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Pet of the month – January – Brooke

by admin on January 2nd, 2019

Category: Pet of the Month, Tags:

Pet of the month for January is Brooke, a 9 year old Jack Russell Terrier cross, who has suffered from Diabetes Mellitus since last August. We are delighted to report that she is doing very well and has just been into the clinic for one of her regular monitoring appointments called a ‘blood glucose curve’ (see below).

What is Diabetes Mellitus (Sugar Diabetes)?
Most of the food that animals eat is turned into sugars to provide energy for the body. The sugar in the blood then needs to get into the cells of the body to help them work. A hormone called insulin, which is produced by the pancreas (an organ in the tummy near the stomach), helps the sugar to get into the cells. Diabetes develops when the body does not produce sufficient insulin. Insulin regulates blood sugar levels, and when the insulin levels are too low, blood sugar (glucose) levels increase, resulting in diabetes. Diabetes is a potentially life threatening illness, but fortunately it is one which we are able to treat successfully in the majority of cases.

Diabetes occurs most commonly in older dogs, and in middle-aged overweight cats. Some dogs and cats develop diabetes when they are younger, because they have a genetic predisposition for the condition.

What are the signs of Diabetes?

  • Increased thirst
  • Increased frequency and/or volume of urination
  • Possible increased appetite
  • Possible weight loss
  • Possible smelly urine – because of the presence of ketones (see below) or infection
  • Possible lethargy/tiredness

How is Diabetes diagnosed?
Diabetes is diagnosed by careful assessment of the patient’s history and a physical examination, followed by blood and urine tests. Excessive levels of sugar in the urine and blood are highly suggestive of diabetes, although occasionally a sick or anxious patient may have increased sugar levels as a result of stress (such as visiting the vets!). If there is some doubt about the significance of a single high blood and urine sugar result, we may perform a special blood test (fructosamine) which gives us an indication of the blood sugar levels over several previous weeks.

When a patient is diagnosed with diabetes, we often look for underlying causes of diabetes such as obesity, Cushing’s syndrome (a steroid hormone imbalance), pancreatitis (inflammation of the pancreas – the organ that produces insulin) or previous administration of some medications. If we find any of these underlying problems, they also need to be managed alongside the diabetes.

What effects does diabetes have?
Diabetes leads to a build up of sugar in the bloodstream and in the urine, and not enough sugar can actually get from the blood into the tissues that need sugars to work properly. This leads to widespread effects on the body, including urinary tract infections, kidney disease, liver disease and eye disease.

If diabetes is left untreated or poorly controlled, the body is starved of glucose-based energy supplies, and the body reacts by using up protein and fat stores for energy instead. Protein stores can be converted to glucose, but using up stored fat leads to the production of substances called ketones. A build up of ketones can lead to a very serious condition called Diabetic Ketoacidosis (see later) – this is a medical emergency requiring intensive care.

How is Diabetes treated?
Diabetes is best treated with insulin. In most cases, insulin is administered as an injection under the skin twice a day. There are also tablets that can be used to help regulate blood glucose levels, but these are not the best way of treating the condition.

Although owners are often concerned about giving injections to their pet, most dogs and cats are very amenable to being given injections. If your pet is diagnosed with diabetes, we will spend as much time as is necessary to teach you how to give insulin injections and how to look after the insulin and syringes.

There are several types of insulin, and the dose of insulin is very individual. It is very important that you do not change the dose of insulin without instructions from your veterinary surgeon. Most dogs and cats need a little modification of the doses of insulin with time, and these changes will be made based on monitoring and blood tests. You may be instructed on how to monitor blood or urine glucose/ketone levels at home. Urine should be checked regularly for the presence of ketones, as the presence of these for two or more days can indicate a complication of uncontrolled diabetes – Diabetic Ketoacidosis (see later).

Care and use of insulin:
It is important that affected dogs continue to exercise regularly as this will help to keep their weight down. Also exercise has also been shown to make insulin work better, resulting in better stability of the blood sugar levels.

  • Diet - In addition to insulin, it may be important to modify your pet’s diet, particularly if your dog or cat is overweight, or has inflammation of the pancreas (pancreatitis) in addition to diabetes. These dietary changes will be directed by your veterinary surgeon. Once stabilised, dogs and cats are fed just before the insulin is administered, to make sure that they have eaten before the insulin is given. We have a full-time veterinary nutritionist who can be consulted regarding the specific dietary needs for your pet.
  • Exercise - It is important that affected dogs still exercise regularly. This helps them to maintain a healthy weight, and it helps to keep the blood sugar more stable.

How quickly does the treatment work?

  • Don’t expect a quick fix. It can be very difficult to regulate the blood sugar in some diabetics. Even in the best situation, it will take several weeks, including check-ups and blood tests, before your pet’s diabetes can be stabilised. It is important to discuss any concerns you have about giving insulin with your vet at any check-up. We may ask you to show us how you are storing insulin and administering it, should control be proving difficult.

