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How can you tell if your pet is in pain?

Domino-sleeping It seems a simple enough task, to be able to tell when your pet is in pain but actually it can be a lot harder than you think. Animals have been programmed over millions of years of evolution to hide when they are sore or in discomfort, otherwise predators and competitors would pick up on the signs and target them. So, as owners, we need to be vigilant to quite subtle changes in our pet’s behaviour that could indicate they are in pain, and ensure they don’t suffer in silence. Depression Most of us assume that if an animal is in pain they will cry out or whine but actually the opposite is true. Chronic (low grade and continual) pain is very depressing and often animals learn to cope with it and show few outward signs of a problem, other than maybe being quieter than normal or sleeping more. The problem with is that this sort of pain is common in older pets, for example with arthritis, and this is what we expect them to do anyway. However, even in excruciating pain our pets can be very quiet and withdrawn. I once saw a cat with a very badly broken leg who had managed to drag himself home, curl up in his basket and was so calm his owner didn’t think he was in any discomfort, until she saw the x-rays! Often with this type of pain, it is not until you give your pet some pain killers, and see the difference in their behaviour, that you realise how sore they were in the first place. Lameness A very common sign of leg pain, from pulled muscles to arthritis, is limping. Other than this the pet can seem quite well and cheerful, and often won’t respond to the leg being moved about or felt, which can lead to their owners thinking they aren’t in any pain, when nothing could be further from the truth! Lameness is a very common problem and if it lasts more than 24 hours (even if it is intermittent) the pet should always be checked over by a vet. Smelly Breath All pets have smelly breath to some degree (!) but halitosis can often be the only sign, without looking in their mouths, which some pets are reluctant to let their owners do, of painful teeth problems. Often people assume if their pet is eating then they aren’t in any dental pain but this isn’t the case, as an animal’s drive to eat will always overcome any soreness. In fact, if a pet does stop eating because of mouth pain, it is likely to be excruciating and will have been there for some time. Other signs of mouth pain include tartar build up on the teeth and swollen gums. If you are concerned, most vets run free dental clinics, so give them a ring and pop along. Weight Loss Bunnies Our smaller pets, like rabbits and guinea pigs, are even better than cats and dogs at hiding when they are sore because, as prey animals, if they show any signs of being ill, they will be quickly singled out by predators. So their owners have to be even more vigilant to spot problems. In fact, it is not uncommon for these pets to be brought into our clinics close to death, their owners distraught that they have missed signs of a problem or thinking they have fallen ill very quickly, when it is more likely they have been poorly for a while but have managed to hide their symptoms. However, one thing which always happens if these animals are in pain or poorly is that they will lose weight, even if they appear to be eating normally. So, weighing your small pets regularly is a great way of monitoring them and any changes in a downward direction should always be taken seriously. Our pets can’t speak for themselves and in many cases are too brave for their own good; trying to pretend that everything is fine when in fact they are in pain and suffering. So, all good owners should be alert to the small changes that could indicate a big problem and make sure they get them treatment they need and deserve. If you are worried that your pet may be in pain, please contact your vet. If any other symptoms are present why not check the urgency of the problem by using our Interactive Symptom Guide?
