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Head Tilt In Dogs

by admin on February 1st, 2017

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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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Myaesthenia Gravis in dogs

by admin on January 3rd, 2017

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In this article, we will look at an important but quite rare cause of muscular weakness and collapse in dogs…Myasthenia Gravis.

 

What is myasthenia gravis?

Myasthenia Gravis (pronounced my-as-theen-ia grar-viss) is a possible cause of generalised weakness in dogs and occasionally cats. It also occurs in humans.

 

What happens in myasthenia gravis?

Nerves work like small electrical cables. They pass an electrical current into the muscles to make them contract or shorten. The nerve doesn’t directly stimulate the muscles to contract; instead, it releases a chemical into a small gap that exists between the end of the nerve and the outer lining of the muscle. This gap is called the neuromuscular junction. The chemical that is released is called a neurotransmitter and in most of our muscles this neurotransmitter is a chemical called acetylcholine. It is packaged into tiny pockets at the end of the nerve and it is released when a nerve impulse comes along.

In a fraction of a second the acetylcholine spurts out from the end of the nerve and sticks to the outer membrane of the muscle. This allows a small electrical current to flow into the muscle and the muscle contracts. To create this effect the acetylcholine must attach to a specific receptor on the muscle surface. This can be likened to a lock and a key opening a door. The lock is the receptor and the key is the acetylcholine. The two fit together perfectly and a microscopic door in the muscle wall then opens to allow the electrical current into the muscle cell. It has to be an exact fit so that the muscle only contracts when the nerve ‘tells’ it to.

In myasthenia gravis this chemical transmission across the neuromuscular junction becomes faulty and if the muscles are unable to contract properly they then become weak. Muscle weakness can affect the limbs so that animals are unable to stand or exercise normally but can also affect other muscles in the body. The muscles of the oesophagus (the pipe carrying food from the mouth to the stomach) are often weak in dogs with myasthenia gravis and this means that affected animals may have problems swallowing and often bring back food after eating.

 

What causes myasthenia gravis in dogs?

Some animals are born with too few acetylcholine receptors on the surface of their muscles i.e. it is a congenital disease. More commonly however, myasthenia gravis is an acquired condition that comes on later in life and here it is caused by a fault in the animal’s immune system.

Antibodies usually attack foreign material such as bacteria and viruses. In acquired myasthenia gravis, the immune system produces antibodies which attack and destroy the animal’s own acetylcholine receptors. No-one really knows why the immune system should suddenly decide to attack these receptors in some dogs. In rare cases, it can be triggered by cancer.

Whatever the reason, when the number of receptors is reduced, acetylcholine cannot fix itself to the muscle to produce normal muscle contractions and muscle weakness results.

 

How do I know if my pet has myasthenia gravis?

The typical picture is a severe weakness after only a few minutes of exercise. This weakness might affect all four legs or only affect the back legs. It is frequently preceded by a short stride, stiff gait with muscle tremors. The patient eventually has to lie down. After a short rest they regain their strength and can be active again for a brief period before the exercise-induced weakness returns. Other signs of myasthenia are related to effects on the muscles in the throat and include regurgitation of food and water, excessive drooling, difficulty swallowing, laboured breathing and voice change. In the most severe form, the animal can be totally floppy and unable to support its weight or hold its head up.

 

Which dog and cat breeds are most commonly affected?

The acquired form is seen most commonly in Akitas, terrier breeds, German Shorthaired Pointers, German Shepherd Dogs and Golden Retrievers. In cats it is Abyssinians and a close relative, Somalis. The rare congenital form has been described in Jack Russell Terriers, Springer Spaniels and Smooth-haired Fox Terriers.

 

What conditions can it be confused with?

Diseases of the muscles (a myopathy) or nerve disease (a neuropathy) can mimic signs of myasthenia gravis and should be considered in the diagnosis.

 

How is myasthenia gravis diagnosed?

Your vet will often be very suspicious based on the clinical signs and medical history alone. A blood test can be performed to detect antibodies directed toward the acetylcholine receptor. Another test that is sometimes performed is known as the ‘Tensilon test’. Here the patient is given a short-acting antidote that boosts the effects of acetylcholine on the muscle. It is injected into a vein and in patients that have myasthenia gravis there will be a dramatic increase in muscle strength immediately after injection and collapsed animals may get up and run about. However, the effects wear off after a few minutes.

In specialist centres an electromyogram (EMG) may be performed. An EMG machine can be used to deliver a small electrical stimulation to an individual nerve or muscle in an anaesthetised animal. Using an EMG machine we can measure how well the muscles respond to stimulation.

The rare congenital form of myasthenia is usually diagnosed by special analysis of a muscle biopsy.

Chest X-Rays will also be performed to look for cancer in the chest cavity which can trigger myasthenia gravis. The chest x rays will also help to evaluate possible involvement of the oesophagus and to detect pneumonia secondary to inhalation of food.

 

Can myasthenia gravis be treated?

Specific treatment of myasthenia gravis is based on giving a long-acting form of a drug that works like the Tensilon in the test described above. These chemicals boost the effects of acetylcholine on the muscle cells and improve the transfer of the electrical signal from the nerves to the muscles. It may also be necessary to give drugs that will suppress the immune system to stop it attacking the acetylcholine receptors. This will make the patient more susceptible to infections and so they would require careful monitoring whilst on immunosuppressive drugs, particularly with the increased risks of pneumonia is myasthenia patients.

