibrosus) like the dough, and a liquid/jelly inner layer (nucleus pulposus) like the jam.

    In chondrodystrophoid breeds like dachshunds, the discs undergo change where the nucleus pulposus changes from a jelly-like substance into cartilage. Sometimes the cartilage can mineralise and become more like bone and show up on an x-ray. In these breeds, this change occurs in all discs from approximately one year of age and is considered part of usual development for these dogs. This change in the discs is a degenerative process and predisposes the disc to disease.

    The most common type of disc disease in dachshunds and other chondrodystrophoid breeds is ‘extrusion’. This is where the annulus fibrosus ruptures and allows the leakage of the nucleus pulposus into the spinal canal. An analogy we often use is the jam leaking from a jam doughnut when it is squeezed.

     

    What are the signs of disc disease in dachshunds and other breeds?

    The first evidence that there might be a problem is that your dog may be in pain. This may consist of yelping and/or a hunched back and more subtle signs such as quietness and inappetence (lack of appetite). Back pain is commonly mistaken for abdominal pain.

    After pain there may be mobility problems. The first thing to occur is wobbliness of the hind limbs – termed ‘ataxia’. After this, weakness can develop with the wobbliness, which is termed paresis. Subsequently, the patient may lose control of the back legs altogether and not be able to walk. If there is no movement in the hind limbs this is ‘paralysis’.

     

    Will my dog need to be referred to a specialist?

    Spinal disease can sometimes be difficult to manage and your dog may be referred to a specialist. At the referral clinic, your dog will be assessed by the specialist neurologist or neurosurgeon. They will test various reflexes to decide where they think the issue may be. They will perform a clinical examination which will assess for other disease processes and look for any areas of pain. One thing that is important to assess is the presence of pain sensation. We call this ‘deep pain sensation’. To assess this, the specialist will pinch your dog’s toes, usually with fingers initially but it may need to be with forceps. This is not a pleasant test to perform but it is necessary as the presence of deep pain comes with a more favourable prognosis. The loss of deep pain sensation means the prognosis is worse and without surgery is considered very poor.

     

    What investigations will be performed?

    After the clinical examination, we will generally have a good idea where the problem is and the next step is to confirm the diagnosis. The best way of diagnosing disc disease is with MRI (magnetic resonance imaging) or CT (computed tomography). With MRI we get detailed information about the soft tissue such as the disc itself and the spinal cord. Computed tomography uses the same technology as x-ray and provides good information about the bone and mineral structures and can tell us where the lesion is and whether or not surgery is indicated.

     

    How is disc extrusion treated?

    If a disc extrusion – the ‘jam out of the doughnut’ scenario – is diagnosed then we can opt for conservative care or surgical management.

    Conservative care is a non-surgical management and can be considered in dogs where the signs are mild or intermittent and when there is only mild compression of the spinal cord. It can also be considered if there are concerns regarding the cost of surgery.
    Surgical treatment involves making a window through the bone structures of the vertebra, into the spinal canal, a procedure called a ‘hemilaminectomy’. Once into the spinal canal, the disc material (nucleus pulposus) is removed and the spinal cord is decompressed. Surgical treatment tends to give a speedier and more predictable recovery and is often considered the treatment of choice, where indicated.

     

    What is the prognosis for a dog with disc disease?

    When dealing with spinal injury, particularly from disc disease, we aim for patients to achieve a functional recovery. This means the patient is pain free, is able to get around on their own (although they may still be wobbly) and able to toilet themselves unaided. Whether a patient will return to normal or whether there will be residual deficits is down to the individual.

    The prognosis for patients who have intact deep pain sensation is favourable, with most patients (80-90%) achieving a functional recovery. In patients without deep pain sensation, the prognosis is guarded, with only 50% of cases achieving a functional recovery but without surgery the prognosis for a functional recovery is approximately 5%.

    Surgery tends to speed recovery and aid early pain control. We expect most patients to recover within the first 2 weeks after surgery, with a smaller number of patients taking longer (2-6 weeks). If there is no improvement after 6 weeks the prognosis becomes more uncertain and long term disability may be present. This occurs in approximately 1 in 10 patients.