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Tooth Care for Horses

Jack_in_StableI've been thinking about teeth this week - horses' teeth in particular. That's partly because my own horses are due for a dental check up, but also because there's been a report in one of my journals that really made me think how much dental work has moved on in the last ten or fifteen years! When I was training as a vet, an equine "tooth check" mainly involved grabbing the tongue, having a quick feel round, then rasping away at anything that felt sharp. If you were properly equipped, you'd use a gag (aka a dental speculum); if not, many vets were happy to work around the horse's tongue and teeth. Nowadays, that sort of cursory examination really isn't good enough in many cases. There are a lot of very well trained and experienced vets, as well as good equine dental technicians (EDTs) who would probably need a sit down if they saw some of the things that were commonplace not that long ago! We also have many more "paraprofessionals" now - EDTs who have a variety of qualifications, and there seem to be fewer quacks out there than there used to be. That said, if you're asking an EDT to do your horse's teeth, check out their qualification first: if something goes wrong, some insurance companies won't pay out if the EDT isn't registered with the BAEDT (British Association of Equine Dental Technicians). For a start, a proper tooth check up needs to include a clinical examination of the horse - is he losing weight? Are there any lumps or bumps on her head that might indicate a tooth root problem? How well are his intestines working to digest his food? It's also true that it is not possible to do a full mouth exam without a gag of some sort. If you're brave enough, yes you can feel the outside edges of the teeth by running your hand up, but anyone who thinks that holding a horse's tongue will stop them biting your fingers has either been very lucky, or hasn't tried it! A gag really is essential so you can examine the inner surfaces of the teeth, and also so you can have a look at the mouth. Although you can learn a lot from feeling, there are some conditions that are easier to detect and evaluate by sight, using a head lamp or a pen torch to have a good look around the mouth. Now, of course, we have to consider the horse himself. In my experience, about 1 in 3 horses aren't safe even to examine without some degree of sedation. Yes, you can often get away with it - but once you've put a gag in, you've effectively given the horse a lethal weapon. He doesn't have to turn his head that far or that fast to knock someone out, or worse. I've only had this happen once while I was working on a horse, but that's enough for me to be very certain I don't want anyone else to be injured. Of course, only a vet can legally prescribe sedatives to a horse, so in many cases, this is where EDTs have to call in backup. And please note, I've found that ACP (e.g. sedalin) barely takes the edge off a nervous horse; for dental work, injectable sedatives are preferable. Once the exam is complete, we need to decide what we're going to do with whatever we've found. Most horses, especially those who are seen regularly, will have a few sharp edges where the tooth has grown into sharp points as part of its daily wear pattern - remember, horses' teeth grow down from the roots constantly through life, and are worn away by the teeth opposite. If they don't line up properly side to side, we get sharp edges and points (usually on the outside, by the cheeks, at the top and the inside, by the tongue, at the bottom); if the misalignment is front to back, we get hooks (at the front of the first cheek teeth, usually on the top) and ramps (at the back of the last cheek teeth, usually on the bottom). All of these changes can make it painful or difficult to chew if they are allowed to continue, and sharp edges can cause mouth ulcers. I'm sure everyone knows how painful those can be! It's even worse if a tooth is missing - the opposite one will grow down into the gap. In severe cases, this can cause "tooth lock", where the horse is unable to open its mouth because the overgrown tooth has locked into the gap left by the missing one. If it’s just a matter of sharp edges, or small hooks, these can usually be fixed with a hand rasp; however, if they're large a power tool may be required. Power tools come in two forms - either a reciprocating power-float, or a rotary dremel are usually used; personally, I prefer a dremel because the blade is guarded so is less likely to damage the soft tissues of the cheeks and tongue. One important thing to remember about power tools is that altough they make the work easier, they do impose some problems of their own. Firstly, it’s very easy to take too much off - I remember once seeing a horse whose owner was very worried because she'd had "the tooth man" (who wasn't a vet or a qualified EDT) out and then the horse had been unable to eat afterwards. On closer examination, he had managed to power float the teeth as smooth as billiard balls so the mare was no longer able to grind any food. She had to live on porridge and mashes for several months, until the teeth wore in and the grinding ridges reappeared. The