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The BBC is wrong to allow an unqualified person to recommend unproven treatments to animals

The Hay Festival is not a place where you might expect to learn about the treatment of animals: it's an annual literature festival held in Hay-on-Wye, Powys, Wales, for ten days at the end of May every year. Caroline Ingraham has written an interesting book - "How animals heal themselves" -  which is presumably the reason she was given the opportunity to give an account of her subject at the Hay Festival last week. The BBC have created a podcast from her talk,  but I believe that the editors were wrong to give her this uncritical forum to propagate her views. Caroline has a controversial belief in the ability of animals to choose their own medicine. There's nothing wrong with her having these beliefs, but there is a problem when her views are broadcast without any "public health warning". There is a serious risk that animals could suffer unnecessarily if members of the public follow her advice to the letter. In her talk, Caroline recounts entertaining anecdotes of animals (including elephants, horses, dogs and cats) that have recovered following her approach of allowing them to choose their own treatment from vegetation and other substances in their natural environment, or from herbal products offered to them by Caroline. In her words, the animals "guide her to help them make a full recovery". Caroline stresses the importance of "letting animals lead the way" for behavioural and physical problems. As a vet in practice, I know that 70% of the animals brought to see me will recover by themselves, with no intervention or medication. Animals have evolved with strong internal natural healing capacity (it's called homoeostasis) Our aim as vets is to assist the healing process using scientific methods. There are many reasons why animals may fail to heal themselves, and science can often help. Serious bacterial infections are cured by giving antibiotics that kill the bacteria. Coughing caused by a failing heart is stopped by giving diuretics that remove the fluid gathering in the lungs. Cancer can be cured by surgical excision, followed sometimes by drugs to slow the regrowth of cancer cells. These are all treatments that are scientifically proven: in trials, it has been shown that if some animals are given the treatment, and some are not, a significantly greater number of animals improve. Caroline offers no such evidence: her treatments are all anecdotal. My concern is that she may be witnessing the "regression towards the mean"  i.e. the ability of animals to heal themselves without human intervention. Since around 70% of animals may recover naturally, if you believe that any recovery that you witness was caused by your intervention, you will believe that your treatment "works" 70% of the time. While this may sound impressive, the truth is that your intervention is having zero effect. If Caroline wants to clearly demonstrate the efficacy of her methods, she needs to do what pharmaceutical companies are obliged to do: carry out trials that compare animals receiving her treatment with animals that receive no treatment (a so-called control group). If she does this, she will be able to say without question that any extra improvement in the treated group is due to her treatment. Without doing this, her claims have no scientific validation, and it's hard for objective observers to take them seriously. At the end of the talk, the presenter did ask Caroline if she was a scientist, and if her work was "evidence based research". She replied "I am not a scientist but the subject of zoopharmacognacy is an academic science". Caroline says that in trying to develop her work, "resistance came in from a variety of different establishments that tried to make it really very difficult for me to continue this work." There is a simple reason for this resistance: there is strong legislation in the UK to protect animals. Only vets are allowed to diagnose and treat animals. The law is there to stop (often well-meaning) unqualified people who may not be aware of their own ignorance  from accidentally harming animals because of their lack of knowledge. There may be some truth in Caroline's claims: animals may be able to choose certain forms of self treatment for some physical and behavioural issues. But this has not been proven, and it is wrong to state it as fact. It just does not seem right when an unqualified person suggests that pets should be allowed to choose their own "pain relieving herbal remedies" rather than the safe proven methods of pharmaceutical pain relief recommended by the vet attending the animal. And it does not seem right that the BBC should give such a person an uncritical platform to disseminate her viewpoint. Update 