Some medications (such as steroids e.g. prednisolone), hormones (such as progesterone) and diseases (e.g. infections such as tooth and gum infections) will interfere with insulin’s action in the body. Any additional medications that your pet is having should be discussed with your veterinary surgeon prior to use. Because hormones affect the action of insulin, it is important that entire female bitches are neutered (spayed) to help to control their diabetes.

What is a ‘hypo’ episode (hypoglycaemia)?
Hypoglycaemia is a low blood sugar level. This occurs when too much insulin for the amount of food eaten results in too little sugar circulating in the blood. This most often occurs when a pet does not eat and still has insulin given, or is accidentally given a higher than normal dose of insulin (most often because the insulin is given twice, by mistake). Low blood sugar levels will make the affected animal very weak, and this can result in collapse or twitchiness and seizures (fits). If you are ever concerned that you have given your pet too much insulin, or that you have given insulin and your pet has not eaten, or has vomited up his or her food, please contact us.

How to monitor your pet’s diabetes at home
There are many features you can measure or observe at home to help to monitor your diabetic pet:

  • Amount of water being drunk
  • Frequency and volume of urination
  • Appetite – how much is eaten?
  • Body weight
  • Behaviour
  • Presence of ketones/glucose in your pet’s urine (using a special dipstick that you put into the urine)

It is very helpful to make a diary with this information in it, and provide it to your vet at every check-up.

Follow-up consultations are performed frequently (the frequency depends on the individual patient). These follow-up visits may include a single blood test (fructosamine), or they may be followed by admission of your pet into hospital for the day for a ‘blood glucose curve’. A blood glucose curve involves us performing several small blood tests throughout the day, and plotting the results on a graph (making a ‘curve’ on the graph). This allows us to see how your pet’s blood glucose changes throughout the day which can be useful for adjusting your pet’s food intake and insulin dosing regime.

What are the possible complications of diabetes?

  • Cataracts – cataracts are changes in the lens inside the eye which can lead to blindness. Many dogs develop cataracts within 6 to 12 months of developing diabetes. Specialist treatment is available, and the majority of diabetic patients do very well after cataract surgery. Diabetic cataracts do not tend to develop in cats unless the diabetes occurs when they are very young • Retinal disease – degeneration of the sensitive area at the back of the eyes
  • Neuropathy – disease of the nerves causing weakness
  • Nephropathy – kidney disease
  • Infections – it is common for diabetic patients to develop infections, especially of the urinary tract (bladder and kidneys)
  • Ketoacidosis – in cases of uncontrolled diabetes, toxic (poisonous) metabolites (natural break-down chemicals) are produced which can lead to illness, lethargy, coma and death

The better the stabilisation of the patient, the better these complications are likely to be controlled or prevented.

What is the long term outlook?
Diabetes can be a very rewarding condition to manage. Most pets are very amenable to treatment, and diabetic animals can have a very good quality of life. Diabetes in cats can be temporary, and affected cats may only require insulin administration for a limited time (often 3 to 6 months) provided that the underlying cause, such as obesity or pancreatitis, is removed. Many dogs with diabetes eventually develop cataracts and these can cause quite rapid onset blindness. Fortunately most diabetic dogs with cataracts are good candidates for surgery, and Specialist eye vets are very experienced in treating cataracts.

Patients should be reassessed at regular intervals set by your veterinary surgeon. Pets that are having insulin treatment should also be reassessed if they:

  • become unwell
  • are losing weight
  • have a change in appetite
  • have excessive thirst or urination
  • become weak, wobbly or disorientated (this can be an emergency due to hypoglycaemia or severe diabetic ketoacidosis – see above)
  • have ketones in their urine for more than 2 consecutive days

If you have any concerns about your diabetic pet please do not hesitate to contact us.

Brooke

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Canine Demodicosis

by admin on January 2nd, 2019

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What are Demodex mites? And what is demodicosis?
Demodex spp. are cigar shaped microscopic parasitic mites that live within the hair follicles of all dogs. These mites are passed to puppies from their mothers in the first few days of life, and then live within the hair follicles for the duration of animal’s life without causing problems. It is thought that the body’s immune system helps to keep mite numbers ‘in check’ and prevent the populations getting out of control. For the vast majority of dogs, these mites never cause a problem. However in some instances, mite populations become huge resulting in inflammation and clinical disease. This disease is called demodicosis.

What causes demodicosis?
There are two presentations of demodicosis depending on the age at which it develops. Juvenile onset demodicosis tends to occur in puppyhood between the ages of 3 months and 18 months, and occurs in both localised and generalised forms. The exact cause is quite poorly understood but probably occurs due to a mite specific genetic defect in the immune system which allows mite numbers to increase. This defect may or may not resolve as the puppy ages. It is thought to be ‘mite specific’ because these puppies are healthy in all other respects and do not succumb to other infections. Generalised demodicosis can be a very severe disease. Adult onset demodicosis usually occurs in the generalised form and in dogs over 4 years of age. It is generally considered a more severe disease than its juvenile onset counterpart. In these cases, mite numbers have been controlled in normal numbers in the hair follicles for years prior to the onset of disease, which tends to result from a systemic illness affecting the immune system. Common triggers for adult onset demodicosis include hormonal diseases and cancer.

