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Ask a vet online- ‘my Bichon friese keeps goin for his side and making bald patchers’

Question from Shell Cottam: My Bichon friese keeps goin for his side and making bald patchers, we are have in to keep his cone on to stop it, is there anything you can recommend to stop him doin this please Answer from Shanika Winters: Hi Shell and thank you for your question regarding your dog going for his side.  I will discuss some possible reasons for your dog’s behaviour and then possible ways to tackle these. From what you are describing it sounds as though your dog is biting and or scratching at himself to the extent that he is losing his hair.  I am sure that both you and your dog would be a lot happier if he did not have to keep a cone on his head long term to prevent his hair loss.  The first think we need to do is find out the history of how your dog is in general and how long the condition has been going on.  Your vet will ask you some of the following questions: Is your dog generally well? By this we mean is he eating, drinking, toileting, happy to exercise and generally acting as normal other than the condition you have brought him in for.  We ask this as underlying illnesses can sometime show up in unexpected ways, so something you may not at first think is linked to the hair loss could be.  An example of this would be if your dog was generally listless and not as keen to exercise along with hair loss this may suggest an underactive thyroid gland. How long has the condition been present and has it changed? Your vet will want to know when the condition first started and if there were any particular changes at this time e.g. getting a new pet, change of food, starting a new job all things that can help us to work out why your dog is losing hair and if the situation is stable, improving or getting worse.  It is really important to tell your vet if you have already tried any treatments even if these are over the counter shampoos or anti parasitic treatments. What are some possible causes for the biting and hair loss? Top of the list is always parasites; they can sometimes be tricky to spot at first.  We would consider fleas(both cat and dog fleas) and mites(sarcoptes and cheyletiella) as possible causes, these can be diagnosed by examining your pet, and sometimes we need to take skin scrapes, hair combings or hair plucks to look at under the microscope. Bacterial infections can sometimes lead to irritation and hair loss, this may be seen in the form of spots, scabs, crustiness and or areas of raw wet skin.  In some cases we would take swabs or biopsies from the skin to make sure we were treating with the correct antibiotic and for the correct length of time.  The samples can be looked at by your own vet but are sometimes sent away to a laboratory to be analysed. Allergies can cause a dog to lose hair, these can be to something your pet has been in contact with such as shampoo/new bedding/plants, something your pet has eaten such as a new food or scavenged items or something inhaled such as pollen and dust (we call this atopy). Hair loss can be due to a behavioural problem such as boredom or stress. Hopefully the questions your vet asks will help narrow down the list of possible causes for the hair loss and will point to the answer or at least the most appropriate tests to carry out. What tests will they do on my dog? After the basic examination and history taking your vet may suggest doing skin scrapes, hair plucks or combings to look for parasites as mentioned above.  If examining the sample in house(at your own vets) did not give enough information they may ask if the samples can be sent away to an external laboratory, the results may take days to week to come back.  Blood test and or biopsies can give us information as to what is happening in your pet’s body/skin e.g. certain white blood cells are increased in cases of allergies, there may be bacteria present in the blood and or infection fighting cells. Specific blood tests to look for allergies and or hormone imbalances which could be causing the hair loss can also be useful.  Special diets, shampoos or medications may be tried and then the how well your dog responds to these can help us to work out the cause of the problem and if we are on the right track. What treatments are there? If parasites are suspected or detected then routine flea and mite treatment will be advised including treatment of the home environment. For some bacterial infections shampoos are very effective but they may need to be used in combination with the appropriate antibiotics also. Allergies can be treated by avoiding the substance if possible, anti-allergy drugs, special diets and special vaccines or a combination of these. Behavioural conditions may need treatment by retraining your dog, strengthening the pet owner relationship, making the home environment more stimulating and sometimes the use of behaviour modifying drugs. I hope that my answer has helped you to understand that we need to take a logical step by step approach to helping your dog, this would most likely start with ruling out parasites followed by a thorough examination and diagnostic work up by your vet. 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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Ask a vet online- ‘my cat is now 18 yrs old, bit loathe to help him on his way’