25th November - Caroline has forwarded this response to the original blog: I believe that your post undervalued the importance of case reports (referred to as anecdotes) that can provide important, detailed information about individual cases that can be very valuable, and it is much better to gather this information than do nothing at all, especially as cases typically come to us after other options have been tried. In fact some successful clinical trials have been started principally because of the promising findings of a collection of related interesting case reports; a topical example is in the human medicine world where the recent FDA approval of a new viral therapy against melanoma, which was inspired by case reports of some patients with cancer going into remission after a viral infection: http://www.nature.com/news/cancer-fighting-viruses-win-approval-1.18651 (of course in this case viral therapy would have to be under the control of a qualified specialist with an appropriately modified virus!). Other observational, non-experimental approaches have also been fruitful, such as with the work by Jane Goodall, among others.  As for Applied Zoopharmacognosy itself, after my lecture to veterinary students at Bristol University yesterday, many came up to me inspired by these case reports and want to explore setting up research projects, and possibly even small scale clinical trials, investigating self-medicative behaviours. I take your point about regression to the mean, but I understand this likely applies more to certain, short term conditions such acute pain, acute infections, slight anxiety etc. that in many cases would be expected to resolve spontaneously. Many of the individuals that I have worked with have long term conditions, most commonly with long standing behavioural issues but also other symptoms as well. The responses can be dramatic and remarkably fast, and so regression to the mean is a less plausible explanation in these cases. It is it important to note that we do not make medical diagnoses, and I advocate self-medicative approaches as complimentary to veterinary treatment not as a replacement; veterinarians are highly trained and highly skilled individuals and their input is typically invaluable. It would be fantastic if veterinarians were to add Applied Zoopharmacognosy as part of their skill set. Finally, I read with great concern in several veterinary blogs (though not this one) and tweets that I have been suggesting to pet owners to offer onions to dogs as a wormer. I would like to clarify that I have never offered, nor recommended giving an onion to a dog. It was merely an observation of an event that I found fascinating since it paralleled other documented occurrences of sick animals selecting typically poisonous plants including: Michael Huffman when he witnessed chimpanzees selecting Vernonia amydalina (locally known as 'Goat killer'), to rid themselves of nematodes (Huffman and Feifu, 1989; Jisaka, et al 1993), and in a study by Singer, et al. 2009, when caterpillars with parasitoid wasp larvae infestations changed their foraging on (normally) poisonous alkaloids such to rid themselves of parasites. The relationship between self-medicative behaviour and plant poisons is a complicated topic, which would take a lot of words to cover adequately. In brief, the most common plant poisons are due to certain chemicals called alkaloids and the reasons for why animals may poison themselves on these are not incompatible with self-medication (possible reasons include evolutionary separation of poisonous plants and companion animals, degradation of bitter warning compounds during drying such as with ragwort, reduced alternative foraging options etc.). Applied zoopharmacognosists typically work with extracts high in other compounds such as terpenoids, not alkaloids. My observations have been presented at a scientific conference in South Korea last year following an invitation by my colleague Michael Huffman, Associate Professor, Kyoto University as well as at Bristol university. I would be more than happy to open dialogue on the subject with any interested parties. Challenges to consider with self-medictaion and clinical trials: I would fully support clinical trials that look into the efficacy of self-medicative approaches. However, clinical trials are often prohibitively expensive and time intensive. The difficulty would also be that it is not immediately obvious how a trial that focuses on two different approaches to animal health could be set up without having to split it up into multiple, equally expensive trials that each focus on particular conditions. It is also important to remember that clinical trials are not completely fail-safe either.  
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Do vets charge too much for bitch spays?

