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May I Make A Suggestion?

Happy New Year! Have you made any resolutions yet? If not, may I make a few suggestions? There are some phrases I hear often in my clinics which I would really rather never hear again (although I’m going to!) and I thought I would share them with you so you know why they irk me and you can make a resolution never to say them! He’s limping but he’s not in any pain This one is my biggest bugbear in practice. If clients say this to me I smile politely but really I want to say ‘Well why else would he be lame?!’. The problem is that our pets don’t display pain as we do and will continue to act fairly normally even if they are very sore. This is why you can feel all over the lame leg and they will rarely even wince. In fact, it is often only when they break something that even us vets can find any discomfort, our pets are much braver than us! If any animal is lame, they are sore; whether it is a cat who has been scrapping and developed an abscess or an elderly dog who has been stiffening up for while, and must be brought to the vet (and don’t tell us the problem isn’t pain!) But she hardly eats anything..... No, in comparison to you, a person probably 10 times her size she doesn’t but for a little animal she must, otherwise she wouldn’t have a head that looks several size to small for her body! (Another statement I would like to say but have to dress it up in a slightly more polite way!) Small dogs and cats only need small amounts of food to keep them going, often only 50-100g of dry food a day, which can look measly in a food bowl. Also, often they are not particularly food orientated and soon learn that if they leave the biscuits in the bowl (which isn’t a hardship because they aren’t hungry anyway), it will soon be replaced with something much tastier from the fridge (sound familiar?!). The best thing to do is to pick a good quality dry food that you know provides all the nutrition they need, ensure they eat a measured amount every day and stop worrying about them! Oh, he never goes off the lead I know it can be difficult to give a dog decent off the lead exercise but it is vital. All dogs can be taught reasonable recall and good dog to dog behaviour but for some it is more challenging than others. Don’t resign yourself to never being able to let your dog run, it is no fun walking a dog who is exploding with energy and often they are quite badly behaved because they are so frustrated, get some professional advice. It can seem embarrassing to have to ask for help for something which many dog owners take for granted but a bit of time and investment can make a huge difference to you and your pets and mean walking them is a pleasure, not a chore. But she’s so old now, is it worth it? How would you feel if someone refused treatment for you for a painful or debilitating condition just because you were old? Would you be pleased you weren’t ‘going to be messed with’ or would you prefer to undergo a procedure that would allow you to live a much more comfortable life for the time you have left? Exactly, so why is it any different with our pets? One of the most common problem I see in elderly animals is dental disease. Not only is it very painful but the infections in the tooth roots can be very damaging to other organs. Unfortunately, they aren’t good at showing they are sore and they are left to suffer in silence. Their quality of life can be massively improved by surgery but it can be difficult to persuade their owners to go ahead. Other diseases which can be very effectively controlled include Kidney Failure, Arthritisand Diabetes, all with very little intervention. Our older pets have given us years of companionship and loyalty, the least we can do is keep them comfortable and pain free. This is just a small selection of the things clients say to be that make me roll my eyes, (others include ‘He doesn’t eat dog food’, ‘She’s not fat, she’s just big boned’, ‘Oh, you can’t touch his face/ears/paws, he doesn’t like it’) I am sure all professions have their versions (and I have probably said them!) but there is an important message here which I hope you understand! I hope you and your families all have a happy 2013!
