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Special Offer – December – Arthritis Awareness Month

by admin on December 2nd, 2017

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Arthritis Awareness

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Pet of the month – December – Zebedee

by admin on December 2nd, 2017

Category: Pet of the Month, Tags:

Pet of the month for December is Zebedee, who was brought in to us a few weeks ago as an emergency following a car accident.

Zebedee’s jaw was fractured along the line of the mandibular symphysis. This is a fibrocartilaginous joint that is the most common site of mandibular fractures in feline patients and always needs to be repaired. The repair was relatively uncomplicated but the swelling and trauma to his jaw meant that Zebedee would not be able to eat or drink normally for several weeks. To enable him to receive adequate nourishment an oesophageal feeding tube was placed and he was tube fed until he was able to eat and drink again normally.

To further his woes Zebedee was not microchipped and an owner did not come forward, so we decided to take him on as a practice cat and are delighted that he has just this week been found a good home.

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Zoonoses

by admin on December 2nd, 2017

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What is a zoonosis?
A zoonosis is a disease which can be passed between animals and humans.

The following information sheet is designed to give an overview of some common or important diseases which can be passed from cats and dogs to humans, however, the list is not exhaustive.  Conditions which can be passed to humans from other domestic or exotic species are not included.  In general, these diseases are of most significance to immuno-compromised people.

What does immuno-compromised mean?
People who are immuno-compromised have immune systems which may not work very well.  This group would include the very old and very young, people recovering from severe illness or surgery, people with AIDS/HIV and people on chemotherapy drugs.

What skin diseases can be caught from cats and dogs?
Humans can be bitten by cat and dog fleas. The bites are seen as small, red, itchy lumps very often on the lower legs/ankles. It is important to keep cats and dogs regularly treated for fleas using a veterinary prescribed flea treatment. If humans are being bitten it is likely that the environment is infested, so the whole home should be treated as well. Make sure you follow any care and safety instructions when you spray your home.

Ringworm (dermatophytosis) is not a worm at all but a fungal infection of the skin. Many species of animals can carry this infection. It is often seen as patches of hair loss and scaling of the skin on cats and occasionally dogs. When humans pick up ringworm they develop red and often circular patches on their skin. This condition is treatable for both humans and pets.

Humans can also become irritated by mites that they acquire from their pets e.g. ‘fox mange’ (Sarcoptes scabei) and ‘walking dandruff’ (Cheyletiella). Infections in humans are usually self-limiting but it is advisable to visit the doctor. Cats and dogs can be treated under veterinary care after diagnosis in their owners.

Can worms affect humans?
We strongly recommend that pet cats and dogs are regularly wormed. Cat worms are currently not thought to cause problems for human health but we are not certain about this. Toxocara canis is a common round worm of dogs. If children are infected by this worm, the larva can occasionally ‘get lost’ on migration within the body and cause damage to the eyes, brain and elsewhere. Monthly worming of dogs with a good quality round wormer will prevent dogs becoming infected and spreading the worm.

Echinococcus granulosus is a dog tapeworm which also causes problems when larva ‘get lost’ on migration in the body, but this worm is thankfully only found in limited habitats (certain areas of Wales and the Hebrides). Hookworms (Ancyclostoma) which are passed occasionally in dog faeces can cause skin irritation when people have close contact with contaminated soil. Fortunately the condition is easily treated.

My pet has a tummy up-set can I catch anything from it?
Hand washing and basic hygiene should always be used when clearing up after a pet, especially when they have vomiting or diarrhoea. Giardia, Campylobacter, Salmonella and E. coli are just some of the infections which may be passed on to humans. If these bugs are suspected we will test for them but sometimes infections are not obvious, so care should always be taken in clearing up pets’ faeces.