What are the clinical signs?
Localised demodicosis in juvenile dogs presents as patches of hair loss and red inflamed skin. These patches often occur around the face, head and feet and are not typically itchy.

Generalised disease in juvenile and adult dogs is a more serious disease, although there is no uniformly accepted way of defining the number of lesions needed to classify generalised disease. Patches of hair loss and inflammation develop which often coalesce into large areas of thickened skin and sores. As the parasites damage the hair follicles, secondary bacterial infections are very common and affected dogs can develop discharging lumps within the skin. Bleeding from these lesions is not uncommon. As with the localised form, lesions often start around the head, face and feet, but often spread to involve large areas of the body surface. The ears can also be affected with this parasite, resulting in secondary infections. Itchiness and pain are commonly seen.

How is it diagnosed?
Demodicosis can often be suspected following a review of the animal’s history and assessment of the clinical signs. The parasitic mites within the hair follicles result in plugging and the formation of ‘black heads’. The plugged follicles also cause large amounts of scale to be present on the hairs themselves. Demodicosis can usually be diagnosed relatively easily. Hairs can be plucked from the affected skin and then examined under a microscope for the presence of the mites. Alternatively, the skin can be squeezed and then scraped with a blade to collect up the surface debris from the skin. This material is then also examined under a microscope for the parasites.

If the numbers of mites are abnormal and if mites can be recovered from multiple sites, demodicosis can be diagnosed. Rarely, a biopsy of affected skin is needed to diagnose the condition.

Is it contagious?
Demodex mites from dogs are considered non-infectious to in-contact animals and people. It is thought that Demodex mites can only be passed between dogs in the first few days of life from the mother to the pup.

How is it treated?
The treatment used for demodicosis depends on the age of the animal and the severity of the disease. Mild and localised forms of demodicosis in young dogs may not require treatment, and may resolve spontaneously as the animal ages. These cases should be closely monitored if no treatment is given. Generalised cases in young dogs and those in adult dogs require intensive treatment. Secondary infections must be treated with courses of antibiotics, and a swab is often submitted to a laboratory to grow the organisms to ensure the correct antibiotic is selected. The licensed treatments for demodicosis in the UK include a dip solution called Aludex and a spot-on product called Advocate. The dip is performed on a weekly basis until mite numbers are brought under control. Advocate spot-on is generally used for milder cases and is usually used monthly. In severe cases not responding to the licensed treatments, off-licence treatments must be used. Some of these drugs, such as Ivermectin and Milbemycin, are used for demodicosis in other countries.

An essential part of treating adult onset cases is to identify the underlying illness that triggered the problem. This often requires blood testing and scans (CT, ultrasound) to investigate.
Treatment must continue until mite numbers have returned to a normal level and this can take a very long time. This can only be assessed by repeat sampling of the patient using plucks of the hair or scrapes of the skin

What is the prognosis?
The prognosis for localised disease in young dogs is very good, and most recover uneventfully from the disease. Generalised cases in young dogs can take many weeks or even months of treatment, but it is usually possible to control the disease with a good long term outlook.

The prognosis for adult onset generalised demodicosis is far more uncertain, as many of these dogs have an underlying systemic illness. If this illness can be identified and cured, the prognosis for managing the demodicosis is much better. Some cases require long term medication to keep mite numbers controlled.

 

Demodex mite

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Patellar Luxation

by admin on December 3rd, 2018

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What is patellar luxation?
The patella is a small bone at the front of the knee (stifle joint). In people it is referred to as the ‘knee-cap’. It is positioned between the quadriceps muscle and a tendon that attaches to the shin bone (tibia). This is termed the quadriceps mechanism. The patella glides in a groove at the end of the thigh bone (femur) as the knee flexes and extends.

Occasionally the patella slips out of the groove. This is called luxation, or dislocation, of the patella. Most commonly the luxation is towards the inside (medial aspect) of the knee, however, it can also dislocate towards the outside (lateral aspect) of the joint.
Patellar luxation can affect dogs and cats.

Why does the patella luxate?
The patella luxates because it (and the quadriceps mechanism in general) is not aligned properly with the underlying groove (trochlea). The resultant abnormal tracking or movement of the patella causes it to slip out of the groove.

The cause of the abnormal alignment is often quite complex, involving varying degrees of deformity of the thigh bone (femur) and shin bone (tibia). In severe cases in dogs, the thigh bone (femur) is bowed at the end due to abnormal growth. These dogs often have either a bow-legged or knock-kneed appearance.

Patellar luxation is most common in certain breeds of dogs, such as Poodles, Yorkshire Terriers, Staffordshire Bull Terriers and Labrador Retrievers. Both knees (stifles) are often affected. These features suggest the condition may be genetic.