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Sedatives and Sedation in Horses

We routinely sedate horses in practice - after vaccination, it’s probably the most common "routine" job that we do. So, what are we doing? How do the drugs work - and why doesn't it always happen the same way? "Sedation - a state of rest or sleep... produced by a sedative drug." That's the dictionary definition, and it makes it sound lovely and simple - give a drug, and the patient goes to sleep. Of course, in reality (as usual with anything equine!) life isn't that easy... For those who haven't seen it before, a sedated horse doesn't lie down, but their head gets lower and lower, and they may require something to lean on to help them balance. It’s also important to remember that a sedated horse CAN still kick - they're just much less likely to do so! It often seems that the horse is still more or less aware of what's going on around them, but they're too sleepy to care about it. As a result, we'd almost invariably use pain relief and local anaesthetic as well if we're carrying out a surgical procedure. There are a wide range of situations in which we like to use sedation. Generally, it’s to make the horse more amenable when something nasty or scary is being done to them. Of course, this varies from horse to horse. There are quite a lot of horses out there that need a sedative before the farrier can trim their feet; and there are others that will allow you to suture up a wound without sedation or even local anaesthetic (not recommended, but occasionally necessary). Probably the most common reasons we sedate horses for are... 1) Stitching up wounds, to stop the horse wriggling! 2) Tooth rasping, especially when using power rasps and dremels 3) Some surgical operations - for example, many vets prefer to castrate colts under standing sedation, rather than a general anaesthetic. This is because sedation is much safer than a general anaesthetic... On the other hand, the surgery is easier and safer (for the vet, as well as the horse) if the patient is completely "out", so it comes down to the type of horse and the preference of the vet doing the op. It’s important to remember that all sedatives temporarily alter the way the horse's brain and body works, and have a serious impact on the heart and circulatory system. As a result, they're all prescription-only medicines, and your vet will want to satisfy themselves that the patient doesn't have any underlying heart problems etc before using them. Overdose of a sedative is rarely fatal in a healthy horse, but it can still be dangerous, especially if there is any underlying illness that makes them less good at maintaining their blood pressure. Its also vitally important to tell your vet the horse's whole medical history if you're asking them to give a sedative - there have been cases of horses who were being treated with a (very safe) antibiotic (TMPS); the owner forgot to tell a vet this, and the combination of sedative and this antibiotic has resulted in a heart attack (technically, a fatal arrhythmia). There are three routes by which we normally give sedation: 1) By syringe or in feed. This is the slowest, least powerful and least reliable way to sedate a horse, but it has two advantages - you don't need a vet to come and do it, and you don't need to get so close to the horse to give it. The drug most commonly used is ACP, sold as Sedalin or Relaquin paste. Occasionally ACP tablets are used, although there are strict restrictions on when a vet is allowed to prescribe tablets instead of paste. There is a newer drug now available as a syringe, detomidine (sold as Domosedan gel), which is absorbed across the membranes in the mouth so shouldn't usually be given with food, but does work faster and give better sedation than ACP. 2) By injection into the muscle. Many injectable sedatives can be given into the muscle - this injection is more reliable than by mouth, but requires much higher doses than if given into the vein (in my experience, you need 4-5 times as much, and it takes about twice as long to work). It’s only usually needed if the horse is too wild or dangerous to get a vein, but it’s quite useful to "take the edge off", and then I can top up with intravenous sedatives if needed. The other situation where I've occasionally used it is when a severely colicing horse has to take a long ride in a box to get to a surgical centre. In these cases, I have sometimes given the driver a preloaded syringe so that if he horse freaks out or goes crazy in transit, they can give it something to calm it down and relieve the pain until they arrive. 3) By intravenous injection. Intravenous sedation is by far the best option if possible - it works fast (usually 5-10 minutes), you need lower doses, and you get much better sedation than by any other route. This is what I'll be concentrating on below. There are three "families" of drugs used to sedate horses: Acepromazine (ACP). This is a very "dirty" drug, in that it affects a wide range of body systems. It can only produce mild to moderate sedation on its own, and the effects are very variable between horses. It’s important to remember that once sedation has been achieved; increasing the dose WON'T result in deeper sedation, just more side effects. It also has no painkilling properties. There are two side effects in particular that we as vets watch out for with ACP. Firstly, it can lead to significant drop in blood pressure, because it makes peripheral blood vessels dilate (this is why it’s sometimes used in laminitis). The second effect is much more interesting - ACP is a mild muscle relacant of some muscle types, so it can be useful in azoturia and choke. There's one exception though (male readers of a senstive disposition, look away now...): ACP