As part of my work as a "media vet", I'm a strong advocate for spaying and neutering pets as the best way to control the problem of pet overpopulation. Accidental pregnancies still account for a high number of unwanted puppies and kittens, and routine spaying/neutering of young adult pets is the best way to prevent these. This doesn't meant that every pet needs to be spayed/neutered when young (there are some good reasons to delay or even not to do the operation for some individual animals), but it does mean that every pet owner should at least discuss the options with their vet around the time of puberty.

Why do people refuse to have their pets spayed?

People have a variety of reasons for not having the operations done on their pets, and the cost is a major factor. In a recent social media discussion, the following comment came in. "Vets should reduce their fee to £120 for a female dog. A lot of people genuinely just can't afford it."

Why don't vets reduce their fees?

This is a good point. Why don't vets reduce the price of spaying? Let's look at how this could be done: what makes up the cost of an operation, and how can those items be reduced? To put this in perspective, what are the typical fees for spaying? The recent SPVS survey found that the median fee nationwide for an adult bitch spay was £204. There is significant regional variation on this, but the figure acts as a reasonable starting point for discussion. How could it be reduced to £120? If you look at the pie chart at the foot of this page, you can see that over half of the costs of vets' fees are made up of overheads that are difficult to reduce: rent, heat, light, phone, drugs, surgical supplies, cleaning, nurses' wages and administration costs. Vets already do as much as they can to keep these costs down: it's in their own interests to do so. So let's leave these alone for the sake of this discussion. So what about the obvious "top item" on the cost list for most people: the money that goes to the vet. Surely vets can manage with less? For every £10 you give the vet, typically only £2 to £2.50 goes to the vet. If a vet gives you a 20 to 25% discount, they are working for nothing. Vets are well enough paid, but their salaries are lower than most people expect. A typical new graduate vet earns around £30000, and a vet qualified for 20 years might earn £50000. Should vets work for less than that, with five years of tough training and high costs in getting through college? For the sake of this discussion, let's say yes, and agree that vets will operate for free on bitch spays: take 25% off £204, and you're left with £153. What next? What about VAT? The government charges 20% on all vet fees, making up £34 of the £204. If this was not charged, £153 minus £34 = £119. Bingo: it's less than £120. So if vets work for nothing, and the government agrees to stop charging VAT, the cost of a bitch spay would reach the desired target. Is this going to happen? Of course not.

In the real world, how can pet owners pay as little as possible for bitch spays?

So what can impoverished pet owners do? Here are three tips. First, plan in advance. You should budget for the spay/neuter surgery when you get a pet, just as you should think about how much it will cost you to feed your new animal. If you genuinely can't afford it, perhaps you should not get a pet. For the financially disadvantaged, there are some subsidised schemes to help, but charity resources are limited, and most of the working population will not qualify for these. Second, shop around, but don't do this on price alone. You should physically visit at least three vets, eyeballing the premises (are they clean?), talking to staff (do they seem to care?) and asking some specific questions: • Do they have qualified veterinary nurses? • Do they use up-to-date anaesthetic, pain relief and monitoring equipment? • Does they monitor all pets after anaesthesia until they are awake? You may not be fully aware of the "right answers" to these questions, but even just by asking the questions and judging the tone of the response, you will learn a lot about the practice. Third, ask for a discount. Some vets may just say "no" ( this is understandable - it directly eats into the 20 - 25% that they are paid), but as in any other consumer transaction, there is no harm in asking the question. If you think a bitch spay is expensive at £200, remember that it would cost around £5000 to have a similar operation carried out on a human. And if you want to help with the pet overpopulation problem, as well as benefitting your own pet's health, it's a price that's well worth paying.
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Ask a vet online- ‘My dog has dandruff . Could it be his diet ?’