Luxation of the patella due to injury (trauma) is uncommon.

Is patellar luxation associated with any other knee (stifle) problems?
Patellar luxation is associated with the development of osteoarthritis within the knee (stifle). This occurs in every case. Osteoarthritis tends to be a progressive disorder and it is doubtful whether treatment of the patellar luxation reduces or stops this progression.

Occasionally luxation of the patella is associated with rupture of the cranial cruciate ligament in the knee (stifle). This may be due to chance or possibly due to abnormal forces on the joint that weaken the ligament.

What are the signs of patellar luxation?
The signs of patellar luxation can be quite variable. A ‘skipping’ action with the hind leg being carried for a few steps is typical. This occurs when the patella slips out of the groove and resolves when it goes back in again. If both patellae luxate at the same time, dogs and cats can have difficulty walking, often with a crouched action.

How is patellar luxation diagnosed?
Examination may reveal muscle wastage (atrophy), especially over the front of the thigh (the quadriceps muscles), although this is often minimal. Manipulation of the knee (stifle joint) may enable the detection of instability of the patella as it slips in and out of the groove. In some dogs the patella is permanently out of the groove. The severity of the luxation is graded from 1 to 4, with a grade 4 being the most severe.

X-rays (radiographs) provide additional information, especially regarding the presence and severity of osteoarthritis. Specific views may be necessary to assess the shape of the thigh bone (femur) and shin bone (tibia).

How can patellar luxation be treated?
Some dogs with patellar luxation can be managed satisfactorily without the need for surgery. The smaller the dog and the milder the grade of luxation (e.g. grade 1 out of 4), the more likely it is that this approach will be successful. Exercise may need to be restricted. Hydrotherapy is often beneficial. Dogs that are overweight benefit from being placed on a diet. Tit-bits may need to be withdrawn and food portions reduced in size. Regular monitoring of weight may be necessary.

Many dogs with patellar luxation benefit from surgery. The key types of surgery, which are described below, are: 1. quadriceps mechanism realignment, 2. trochlea deepening and 3. femoral osteotomy.

1. Quadriceps realignment surgery
The aim of this surgery is to move a small piece of bone (the tibial tuberosity) at the top of the shin (tibia) that is attached to the patella and reposition it so that the patella is correctly aligned with the groove in the thigh (femur) bone. This procedure is called a tibial tuberosity transposition. The transposed piece of bone is re-attached with one or two small pins, with or without additional support with a figure-of-8 wire.

Exercise following quadriceps realignment surgery must be very restricted for the first few weeks until the cut bone and soft tissues heal. It must be on a lead or harness to prevent strenuous activity, such as chasing a cat or squirrel. At other times, confinement to a pen or a small room in the house is necessary. Jumping and climbing should be avoided. After a few weeks, exercise may be gradually increased in a controlled manner (still on a lead). Hydrotherapy may be recommended.

2. Trochlea (groove) deepening surgery
In dogs and cats with patellar luxation the groove (trochlea) at the end of the thigh bone (femur) is often shallow. In these cases it may be necessary to deepen the groove. This can be done by removing a block or wedge of bone and cartilage from the groove, deepening the base, and replacing the block or wedge. These techniques are called ‘recession’ techniques since they recess the surface of the groove and thus make the groove deeper, while at the same time preserving the surface (cartilage) of the groove.

3. Femoral osteotomy surgery
Femoral osteotomy surgery involves changing the shape of the deformed thigh bone (the femur) by cutting it just above the knee (stifle) and stabilising it in a new position with a plate and screws. This may be all that is needed to prevent the patella luxating, however, in some dogs it is also necessary to perform a tibial tuberosity transposition.

Exercise following femoral osteotomy surgery must be restricted until the cut bone has healed. Exercise must be on a lead or harness to prevent strenuous activity. Jumping and climbing should be avoided. X-rays (radiographs) are necessary between six and eight weeks following surgery to ensure bone healing is progressing without complication. Exercise may then be gradually increased in a controlled manner. Hydrotherapy may be recommended.

What is the outlook with patellar luxation surgery?
The outlook or prognosis with patellar luxation surgery is generally good. Although all dogs and cats develop osteoarthritis to some degree, this is often not a cause of pain or lameness. Stiffness, especially after rest, can be a feature in some cases. Potential complications include recurrence of the patellar luxation and loosening of implants. These are uncommon.

Patellar luxation

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Special offer – December 2018

by admin on December 3rd, 2018

Category: Special Offers, Tags:

Arthritis Awareness

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Pet of the month – December – Barry

by admin on December 3rd, 2018

Category: Pet of the Month, Tags:

Pet of the month for December is Barry, a name we chose for a semi longhaired domestic cat brought into the clinic this week following a road traffic accident.

We are delighted to report that he has responded well to treatment but unfortunately we have been unable to locate Barry’s owner. Fingers crossed!

BARRY

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Cataract Surgery

by admin on November 1st, 2018

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What is a cataract?