 

What is the outlook for dogs and cats with myasthenia gravis?

The outlook is generally good unless the patient develops a secondary severe pneumonia due to the inhalation of food material. Treatment usually lasts many months and your vet will need to re-examine your pet on a regular basis to check that they are improving. Repeated blood tests to measure the levels of the antibodies against the acetylcholine receptors will also be required.

Myasthenia gravis is a serious and very debilitating disease. However, with an early diagnosis and a high level of care the symptoms may be controlled so that your pet has an active life. Some patients may make a full recovery.

Akita

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POISONS PUT LITTLEHAMPTON PETS IN PERIL

by admin on December 1st, 2016

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Poisons put Littlehampton pets in peril, as 95% of vets report cases.

Fitzalan House Vets warn local pet owners to guard against poisonous perils after the British Veterinary Association’s (BVA) Voice of the Veterinary Profession survey showed 95%of South-East region companion animal vets had seen cases of toxic ingestion or other toxic incidents over the last year.

Across the UK, vets saw on average one cases of poisoning every month, with chocolate (89%), rat poison (78%) and grapes (60%) the most common poisons that vets had treated. Other poisons involved in the cases vets had seen included:

• Human non-steroidal anti-inflammatory drugs, such as high-dose aspirin (57%)
• Antifreeze (47%)
• Lilies (43%)
• Slug pellets (41%)
• Accidental overdose of prescribed veterinary medicines (34%)
• Inappropriate application of permethrin (flea treatment) (30%)
• Paracetamol (26%)
• Adder bites (21%)
• Mouldy food (10%)
• Detergent (10%)
• Blue green algae (8%)
• Other medicines, such as antidepressants or nicotine products (9%)
• Recreational drugs (4%)

Other less common cases involved xylitol poisoning from chewing gum, poisoning from wild mushrooms and fungi, as well as horse worming products ingested by dogs.

Vets know that sometimes owners can take every precaution and accidents still happen. If an owner suspects their pet may have ingested or come into contact with any harmful substance they should contact us immediately on 01903-713806 for advice.

BVA President Gudrun Ravetz said:
“These findings from BVA’s Voice of the Veterinary Profession survey show how common incidents of pet poisoning are and underline that owners must be vigilant especially with prying pets. The top five poisoning cases seen by vets include foods that are not toxic to humans but which pose a significant risk to pets such as dogs, like chocolate and grapes, alongside other toxic substances such as rat poison and antifreeze. Owners can take steps to avoid both perils – keep human food away from and out of reach of pets and make sure other toxic substances and medicines are kept securely locked away in pet-proof containers and cupboards.”

 

 'PET POISONS'

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Corneal Ulcers in Dogs and Cats

by admin on November 3rd, 2016

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Corneal ulcers are defects of the ‘cornea’, the clear ‘window’ of the eye.

 

What is the cornea?

The cornea is a very special tissue that is completely transparent. In contrast to the skin, it lacks pigment and even blood vessels to maintain its transparency. The cornea is very rich with nerves, making it a very sensitive tissue. This is the reason why even small particles such as dust on the surface of the eye can be so uncomfortable.

The cornea is made of three layers:

  • a very thin outer layer (epithelium)
  • the thick middle layer (stroma)
  • a very thin inner layer (endothelium)

All three layers are important for the cornea to work. The outer layer or ‘epithelium’ can be thought of as a layer of cling film that forms the surface of the cornea and protects it from infections. It works as a shield to the eye. The thick middle layer or ‘stroma’ is what gives the cornea its strength and stability.

 

What are corneal ulcers?

Corneal ulcers are classified by the depth, depending on the layers they affect. Corneal Ulcer

If only the epithelium is missing this is classified as a ‘superficial ulcer’ or surface defect only. If the ulcer reaches into the stroma it is classified as a ‘deep ulcer’.
corneal ulcer

While superficial or surface ulcers are uncomfortable and present a risk of infection to the eye; the eye is not at risk of bursting unless additional problems occur. However when the ulcer gets deep the eye becomes weak and can even perforate. Deep ulcers lead to visible indentations on the surface of the eye and can be accompanied by inflammation inside the eye.

Signs of corneal ulcers usually include eye pain (squinting, tearing, depressed behaviour) and ocular discharge, which can be watery or purulent. Sometimes a lesion may already be visible on the surface of the eye. In this case it is particularly important to seek help from your veterinary surgeon as soon as possible.

 

How is a corneal ulcer diagnosed?

To diagnose a corneal ulcer your vet may use a special dye that highlights any defects of the surface layer by staining the underlying tissue green (see the image at the start of this article). This test is called the fluorescein test.

 

Why do corneal ulcers occur?

When the presence of an ulcer has been confirmed, it is important to try and find a reason for it. Most ulcers occur due to an initial trauma. This is more likely to happen in dogs and cats with very prominent eyes (also called ‘brachycephalic’ animals), for example in Pugs and Pekingese dogs or Persian cats. In cats the flare up of a Feline Herpes Virus infection is also a common cause for the development of a corneal ulcer. Many conditions can increase the risk of corneal ulcers. Reduced tear production is a common contributing factor, but other conditions such as an incomplete blink, in-rolling of the eyelid (also called ‘entropion’) or eye lid tumours may contribute to the occurrence, but even more so may interfere with the healing process.

