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Could Carprodyl Kill your Dog?

The headline in today's Daily Mail is typically attention-grabbing: "Could the drug that cost this beloved pet its life
kill YOUR dog too?" The article tells the sad story of a thirteen year old Labrador who died after taking pain-relieving
medication prescribed by her vet. There's no doubt that many owners of elderly, arthritis-ridden dogs will be rushing to
their vets this week to find out if their own pets are at risk of the same fate.
So what is this drug? Why do vets prescribe medicine which may risk such a severe reaction? And when they do use it,
why don't they tell owners about the potential dangers?
First, the medication was Carprodyl, a generic form of a chemical called carprofen, which is part of a group of drugs
known as non-steroidal anti-inflammatory drugs (NSAIDS). Carprofen has become perhaps the most widely used pain
relieving medication used in veterinary medicine since it was launched as "Rimadyl" by Pfizer, around fifteen years
ago. The patent on the chemical has now lapsed, so a wide range of cheaper generic alternatives have become available.
Most vet clinics in the UK are likely to sell some version of the product.
Second, why do vets prescribe it? Simply put, because it's the most effective way of treating arthritis in dogs. Many
millions of older animals have been given extra, pain-free life thanks to this type of medication. Three years ago, a
major review was published in the Vet Record, comparing the wide range of treatments available to help dogs with
the common, painful, debilitating problem of arthritis. The review gathered together the results of research papers
published between 1985 and 2007, attempting to derive the best science-based opinion of the best treatment method.
The conclusion? There was strong evidence that carprofen and two other commonly used drugs from the same group
were "effective in moderating the clinical signs of osteoarthritis". There was only weak or moderate evidence that other
treatments were effective. The conclusion for any vet reading this paper was clear: carprofen and other similar drugs are
the most effective way of helping animals with arthritis.
Obviously, an effective drug needs to be safe, so what about those risks? While it's true that all drugs in this group can
have undesirable and potentially life threatening consequences, the incidence is very low. The most common side effect
is gastric irritation: affected dogs suffer from gastroenteritis which usually resolves when the medication is stopped.
Much more rarely, there's a very low risk of kidney failure associated with non-steroidal anti-inflammatory drugs. The
cause of this is complicated: it's more common in geriatric patients suffering from underlying heart, kidney or liver
disease, but it can seem to happen in a random fashion. To minimise this risk, vets may suggest blood or urine tests
before starting a dog onto anti-arthritis medication. Such tests don't completely remove the small risk, and they add
significantly to the cost of treatment for a pet, so they aren't always done.
So finally, why don't vets always tell owners about the potential dangers of such medication? There's a lot of variation
in what happens here: some vets do take the time to tell owners about every possible side effect of every drug that's
used. The problem with this approach is that it's time consuming, leading to longer (and more expensive) consultations
for owners. Most owners don't particularly want to hear a long list of potential side effects that are unlikely to happen,
and they're happy to trust that the vet, on balance, feels that the medication is most appropriate having taken all the risks
and benefits into account.
Vets may also feel that detailed listings of potential adverse reactions may lead to unnecessary worrying for an owner,
so they just mention the most common side effects ("stop the tablets and let me know if she gets an upset stomach").
Sometimes a compromise may be to hand out the package insert with the tablets: the owner can then read the full list of
possible complications if they so wish (and if they have a magnifying glass).
I feel very sorry for the owners of any animal that suffers the consequences of a serious adverse reaction to medication.
There's no easy answer here, but there's a simple message: if you want to know about potential side effects of any drug,
ask your vet. We're happy to tell you if you're happy to listen. It's likely that the same treatment decision will still
be made, but at least, in the rare instance of a severe reaction, you won't have that awful sense of unfairness that you
weren't told about the risk.

The headline in today's Daily Mail is typically attention-grabbing: "Could the drug that cost this beloved pet its life kill YOUR dog too?" The article tells the sad story of a thirteen year old Labrador who died after taking pain-relieving medication prescribed by her vet. There's no doubt that many owners of elderly, arthritis-ridden dogs will be rushing to their vets this week to find out if their own pets are at risk of the same fate.

So what is this drug? Why do vets prescribe medicine which may risk such a severe reaction? And when they do use it, why don't they tell owners about the potential dangers?