A cataract is an opacity or clouding in the lens in the eye. The opacity normally makes the lens look white. The lens in the eye is like the lens in a camera except that, rather than being at the front as it is in a camera, the lens in the eye is deep inside it, just behind the coloured part of the eye (the iris). The lens shows up as black in the central part of the eye (the pupil). The lens is normally crystal clear but it looks black because the darkness inside the eye shows through it. The lens is there to focus light on the sensitive tissue at the back of the eye (the retina).

Cataracts often form in both eyes and they frequently get worse. One eye is often more affected than the other, at least initially. It is not known why most cataracts develop. They are most common in older dogs and sometimes they occur due to other problems such as diabetes or disease in the back of the eye (the retina). Some cataracts are inherited.

What treatment is there for cataracts?
At the moment the only treatment for cataracts is surgery. Unfortunately not every cataract is suitable for surgical treatment, and it is necessary for the eye specialist to assess each patient and decide what therapy might be possible. Some cataracts are more complicated to treat than others, and the specialist will give guidance depending upon the circumstances in each case.

When is the best time to operate on a cataract?
The previous belief that it is best to let a cataract ‘ripen’ and the eye to become totally blind before removing the opaque lens (the cataract) has been proven wrong. Any cataract that is developing will cause potentially damaging inflammation in the eye due to release of lens proteins – a condition called ‘lens-induced uveitis’. Lens-induced uveitis can be subtle and easily missed – or, in some cases, it can be severe and associated with an obviously sore and inflamed eye.

Left untreated, even low levels of lens-induced uveitis are likely to result in complications, including adhesions (sticking) between the iris and the lens, retinal detachment (where the light-sensitive tissue at the back of the eye comes away from the back of the eye and stops working) and glaucoma (increased pressure in the eye which is potentially blinding and painful). Many eyes with long-standing cataracts that have not been operated on will eventually become irreparably blind and painful, and have to be removed as a result of the effects of lens-induced uveitis.

Early cataract surgery is therefore recommended in order to avoid the detrimental effects of lens-induced uveitis, and in general surgery is carried out once a cataract starts to interfere significantly with vision. This especially applies to young and diabetic patients, where progression of cataracts can often be rapid and result in significant complications if treatment is delayed. We will endeavour to see such patients at short notice and we will also often advise the referring veterinary surgeon to start treatment with topical anti-inflammatory drugs to manage lens-induced uveitis prior to us seeing the patient.

Cataracts in older dogs or patients with very slowly progressive cataracts may be monitored, but we will often recommend the prophylactic use of anti-inflammatory drugs in such cases.

The surgery
Your dog will usually be admitted on the morning of the surgery and no breakfast should be given. Water should not be withheld overnight. Diabetic patients need special management, and this should be discussed with the vet involved. After the patient is admitted, drops are given every 15 minutes prior to surgery to prepare the eye for the operation. These drops help to dilate the pupil and reduce the effects of inflammation which always happens in dogs having cataract surgery.

Before surgery all patients have an ultrasound scan to check for problems such as retinal detachment or rupture (bursting) of the lens. These changes are more common in advanced cases. The scan is performed under sedation. Some patients may be found to be unsuitable for surgery when the ultrasound scan is carried out.
Cataract surgery is performed under a full general anaesthetic and a muscle relaxant is given so that the eye comes into the correct position for the operation. This means that a ventilator needs to be used to inflate the chest during the procedure. We monitor your dog very carefully throughout the surgery using very modern sensitive equipment and the staff involved are specially trained in the procedure. This helps to reduce the risks of the anaesthetic to a very low level.

The operation is very delicate and involves the use of an operating microscope and tiny instruments. Two small cuts are made in the window of the eye (the cornea), near where the coloured part (the iris) joins the white part.

The lens is just behind the iris and lies in a delicate bag of tissue called the capsule. After the eye has been filled with a special gel called a viscoelastic, some of the lens capsule is taken out. The gel which is used helps to inflate the eye and protect the structures inside it from the effects of the surgery, and especially from the instruments and the ultrasound. The cataract (in other words, the lens) is then removed through the hole in the capsule using a technique called phacoemulsification – this is an ultrasound procedure using very sophisticated equipment which is exactly the same as that which would be used on a human eye. This type of surgery has been shown to give the best results in dogs’ and humans’ cataracts. There is currently no laser treatment for cataracts in dogs or humans.

In most patients it is possible to put in a special artificial lens where the old lens was. Plastic lenses make vision in the eye similar to the way it used to be before the cataract developed. The lenses used in our patients are made especially for dogs as they are bigger and more powerful than human lenses. They are permanent and buried deep inside the eye. The complication rate of lenses is very low indeed. For technical reasons it is not possible to implant an artificial lens in some eyes. Not having a lens implanted does not make the difference between being blind and having sight – it is similar to someone who wears glasses not putting them on.
At the end of the surgery the wounds in the eye are closed with tiny dissolving stitches. These are absorbed over the next few weeks, leaving only very small scars.