 

How are corneal ulcers treated?

To treat an ulcer it is essential that the underlying cause is identified and if possible corrected. This will stop the ulcer from getting worse and allow the eye to heal as quickly as possible. The treatment plan will usually include eye drops to treat or prevent infection but may include other medication depending on the cause and severity of the ulcer. Painkillers and/or antibiotics by mouth may also be necessary.

 

Do any corneal ulcers require an operation?

If an ulcer is deep or the cornea is even ruptured, surgery is required to save the eye. Different techniques are available, but all of them place healthy tissue into the defect to stabilise the cornea. Very small suture material, as thin as a human hair, is used to repair the cornea and an operating microscope should be used to handle the small and very fine structures of the eye.

In most patients the healthy tissue is taken from the same eye from an area adjacent to the corneal ulcer.

The pink tissue next to the cornea (the conjunctiva) can be used for that to place a ‘conjunctival pedicle graft’ into the defect. More commonly, healthy corneal tissue attached to conjunctiva is used as it provides more strength to the wall of the eye. This is called a ‘corneoconjunctival transposition’ (Figure 5).

Corneal grafts are also possible but rely on the often limited availability of donor corneal tissue. Grafting surgeries are very successful in saving eyes, but can lead to scaring of the cornea leaving it less transparent in areas.

 

How can corneal ulcers be prevented?

Particularly in patients with prominent eyes, regular eye examinations should be performed to detect weaknesses in the corneal health. Indications of that may include white or brown marks on the surface of an otherwise comfortable eye or sticky discharge that continues to recur. Any painful eye should be presented to a veterinary surgeon as soon as possible.

Eyes may be cleaned with tap water that ideally should be boiled and cooled down again, using a lint-free towel. This should however not replace or delay the visit to a veterinary surgeon, as many ulcers require medication to achieve fast healing and prevent ill effects to the transparency of the cornea and therefore the sight of the dog or cat. Particularly; if a deep indentation or bulging tissue is noted on the surface, the eye should not be manipulated to prevent any additional damage.

Corneal ulcers are best prevented but if they are present they should be treated as soon as possible to stop them from getting bigger and deeper.

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Addisons Disease

by admin on October 7th, 2016

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Adrenal glands

 

What is Addison’s disease?

Hypoadrenocorticism (or Addison’s disease as it is more commonly known) is a disease where the body does not produce enough steroid hormone. Steroids in the body are primarily produced by the two adrenal glands which are found in the abdomen close to the left and right kidneys. The main steroid hormones produced by the body are called aldosterone and glucocorticoid.

Aldosterone is important in the maintenance of normal salt and water balance in the body. Glucocorticoids have widespread effects on the management of proteins and sugars by the body.

Glucocorticoid release from the adrenal glands is under the control of a substance produced in a gland in the brain called the pituitary gland. Aldosterone release is regulated by a hormone system and by blood potassium levels.

 

What causes Addison’s disease?

Addison’s disease is normally caused by destruction of tissue of the adrenal gland.In the majority of cases the destruction does not have an identifiable underlying cause (this is called ‘idiopathic disease’).In most cases the adrenal glands stop producing both aldosterone and glucocorticoid (known as ‘primary hypoadrenocorticism’). Occasionally, only glucocorticoids are lacking (known as ‘atypical hypoadrenocorticism’).

Sometimes Addison’s disease occurs in combination with diseases of other glands such as hypothyroidism (this is a disease that causes thyroid hormone levels in the blood stream to be low).

 

Which animals are at greater risk of developing Addison’s disease?

Addison’s disease is a rare disease in the dog; however, it probably occurs more often than is recognised. It is a very rare disease in the cat. Any breed of dog can be affected with Addison’s disease but a predisposition has been shown in Nova Scotia Duck Tolling Retrievers, Bearded Collies, Portugese water dogs and Standard Poodles. In addition Great Danes, Rottweilers, West Highland White Terriers and Soft Coated Wheaten Terriers appear to be at greater risk. Addison’s disease appears to be a disease of the young and middle-aged dog. Approximately 70% of dogs with naturally occurring Addison’s disease are female.

 

What are the signs of Addison’s disease?

Presenting signs in Addison’s disease vary from mild to severe and do not typically focus attention on any one major body system. The presentation of sudden onset Addison’s disease (the so called ‘Addisonian crisis’) is collapse and profound dullness. Some patients have a slow heart rate. Addison’s disease is easily confused with many other diseases. The presenting signs in longer standing disease are vague and may include vomiting, reduced appetite, tiredness, weight loss, diarrhoea, increased thirst and increased urination.

 

How is Addison’s disease diagnosed?

Blood tests can sometimes reveal characteristic changes in salt levels. Kidney numbers can also be elevated and mild anaemia (low red blood cells) is not uncommon. The salt changes occur as a result of a deficiency of aldosterone and subsequent effects on the way the kidney normally handles these salts. The salt changes, specifically a high blood potassium level, can have serious effects on the heart.