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    Mycoplasma in Poultry

    by admin on May 30th, 2017

    Category: News, Tags:

    The ‘Head Cold’ of the Poultry World

    As more and more pet owners are keeping poultry we felt it appropriate to look at one of the most common infections that may be seen.

    The main culprit of Mycoplasma infection in backyard poultry is Mycoplasma gallisepticum. This is one of the organisms that makes up the colloquially-termed ‘chronic respiratory disease syndrome’ (potentially in association with Infectious Laryngotracheitis) in poultry worldwide. It is considered to be responsible for some of the greatest economic losses throughout commercial flocks around the globe, but can just as easily impact on smaller backyard flocks.

     

    Who catches Mycoplasma, and how?

    Poultry, including chickens and turkeys, are most often presented with respiratory issues involving Mycoplasma gallisepticum, but a wide range of other birds including pheasants and wildfowl can be affected.

    Mycoplasma gallisepticum can be spread vertically (from hen to egg) leading to infected chicks, or, and perhaps more commonly, through horizontal transmission (bird to bird). The disease can be spread short distances through the air as an aerosol, or on shoes/water drinkers/feeders. The disease itself may remain dormant within the infected bird for potentially months before causing any overt clinical disease. It is often at this stage that rapid spread of the disease occurs throughout a flock.

     

    What does Mycoplasma in poultry look like?

    Focusing on the presenting signs of poultry, the degree of clinical signs can vary widely from no apparent signs up to the potential death of the bird in more aggressive, complicated disease development.

    The more common presenting signs can include:

    • Rales (clicking, rattling, or crackling noises)
    • Coughing
    • Nasal discharge
    • Discharge from around the eyes
    • Swelling under the eyes

    In more advanced cases, sinusitis may become apparent.

    There may also be more generic signs of illness present including the birds appearing fluffed up, off food, keeping themselves away from the rest of the flock and reduction in egg production or going off lay completely.

    Clinical signs are often quicker to develop and more severe in turkeys than chickens.

     

    Can Mycoplasma in poultry be treated?

    Mild to moderate disease can be treated successfully with appropriate antibiotics prescribed by your vet, pain relief and good nursing management (TLC!). It is important to note however that once your bird/flock has suffered from the disease, it likely to circulate and be present from thereon in. This becomes an important factor when either bringing in new birds or selling/moving your own birds.

    Chickens, as well as most other birds, will suffer a much more marked immune ‘crash’ when stressed in comparison to other animals. This means that when birds are moved to a new location or mixed with other birds, the stress can induce a marked reduction in their active immunity causing a rapid onset of disease symptoms (sneezing, coughing, etc.).

    Due to the risk of disease spread amongst new birds, it is absolutely vital to quarantine any incoming birds for at least 3-4 weeks to ensure that you are not putting your own birds at risk of disease.

     

    Prevention is better than cure!

    Vaccinations are available against certain strains, but use of a vaccine must be with caution as quarantine procedures would still always be advised, and any new birds bought in would have to have been vaccinated. The danger with vaccinating poultry is that all too often it is seen as an easily-achievable blanket cover for disease. Good biosecurity, involving washing boots, is important. Always thoroughly disinfect items that are brought in or taken off the holding containing your particular birds.

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    Brachycephalic Obstructive Airway Syndrome (BOAS)

    by admin on May 1st, 2017

    Category: News, Tags:

    ‘BAOS: Too much soft tissue and not enough space’

    Brachycephalic breeds are those with squashed up faces! We love them and they are great characters but selective breeding over many generations has encouraged the skull to be progressively shorter over time. However, the amount of soft tissue in the nose and throat has remained the same. These soft tissues include the soft palate, turbinates (cartilage inside the nose) and tongue. These are all crammed into a smaller space. In addition, a lack of underlying nasal bones also causes the nostrils to become very narrow appearing like small slits instead of open holes.

     

    Breathing problems

    The crowding of this tissue inside the nose and the back of the throat obstructs airflow through the upper airways. This is why many of these dogs are forced to breathe through their mouth and pant. In an attempt to draw air in through this cramped space many affected dogs will put much more effort into their breathing. This is why if you watch these patients closely you will see them using their abdominal muscles as bellows during breathing. A good analogy for this is comparing how difficult it would be to suck through a very narrow straw compared to a normal one.