Some dogs can have both eyes operated on at the same time. The main reason for doing this is that it makes it more likely that the patient will have vision after the surgery – if something goes wrong with one eye, hopefully it will not also go wrong in the other one. However, a dog with one good eye will have overall vision which is almost as good as that in a dog with two good eyes, and so it is not essential to have both eyes operated on.

Most patients stay in overnight after their operation and are discharged the following day, provided that progress is satisfactory. Most dogs can see something on the day after surgery, but it frequently takes a few weeks for vision to settle down as the eye adjusts to the effect of surgery and the presence of a plastic lens implant. In addition, there is often some clouding inside the eye which takes time to clear.

Aftercare
The aftercare following cataract surgery is intensive. All patients  develop inflammation inside their eyes after surgery. This happens more in dogs than in humans. Usually there are several types of drops used. The most frequently applied drops are used six times daily initially. The number of applications gradually decreases over the next two months or so. There are also tablets to be given for a few weeks after the surgery.

Your dog will need to be kept as quiet as possible for a few weeks after the surgery, although this can obviously be difficult with many of our patients! You can only do your best in this regard. Pulling on a lead should be avoided for several weeks after surgery, as this puts up the pressure inside the eye and can encourage bleeding. Avoiding pulling around the neck is best achieved by using a harness, and it is a good idea to obtain one before the operation – it can be fitted at the time that your dog goes home. A plastic Elizabethan collar also has to be worn for about a week after the operation.

There will need to be at least four or five re-examinations after surgery. These are mostly within the first two to three months after the operation. Some patients, especially those with complicated cataracts, may need longer term treatment and more check-ups than average.

Risks and complications
The success rate of cataract surgery in dogs is about 90 to 95% initially. This means that 5 to 10% of patients cannot see in the operated eye after surgery. There are various reasons why not all patients have a successful outcome or may have a less straightforward recovery than normal. These include:

Inflammation
Every patient gets inflammation after surgery, no matter how smoothly the surgery goes. This is usually well controlled by the medications which are given. The occasional dog gets more inflammation than average, and this can lead to changes in the eye. These may not be of any great significance, but sometimes they can cause reduced vision.

Occasionally an injection into the eye is needed to dissolve inflammatory clot material. Inflammation is the main problem in dogs after surgery, and is the major reason why frequent medications and regular post-operative check-ups are required.

Infection
This can be very serious, but is extremely rare. Antibiotics in the form of tablets and ointment are used before and after the surgery to help to prevent this.

Wound breakdown
This means that the wound gives way. Again this is an uncommon complication, but if it occurs another general anaesthetic will be required to re-stitch the wound.

Bleeding
A very small amount of bleeding at the time of surgery is not unusual and this is not a major problem. Very occasionally a larger haemorrhage can develop and this can affect vision.

Increased pressure
The pressure in the eye can occasionally go up in the first few days after surgery, but eye drops will usually settle this down very quickly. Rarely a more severe increase in pressure may develop (glaucoma). If this problem develops it will involve additional medication and possibly surgery. It can lead to blindness and even loss of the eye in severe cases which don’t respond to treatment.

Ulcers
Occasionally the surface layer of the window at the front of the eye (the cornea) can partly come away after surgery. This is usually a very minor problem which normally resolves within about a week.

Corneal oedema (water-logging)
The window at the front of the eye (the cornea) can very occasionally go blue after surgery due to disturbance of its inner layer. Careful surgery and the use of viscoelastic gel (as previously mentioned) help to reduce the chances of oedema developing.

Retinal detachment
This is an uncommon complication, but if the sensitive tissue at the back of the eye detaches it can lead to loss of sight. A routine ultrasound scan before the surgery helps to identify at-risk patients.

Poor vision
Some dogs have problems inside their eyes (for example with their retina) which cannot always be detected before the surgery, and this may then mean that the surgery is not successful, or that the vision given by the surgery is not as good as it once was. Some suspect cases may have an electrical test (an electroretinogram) performed on the eyes to look for retinal problems before surgery, but this may well require sedation or even general anaesthesia and is not necessary or recommended for every case.

‘After-cataract’
A small percentage of dogs that see well immediately after their surgery may not continue to do so for the rest of their lives. This later deterioration may happen for many reasons (such as some of the complications mentioned). However, one such problem is known as after-cataract, in which a white membrane can grow across the pupil inside the eye. In most patients the amount of after-cataract which forms is not significant, but it can very occasionally affect vision in the long-term. Having a plastic lens implant has been shown to help to prevent the membrane growing across the pupil.
If after-cataract becomes very severe it can be removed surgically, although this is very rarely necessary.

Conclusion
The success rate of cataract surgery in dogs is high, and the great majority of patients do very well after their operation. It is undoubtedly a major undertaking, but the procedure is one which is commonly performed.

Dog Cataracts

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Pet of the month – November – Kim

by admin on November 1st, 2018

Category: Pet of the Month, Tags:

Pet of the month for November is Kim, a 14 year old Golden Retriever, seen here having her weekly bath. Kim has suffered from an underactive thyroid for some years and despite longterm supplementation with thyroid hormone still suffers from a flaky skin, which is a common symptom. Other than that the condition is being well managed.