A definite diagnosis of Addison’s disease is made by your veterinary surgeon performing an ACTH stimulation test on your dog’s blood. This is a test where blood is taken, a drug (ACTH) is given to try and stimulate the adrenal gland and then a second blood test is taken one hour later. If the adrenal gland fails to respond to the drug, Addison’s disease is diagnosed.

 

What is the treatment for Addison’s disease?

The immediate treatment of life-threatening Addison’s disease involves the careful administration of fluids (‘a drip’) into the blood stream. Steroids are replaced by injection into the vein.

Once animals are stable they were traditionally gradually moved onto tablet medication. Most animals with Addison’s disease would have been discharged with prednisolone and fludrocortisone. Long term, the majority of animals were managed with fludrocortisone alone and this drug is given once or twice daily. The fludrocortisone dose often needs to be increased with time. In times of stress or illness (veterinary visits, bonfire night, boarding etc) animals will often need a dose of prednisolone in addition to their fludrocortisone and your veterinary surgeon will advise you on what to do in these situations.

Side effects of fludrocortisone can include increased drinking, increased urination, panting and muscle wastage.

Recently a new injectable medication (desoxycortisone pivalate) has become the first veterinary licensed product available for Addison’s disease and is used in place of fludrocortisone. It is intended for long term administration at intervals and doses dependent upon individual response as evaluated by regular blood tests.

 

What is the outlook for dogs with Addison’s disease?

Once animals are on appropriate therapy, they will require regular veterinary appointments for re-assessment and monitoring. The outlook for many dogs with Addison’s disease is very good with appropriate monitoring and treatment.

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Hyperthyroidism in Cats

by admin on September 1st, 2016

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What is hyperthyroidism?

Hyperthyroidism is a relatively common disease of the ageing cat. It is typically the result of a benign (non-cancerous) increase in the number of cells in one or both of the thyroid glands. The thyroid glands are located in the neck although there is occasionally additional tissue within the chest. In the image the red shapes indicate approximately where the thyroid glands are located in a cat. The result of enlargement of the thyroid glands is an increased production of thyroid hormone within the body. Thyroid hormone controls the rate at which cells in the body work; if there is too much hormone, the cells work too fast. Despite many years of research the exact cause of hyperthyroidism remains unknown.

Cats fed almost entirely canned food have been reported to have an increased risk of developing hyperthyroidism but it is likely that there are many causes.

HYPERTHYROID in cats

What signs do cats with hyperthyroidism get?

Hyperthyroidism is a disease of middle aged to older cats with an average age of onset of 12-13 years. Increased drinking and increased urination, weight loss, increased activity, vomiting, diarrhoea and increased appetite are often reported. Physical examination often reveals a small lump in the neck which represents an enlarged thyroid gland.

 

How is hyperthyroidism diagnosed?

A diagnosis of hyperthyroidism is made by the demonstration of increased levels of thyroid hormone in the blood stream. Thyroxine (T4) measurement is the initial diagnostic test of choice.

 

How is hyperthyroidism in cats managed?

  • Medical treatment with either carbimazole or methimazole. These tablet medications are given once or twice daily lifelong. Side effects are uncommon but can occur. They include vomiting and reduced appetite. Very occasionally severe bone marrow or liver problems can be seen.
  • Dietary treatment. A specific prescription diet can be fed to hyperthyroid cats to control the disease. The diet is very low in iodine. Iodine is an essential component of thyroid hormone and less dietary iodine means less thyroid hormone is produced. The diet must be fed exclusively (i.e. the cat must eat no other food). Dietary treatment does not lower the thyroid hormone levels as much as the other treatment options
  • Surgical treatment. One or preferably both thyroid glands are removed with an operation. A short period of treatment with tablets is recommended prior to surgery. Anaesthesia can be a risk in older cats with hyperthyroidism that possibly have other concurrent diseases. There is a risk of a low blood calcium level after surgery if the parathyroid glands are removed with the thyroid glands. This can be a very serious problem if it is not recognised. Signs of a low blood calcium level can include facial rubbing, fits, tiredness, reduced appetite and wobbliness. Low blood calcium levels are relatively easily managed with oral medication and treatment is rarely necessary lifelong.
  • Radioactive iodine treatment. Radioactive iodine is concentrated in the thyroid gland and destroys excessive thyroid tissue. The drug is given by injection under the skin. After the injection, cats need to spend 2-4 weeks in an isolation facility whilst they eliminate the radioactive material. Owners are not able to visit their pets whilst they are in isolation.
  • Hyperthyroidism can mask underlying kidney problems and these can become apparent after treatment. Blood tests will be necessary to assess kidney function as well as the thyroxine level during/after treatment.

Can dogs get hyperthyroidism?

Dogs are rarely affected by hyperthyroidism and when it occurs in this species it is normally the result of a diet problem or cancer of the thyroid gland. Treatment for dogs with cancer of the thyroid gland can involve one or a combination of surgery, radioactive iodine, radiation therapy and chemotherapy. Unfortunately many dogs have advanced disease by the time the cancer is identified. The majority of dogs with thyroid cancer are not hyperthyroid; they typically retain normal thyroid function or become hypothyroid.

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Chronic Inflammatory Bowel Disease (IBD) in Dogs

by admin on August 1st, 2016

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Chronic inflammatory enteropathy (or CIE) is a disease that causes inflammation of the bowel. It has some similarities to a human disease called Crohn’s disease. The inflammation can affect any or all of the stomach, small bowel and large bowel (colon).