First, the medication was Carprodyl, a generic form of a chemical called carprofen, which is part of a group of drugs known as non-steroidal anti-inflammatory drugs (NSAIDS). Carprofen has become perhaps the most widely used pain relieving medication used in veterinary medicine since it was launched as "Rimadyl" by Pfizer, around fifteen years ago. The patent on the chemical has now lapsed, so a wide range of cheaper generic alternatives have become available. Most vet clinics in the UK are likely to sell some version of the product.

Second, why do vets prescribe it? Simply put, because it's the most effective way of treating arthritis in dogs. Many millions of older animals have been given extra, pain-free life thanks to this type of medication. Three years ago, a major review was published in the Vet Record, comparing the wide range of treatments available to help dogs with the common, painful, debilitating problem of arthritis. The review gathered together the results of research papers published between 1985 and 2007, attempting to derive the best science-based opinion of the best treatment method. The conclusion? There was strong evidence that carprofen and two other commonly used drugs from the same group were "effective in moderating the clinical signs of osteoarthritis". There was only weak or moderate evidence that other treatments were effective. The conclusion for any vet reading this paper was clear: carprofen and other similar drugs are the most effective way of helping animals with arthritis.

Obviously, an effective drug needs to be safe, so what about those risks? While it's true that all drugs in this group can have undesirable and potentially life threatening consequences, the incidence is very low. The most common side effect is gastric irritation: affected dogs suffer from gastroenteritis which usually resolves when the medication is stopped. Much more rarely, there's a very low risk of kidney failure associated with non-steroidal anti-inflammatory drugs. The cause of this is complicated: it's more common in geriatric patients suffering from underlying heart, kidney or liver disease, but it can seem to happen in a random fashion. To minimise this risk, vets may suggest blood or urine tests before starting a dog onto anti-arthritis medication. Such tests don't completely remove the small risk, and they add significantly to the cost of treatment for a pet, so they aren't always done.

So finally, why don't vets always tell owners about the potential dangers of such medication? There's a lot of variation in what happens here: some vets do take the time to tell owners about every possible side effect of every drug that's used. The problem with this approach is that it's time consuming, leading to longer (and more expensive) consultations for owners. Most owners don't particularly want to hear a long list of potential side effects that are unlikely to happen, and they're happy to trust that the vet, on balance, feels that the medication is most appropriate having taken all the risks and benefits into account.

Vets may also feel that detailed listings of potential adverse reactions may lead to unnecessary worrying for an owner, so they just mention the most common side effects ("stop the tablets and let me know if she gets an upset stomach").

Sometimes a compromise may be to hand out the package insert with the tablets: the owner can then read the full list of possible complications if they so wish (and if they have a magnifying glass).

I  feel very sorry for the owners of any animal that suffers the consequences of a serious adverse reaction to medication. There's no easy answer here, but there's a simple message: if you want to know about potential side effects of any drug, ask your vet.  We're happy to tell you if you're happy to listen. It's likely that the same treatment decision will still be made, but at least, in the rare instance of a severe reaction, you won't have that awful sense of unfairness that you weren't told about the risk.

If you are concerned that your dog is ill or sick please use our interactive dog symptom guide to find out what you should do

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Roses are Red, Violets are Blue, Lilies are Downright Dangerous