What is hypothyroidism?
Hypothyroidism develops when the thyroid gland function falls below normal. In dogs and cats the two thyroid gland lobes lie on either side of the windpipe and produce thyroid hormone. This hormone controls the speed at which the body’s metabolism works. In patients with hypothyroidism, not enough of the hormone is produced. As a result the metabolism ‘slows down’, and, with time, this can affect almost all the organs of the body.

Hypothyroidism is common in adult dogs, but is very rare in cats.

How do animals get hypothyroidism?
In the majority of cases hypothyroidism is diagnosed in adult dogs that have previously been healthy. In most dogs the disease either develops due to the affected animal’s own immune system attacking the thyroid gland (‘lymphocytic thyroiditis’) or due to degeneration of the gland tissue. It is possible that both forms of the condition may in fact represent the same disease process. Over time, more and more thyroid tissue is destroyed until the gland cannot function any longer.

It is still not known why dogs develop this disease. Certain breeds of dogs are more susceptible to hypothyroidism – these include Retriever breeds, Doberman Pinscher, Setters, Terrier breeds and Spaniels (especially Cocker Spaniels). Hypothyroidism is rare in toy and miniature breeds. Several factors have been proposed that could trigger the immune reaction, but so far nothing has been proven.

Hypothyroidism is extremely rare in cats, but can very occasionally be seen after zealous treatment of an overactive thyroid gland.
In rare cases puppies and kittens are born without a functioning thyroid gland.

What are the clinical signs of hypothyroidism?
As the disease affects the whole metabolism, clinical signs are often vague and non-specific and can affect almost every aspect of the dog’s body. The disease can also mimic many other problems.
Many dogs are presented with weight gain and lethargy or lack of interest in activities they previously enjoyed. However, the majority of dogs presented because of weight gain are simply overweight because they eat too much (See Nutrition advice for dogs information sheet).

Often a ‘tragic expression’ of the face is noticed by owners of dogs with hypothyroidism, and this is due to thickening of the skin and loss of tone of facial muscles. A dull coat, greasy or darkened skin and hair loss, especially on the sides of the body and the tail, are also frequently noticed. Constipation can develop, although diarrhoea is also a possible problem because the immune system is less effective. This reduction in immunity can also lead to other infections such as chronic skin or ear problems. Less commonly, more severe clinical signs can be seen, such as those related to nerve function problems.

Hypothyroidism is not usually fatal, but it can compromise an affected dog’s quality of life.

Puppies and kittens born without a functioning thyroid gland do not grow properly and their mental development may be affected. Many of these patients do not survive, and those which do often suffer from chronic arthritis because of abnormal joint development.
Adult cats with hypothyroidism show similar signs to dogs, but such cases have only very rarely been reported.

How is the disease diagnosed?
Hypothyroidism is diagnosed by blood testing – the amount of thyroid hormone in the blood as well as the amount of TSH (a hormone that controls the function of the thyroid gland) is measured. However, further blood values are also looked at in order to test for other diseases, because the clinical signs of thyroid disease are not usually very specific. Depending on the individual case it may also be necessary to analyse a urine sample or even to perform further tests such as radiography (X-rays) or ultrasound examination.

If other diseases can be ruled out and the blood values show low thyroid hormone, then a diagnosis of hypothyroidism can be straightforward. However, not all blood tests results lead to a clear-cut diagnosis as thyroid hormone measurement can be influenced by a variety of other factors. In such cases it may be necessary to perform further blood tests, or in some cases to re-test after several weeks or months to confirm the disease. In some cases the diagnosis of hypothyroidism can be quite problematic.

Can hypothyroidism be treated?
Once hypothyroidism has been diagnosed, it can be readily treated with tablets containing thyroid hormone. The condition can be controlled rather than cured, and life-long medication has to be given to provide the body with thyroid hormone. As the required dose can change over time, repeat blood tests are necessary at intervals to check the level of hormone in the blood.

The clinical signs of hypothyroidism will improve with treatment but it can take several months for all the signs to resolve.

My pet has hypothyroidism, what is the outlook?
Once a pet is stabilised on medication, it will not be noticeable to anyone – including the animal – that he or she actually has a chronic disease. Pets with hypothyroidism that are on therapy have an excellent prognosis and can expect to live a normal life, as long as they receive medication and are properly managed with the help of your veterinary surgeon.

 

Kim

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Special offer – November 2018

by admin on November 1st, 2018

Category: Special Offers, Tags:

Diabetes Offer

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Feline leukaemia virus (FeLV) and Feline immunodeficiency virus (FIV)

by admin on October 1st, 2018

Category: News, Tags:

What are FeLV and FIV?
Feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV) both belong to the same group of viruses, the retrovirus group. This means they are somewhat related to one another and act in a similar way. Retroviruses such as FeLV and FIV are particularly successful because the immune system usually fails to remove them completely (unlike many other viruses), so affected cats become infected for life. Feline immunodeficiency virus (FIV) is related to the human immunodeficiency virus (HIV), but humans and cats cannot infect each other with their respective viruses.