is a very powerful relaxant for the retractor penis muscle. This is the muscle that holds the penis in the sheath, and even low doses of ACP usually lead to male horses "dropping" the penis. This can be useful, but unfortunately in some horses (especially stallions, with a larger and heavier penis than most geldings); the paralysis of the penis can be quite prolonged, which can result in penile trauma. In extreme cases, this can be permanent or lead to gangrene, requiring amputation. Bottom line - if at all possible, avoid using ACP in stallions and entire colts! ACP does, however, have a place in sedation - when mixed with other drugs, it often prolongs sedation and means that the doses of each part of the combination can be dropped, reducing the risk of side effects. A quick note on ACP tablets - under the current Veterinary Medicines Cascade laws, it is illegal to use ACP tablets instead of paste in horses unless the vet has a clinical reason (unfortunately, price isn't considered good enough) to think that they are more appropriate. As a result, if your vet refuses to give you the tablets, they're not trying to rip you off - they're just obeying the law. Opiates Although opiates on their own are only very weak sedatives in horses, when combined with other drugs they lead to much deeper and smoother sedation than any other drug on its own. The drug usually used is butorphanol, which is a synthetic opiate (it’s a mu/kappa agonist/antagonist related to buprenorphine, for anyone interested) that has a fairly good painkilling effect as well as potentiating sedation from other drugs. Fortunately, it also has very few side effects, although its worth bearing in mind that any other opiates (e.g. Pethidine or Fentanyl) that the horse is given up to about 8 hours later won't work quite like they're supposed to, as the butorphanol will partially block their activity. Alpha-2 Drugs These really are the mainstay of sedation in horses (and in dogs and cats, for that matter). Alpha-2 drugs act by tricking the body into thinking it's produced too much adrenaline, so it stops releasing it, resulting in reliable deep sedation. They're also pretty powerful painkillers. There are three drugs that are commonly used, with slightly different properties. Detomidine and Romifidine are both fairly long acting drugs (30-40 minutes after i/v use), and when mixed with butorphanol are the standard sedative preparation for intravenous use, or on their own into the muscle. Detomidine is also available in a syringe for oral use. The third drug is xylaxine; this is a bit different in that it gives milder sedation, and only lasts 20 minutes or so. It’s particularly useful for sedating horses for nerve blocks etc, where in half an hour they need to be completely recovered and able to trot up. Before I sedate a horse, I always have a good listen to the horse's heart, and check its pulse and colour to make sure its cardiovasclar system is healthy. I'll then double check it’s not on any medication, and then give i/v sedation. I like to use either detomidine or romifidine mixed with butorphanol for routine sedation - I personally prefer detomidine, but that’s probably just because it’s what I "grew up" as a vet using! For longer lasting procedures, or if I want muscle relaxation (especially for dentals where I want the tongue nice and floppy!), I add ACP into the mix. Dosage is incredibly variable between horses and experience and judgement is more important than all the book learning available. As a rule of thumb, the bigger the horse, the less sedative per kilo of body weight it needs (so Shetlands often need as much as a light hunter). In addition, it depends on temperament - the more highly strung or excited, the more sedatives are needed. The other thing to remember is that apparently identical horses, in the same circumstances, may react very differently - the dose that will have Alf so deep his head's on the floor will have Brutus untouched, while Charlie is in the "Goldilocks" zone where he's just right. Of course, it also depends how deep the sedation you want - although personally, I've found that if you aim for "light sedation" to start with, you usually end up having to top the horse up halfway through. Once the injection's been given, it is VITAL to give the horse time for it to work in a quiet, dim, calm place. If the horse gets excited while you're waiting for the sedative to kick in, it won't work well. This is doubly true for oral sedatives, but it applies to injections as well. During the procedure, its sometimes necessary to top up, which is fine - the great thing about the drugs we use is that they work fast enough i/v that you can monitor their effects more or less in real time. Recovery is usually rapid and uncomplicated, although it’s important not to let the horse eat anything until it’s completely woken up, or it may choke. Very occasionally, I've had a horse that refused to wake up, or went too deep. After my first one, I took to carrying the antidote (Atipamezole, aka Antisedan or Sedistop) with me when I sedated sick or old horses. It's very expensive, but it works within a minute or two to reverse the effect of alpha-2 drugs - and once they're reversed, the horse wakes up incredibly fast! In practice, sedating horses is as much an art as a science, and there's rarely one "right answer" - it depends on the horse, the circumstances, and what you're trying to achieve. The main purpose is to allow us to treat your horse effectively and humanely. If you are worried about any problems with your horse or pony, please talk to your vet or try our Interactive Equine Symptom Guide to help decide what to do next.
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Ask a Vet Online – “My dog gets frontline flee treatment ..”