I am pregnant, are there any specific zoonoses I should be concerned about?
Toxoplasmosis is of particular concern for pregnant women. This is a common single-cell parasite which only causes mild flu-like symptoms in most affected people – however, it can be critical to the health of both mother and fetus if a pregnant woman is infected. Many species of animal can be affected by toxoplasmosis, but only cats, the primary host, can spread the disease. When the spores pass out of the cat in its feces they are inactive. It takes about 24 hours of contact with air for the spores to become active or infective. This means that direct handling of an animal is not a great hazard, but pregnant women should not handle cat faeces or the litter tray. The greatest risk factors for Toxoplasmosis are gardening (i.e. handling soil), unwashed fruit and vegetables as well as undercooked meat. However, it is always recommended that pregnant women are especially careful to wash their hands after touching animals and before handling food. If you have any concerns about zoonoses during pregnancy you should discuss these with your midwife or doctor.

Can I catch Weil’s disease from my dog?
Weil’s disease is the severe human form of leptospirosis. This is an uncommon disease in humans and it is very rare for it to be passed by pet dogs. However, if a dog is affected its urine can be infective to humans. Both dogs and humans most commonly catch leptospirosis from stagnant or slow-moving water (specifically that which has been contaminated with rat urine). The disease causes sudden kidney and liver failure. We strongly recommend that dogs are vaccinated against leptospirosis annually. Care should be taken when handling dogs’ urine and, if leptospirosis is suspected, handlers should wash their hands and ideally wear gloves.

What should I do if I am scratched or bitten?
Cat and dog bites can be very serious. Wash all bites liberally under running water and always seek medical advice from your doctor as antibiotics are often required. There may also be legal implications if a dog has bitten a person – please see the UK Government website.

Cat scratches can also be nasty. All scratches should be thoroughly washed. Any scratch which becomes inflamed or painful should prompt a visit to a doctor. There is a bacterium which some cats have in their saliva and on their claws called Bartonella henselae which causes ‘cat scratch disease’ in humans – symptoms include swelling at the site of infection, fever, and swollen glands. Treatment may be required, especially in immuno-compromised patients.

If you have any queries concerns about your dog or cat and Zoonoses, please do not hesitate to contact us.

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Pet of the month – November – Fred

by admin on November 1st, 2017

Category: Pet of the Month, Tags:

This month’s pet of the month is Fred who has sailed through his recent checkup and blood test for hyperthyroidism.

Hyperthyroidism is a relatively common disease of the aging 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 bodywork; 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.

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 bloodstream. 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 has 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 are therefore necessary to assess kidney function as well as the thyroxine level during treatment.

Fred

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Special Offer – November – Diabetes Awareness Month

by admin on November 1st, 2017

Category: Special Offers, Tags:

Diabetes

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Lymphoma in Dogs

by admin on November 1st, 2017

Category: News, Tags:

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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Special Offer – October – 10% Off Anxiety Relieving Products

by admin on October 3rd, 2017

Category: Special Offers, Tags:

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Pet of the month – October – Sophie

by admin on October 3rd, 2017

Category: Pet of the Month, Tags:

Sophie is recovering extremely well following the removal of a stick from her stomach using our new fibreoptic endoscope.

An endoscope is a long, thin, flexible tube that has a light source and camera at one end. Images of the inside of your body are relayed to a television screen.

Endoscopes can be inserted into the body through a natural opening, such as the mouth and down the throat, or through the bottom. An endoscope can also be inserted through a small cut (incision) made in the skin when keyhole surgery is being carried out.

Our three endoscopes range from one that is small enough to examine the nasal cavity to larger diameter ones for exploring the airways and gastrointestinal tract. It is amazing to be able to explore deep within the body yet with minimal trauma to the patient, and in this instance without the need for a surgical laparotomy to remove the stick. For Sophie this meant instant resolution.

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Pet of the Month – September 2017 – Lola

by admin on September 2nd, 2017

Category: Pet of the Month, Tags:

We are delighted to report that Border Terrier Lola is recovering well from a procedure called gastrotomy in which an incision is made into the stomach under general anaesthesia.

Lola became unwell recently, quite out of the blue, and was in obvious abdominal pain. Medication was of little assistance so further investigation was undertaken. When a round opaque object was seen on radiographs of her abdomen an exploratory laparotomy was performed. A stone was located in and removed from her stomach.

Lola was a pleasure to look after and is now back to her former self as you can see in this picture.

Lola

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