Question from Susan Banfield: My cat is 18 yrs old, has lost most of his front teeth, bad breath, dribbles all the time, extremely skinny and has trouble keeping himself clean.  Bit loathe to help him on his way over the bridge as his coat still shines, bright eyes, eats well and still goes outside to toilet and explore.  Am I being fair? Thank you Answer from Shanika Winters: Hi Susan and thank you for asking one of the most delicate questions that a pet owner and vet will face ‘when is the right time to have my pet put to sleep?’ As our pets ages we are very aware that we do not want them to go on for too long and that our vet can put our pet to sleep so as to prevent unnecessary suffering.  This is however never a simple or easy decision to make and is very much specific to each individual pet, its condition and its owner.  I will go through the way in which we try to help an owner work out if that time has arrived.  Please remember that as your veterinary team we are here to help and support you any your pet through all situations even after you lose a pet we are here to talk to. From what you are describing it sounds like your cat has done very well to get to 18 years of age and still be going out, toileting correctly and eating.  Loss of teeth is to be expected as pets get older, often as vets we may have extracted teeth due to infection or damage.  You mentioned that your cat was struggling to keep clean, by this I assume that we are talking about grooming of his coat.  Cats and dogs use their front teeth to almost comb through and nibble at their coats, as you mentioned most of these are missing then it would necessary to groom your cat using a comb, brush or mitt.  If an elderly cat is skinny yet eating well this tends to make us wander if the cat may have an overactive thyroid gland, which can be diagnosed by blood test and then  can be treated using tablets or by surgery/radioactive iodine. Does my cat still have a good quality of life? There is not a simple answer as to whether a pet still has a good quality of life, we need to discuss how your pet was at its prime and take into consideration that even though it may not be able to do all those things now he can still be leading a happy, pain free life. The most basic functions are eating, drinking and being able to go to the toilet.  As cats age we may need to offer them softer foods/smaller meals more often in order for them to get enough food.  Some cats need encouragement to drink, making sure we refresh the water in their bowls regularly, have the bowl near where they rest and some cats prefer running water so a water fountain may help.  Toilet function for a cat involves getting into the correct posture which is not always easy if there is any arthritis/pain in the legs/spine and also accessing the litter box( use of lower sided litter boxes can make it easier to get in/out of them).  Minimising pain can be achieved by treating any underlying arthritis and or use of joint supplements. So even if your pet needs a few small changes to be able to perform its basic functions then it can still be having a good quality of life just with a little bit of extra help. As owners we ask ourselves whether our pets are still happy.  How happy and responsive your cat is also needs to be considered relative to how it was when younger taking into account normal changes expected with age.  Not all animals are very responsive so cannot all be measured on the same scale, also there are natural changes at different life stages e.g. juvenile cats are very playful and this will reduce as they become adult cats.  Also obesity can affect how interactive a cat is, so helping your cat to reach its optimum weight will reduce risk of diseases such as arthritis and diabetes as well as help him to be more interactive with you. Grooming is an activity which cats spend a lot of time doing, as they become older and potentially less flexible then this becomes harder for them, but as owners we can help.  If we did not brush our hair for days on end think how uncomfortable, itchy and sore we would feel. So this is a really simple area in which we can help our older cats to feel happier and more comfortable. But they may not appreciate that we are trying to help them at first so little, often and gently is the way forward. I hope that my answer has helped you to work out how you can help your cat and that the final decision is always yours as the pet owner but that your veterinary team are here to help you make such a hard decision.  We are more than happy to give you the time you need to discuss matters with us to make sure we all do the right thing for your much loved pet. 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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The unnecessary death of the Ebola dog

Ebola virus hysteria is taking hold of the northern hemisphere. The latest victim was a cross-bred dog called Excalibur, who was euthanased by the Spanish authorities even though he showed no signs of being infected with the virus, and despite the fact that there is no evidence that dogs can transmit Ebola to humans. The twelve year old rescued dog had the misfortune to belong to a Spanish nurse who became the first person to become infected with Ebola in Europe after nursing a Spanish missionary priest who had been repatriated from Sierra Leone to Madrid for intensive treatment. The priest died of the virus on September 25th,, and the nurse is thought to have picked up the virus after touching her face with a contaminated glove as she removed her protective suit after finishing her shift. Excalibur was a much loved pet in perfect health, and after Madrid's regional government obtained a court order to euthanase him, the