Question from Tracey Newall My dog dexter gets frontline flee treatment but recently he seems 2 scratch more i havent found anything but his skin flakey Answer from Shanika Online Vet It is good to hear that you are treating Dexter for fleas; fleas are definitely high up on the list of causes for an itchy dog. Dry flaky skin may well be as a result of scratching due to flea infestation but can also be affected by allergies and medical conditions. It is really important to remember that a pet suffering from a flea allergy or irritation does not need to be full of fleas. All it takes is one flea to bite your pet to set off the allergic reaction cascade that leads to the skin being irritated. What is a flea? Ctenocephalides canis or felis (the dog and cat flea) are a small wingless parasitic insect that live on our pets and in the environment.  Fleas can jump but they can’t fly, they need blood feeds to survive and a large proportion of the flea population are in the environment as oppose to on your pet. Where are the fleas coming from? Fleas live on animals as well as in the environment. The flea population consists of adult fleas, immature larval stages, dormant pupae and then eggs, as you move down the list the numbers increase significantly which is why we refer to them as a pyramid. Fleas in the environment, by this we mean anywhere a pet with fleas has been, the warmth of our homes provides a great breeding ground for fleas in carpets, pet bedding and just about any nook and cranny. Cats can also carry the fleas and they do not even have to be your own cats, for example if a cat comes through your home or garden then the fleas can jump off or deposit eggs as they go. This is why we often advise treating the home environment and in-contact animals also. So how can you tell if your pet has fleas? Gently part your pets fur and search through close to the skin, fleas are a reddish/brown colour and quickly move away from the light. It can be easier to find fleas on the underside of your pet as the coat is naturally thinner here. It is often easier to see the flea dirt in your pet’s coat than the actual fleas. So what is flea dirt and how can you tell if there is any on your pet? Flea dirt is the waste product produced by fleas and when dry it looks like little black specs, however if you wet it these black specs turn red as they contain digested blood. This brings us to the ‘wet paper test’, we comb through your pets coat and collect the debris onto a piece of wet white paper, if there is flea dirt present there will be small red dots visible where the flea dirt has dissolved in the water. The wet paper test helps to distinguish between flea dirt and just dried mud that may be on your pet’s coat. Can the fleas live on humans? You will be relieved to hear that cat and dog fleas don’t tend to live on humans, fleas can however bite humans and cause an irritation at the site of such bites. Commonly humans find flea bites on their ankles, wrists or at their waist band as small itchy raised red areas on the skin. How to treat the flea problem? I would recommend using a veterinary flea product either in the form of a spot on (applied to skin at base of neck), impregnated collar or a spray directly on your dog. It is however really important to treat any in-contact animals not just dogs but cats too. Lastly do not forget to treat the environment; this is most easily done by use of an aerosol spray applied to the carpets, skirting boards and soft furnishing. Instructions often advise to vacuum carpets before you spray to help the chemicals to be more effective. Always read the safety information as the chemicals may be harmful to fish or birds and it is important to allow good ventilation after spraying also. In my experience it is best to treat half the house at a time so as to leave somewhere for pets and people to hang out without having to breathe in the spray. The chemicals in the spray are designed to kill or prevent further development of the fleas and their various life stages. The effect of the environmental sprays can last for a year. Why is my pet still scratching even though I have treated him/her for fleas? Provided a thorough approach to flea treatment using appropriate products has been undertaken then if your pet continues to scratch there are likely to be other factors contributing. These may include allergies or intolerances to food substances, cleaning products and or an underlying medical condition. What medical conditions may be causing my pet to scratch? The skin has its own inbuilt barrier to substances that can cause irritation this however can be weakened in conditions such as Hypothyroidism (under active thyroid gland), Cushing’s disease (over production of natural steroids) and bacterial skin infection. What should I do if after treating my pet, in-contact animal and the environment my pet is still scratching? It is likely you will need to discuss further investigations into your pet’s skin condition with your vet, to try and rule out some of the conditions listed above. The investigations may involve blood and or skin tests. There is also the possibility that an exclusion diet or low allergy diet may be suggested if diet is suspected as a contributing factor to the skin problem. So in conclusion an itchy pet may well need more than flea treatment. That is not to say that fleas are not very high up on the list of things to rule out by taking a thorough approach to flea treatment. If you are in any doubt always talk to your vet as we are here to help you and your pet.