Question from Andi Jane William: My dog has dandruff . Could it be his diet . What is best to feed him . He is a 7 year old border collie Answer by Shanika Winters: Hi, thanks for your question regarding your border collie and his dandruff.  I will answer your question by discussing what dandruff is, possible causes and then possible treatment options. What is dandruff? Most people think of flaky white bits of dry skin usually found on the head and shoulders of a person when they hear the word dandruff.  Dandruff is a word used to describe flaky bits of skin, they can be dry or oily, different sizes and come from any area of skin on the body. Mostly we are talking about dry white coloured flakes when we use the word dandruff to describe the appearance of a skin condition.  The flakes can however be yellow in colour if oily or even red/brown if they also have some scabs/dried blood in them. Why does my dog have dandruff? There are various reasons why your dog may be showing the symptom of dandruff including:
  • Diet
  • Excessive shampooing- dries out the skin
  • Parasites-mites such as cheyletiella or after effect of scratching due to e.g. fleas.
  • Skin conditions- such as underactive thyroid and seborrhoea
How do we work out why my dog has dandruff? The best way to get to the root of the problem if your dog has dandruff is to take him to your vet, where he can have a thorough examination, detailed history of how long the condition has been going on for including how it has changed and have appropriate test carried out. Your vet will ask general questions about your dog's health, diet, grooming regime and parasite control.  This will be followed by a physical examination, concentrating on the area of affected skin.  Depending on their finding your vet might then suggest some tests be carried out e.g.
  • Skin scrapes
  • Hair plucks
  • Sticky tape strips
  • Blood tests
  • See response to parasite treatment
  • Skin biopsies
  • Diet trials
Skin scrapes are when a sterile scalpel blade is used to scrape your dog’s skin usually until the point of light bleeding; this sample is then examined under a microscope to look for parasites and signs of infection. Hair plucks are when a clump of hair is pulled out and then examined under the microscope or cultured to see if any bacteria/fungi are grown. Sticky tape strips are literally when a strong clear sticky tape is applied to your dog's skin and it then removed taking with it surface loose hairs and skin which can then be examined under a microscope. Blood tests are performed on a sample of blood taken from either a vein on your dog’s front leg (cephalic vein) or the large vein on your dog’s neck (jugular vein).  The blood is analysed at your vet practice or may be sent to a laboratory.  Your vet will be looking for conditions that can affect the skin hormonal imbalances such as hypothyroidism (underactive thyroid) and Cushing’s disease (over production of steroids). If parasites are suspected as the cause of the dandruff, even if they cannot be seen then a response to a course of antiparasitic treatment can be used to make a diagnosis. Skin biopsies are when a sample of full thickness of your dog's skin is cut out and sent to a laboratory for analysis.  Often several sites may be biopsied and sent off.  Skin biopsies will usually be performed with your pet under some form of anaesthesia to provide pain relief and to keep your pet still. A diet trial is when your dog is fed a specific diet and water to drink but nothing else for a period of time, which could be 8-12 weeks.  This is to ensure that other food substances are out of your dog’s system.  Some animals will show a dramatic improvement in their skin condition as a result of a specific diet; this could be one which has avoided a substance your dog is allergic to or perhaps one with added ingredients to support a healthy skin and coat such as omega oils. How can we treat my dog's dandruff? This will depend on the cause of the dandruff.  A good starting point is to ensure good parasite control for your pet, in contact pets and the home environment followed by a good quality diet which is appropriate to your dog's age, activity level and general body condition.  We will also sometimes recommend dietary supplements to increase the good oils in your dog's diet as these can help the skin to stay healthy and move away from the itchy pathways. Certain fish oils and evening primrose oil contain a good balance of oils, please do not use products you get from health food shops or which are designed for people unless this is under the direction of your vet. Some dogs specifically benefit from a low allergy diet, this is one where an unusual protein and carbohydrate source are used or where the molecules of protein are broken down to a point beyond which they can trigger off allergic reactions.  Low allergy diets need to be stuck to strictly and given for a long period, 8-12 weeks minimum in order to see if there is any improvement before we can say they are not working.  Low allergy diets can be bought or home cooked. If a an infection is found then the correct antibiotic or antifungal medication will be prescribed, this may be in oral form such as tablets or capsules or could be as a shampoo.  Whatever form the treatment is in, it is very important to follow instructions closely to provide the best chances of successfully treating the condition. In cases of seborrhoea your pet will have a sensitive easily irritated skin that can have dry or oily flakes.  This can be underlying due to a dietary issue which will need addressing but it can also be massively improved by use of an appropriate shampoo.  It is important that you use the shampoo as directed, allowing adequate contact time with your dog's skin for the active ingredients to do their job. The shampoo will usually need to be used more frequently at the start of the treatment and this will reduce to less often as the condition starts responding and is being more controlled. Where hormonal imbalances have been detected via blood tests then appropriate medication will be given, in cases of Hypothyroidism supplements of thyroid hormone are given, the levels of which will be monitored in your pet’s blood.  Other conditions such as Cushing’s disease require treatment to stop the overproduction of steroids in the body, these too need carefully monitoring. I hope that my answer has helped you to understand how complex dandruff can be to get to the bottom. With the help of your vet then we hope that your dog's coat soon returns to its former glory and that he is much more comfortable. Shanika Winters MRCVS (online vet) If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.
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Elizabethan Collars – a necessary evil?