nurse's husband put out a call for his life to be saved. An online  petition rapidly gathered over 400000 signatures, and crowds of angry animal-loving protestors had to be restrained by police outside the apartment where the dog lived. Despite the protests, Excalibur was euthanased. The deed has been done. But was it really necessary? Did the animal present a risk, or was he just a scapegoat sacrificed to give the authorities a sense that they were doing something? There is scanty evidence to support killing a dog in a situation like this. Bats are thought to be the natural reservoir for the Ebola virus in central Africa, carrying the virus without showing signs of illness. Monkeys and apes become infected and fall seriously ill, like humans. But despite extensive research, there's been almost no evidence of other animals becoming infected or carrying the virus. There is one study that casts a cloud over the innocence of dogs: researchers investigating the 2001-2002 outbreak of Ebola in Gabon found low levels of antibodies in blood samples from dogs in areas where there had been cases of Ebola in humans and apes. This confirmed that the dogs had been infected with the virus, but it was impossible to know the source of their contact: from bats, apes, or from humans? It was also not possible to determine whether the dogs could have been infectious to humans at some point. In theory, the fact that they had been infected with the virus implies that at some point they may have shed the virus in their secretions, in the same way as infected humans pass on the infection. Some researchers believe that it would have been wiser to have kept Excalibur alive, not for sentimental reasons, but to learn more about the spread of the disease. If he had been kept in quarantine, serial blood samples could have been taken, monitoring his immune status. The question of whether or not dogs need to be included in Ebola virus control schemes could have been definitively answered in a safe environment. And if he had been clear of any sign of the virus after several months, he could have been released from quarantine to resume a normal happy doggy life. Sorry, Excalibur: the precautionary principle and the political need for action seized the initiative: we still don't know much about Ebola in dogs, and you'll never enjoy another happy walk with your owners.
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Are vets more interested in the health of their patients or the money in their pockets?

I recently wrote a blog here titled "Debunking myths about “rip off" veterinary fees”, and since then, the subject of money has continued to be one of the banes of my life as a vet in practice. My aim in life is to do a job that I enjoy, and to be paid a reasonable salary: for most people, that just means that you go to work, do your stuff, and come home at the end of each day. For vets, it's different: every day, as part of our job, we need to ask people to give us money. Most of us would be delighted if this discomfitting task was taken away from us, but unfortunately, it's an unavoidable part of our job description. One recent case provided a good example of the type of daily dilemma that faces vets. An elderly terrier, Sam, had a small benign tumour on his flank. He was fourteen years of age, and his owner had been hoping that we might be able to leave the tumour alone: it'd be better to avoid a general anaesthetic unless it was absolutely necessary. When the tumour began to ooze blood, and Sam began to lick it a lot, we couldn't leave it any longer so he was booked in for surgery. When booking the operation, I mentioned to his owner that it would be wise to take the opportunity to clean up his teeth, which were caked in tartar. And I gave a detailed estimate of the expected costs. We took all the usual precautions to ensure Sam's safety. He had a detailed clinical examination and pre-anaesthetic blood tests to ensure that he had no underlying illnesses that could make an anaesthetic risky. An intravenous line was set up to give him continual fluids during the procedure and to give us instant access to a vein if any emergency treatment became necessary. And a vet nurse was designated to hold his paw and to monitor him for every second of his time under anaesthesia, from induction until he was sitting up at the end. Everything went well: the tumour shelled out quickly and easily, and a line of sutures closed the wound. I carried out a thorough descale and polish of his teeth, as planned. But it was then that the dilemma arose: beneath the tartar covering his teeth, it turned out that two of his molar teeth had large diseased areas. The gum margins had recessed, exposing large parts of the tooth roots. One of the teeth had serious infection, causing the tooth to be loose: it was easily removed. The other molar tooth was more complicated: one root was seriously diseased, but the other two roots were healthy. The tooth needed to be extracted, but it would be a tedious, time consuming surgical extraction, taking over half an hour, and requiring follow up x-rays to ensure that it had been done properly. This would involve an extra cost to the owner of well over £100. I had already given an estimate, and I didn't feel that I could go ahead with this without permission. While Sam was still anaesthetised, I asked a nurse to phone his owner to explain the situation. There was no answer on the home line, and the mobile number wasn't working. What should I do now? If I went ahead, I'd be carrying out unauthorised work on someone's pet. If