     

    The ‘knock-on’ effects of laboured breathing

    Unfortunately, the increased effort creates a suction effect in the back of the throat at the opening into the trachea (windpipe). This opening into the windpipe is called the larynx (or voice box in people). It has a tough cartilage frame which keeps it open wide. However, constant suction in this region over a period of months can cause it to fold inwards further narrowing the airway and causing serious breathing difficulty. This secondary problem is called laryngeal collapse.

     

    What about the nose?

    The nose is an important part of the anatomy and it functions to warm and humidify the air before it is inhaled into the lungs. It is a crucial part of how dogs maintain a normal body temperature. If affected dogs can’t breathe through their nose then this significantly affects their ability to thermoregulate and explains why they have poor heat tolerance. Of course, it is no surprise that many patients present with breathing problems in the summer months.

     

    What are the clinical signs of Brachycephalic Obstructive Airway Syndrome (BOAS)?

    The main clinical signs in approximately increasing the order of concern include:

      • Loud snoring during sleep
      • Noisy breathing (especially during excitement or exercise)
      • Panting
      • Poor ability to exercise
      • Heat intolerance
      • Choking on food
      • Regurgitating
      • Laboured breathing
      • Development of blue gums or tongue
      • Fainting

     

    Aren’t some of these signs just ‘Normal’ for the breeds?

    Yes and no. The problem is that a large number of brachycephalic dogs show the signs at the milder end of the above spectrum and our tolerance of what is normal for these breeds has become skewed. We frequently see patients coming into our clinic for unrelated problems with marked breathing difficulty. When questioned their owners often state that they consider these signs as normal for the breed. They often add that most other dogs of the same breed that they come across on walks sound and react the same which reinforces this notion! Therefore it is important that we get the message across that these signs are abnormal and if your dog is displaying some of them then a veterinary opinion should be sought.

     

    Be proactive!

    A proactive approach is beneficial as there are many surgical treatments which can be carried out that will help these patients breathe. Although these treatments will not produce a ‘normal’ airway it will invariably improve airflow, thus improving their quality of life and ability to exercise. The latter is particularly important as obesity makes this problem significantly worse. Intervention early in life can reduce the amount of suction at the back of the throat and therefore reduce or delay the development of secondary laryngeal collapse for which there are limited options available.

    See the excellent new film on BAOS by the Kennel Club on Youtube entitled ‘Dog Health: What Is Brachycephalic Obstructive Airway Syndrome?’

    'BAOS'

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    Epilepsy in Dogs

    by admin on April 1st, 2017

    Category: News, Tags:

    Epilepsy means repeated or recurrent seizures or “fits” due to abnormal activity in the brain. Electrical activity is happening in the brain all the time however in some patients an additional and abnormal burst of electrical activity can occur which causes a fit. Some dogs will just have one fit but in others it becomes a regular event – this is Epilepsy. It is important to realise that Epilepsy is not a disease in itself but the sign of an abnormal brain function. The most commonly diagnosed form of epilepsy is referred to as Primary Epilepsy and is more common in certain breeds. Epilepsy does occur in cats but is much less common.

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    Are all fits the same?

    No and as It is very likely your vet won’t see the fit taking a short video can be extremely helpful to them in deciding on the best course of action. Many types of seizure have been described in dogs and cats. The most common type is the grand mal which is the dramatic, typical fit where the patient lies on the floor and the whole body twitches and convulses rhythmically. Partial epileptic seizures that affect only one part of the body can also occur. These are less common and can be difficult to differentiate from other unusual non-epileptic movement disorders.

    The seizure frequency is extremely variable between dogs (from many seizures a day to a seizure every few months). Despite being born with this functional brain disorder, dogs with primary epilepsy usually do not start seizuring before the age range of 6 months to 6 years. In the absence of disease affecting the brain, animals are typically normal in between the epileptic seizures.

     

    What causes epilepsy?

    The exact mechanism is unknown but in many cases the tendency to develop epilepsy is thought to be passed on genetically. In Primary epilepsy there is no obviously abnormal brain tissue and it is due to a chemical imbalance or to some ‘faulty wiring’ in the brain.

     

    What is Secondary Epilepsy?