It is good to hear that you are treating Dexter for fleas; fleas are definitely high up on the list of causes for an itchy dog. Dry flaky skin may well be as a result of scratching due to flea infestation but can also be affected by allergies and medical conditions.
It is really important to remember that a pet suffering from a flea allergy or irritation does not need to be full of fleas. All it takes is one flea to bite your pet to set off the allergic reaction cascade that leads to the skin being irritated.
What is a flea?
Ctenocephalides canis or felis (the dog and cat flea) are a small wingless parasitic insect that live on our pets and in the environment.  Fleas can jump but they can’t fly, they need blood feeds to survive and a large proportion of the flea population are in the environment as oppose to on your pet.
Where are the fleas coming from?
Fleas live on animals as well as in the environment. The flea population consists of adult fleas, immature larval stages, dormant pupae and then eggs, as you move down the list the numbers increase significantly which is why we refer to them as a pyramid.
Fleas in the environment, by this we mean anywhere a pet with fleas has been, the warmth of our homes provides a great breeding ground for fleas in carpets, pet bedding and just about any nook and cranny.
Cats can also carry the fleas and they do not even have to be your own cats, for example if a cat comes through your home or garden then the fleas can jump off or deposit eggs as they go. This is why we often advise treating the home environment and in-contact animals also.
So how can you tell if your pet has fleas?
Gently part your pets fur and search through close to the skin, fleas are a reddish/brown colour and quickly move away from the light. It can be easier to find fleas on the underside of your pet as the coat is naturally thinner here. It is often easier to see the flea dirt in your pet’s coat than the actual fleas.
So what is flea dirt and how can you tell if there is any on your pet?
Flea dirt is the waste product produced by fleas and when dry it looks like little black specs, however if you wet it these black specs turn red as they contain digested blood. This brings us to the ‘wet paper test’, we comb through your pets coat and collect the debris onto a piece of wet white paper, if there is flea dirt present there will be small red dots visible where the flea dirt has dissolved in the water. The wet paper test helps to distinguish between flea dirt and just dried mud that may be on your pet’s coat.
Can the fleas live on humans?
You will be relieved to hear that cat and dog fleas don’t tend to live on humans, fleas can however bite humans and cause an irritation at the site of such bites. Commonly humans find flea bites on their ankles, wrists or at their waist band as small itchy raised red areas on the skin.
How to treat the flea problem?
I would recommend using a veterinary flea product either in the form of a spot on (applied to skin at base of neck), impregnated collar or a spray directly on your dog. It is however really important to treat any in-contact animals not just dogs but cats too. Lastly do not forget to treat the environment; this is most easily done by use of an aerosol spray applied to the carpets, skirting boards and soft furnishing. Instructions often advise to vacuum carpets before you spray to help the chemicals to be more effective. Always read the safety information as the chemicals may be harmful to fish or birds and it is important to allow good ventilation after spraying also. In my experience it is best to treat half the house at a time so as to leave somewhere for pets and people to hang out without having to breathe in the spray. The chemicals in the spray are designed to kill or prevent further development of the fleas and their various life stages. The effect of the environmental sprays can last for a year.
Why is my pet still scratching even though I have treated him/her for fleas?
Provided a thorough approach to flea treatment using appropriate products has been undertaken then if your pet continues to scratch there are likely to be other factors contributing. These may include allergies or intolerances to food substances, cleaning products and or an underlying medical condition.
What medical conditions may be causing my pet to scratch?
The skin has its own inbuilt barrier to substances that can cause irritation this however can be weakened in conditions such as Hypothyroidism (under active thyroid gland), Cushing’s disease (over production of natural steroids) and bacterial skin infection.
What should I do if after treating my pet, in-contact animal and the environment my pet is still scratching?
It is likely you will need to discuss further investigations into your pet’s skin condition with your vet, to try and rule out some of the conditions listed above. The investigations may involve blood and or skin tests. There is also the possibility that an exclusion diet or low allergy diet may be suggested if diet is suspected as a contributing factor to the skin problem.