second issue is that power tools often generate a lot of heat, and if left applied to the tooth for too long can actually kill the tooth so that it rots and needs to be removed. Some tools have a built in water spray for cooling; otherwise, I only leave the cutting surface on the tooth for a matter of seconds, remove it, apply water if needed, then do a bit more. Now, once again we need to consider sedation; the more you need to do, the more likely it is that you will need sedation, and personally, I almost always sedate horses if I'm going to use power tools like a dremel. I didn't always follow this rule, until one day a very calm pony I was working on jumped forward and swallowed the running dremel. Fortunately, all was well in this case, because as I felt the dremel vanish down the pony's gullet I managed to cut the power, and then retrieve it before it was all gone, but it certainly made me think twice before working on unsedated patients! In addition, even a quiet power tool makes vibrations that the horse will feel through the bone of his skull. My experience is that it's a very rare horse that will stand perfectly still and allow you to do a proper job, rather than rush through and say "that's fine" just before you think the horse is going to start throwing himself around the stable! There are a number of other problems we come across on regular check ups as well. One of the commonest is misaligned arcades, where one tooth grows out at an odd angle - often straight sideways into the cheek. These require very careful treatment, and often need seeing on a very reglar basis (I had one which needed seeing every 6 weeks a one point). Another major problem I've seen is where there's a really painful tooth, but nothing obvious on examination. These are often due to tooth root abscesses. Unfortunately, a horse with an abscess like this can't usually be fixed with a simple course of antibiotics; we need X-rays to see exactly which tooth is involved and how badly, and often we need to remove the tooth. If it’s already pretty wobbly, this can sometimes be done in the field under deep sedation, although it tends to be a lot of physical work to rock it and work it out of its socket. If it isn't wobbly yet, it usually means the horse needs to come into a hospital facility and have the tooth removed surgically. This can frequently be done under sedation, but occasionally a general anaesthetic is required. You can find information about other tooth problems that horses can suffer from here: That said, the vast majority of dental problems I've seen can be managed at home, with a good examination, sedation if needed, and then appropriate treatment with either hand or, occasionally, powered tools. Will I be sedating my horses? One, definitely yes - I have no wish to fight with a 17hh stroppy eventer! The little pony, on the other hand, I'll see how she feels about it; if I can get away without, I certainly will, but with her there are no guarantees... If you are worried about your horse's teeth, talk to your vet or check out any symptoms with our Interactive Horse Symptom Guide to see what to do next.
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Baldness in Dogs (Alopecia)

Bald SetterI've been seeing a number of bald dogs in the consulting room recently, and it made me wonder how common a problem it is - and how many conditions there are that can lead to a dog losing his hair! Baldness (or alopecia, to give it its technical name) isn't generally a disease in its own right - it is almost invariably a symptom of an underlying disease condition. So, when I'm faced with a poor, balding dog in the consult room, my first task is to try and define what the underlying cause is. With a symptom with so many possible causes, what we do to narrow down the possibilities is to work out a differential list - a list of all the possible conditions that can cause baldness - and then eliminate them until we come to the actual cause in this specific case. So, in no particular order, here are the more common causes of hair loss in dogs, along with their other major signs or symptoms: Firstly, those disorders that give a symmetrical pattern of hair loss (i.e. the same pattern of hair loss on both sides of the body): Hypothyroidism Hair loss is symmetrical along the trunk and may also involve the tail, armpits and the belly. The skin isn't inflammed or itchy, but there may be a darkening of colour and dandruff or greasy skin. Caused by production of too little thyroid hormone, other common symptoms include lethargy, weight gain, and sometimes muscular weakness. To diagnose hypothyroidism, your vet will take a blood sample; treatment is simple, with daily tablets containing replacement thyroid hormone. Cushing's Disease Once again, hair loss is symmetrical, and there may be hard lumps in or under the skin (calcinosis cutis). Cushing's is caused by too much cortisol (an important natural steroid hormone) being produced by the body. Other symptoms include increased hunger, thirst and urination, development of a pot-belly, muscle weakness, skin thinning and "spots" or "blackheads" developing. To diagnose it, your vet may have to do a series of blood tests to see how your dog's body responds to injections of