  [caption id="attachment_4253" align="alignleft" width="768"]Elizabethan collars are named after clothing worn in the time of Queen Elizabeth I Elizabethan collars are named after clothing worn in the time of Queen Elizabeth I[/caption] One of my clients was talking about his recently neutered bitch today. "She needs one of those Victorian Buckets" he said. I knew what he was talking about, but his terminology was not quite correct. The problem was that his bitch had been licking her operation wound, and he wanted to stop her. The item he was describing is an important tool to assist the healing of animals' wounds. It is more correctly called an 'Elizabethan Collar', because it resembles the white starched lace collars that Queen Elizabeth I and her subjects used to wear. Most people have seen animals wearing these large, lampshade-shaped cones, fastened around their necks and extending up around their heads. Animals have a strong instinct to lick their wounds. In moderation, such licking can be cleansing and beneficial. The problem is that animals do not know when to stop. Excessive licking causes redness, soreness and itchiness, and this makes an animal want to lick a wound more and more. It is a vicious circle - the more licking , the more sore a wound becomes, and the more the animal wants to lick it. In the worst cases, a wound can be completely prevented from healing. Animals have even been known to cause themselves serious open wounds by biting and chewing itchy areas. Drugs can be used to ease the itchiness, but they are seldom adequate alone. The only sure answer is the Elizabethan collar. These were originally home-made by vets, using pieces of cardboard, or by cutting the bottoms out of buckets. However, it was not always easy to create a finished product which was effective. Modern pet Elizabethan collars are custom-made from shiny lightweight plastic. They are manufactured in different sizes, to suit anything from a kitten to a Great Dane. They have become more sophisticated as time has passed, and there is now a range of different products available. The traditional collars are made from white plastic, but these restrict an animal's vision, causing animals to crash blindly around the house, bumping into people and furniture. Some modern collars are semi-transparent, to allow animals to see where they are going. We often advise people to line the outer edge of the collar with elastoplast, to blunten the sharp plastic edge which can otherwise cause painful scratches on an owner's legs as an excited animal barges past. Attaching the collar to the animal can be a fiddle - buckles and slots are fitted into place and the whole construction is strung onto the animals normal leather collar. Owners sometimes feel that it is unfair to inflict these collars on their animals, but you only need to see one example of the serious damage which self mutilation can cause to realise how important it is to stop some animals from reaching their wounds. Animals cope with the imposition of an Elizabethan collar in different ways. Most accept their fate sadly but in a quietly resigned fashion. Some Labrador-types seem to enjoy their new 'hats', and they dash around the room enthusiastically causing chaos as they bounce off walls, people and objects. Some cats do what I call an 'Elizabethan Dance', when they twist, leap and pirouette in an effort to escape the collar. After an initial uneasy settling in period, most pets do not mind this odd looking, but very effective structure. There are, of course, a number of modern alternatives, from inflatable life-ring type products to neck braces to soft floppy collars. Some of them are definitely worth trying, but as is often the case in life, I suspect that the reason there are so many alternatives is that nobody has yet found the perfect way of preventing pets from interfering with their own wounds.
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Ask a vet online-‘Why do dogs find cat poop so alluring ?’