What are the signs of chronic inflammatory bowel problems in dogs?

Gastrointestinal (bowel) signs are considered chronic when they have been present for three weeks or more and often clinical signs will come and go. The most common signs associated with gastrointestinal tract disease in dogs include vomiting and diarrhoea. It is important to remember that diarrhoea is a term used to describe altered stool frequency as well as altered stool consistency. Blood and mucus are sometimes seen mixed with the stool. Abdominal pain, ‘squeaky’ guts (this is called ‘borborygmi’) and wind can also be seen. Some cats with chronic inflammatory bowel disease will have no vomiting or diarrhoea and their main sign will be reduced appetite.

IBD

What causes chronic inflammatory enteropathy in dogs?

The gastrointestinal signs seen in chronic inflammatory enteropathy arise due to inflammation of the wall of the intestines and/or stomach. The initial cause of the inflammation is often unknown; environmental and genetic factors are thought to play a role along with an abnormal response of the body’s immune system that normally fights infection. Chronic inflammatory enteropathy is generally considered to be an ‘idiopathic’ disease (i.e. a disease with no known underlying cause). The diagnosis is one of exclusion and the diagnosis can only be made if other possible causes of the signs have been excluded.

Chronic inflammatory enteropathy is not a single disease process but it is actually a catch-all term applied to a number of diseases with similar signs. It encompasses food responsive disease (FRD), antibiotic responsive diarrhoea (ARD) and inflammatory bowel disease (IBD).

  • Food responsive disease is diagnosed when a dog or cat has clinical signs of gastrointestinal tract disease that responds to dietary modification.
  • Antibiotic responsive diarrhoea is the term used when gastrointestinal tract signs respond to antibiotic(s) and relapse when antibiotics are stopped. The immune system is thought to have an exaggerated response to ‘normal’ gut bacteria in patients with this disease. It is important to note that antibiotics are not normally indicated in sudden (acute) onset diarrhoea.
  • Inflammatory bowel disease has a complex set of underlying causes. It is diagnosed with bowel biopsies that are normally taken with the aid of a camera (endoscope) meaning that surgery is not necessary. It is normally managed with steroid therapy.

Which breeds can be affected by chronic inflammatory enteropathy?

Chronic inflammatory enteropathy can occur in any breed of dog, but certain breeds such as German Shepherds, Soft-coated Wheaten terrier and Irish Setters are known to have an increased risk. It is typically a disease of the middle aged dog but any aged dog can be affected. Cats can also get CIE.

How is chronic inflammatory enteropathy diagnosed?

Chronic inflammatory enteropathy in dogs is normally diagnosed on the basis of history, blood tests, abdominal imaging (typically an ultrasound scan) and sometimes camera evaluation of the upper and/or lower bowel.

How are chronic inflammatory bowel problems in dogs treated?

Dependent upon the severity of the presenting signs, a change in diet may be the first treatment undertaken by your vet. Generally diet trials are performed using a diet that contains a single protein source or one where the proteins are broken down to such a small size (hydrolysed) that they are not recognised as ‘foreign’ by the immune system in the bowel. Some vets prefer to use a single protein source that the patient is unlikely to have been exposed to before (i.e. duck or venison). The diet is normally fed for a minimum of two to four weeks but many dogs respond sooner. If the signs respond to dietary therapy, a diagnosis of food responsive disease is made and dietary therapy is continued long term.

If patients fail to respond to a diet trial or only partially respond, antibiotics may be trialled. If the signs respond, a diagnosis of antibiotic responsive diarrhoea is made.

If the animal’s clinical signs persist despite dietary change or antibiotic therapy, or if the clinical signs are particularly severe, camera examination of the bowel will be performed. This is called endoscopy and the procedure is always done under general anaesthesia in animals. Small biopsies are taken from the bowel during this procedure. Assuming inflammation is identified on the biopsies, a diagnosis of inflammatory bowel disease is made. Inflammatory bowel disease is managed with drugs that suppress the immune system’s exuberant response. A steroid called prednisolone is often the first choice medication in both dogs and cats. Additional medications such as ciclosporin and chlormabucil are sometimes used.

What is the outlook for chronic inflammatory bowel disease in dogs?

The outlook for patients with chronic inflammatory enteropathy is dependent upon the severity of the signs and the response to treatment. Many patients will experience intermittent flare ups of their disease long term despite therapy but these are typically milder and shorter in duration once animals are receiving appropriate treatment. Unfortunately a very small proportion of dogs with IBD have disease that is not responsive to drug therapy.

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Episodic Weakness and Collapse

by admin on July 1st, 2016

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Dog sore foot

What is Episodic weakness and collapse?

Essentially, ‘episodic weakness and collapse’ refers to involuntary falling over!  Dogs are more commonly presented to veterinary surgeons with this problem than cats. Syncope (pronounced sin-coh-pea) is the technical term for fainting when the patient temporarily loses consciousness. Collapse, such as fainting, may be completely benign and require no treatment. However, in some circumstances it is due to a life-threatening situation that requires a specific treatment.