    Secondary epilepsy is when the fits are being caused by another brain disorder such a brain tumour, an inflammation or infection of the brain (encephalitis), a brain malformation, a recent or previous stroke or head trauma. In other words there is an identifiable cause for the regular fits and there is some structurally abnormal brain tissue.

     

    How is Epilepsy diagnosed?

    The diagnosis of primary epilepsy is unfortunately a diagnosis of exclusion after elimination of other causes. There is no definitive diagnostic test for this condition and all investigations such as blood tests, brain scans and laboratory analysis of the cerebrospinal fluid (CSF), which surrounds the brain and spinal cord, will all come back as completely normal!

     

    Can you cure epilepsy?

    Primary Epilepsy is unfortunately a condition that the animal is born with and as such it cannot be cured. Using anti-epileptic medication such as phenobarbitone will prevent some patients having any more fits. Although complete control is the goal of treatment, in most circumstances ‘successful treatment’ is a balancing act of reducing the frequency and severity of the seizures to a low level whilst avoiding unacceptable side effects of the drugs. So a patient may still have some fits despite being on treatment.

     

    When should medication be started?

    This isn’t a black and white issue. A substantial number of dogs will only have one fit in their entire lifetime and so if every dog was started on treatment after its first fit then all these dogs would be receiving medication unnecessarily. However, there is some evidence to suggest that early treatment offers better long-term control of the seizures as compared to animals that are allowed to have numerous seizures prior to the onset of treatment.  We also have to take into account that anti-epileptic medications can have side effects and getting things under control will often place significant demands on you as the pet owner and carer.

     

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    Elbow Dysplasia in Dogs

    by admin on March 1st, 2017

    Category: News, Tags:

    Elbow Dysplasia simply means ‘abnormal development of the elbow joint’. The term Elbow Dysplasia includes a number of specific primary problems that affect different sites within the elbow joint. These include:
      • Elbow Dysplasia'Osteochondrosis or osteochondritis dissecans(OC or OCD)
      • Fragmented coronoid process (FCP)
      • Ununited anconeal process (UAP)

    These conditions may be related to a poor fit between the three bones that make up the elbow joint. This poor fit or ‘incongruity’ can be seen on X-rays or by CT or MRI examination. In some patients, it may be difficult to identify because it is only present when the dog does certain activities, and sometimes this poor fit may have been present briefly during the dog’s development and is no longer present when investigations are performed.

    These primary problems tend to develop when the puppy is only a few months of age and will commonly affect both elbow joints. Once a primary problem has started, secondary change soon follows. Secondary change takes the form of abnormal joint wear and arthritis. These secondary changes may have consequences for the rest of the dog’s life.

     

    Are certain breeds prone to getting Elbow Dysplasia?

    Elbow Dysplasia is a significant problem in many breeds worldwide. It is recognised in numerous breeds although large breeds seem to be most affected – particularly Labrador Retrievers, Newfoundlands, Golden Retrievers, Boxers, Rottweilers and German Shepherd Dogs. As investigation methods have improved we are increasingly recognising it in smaller breeds too.

     

    Why do dogs get Elbow Dysplasia?

    Elbow Dysplasia is a multifactorial disease which means that a number of factors influence its occurrence. Genetics plays an important role although the precise genetic basis of Elbow Dysplasia remains undetermined. Other factors that are thought to influence the disease include growth rate, diet, and level of activity.

     

    How do I know if my pet has Elbow Dysplasia?

    Not all dogs with Elbow Dysplasia will show obvious clinical signs of lameness. This may be because the condition is mild or because similar changes exist in both elbows which may mask the lameness. Clinically affected dogs with Elbow Dysplasia commonly show stiffness or lameness between 5 and 12 months of age. Typically owners describe that their dog is stiff after rest and after exercise but improves with light activity. Others will observe that their dog’s front feet begin to turn out. It is thought that this is an adaptation to elbow pain and is the dog’s way of relieving it.

     

    What tests may be required?

    Clinical examination may determine that the elbow joint is painful or swollen, although initially, the lameness may be difficult to localise to a particular joint. Confirmation of the diagnosis of Elbow Dysplasia is made by performing further investigations which would typically be X-rays or CT examination. X rays will often be able to determine whether your dog has elbow dysplasia either by identifying the primary problem or the osteoarthritis that occurs as a result. Three bones (humerus, radius, and ulna) combine to form the elbow joint and these overlap on radiographs. This makes identification of the primary lesion problematic in some cases.