So in conclusion an itchy pet may well need more than flea treatment. That is not to say that fleas are not very high up on the list of things to rule out by taking a thorough approach to flea treatment. If you are in any doubt always talk to your vet as we are here to help you and your pet.
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Rain Scald, Mud Fever and Greasy Heels – Wet Weather Care for Horses

I heard on the news recently that last year was one of the wettest on record. I don't know if it’s true - but it certainly feels about right! The big danger to our horses from this, of course, is Rain Scald and Mud Fever. Most people have probably come across Rain Scald on occasions - the scabs hidden away in the coat feel like mud, until you pull them up and see the characteristic "paint brush" appearance as the hair stays stuck in the scab. Rain Scald is caused by a bacterium called Dermatophilus congolensis. This usually lives (fairly) harmlessly on the skin, but if the skin gets and stays wet, the bacteria can invade and set up an infection. Most cases are mild, with just a few scabs here and there, but (especially in older horses and those with Cushing's disease) it can be more general and leave large raw patches. Even a mild case can put a horse "off games" if the scabs or raw patches are under the saddle. Most cases resolve on their own with simple care - gently brush out the scabs, and most importantly keep the area dry to allow it to heal. That said, older horses and those with other diseases may need a helping hand, in which case a short course of antibiotics from your vet will usually clear it up. HOWEVER... Unless the underlying problem is sorted, it will rapidly return! Prevention is far more important, and that means keeping the skin as dry as possible. Remember, if your horse gets wet, that’s fine as long as he can then dry out thoroughly. It’s if the skin stays constantly wet that problems ensue - and watch out for rugs, especially in early autumn! When it’s wet, but not that cold, horses can easily sweat up under their rugs, and sweat seems to be even worse than rain for causing Rain Scald. The other thing to watch out for, of course, is Mud Fever. This is an infection of the skin behind the heels (its sometimes called Greasy Heels), and is most common in horses with long feathers. It's a far more complicated disease than rain scald, and has a large number of contributary causes. The most important is wet weather, of course - as the skin gets wet, bacteria can invade, as in rain scald - long feathers keep the water trapped in the area, slowing down the drying, so cobs and heavy horses are more prone. However, mites are also a known cause (the first signs are usually stamping of the hind legs), and its not just bacteria, because some cases include yeasts and other fungi as well. Sometimes, really aggressive bacteria like Pseudomonas can establish themselves, and they can be really difficult to manage. The symptoms vary, but generally it first presents as scabs in the angle of the heels behind the pastern. If untreated, or as the infection gets worse, cracks in the skin can open up and start oozing fluid and pus, and the legs thicken. Eventually, lymphangitis can occur and ultimately, the skin can slough or even become gangrenous. Initial treatment is very simple: wash the affected area with a skin disinfectant (like Hibiscrub or similar), and once the scabs are softened, gently wash them off. This may take several days of work! If the infection progresses, or doesn't improve, you will need veterinary attention. Most cases respond well to a course of first-line antibiotics (e.g. Penicillin/Streptomycin or Timethoprim Sulpha); however, if it doesn't respond in a week or so, I would always take a swab for bacterial culture and sensitivity testing. This give you a much better idea what bacteria you're dealing with, and how best to kill them - I had a case once which turned out to be a multi-resistant Pseudomonas infection, that needed some really powerful off-license antibiotics to resolve it. Sometimes you can use topical antibiotics (creams, ointments etc), and in severe cases, I have occasionally used a "bespoke" ointment that I made up from several different antibiotics and an anti-inflammatory. If there are mites involved, most vets will use an injectable anti-mite drug; however, this isn't licensed for use in horses so has to be put up by your vet. As usual, prevention is much better (and cheaper!) than treatment, though, so keeping the heels dry is vital. Sometimes using an aqueous cream like zinc and castor oil, or Vaseline, can be useful in encouraging the water to run off - but if you do use them, make sure you wash it off and dry it thoroughly once or twice a week before reapplying, so it doesn't get too thick. Of course, in an ideal world, keep the horses out of muddy fields and trackways... But given the recent weather, I fear we're all going to have to be a lot more careful to keep our horses and ponies warm and dry this autumn. If you are worried about any symptoms your Horse or pony may be displaying please talk to your vet or try our Interactive Equine Symptom Guide to help decide what to do next.
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