Remember these conditions are both Involuntary (the patient has no control over them) and intermittent or ‘episodic’ and the patient may be completely normal between bouts. There are no seizures or fits as we see in Epilepsy. Also, before starting our investigations, we need to be as sure as possible that involuntary collapse is truly occurring. If a dog is choosing to lie down, for instance because of tiredness or heat exhaustion, or because of feeling faint after pulling hard on the lead this is not collapse.

What causes episodes of weakness, collapse or fainting?

The causes are many and varied and can involve:

  • The airways
  • The heart and blood vessels
  • The nervous system – brain, spinal cord, peripheral nerves
  • The muscles, bones and joints
  • A malfunction of one or more chemical processes occurring in one of a number of body organs (these are usually referred to as ‘Metabolic’ causes).

To further complicate matters there are plenty of potential causes of collapse within each of these broad categories. So, what might seem to be a relatively ‘simple’ clinical presentation can turn into the proverbial search for a needle in a haystack when it comes to finding out the cause of the problem.

Investigations can therefore be costly, frustrating and extremely time consuming for all concerned. For example, it is quite common for blood samples to be sent to more than one specialist laboratory and some of these may be outside the UK. Finally getting all the results together can take several days or even weeks. It can be a trial of patience waiting for such tests but it is better to wait for accurate results than to choose a more rapid but less helpful alternative.

How can pet owners and carers help in getting to a diagnosis?

Getting to a diagnosis is clearly very important so we know how to treat effectively. You can help your vet a lot in this regard! It is often very helpful if video footage of the events occurring can be provided as sometimes this may show important information which to the untrained eye may not be obvious. Your vet may well not see the event you are concerned about as by their very nature these are intermittent events.

It is very helpful to know the following:

  • What a pet is doing just before he or she collapses
  • What he or she does during the collapse
  • What he or she does after the collapse

Your vet will then want to perform a thorough clinical examination. Ideally, the information you provide and the results of your vet’s examination will give diagnostic ‘clues’ as to which direction in which to look first. If these findings make one particular cause of collapse more likely than others then this gives a far better chance of determining the cause. A problem arises where signs are vague and do not allow us to ‘home in’ on a particular group of possibilities. In these circumstances unfortunately investigation needs to be very broad-based and we would start by evaluating for the most common causes of collapse.

How is collapse investigated?

There is no single test that will evaluate the patient for all causes of collapse. Tests are picked on an individual basis according to how valuable the clinician expects the test to be in a particular case. This is why the intial information and history is so important because it will help the clinician to be more specific with the tests performed and therefore more likely to discover the cause.

Each case is different but investigations will often involve

1. Blood tests to look for metabolic causes

2. Assessment of the heart by an electrocardiogram (ECG), an echocardiogram (heart ultrasound) and chest x-rays.  In some patients where an intermittent electrical abnormality is suspected, the patient will be fitted with a device to perform an ECG for 24 hours in an effort to ‘catch’ the irregular heart rhythm. This special ECG device is called a Holter monitor and it is connected to sticky pads which adhere gently to the skin to allow the rhythm of the heart to be recorded for extended periods of time and even at home.

If these tests are normal then further testing depending on the remaining clinical possibilities is indicated. Sometimes further tests may be advised straight away or in some instances it may be worth performing these after a delay both to make sure that the problem is persisting and also to allow some time for further ‘clues’ pointing to a particular diagnosis to develop.

Is a specific diagnosis always found?

In some instances, despite lengthy and thorough investigation, no cause of the collapse is found. The same is also true in human medicine. Sometimes this may be because the cause is either benign or occurring so rarely that the cause is not caught ‘in the act’. Other causes of collapse may remain undiagnosed because some potential causes are simply not possible to evaluate in dogs and cats, particularly tests that in humans would require a period of voluntary bed rest – clearly this is not possible to achieve in a dog or cat.

How is Episodic weakness and collapse treated?

This completely depends on identifying the cause. Appropriate treatment is then instigated.

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Management of Atopic Dermatitis in Dogs and Cats

by admin on June 1st, 2016

Category: News, Tags: Tags: , , ,

Dog sore foot

Last month we explained what atopic dermatitis is and how it is diagnosed. In this article we consider how atopic dermatitis can be managed in affected dogs and cats.

 

Can I cure atopic dermatitis?

In one word “No”, but you can manage the condition successfully. Atopic dermatitis in dogs and cats can be compared to asthma in people. Asthma can’t be cured but it can be managed; and just like asthma the management of atopic dermatitis is life-long. It is therefore important to put in place measures that are going to have the least side-effects for your pet in the long term that will provide him/her a good quality of life and that are the most cost effective and affordable for you.

 

How can I manage the condition?

You need to take a multi-step approach to managing atopic dermatitis. These steps include:

  • Treatment and prevention of infections
  • Medications to stop the itch
  • Treatment that modulates the immune system
  • Nutritional supplements
  • Topical treatments
  • Unfortunately some treatments work some of the time but not all the time and so you may need to switch treatments periodically. Some treatments may result in undesirable side effects and so may need modification.

Management options:

 

1) Treatment and prevention of infections:

Any bacterial (mostly staphylococcal) and/or yeast (Malassezia) infections should be treated at the outset. Antibiotics for bacterial infections need to be administered for 7 – 14 days beyond clinical cure and the duration of treatment is generally determined by the depth of the pyoderma.