Question from Jayne Whybrow: Why do dogs find cat poop so alluring ? How can I stop my pup sticking his head in the cat litter? Answer from Shanika Winters: Thank you Jayne for your question regarding your puppy and his interest in the cat litter tray.  I will answer your question by discussing why your dog is interested in the cat litter tray and possible methods to stop this unwanted behaviour. Why does my dog find another animal’s poo so interesting? Animals in general leave a scent marker where they pass faeces (poo) and this helps to mark out their territory.  Therefore faeces are naturally interesting whether it is of your own species or another.  The scents could indicate a possible mate, a possible threat to your territory and even predators/prey. Even our domesticated pet animals have not lost these instinctive behaviours.  Unfortunately as humans/pet owners we find our dogs interest in the faeces of other animals very off putting especially when they may lick or eat it.  Not only do we worry about them passing germs onto us humans but also we are concerned about them getting ill from infections or even parasites. So what we are dealing with when a dog is interested in e.g. cat poo is a bad habit/unwanted behaviour. How can I stop my dog from investigating the cat litter tray? In order to try and change a behaviour we have to firstly understand why it happens and then try and redirect the behaviour in a direction we are happy to encourage.  The first section of my answer goes into why the behaviour happens and now we can address possible solutions. Types of litter tray: Simple open litter tray-this is just a shallow plastic tray with sides but no cover Covered litter tray-this is a shallow plastic tray at the base but then has a cove over the top, with an opening at one end to allow your cat in and out. Covered litter tray with a door-this is as above but the opening has a door on it, this can help reduce the amount of litter that gets flicked out of the tray as well as helping to contain odours. The more difficult it is for your dog to access the cat litter tray, the more masked/hidden the scent of the cat faeces are then the less likely he is to show interest in the tray and its contents.  Therefore if you place the cat litter tray in a place that is easy for your cat to reach but not your dog, use litter that helps to mask the smell of the faeces/urine and ideally use a covered litter tray with a door then this will all help to discourage your dog from being interested in it. It is also advisable to clean out the litter tray as often as you can, at the very least once daily but if possible after each time the tray has been used.  This will reduce the smells present which will mean that the litter tray will be far less interesting to your dog. How to discourage your dog from his interest in the cat litter tray: Distraction and deterrents are the next area I will discuss! Generally when it comes to trying to modify an animal’s behaviour we try and focus on positive reinforcement, this is where you praise and reward a behaviour which you want you’re pet to show rather than punishing them for unwanted behaviours. It would be great if you can provide your dog with as much distraction as possible to help lessen his interest n the cat litter tray and its contents.  Methods of distraction can include play, toys and training.  Playing with your dog whether it be throwing a ball or rolling around and tickling his tummy will give your dog mental stimulation as well as strengthen the pet owner bond.  Toys such as squeaky balls treat stuffed puzzles and chews are also good to give your dog something more attractive and interesting than the cat litter tray to investigate.  When choosing toys, make sure that they are safe, regularly inspect them for damage and replace before they become dangerous e.g. possible risk of them being eaten and getting stuck.  As regards food stuffed toys keep in mind your dog's overall energy requirements and how you may need to reduce how much food you give him if he is getting extra calories from his treat stuffed toy. Training either in the form of organised classes or quality dog and owner time can really help to give extra mental stimulation to your dog, build up the dog owner bond as well as distracting your dog form unwanted behaviours.  It is really important to remember that the more we put into our pets the more we will get back from them in terms of good behaviours and owner enjoyment. Deterrents are verging on negative reinforcement to try and avoid/stop an unwanted behaviour.  If the deterrent is used carefully and we try and follow up other good behaviours with positive reinforcement then there is a place for this.  Most owners will have already told their dog off/shouted at him for unwanted behaviours.  The problem with this is that the negative focus then is directed at the owner.  If possible it would be better to remove yourself one step from the deterrent; one possibility is the use of a high pitch sounds device or a spray.  Ideally these negative reinforcement behaviours should be used as a last resort and under the close direction of either your vet or a trained animal behaviour specialist. It is really important to remember to positively reward/praise your dog for all the times he does not show interest in the cat litter tray. The reward can be in the form of kind words, a pat/cuddle and at times treats. I hope that my answer helps you to understand your dog's behaviour and that you can make a start on discouraging his unwanted behaviour. Shanika Winters MRCVS (online vet) If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.
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