steroids or other hormones. Tablets to treat Cushing's usually act to reduce production of steroids, although some destroy the adrenal glands that make the excess hormones. Iatrogenic Cushing's Disease This is a form of Cushing's disease caused by long term use of steroid medications (e.g. Prednisolone for severe allergies). The only treatment is to VERY GRADUALLY reduce the steroid dose - but this needs to be done carefully, following advice from your vet, because if you reduce it too far, too fast, it can result in severe withdrawal effects, or even death, due to a lack of cortisol in the body. Sex hormone disorders Excess production of sex hormones (e.g. due to a testicular tumour) or insufficient sex hormones (usually after neutering) can, in rare cases, cause symmetrical hair loss. And now, those diseases where there are patches of hair loss in various sites across the body: Flea Allergic Dermatitis This is probably the commonest cause of all! Dogs with a flea allergy scratch and scratch, and wear the hair away. FAD is usually straightforward to diagnose (very itchy dog plus fleas is something of a giveaway), although in extreme cases, a single flea bite can set it off, which is harder to detect. Prevention is simple - avoid and kill fleas - although it can be hard in severe cases to keep the flea population low enough, and anti-allergy medication may be required. Sarcoptic Mange Mange mites burrow into the skin, creating a very itchy patch covered in little bumps. The dog scratches away at it, wearing the hair away, creating a bald patch. The most common site is on the ear; fortunately, there are some spot-on treatments available from your vet that will kill the mites and stop the itching. Demodectic Mange This is a different variety of mite, and unlike the sarcoptic mite, it doesn't itch at all. Most dogs have a few, and they don't cause any problems, living harmlessly deep inside the hair follicles. However, sometimes they can start to multiply, and the sheer numbers start to result in hair loss. Typically, it is a patchy disease, with hair loss in distinct regions that get bigger over time. Sometimes there is a bit of scale forming, but the mites themselves do not cause itching, although secondary bacterial infection may occur, which can. To diagnose Demodex mites, your vet will have to take a deep skin scrape, usually with a scalpel blade, and then look at it under the microscope. If Demodex mites are found, treatment may involve spot-ons like Promeris Duo, or bathing with Aludex for several months - sadly, it can take a lot of work to get it under control. Primary Pyoderma Bacterial skin infections are common in dogs, and can result in hair loss. The skin is usually reddened and inflamed, and there may be pussy "spots". Often the area is itchy and sore, but occasionally there are cases where the skin looks almost normal but hairless. The vet can diagnose it by taking scrapes and smears from the skin, then looking at them under the microscope. Treatment nay involve antibiotic creams, washes, and sometimes tablets to kill the bacteria. Sometimes a yeast infection can cause the same symptoms; treatment then is usually with anti-fungal washes. Ringworm (Or dermatophytosis) is often diagnosed in practice, generally by using a Woods Lamp, which makes the fungus glow. Its appearance can vary widely, but most looking involves patches of hair loss, sometimes with scales, sometimes itchy (but not always). It's particularly a problem in dogs that are ill with something else, and have reduced immunity. To get a definite diagnosis, hair plucks have to be sent to a lab and cultures, but that can take weeks so vets will often start treatment while waiting for confirmation to come back. Treatment usually involves washes, shampoos and occasionally tablets to kill the fungus, but it can take a long time to completely clear a bad infection. Allergic Reactions (e.g. to a spot-on medicine, or a new floor cleaner, sometimes even to food!). Usually, there is reddening and inflammation of the skin, and itching, before the hair comes out, but occasionally hair loss is noticed first. There are other causes (e.g. genetic disorders, immune diseases like pemphigus) but they are generally far less common. It's important to remember the old adage that "common things are common" before jumping to conclusions. Baldness and hair loss in dogs can be a marker for a serious underlying condition - it's almost never due to simple old age! - but most of these conditions are either curable or at least manageable. And the dogs I saw this week? Well, one was a nice simple skin infection (although it didn't look like it to begin with, the tests were clear and she responded really well to antibiotics). The other one had been on steroids for several years, and the effect over that time had given him Iatrogenic Cushing's. His owners are working to reduce the dose (very, very gradually, as his body has become dependant on the tablets now), and to keep him warm, they've bought him a coat to wear when he goes out in the cold for a walk! If you are worried about bald patches on your dog, talk to your vet or check any other symptoms using our interactive Dog Symptom Guide to help decide how urgent the problem may be.