For yeast infections a shampoo containing either 2% chlorhexidine/2% miconazole or one containing 3% chlorhexidine have shown good efficacy and will suffice; however, if the infection is severe your vet may opt to prescribe antifungal tablets. Because there is a tendency for infections to recur it is best to bath your pet once or twice a week on a regular basis, which will keep the microbial load on the skin low and thus help reduce the frequency of infections.

 

2) Stopping the itch:

Glucocorticoids (steroids) will stop the itch in most cases, but need to be used with caution, especially if used for a long time. In the short term they can increase water intake, increase urination and appetite. Some owners and pets find these side effects distressing. In the long term they can affect almost any organ in the body, therefore, even when well tolerated, they should be used with caution and your pet should be monitored regularly. Topical steroid containing sprays and ointments may be useful for targeted areas but with long term use thinning of the skin, infections and systemic side effects can occur.

Cyclosporin is used to damp-down (modulate) an over-reacting immune system in an atopic pet. One starts with a high dose and then tapers it down to alternate day, or better still twice a week, treatment. The most common side effects with ciclosporin are vomiting and diarrhoea. In some dogs, gingival hyperplasia and papillomas may also occur.

Oclacitinib is another immunomodulating drug which specifically targets the pathway that results in an itch. It is effective and can stop itching rapidly. This is the newest drug on the market and the reported side effects are vomiting and diarrhoea in a small number of cases. It can be used both short term and long term; however, given that this drug has now been on the open market for only a few months (at the time of writing this) it should be used with caution as side effects with prolonged use are not known.

Antihistamines; the response to this group is variable and they are often used in combination with steroids in order to reduce the steroid dose.

 

3) Immune Modulation:

Allergen specific immunotherapy is the most specific treatment for Atopic Dermatitis. It involves either an injection, or an oral dose of the allergens your pet is allergic to, to modulate the immune system. It has responses ranging from roughly 33% where there is complete cessation of itch, to 33% improving but requiring additional treatments, to 33% where there is no response. If your pet responds well to immunotherapy, it is likely to have the least adverse side-effects and to be the most cost effective treatment in the long term.

 

4) Nutritional support:

Omega -3 and Omega -6 essential fatty acids help the skin function by altering the lipid barrier and by reducing inflammation. On their own they are unlikely to benefit your pet but can be helpful when combined with other treatments. Diets that are high in essential fatty acids (EFAs) also help.

 

5) Topical treatments:

Moisturisers containing ceramides help maintain the skin barrier, which in turn reduces the penetration of allergens and therefore your pet’s reaction to them. Bathing with an oatmeal based shampoo can also help relieve itching and re-hydrate the skin.

Atopic dermatitis is a lifelong condition that requires life-long management; and often more than one type of treatment will be required. So, when your vet chooses a treatment, it should be efficacious, suitable for your pet with the least side effects, easy for you to administer and affordable. Most of all it/they should improve your pet’s (and your) quality of life.

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Atopic Dermatitis

by admin on May 2nd, 2016

Category: News, Tags: Tags: , , ,

Sore skin dog belly

What is atopic dermatitis?

Many of you will have been told by your vet that your pet has atopic dermatitis, but what is it? Atopic dermatitis is the visible sign of a hypersensitivity (allergic) reaction; specifically a reaction to something (called an allergen) in your pet’s environment, either indoors or outdoors. It may be a reaction to pollens, or moulds, or to mites, such as house-dust mites.To complicate the issue further, some pets can have an allergic reaction to some foods, which is ‘food induced atopic dermatitis’.

Hypersensitivity is when the immune system goes into an overdrive. Normally when a pet is exposed to an allergen, its immune system produces antibodies to the allergen and once it has performed its protective role it will automatically revert to normal; however, if your pet is predisposed to atopic dermatitis its immune system continues to produce antibodies, which may then result in a hypersensitivity.

What are the main signs of atopic dermatitis in dogs and cats?

The hallmark of atopic dermatitis is an itch, usually without any visible signs other than a reddening of the skin. Often when I ask an owner where their pet animal is itching they say “Oh, Fido does not scratch”, but dogs exhibit itch by licking, rubbing, or chewing at the itch as well as by scratching at it.

The itching usually starts between the ages of 6 months and 3 years. Initially it may be seasonal – that is it occurs only at certain times of the year – but over the years that can change. Spring and summer time itching is usually associated with pollen allergies (e.g. tree, grass and weed pollens) whereas winter or all year round itching is associated with indoor allergens such as house dust and storage mites or mould allergens. Food associated atopic dermatitis is likely to be non-seasonal, unless your pet is only being fed the food intermittently (e.g. on holiday). The itchy areas of the skin are usually the face, ears, feet and underside.

Often the condition is complicated with secondary infections (bacterial and/or yeast) and sometimes, just to complicate the situation further; some patients have been known to develop an allergy to the infection as well. Infections increase the level of itching and so just treating these will often decrease or stop the itch entirely. Once infections occur a rash may appear on the belly, neck and feet and your pet will lick, chew or scratch these areas. Infected skin is malodorous (has a bad smell) and, as the infection progresses the skin becomes thickened, blackened and crusty. If your pet then licks or scratches these areas aggressively, the skin can become broken or ulcerated, and also bleed.

Since similar lesions can also be seen with parasitic infestations (e.g. mange) these must be ruled out, or treated, at the same time as the allergy.