there were any unexpected complications, the owner could hold me liable. And as for the extra cost? Could the owner justifiably refuse to pay? The safest legal approach would be to make a note of what needed to be done, and then to inform Sam's owner that he needed a follow up anaesthetic in a few weeks, during which we'd tackle his dental issues. But I knew that it would be far safer for Sam to have the entire procedure completed during this first anaesthetic, and I knew that his owner would be unlikely to agree to pay for a second anaesthetic on top of this first one. So Sam's dental issues would probably not be treated, and he would suffer as a consequence. I made an "on the hoof" decision to go ahead with the dental procedure. It took even longer than I had anticipated, and I had to take a series of x-rays rather than just one. By the end, I was happy that Sam had been given the best treatment, but I was nervous about the owner's response. Would she think that I had done this just as a way of extracting more money from her? What if she genuinely couldn't afford more than the estimate that I had given her? I felt so uncomfortable about the situation that I gave a significant discount on the extra work that I had done. Effectively, I ended up working my lunch hour for nothing because I felt so awkward about it. But what else could I have done? In the interest of the dog, I could not have left painful, diseased teeth untreated. What would pet owners feel if the vet presented them with a situation like this? Should you pay the full amount of justifiable extra work if it is unauthorised?  Do you trust your vet? Or do you feel that we are working more for our own interests than for the benefit of your pet?  
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Is your doggy going doddery? – Cognitive Dysfunction in dogs

Cognitive Dysfunction, a condition similar to Alzheimer's, is very common in older dogs.  50% over the age of 10 year will show some sort of symptoms and this only increases with age.  In the early stages these changes can be subtle and often the condition is only noticed when the pet’s behaviour becomes more severe.  However, recognising and treating the condition early is vital to have the best chance of halting or even reversing the changes in the brain. The symptoms of cognitive dysfunction will vary between individuals but can include;
  • Confusion or vacancy - these are often the first signs to manifest but are also the most difficult to pick up on.  Affected dogs will have periods (which can initially last just a few seconds) of seeming confused or lost in familiar surroundings.  In the early stages a call or command can bring them out of it but later on it can be more challenging.
  • Pacing or circling - again this can begin as quite a subtle problem but gradually becomes more apparent.  Dogs will often move from room to room in the house, resisting all attempts to stop them or move in small circles.  They can appear quite distressed during the activity, panting and wide eyed, but they won’t stop.
  • Loss of toilet control - This is the change that is most obvious and most often prompts a visit to the vets.
  • Loss of sleep patterns - Whereas they previously slept without problems, affected dogs can be awake in the night and often will howl or bark as well.
  • Becoming withdrawn - Many dogs with cognitive dysfunction will gradually become distant from their family.  They may shy away from contact, deliberately choose to rest away from people or sleep more than normal.
  • Becoming anxious and clingy - Others will go the other way and become more dependent on their owners.  They can develop separation anxiety problems, which is distressing for both them and their owners.
Changes like these used to be just put down to ‘old age’ but now we realise they are a medical condition, similar to Alzheimer’s in humans.  The changes in the brain are similar between dogs and humans, which has lead to more effective treatments being developed. There are no specific tests for Cognitive Dysfunction, so it has to be diagnosed on symptoms and the lack of other problems.  It is therefore important to rule out, or simultaneously treat, other issues common in older dogs such as arthritis and poor eyesight. Treatment can be challenging and is aimed at improving the blood flow to the brain and so supporting and maintaining it’s function.  There are medications that achieve this but because of the nature of the problem, they have to be given for at least a month before it can be judged if they are helping or not.  However, in my experience improvements are usually seen well before then and they can be quite dramatic! There are special diets available containing high levels of anti-oxidants and omega-3 oils, both of which have been shown to aid cognitive function in dogs. Also helpful is simple environmental enrichment for your pet.  In practical terms this means you need to keep interacting with them, training them and regularly give them new and interesting toys to play with.  You can teach an old dog new tricks! It is distressing to see a beloved pet’s personality changing and, sadly, given how common it is, many dog owners will have to deal with it.  However, being aware of the symptoms, spotting them early, starting the right medication and making some simple changes to your pet’s routine will make a huge difference. Cat Henstridge BVSc MRCVS - Read more of her blogs at www.catthevet.com If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.
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