    Elbow radiographs and CT/MRI scans are important tests for detecting elbow dysplasia in dogs. CT/MRI examination is an excellent method of looking at the detailed structure of the joint and determining the precise nature of Elbow Dysplasia. It provides additional information to radiography and this can be useful when planning surgical treatments, especially in more complex cases.

     

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    Head Tilt In Dogs

    by admin on February 1st, 2017

    Category: News, Tags:

    What does it mean if my dog has a Head Tilt?

    A persistent head tilt is a sign of a balance (vestibular) centre problem in dogs. It is very similar to ‘vertigo’ in people and is often accompanied by a ‘drunken’ walk and involuntary eye movements, either side to side or up and down.

    The feeling that the room is spinning due to the eye movements is what causes a feeling of nausea in both people and dogs. The signs may not be as severe as mentioned here and can just consist of a mild head tilt. Signs often seen associated with a head tilt but unassociated with balance abnormalities include a facial ‘droop’ and deafness.

    Causes of a head tilt

    A head tilt represents a disorder of the balance centre. However, the balance centre resides in the inner bony portion of the ear as well as the brain. So a head tilt could represent a simple ear problem or a very serious brain disease.

    Ear problems which are responsible for head tilts include:

    • Infections
    • Polyps
    • Reactions to topical drops or solutions if the ear drum is damaged
    • Hits to the head
    • (Occasionally) ear tumours
    • (Rarely) a genetic abnormality affecting puppies, especially those of the Doberman breed
    • Idiopathic vestibular disease

    The most common cause is what is called idiopathic vestibular disease. There is no known cause of this disease, a variant of which is also seen in people. The signs can start very suddenly and be accompanied by vomiting in severe cases. This condition, however, will resolve given time without any specific treatment.

    Brain diseases responsible for balance centre dysfunction can include:

    • Tumours
    • Trauma
    • Inflammation
    • Stroke
    • Rarely, similar signs can be seen in dogs that are receiving a specific antibiotic called metronidazole. Recovery will often take place within days of stopping this medication

    Clinical signs of vestibular disease – is it the ear or is it the brain?

    In addition to a head tilt, signs of vestibular disease (balance centre dysfunction) include ataxia (a drunken, falling gait) and nystagmus (involuntary eye movements). There are several signs to look for which help separate out whether the origin of the disease is inner ear or brainstem (Central Nervous system – CNS).

    Central nervous system localisation will often be associated with weakness on one side of the body that can manifest as ‘scuffing’ or even dragging of the legs, in addition to lethargy, and sometimes problems eating and swallowing, or loss of muscle over the head.

    A balance problem associated with an inner ear disease is not likely to be associated with any of these signs. However, some dogs will exhibit a droopy face and a small pupil on the same side as the head tilt.

     

    Tests recommended for a dog with a head tilt

    Evaluation of an animal with a head tilt includes physical and neurologic examinations, routine laboratory tests, and sometimes x-rays. Your veterinary surgeon may carry out a thorough inspection of the ear canal, which may require sedation of your dog – this can be useful to rule out obvious growths or infections. Additional tests may be recommended based on the results of these tests or if a metabolic or toxic cause is suspected. Identification of specific brain disorders requires imaging of the brain, such as magnetic resonance imaging (MRI). Collection and examination of cerebrospinal fluid, which surrounds the brain, is often helpful in the diagnosis of certain inflammations or infections of the brain.

     

    How do we treat head tilt in dogs

    Treatment for vestibular dysfunction will focus on the underlying cause once a specific diagnosis has been made. Supportive care consists of administering drugs to reduce associated nausea and/or vomiting. Travel sickness drugs can be very effective. These must only be given following advice from your veterinary surgeon. Protected activity rather than restricted activity should be encouraged as this will potentially speed the improvement of the balance issues.

     

    Outlook (prognosis) for head tilt in dogs

    The prognosis depends on the underlying cause. The prognosis is good if the underlying disease can be resolved and guarded if it cannot be treated. The prognosis for animals with an idiopathic vestibular disease is usually good because the clinical signs can improve within a couple of months.

    Dog with head tilt

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