Recurrent ear infections are also associated with food or environment associated atopic disease. Usually the ear flap and the ear canals appear red in the early stage, which is then often followed by head shaking, discharge and swelling.

What is my pet allergic to?

To find out what your pet is allergic to, your vet can perform an allergy test, which will either involve sending a blood sample to a laboratory, or performing an intradermal skin test. Intradermal skin tests are when very small amounts of allergens are injected under the skin to identify which ones that particular animal is allergic to by provoking a small, controlled allergic response. Both forms of testing have their advantages and disadvantages. The results of the test should be interpreted bearing in mind the seasonality of the condition and your pet’s environment.

Allergy testing identifies the allergens to which your pet might be allergic to, but the main reasons for testing should be to find out what your pet is allergic to, so as to be able to improve quality of his/her life. Your vet can use the information for therapeutic purposes and to look at means of reducing the allergen load in the environment. The lower the allergen load, the lesser the itch and the easier it will be to keep your pet comfortable. One can compare atopic dermatitis in dogs to hay fever in people. If you have hay fever and you stand in a field full of flowers whose pollen you are allergic to, you will suffer severely, as opposed to if you stayed indoors when the pollen count is high. The same goes for dogs, by reducing the allergen load you will be helping to relieve your pet’s symptoms.

Can I cure atopic dermatitis?

In one word “No”, but you can manage the condition successfully. Atopic dermatitis in dogs and cats can be compared to asthma in people. Asthma can’t be cured but it can be managed; and just like asthma the management of atopic dermatitis is life-long. It is therefore important to put in place measures that are going to have the least side-effects for your pet in the long term that will provide him/her a good quality of life and that are the most cost effective and affordable for you.

How can I manage the condition?

You need to take a multi-step approach to managing atopic dermatitis. These steps include:

  1. Treatment and prevention of infections
  2. Medications to stop the itch
  3. Treatment that modulates the immune system
  4. Nutritional supplements
  5. Topical treatments

Unfortunately some treatments work some of the time but not all the time and so you may need to switch treatments periodically. Some treatments may result in undesirable side effects and so may need modification.

Management options:

1) Treatment and prevention of infections:

Any bacterial (mostly staphylococcal) and/or yeast (Malassezia) infections should be treated at the outset. Antibiotics for bacterial infections need to be administered for 7 – 14 days beyond clinical cure and the duration of treatment is generally determined by the depth of the pyoderma.

For yeast infections a shampoo containing either 2% chlorhexidine/2% miconazole or one containing 3% chlorhexidine have shown good efficacy and will suffice; however, if the infection is severe your vet may opt to prescribe antifungal tablets. Because there is a tendency for infections to recur it is best to bath your pet once or twice a week on a regular basis, which will keep the microbial load on the skin low and thus help reduce the frequency of infections.

2) Stopping the itch:

Glucocorticoids (steroids) will stop the itch in most cases, but need to be used with caution, especially if used for a long time. In the short term they can increase water intake, increase urination and appetite. Some owners and pets find these side effects distressing. In the long term they can affect almost any organ in the body, therefore, even when well tolerated, they should be used with caution and your pet should be monitored regularly. Topical steroid containing sprays and ointments may be useful for targeted areas but with long term use thinning of the skin, infections and systemic side effects can occur.

Cyclosporin is used to damp-down (modulate) an over-reacting immune system in an atopic pet. One starts with a high dose and then tapers it down to alternate day, or better still twice a week, treatment. The most common side effects with ciclosporin are vomiting and diarrhoea. In some dogs, gingival hyperplasia and papillomas may also occur.

Oclacitinib is another immunomodulating drug which specifically targets the pathway that results in an itch. It is effective and can stop itching rapidly. This is the newest drug on the market and the reported side effects are vomiting and diarrhoea in a small number of cases. It can be used both short term and long term; however, given that this drug has now been on the open market for only a few months (at the time of writing this) it should be used with caution as side effects with prolonged use are not known.

Antihistamines; the response to this group is variable and they are often used in combination with steroids in order to reduce the steroid dose.

3) Immune Modulation:

Allergen specific immunotherapy is the most specific treatment for Atopic Dermatitis. It involves either an injection, or an oral dose of the allergens your pet is allergic to, to modulate the immune system. It has responses ranging from roughly 33% where there is complete cessation of itch, to 33% improving but requiring additional treatments, to 33% where there is no response. If your pet responds well to immunotherapy, it is likely to have the least adverse side-effects and to be the most cost effective treatment in the long term.

4) Nutritional support:

Omega -3 and Omega -6 essential fatty acids help the skin function by altering the lipid barrier and by reducing inflammation. On their own they are unlikely to benefit your pet but can be helpful when combined with other treatments. Diets that are high in essential fatty acids (EFAs) also help.

5) Topical treatments:

Moisturisers containing ceramides help maintain the skin barrier, which in turn reduces the penetration of allergens and therefore your pet’s reaction to them. Bathing with an oatmeal based shampoo can also help relieve itching and re-hydrate the skin.

Atopic dermatitis is a lifelong condition that requires life-long management; and often more than one type of treatment will be required. So, when your vet chooses a treatment, it should be efficacious, suitable for your pet with the least side effects, easy for you to administer and affordable. Most of all it/they should improve your pet’s (and your) quality of life.

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