How do cats get FeLV or FIV?
Cats can get FeLV and FIV through contact with other cats.
Feline leukaemia virus is usually transmitted through saliva, most commonly by friendly, social cats who like mutual grooming and do not mind sharing food bowls. However, FeLV can also be transmitted through bites.
Feline immunodeficiency virus is usually transmitted through biting by an infected cat, so individuals with FIV are typically entire tom cats or any other cats that like fighting.

What are the clinical signs of FeLV and FIV?
Both FeLV and FIV cause similar problems by gradually weakening the immune system. The protection this system normally gives against invading bacteria, viruses, fungi or parasites functions less and less well, and infected cats become prone to infections that a healthy immune system would often just fight off. As the immune system also helps to protect the body against cancer, infected cats in advanced stages of the disease have a much higher chance of developing a cancerous disease. Anaemia is another common problem, particularly in cats with FeLV. Despite its name, feline leukaemia virus does not necessarily cause leukaemia – it can do so, but it also causes a multitude of other diseases.

When an infected cat becomes ill, the clinical signs seen are usually due to the secondary infection or the cancerous disease which develops, rather than the underlying FeLV or FIV infection. This means that there are no typical clinical signs for either disease. Vets usually become suspicious when cats are presented either with persisting infections which they should be able to fight off, or with ‘non-standard’ disease, or with several concurrent infectious problems, or if the response to treatment is not as expected.

How and when is the disease diagnosed?
There are two possible situations in which tests are carried out for either FeLV or FIV.

  • FeLV or FIV is suspected as an underlying disease
  • A healthy cat is tested for FeLV and FIV to ensure that he or she is not carrying the virus already. This may be advisable before a newly adopted cat is introduced into the household, before breeding is attempted or before the first FeLV vaccination is given.

Whatever the reason for testing a particular cat, it is usually possible to diagnose FeLV and FIV with a blood test that can be done at the surgery. However, in some cases we may suggest sending a blood sample to a laboratory for more advanced testing methods to be used.

Can FeLV or FIV be treated?
Cats carrying FeLV and FIV virus cannot be cured. Both viruses cannot be destroyed by medication – this is similar to the situation in people with HIV. In human medicine, advanced anti-viral drugs are now available – these can effectively suppress the activity of the virus for long periods of time. Few of these (very costly) drugs have been used in cats and it is not really known whether such drugs are effective for FeLV/FIV or safe for cats to take. This means that there is currently no recommended specific treatment against either FeLV or FIV.

As the majority of clinical signs caused by both FeLV and FIV are due to a non-functioning immune system, it is often possible to treat any secondary infections or problems, thereby giving the patient a reasonable quality of life for a longer period of time. However, it must be remembered that the infected individual is a danger to the rest of the cat population and will spread FeLV or FIV unless he or she is kept isolated from other cats.

Can FeLV or FIV be prevented?
Whilst FeLV cannot be treated once a cat carries the disease, it is possible to prevent infection by vaccination. FeLV vaccination is advisable for all cats that can go out or have contact with cats that go out. Only cats that are kept indoors and have no contact with other cats do not need FeLV vaccination.

Unfortunately there is no FIV vaccine which is licensed for use in the UK, so prevention is much more difficult than it is for FeLV. Any cat that is not kept indoors at all times is at risk of infection with FIV.

My cat has tested positive for FeLV or FIV – what is the outlook?
This can depend very much on why your cat has been tested. If he or she was tested because of severe or recurrent illness and is positive for one or both diseases, this means that the disease is already present and the immune system is already compromised. Under these circumstances unfortunately the outlook may be poor. It may be possible to give your cat a reasonable quality of life for a period of time with medication and very good care. However, he or she will be shedding the virus and will therefore be a danger to other cats. If other cats live in the family, they should certainly be tested – even if they appear healthy – in order to find out whether they are already carrying the virus.

If your FeLV or FIV positive cat is otherwise healthy and was tested as a routine precaution, then the outlook depends very much on the particular circumstances. Depending on the individual animal, it may take months or even many years before the disease breaks out and the cat will seem healthy in the meantime. However, he or she will be able to pass on the virus to other cats. This means that your cat should be kept indoors and away from other cats. It is also advisable to ensure good health through regular vaccinations and worming, very good nutrition and dental care.

While some cats are happy to stay indoors and away from other cats – especially if someone in the family is at home at all times, too – others will not like being so confined, especially if they are used to an outdoor life. Should such a situation arise, we will discuss the options with you in detail and should you feel that you are able to give your cat a good quality of life we will also discuss special health-care issues to keep your cat happy and comfortable for as long as possible.

cat face

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Special offer – October 2018

by admin on October 1st, 2018

Category: Special Offers, Tags:

FIREWORKS

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