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Ask a vet online – my dog has skin allergies, how do I help?

Question from Leona Poppleton: my dog has skin allergies and so gets very dry skin and sometimes scabs that look quite painful is there anything that I can get or do to help this? Answer: Scabby Skin Hi Leona, thanks for your question about your dog's skin. Allergies with skin symptoms are pretty common in dogs, so I'll briefly discuss allergic disease, then go on to some of the many different treatment options. What are skin allergies? The phrase "skin allergies" refers to the itching, scratching and sore skin that allergic dogs get. However, it doesn't have to be caused by something on the skin - e.g. food allergies (although quite rare in dogs) can lead to skin symptoms - so "allergic skin disease" is a better term. Essentially what is happening is that the dog's immune system misidentifies a harmless substance as a dangerous threat, and tries to attack it, causing soreness and itching. Allergic reactions may be triggered by a wide range of substances such as pollen, certain foods, fleas, mites, plants or even some washing powders. In a large number of cases, there's no specific "allergy" involved, but the dog has a disease called Atopy (or Atopic Dermatitis), where the immune system reacts abnormally to a wide range of different stimuli. Atopy is partially genetic, and is more common in some breeds (e.g. West Highland White Terriers). How is it diagnosed? It is important to get allergic skin disease properly diagnosed by your vet because there are many contributing factors and different underlying problems. As a result, diagnosis can be long and exasperating! In addition, diagnosing Atopy requires ruling out all other possible causes. 1) Initially, its vital to make sure that there aren't any parasites (especially fleas!) on the dog - this is a LOT harder than most people think, and usually requires treatment of the affected dog, all other pets in the house, and the house itself. (A side note here - there are a lot of over-the-counter products available for treating fleas: some work, some don't work, and some are very dangerous if not used correctly. I would strongly advise talking to your vet for advice, particularly as the most effective treatments are prescription-only medicines, some of which will also act over time to treat the environment as well as killing adult fleas). 2) The next step is to make sure there aren't any skin infections that could be contributing to the symptoms, or mites burrowing into the skin. This may require skin scrapes to remove a layer of skin (it really doesn't hurt!) and tape-strip tests to check for yeasts or bacteria. 3) There are a number of allergy tests available - these mostly use blood samples; intradermal tests (injection of test substances into the skin) may be more reliable, but they are expensive and difficult to perform. 4) To rule in or out food allergies, a controlled food trial is essential. This can be done with truly novel food sources, but in general it is more effective and practical to use a hypoallergenic diet from your vet. These diets are formulated so that the proteins are broken down so small that the immune system can't recognise it. In a food trial, the dog is fed ONLY the controlled diet (no treats or snacks!) for a number of weeks. If the symptoms resolve, you reintroduce the original diet one item at a time, to determine what's causing the allergy. But why does it make my dog itch so much? Itching is what's called a "summative, threshold" experience. This means that there is a threshold level, below which itching won't be felt. Anything that stimulates an itch ("pruritic") response such as a flea bite, an allergy, or a skin infection, raises the level of "itch" until it breaks this threshold and the dog feels itchy. In most allergic dogs, several different factors combine to make the itching overpowering. Unfortunately, actually scratching makes things worse - this is called the "itch/scratch cycle". What are the scabs I can sometimes see? Scabs generally mean one of three things: 1) Flea bites 2) Skin infection 3) MOST COMMONLY - self-inflicted skin damage caused by scratching. The skin is sore because it's been scratched, and it's been scratched because its sore etc etc... Scratching also damages the skin and allows infection to become established, which makes the itching worse. What can I do about it? The bad news is that most allergies cannot be cured, only managed. However, with good management, most cases of allergic skin disease can be fully controlled the vast majority of the time. There are a number of classes of treatment, which I'll deal with in turn; however, many cases will require multiple overlapping treatments, so it is essential that you work with your vet to put together a management programme. 1) Disease modifying treatments These attempt to reduce the underlying allergic response. The most effective are licensed immune-modifying drugs such as ciclosporin*, which when used long term reduces the allergic response. There is great hope for immunotherapy, where the immune system is gradually taught to tolerate certain allergic substances; this must be made up by a lab specifically for your dog's allergies. Sometimes an allergy can be "cured" by this route, but it is more usually used to reduce the dog's sensitivity. 2) Relieving symptoms These act specifically to reduce the sensation of "itch". There are three main drugs used for this. Firstly, antihistamines; these are not licensed for use in dogs and may have noticeable side effects, but a vet can legally prescribe them under the cascade if necessary. My experience is that they aren't very reliable in dogs, but may be useful in some cases. There is also a new drug called oclacitinib which works purely to suppress a dog's itch sensation. Finally, there are steroids. These reduce inflammation, mildly suppress the immune system and are very, very effective at reducing itching. They're also inexpensive; however, if used long term, they have a wide range of side effects. They're often best used as a "rescue" treatment, although steroid creams and sprays that can be applied directly to the sore spots on the skin have fewer side effects. 3) Reducing other sources of itching This category would include products such as antibiotics for skin infections and antifungals for yeast infections (many of which are available as medicated shampoos), and parasite treatments for fleas and mites. 4) Reinforcing the skin barrier This is a relatively new area, but seems to be a really useful in some cases or in addition to other treatments. There are soothing and hydrating shampoos which work to remove allergic substances from the coat and soothe the skin; as well as oatmeal shampoos which seem to have an anti-itching effect. Finally, there are the ω-3 fatty acids which appear to help many itchy patients; they may be in the diet (particularly in "skin" or "dermatology" diets), added to food as a supplement, or used as a topical spray or spot-on. Overall, you and your vet need to find the combination of treatments that suit your dog. Managing the allergic pet is a big task, but I hope this has helped, and that you can keep your dog comfortable! David Harris BVSc MRCVS * PS - you may notice I'm using generic drug names not brand names in this article. This is because, for legal reasons, I'm not permitted to name specific brands in a blog like this. If you want to know more, check out the government's Veterinary Medicines Directorate website.
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Communicating with pets: body language versus speaking English

One of the biggest challenges for vets is our lack of ability to have conversations with our patients. This isn’t always a huge problem: for example, if a dog has a broken leg, or a cat has an abscess, the problem is very easy to identify just by examining the patient. But we could still learn useful information from a verbal discussion. I would like to ask “How painful is it?”, or “Which cat attacked you?”. Treatment would also be easier to give if we could give our patients verbal instructions, such as “You must not chew this plaster cast off” or “You must let your owner bathe the sore area twice daily”. Pain is a specific area where communication would be particularly useful. An animal in pain does not usually yelp or miaow. This only happens if the sore area is touched. More frequently, pain just causes an animal to become dull and quiet. If you could ask them, they would certainly tell you about the pain, but in the absence of language, you need to learn to interpret the more subtle signs of pain. Dilated pupils, an increased heart rate and rapid shallow breathing are all indications that an animal may be in pain. A better understanding of the non-vocal signs of pain in pets has led to much wider use of pain relief for animals, especially after surgery. Over the years, vets have learned to understand the body language of their patients. If a dog holds his head to one side, he may have a sore ear. If a cat spends more time hovering near her water bowl, she is probably thirsty and may be suffering from kidney disease. A dog who stops wanting to go up steps will often be suffering from back pain. Close observation of animal body language can give plenty of information. Owners also become very tuned in to their own pets’ attempts at communication. I have often been told that an animal ‘would almost talk to you’. Dogs in particular learn that if they behave in a certain way, they will get what they want, and they can be very persistent. I know a Cavalier King Charles Spaniel called Chloe who always sleeps in the kitchen. Mrs O’Reilly, her owner, had recently started to put a big floor cushion on the tiled surface, to give Chloe a softer bed. After a few weeks, Chloe had learned the routine, and towards the end of the evening, Chloe recognised the signs that bedtime was approaching. The television was turned off, the doors were locked, keys were hung on the hook and finally Chloe’s cushion was put on the kitchen floor. Last week Mrs Reilly was away and her husband was doing the evening routine alone. He forgot about Chloe’s cushion! Chloe did her best to tell him that she wanted her cushion. Firstly, she followed him around, deliberately getting in his way so that he would surely know that she wanted something. When he did not understand, she went over to the cupboard where the cushion was kept, and she pawed at the door. He still did not get the message, and so finally she barked repeatedly at the cupboard door. Only then did the poor man understand what his dog wanted. As soon as he had placed her cushion in its usual place, Chloe contentedly lay down on it, and slept. Pets cannot speak but they are much better than humans at using body language. If my dog could talk to me, the first thing he might say would be: “Why can’t you humans understand the most basic body language?”
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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.
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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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