[caption id="attachment_755" align="alignleft" width="225" caption="Lilies - the stamens can easily be removed but ALL parts of the plant are poisonous if eaten"]Lilies - the stamens can easily be removed but ALL parts of the plant are poisonous if eaten[/caption] As far as plants go, lilies are among the most beautiful. They smell lovely and seem to last forever, making them a fantastic addition to any floral arrangement. Humans adore them and most animals aren’t bothered by them, but for cats, lilies are positively deadly. And it doesn’t take much. A single bite of leaf or lick of pollen can be all it takes to send a cat into irreversible kidney failure. As cat owners, we all need to be aware of how dangerous this common household plant can be, and take the necessary steps to keep our unsuspecting pets safe. What makes lilies so toxic to cats? • We don’t know exactly which chemical within the lily is so dangerous, but we do know that ingesting the smallest amount of leaf, stem, flower or even pollen can be deadly. • Most types of lilies are poisonous, including asian lilies (Lily asiatica), tiger lilies (Lilium tigrinum), stargazer lilies (Lilium orientalis) and Easter lilies (Lilium longiflorum). • Other animals, including dogs and rabbits, can eat lilies with just a bit of mild stomach upset and do not seem to suffer from toxicity. What are the symptoms of lily poisoning? • At first, lily poisoning can mimic other cases of ‘dietary indiscretion’ as we like to call it (eating something that they shouldn’t have), so it can be difficult to know what has happened unless you saw them eat it. Signs include vomiting and lethargy, lack of appetite and shaking. If your cat does vomit, always take a look to see what they brought up – this may be icky but it could save your cat’s life if you can tell the vet what they got into. • These initial symptoms can actually disappear for a few hours to a few days, after the plant has passed through the digestive tract but before the real disease becomes obvious. • Within a few days, however, the symptoms become those of kidney failure. This includes increased thirst and urination, dehydration, and worsening lethargy, vomiting and inappetence. Eventually, this increased urination turns into a decrease in urination, and finally no urination at all, which indicates that the kidneys are no longer functioning. What can be done about it? • If you think your cat has eaten any amount of any part of a lily, it is critical that you take them to the vet right away, even before clinical signs appear. And of course, if you notice any of the symptoms listed above, get them to the vet immediately. If it happens outside of your vet’s normal opening hours, phone the designated emergency clinic. • If they make it to the vet within a few hours of ingestion, the vet will likely induce vomiting and possibly give a substance called activated charcoal, which will help lessen the effects of the toxins. • Then, or if too much time has already gone by, the vet may put your cat on a drip and give IV fluids for as long as necessary. These fluids will help support the kidneys as they try to process the poison and flush out any toxins that do make it into the blood stream. • There is no special blood test to diagnose lily toxicity, so many cases go undiagnosed. Your vet will however likely run a general blood and urine test to check how badly the kidneys may have been damaged. These tests will probably need to be repeated several times during their stay in hospital. What happens next? • If you are able to get your cat to the vet within a few hours of ingestion, the chances are much greater that they will make it through the incident with the appropriate medical care. It is vitally important that your cat see the vet as soon as possible to begin treatment. • If it has been more than 4 hours since ingestion and the lily toxins have already been absorbed, the prognosis is significantly worse and kidney damage to some degree is likely. • If no treatment is given, or the kidneys have been damaged to the point where urination is starting to decrease, then sadly the chance of survival is very low. • The feline kidney is a very delicate structure and unlike other organs such as the skin or the liver, it does not heal itself once damaged. Therefore, the chance of permanent kidney damage is high and even if the cat survives the initial incident, they may suffer from chronic kidney disease later in life. Long-term fluid therapy and regular blood tests may be necessary to monitor kidney function even after recovering from the initial toxicity. How can lily poisoning be prevented? • The best way to prevent lily poisoning in your own home is to prevent lilies from entering your home in the first place. This is easier said than done when well-meaning significant others or dinner guests bring home a lovely bouquet, however most people will understand your concerns. • Remember, however, that it’s not just lilies in your house that can be deadly, always check your own garden for these and other toxic plants. The internet is a good resource for finding out which plants are child and pet-friendly and which should be avoided, just always make sure you trust the source of your information. • Spread the word - by telling other people about the dangers of lilies, you are helping to increase awareness of the problem. The ISFM (International Society of Feline Medicine) has launched a campaign to help educate the public about lily toxicity. Their website has informative posters and tags to be put around floral arrangements that contain lilies at the florist. The more people know about lily toxicity, the safer all of our cats will be. If you are concerned that your cat may have eaten any part of a lily, or any other toxic material, contact your vet immediately. If you are sure lilies are not to blame our Interactive Cat Symptom Guide can be used to check out any problems you are worried about.
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Pet Emergencies Happen When You Least Expect Them

A couple of weeks ago I was enjoying a Sunday afternoon walk along the seafront with my husband and our dog, when we came across a couple crouched over a small dog on the pavement. At first I thought they were drying the dog after a dip in the sea, but when we got close I could see that the dog was having a fit. I asked if I could help at all, and they were very relieved to find an off-duty vet on the scene. Luckily all that was needed in this case was some advice and some reassurance, and the fit soon stopped. The owners were able to take him home to rest, and I advised them to phone their own vet to discuss what to do next. Blood tests to rule out certain problems would be helpful, but could wait until Monday. If the dog continues to have fits it might need to take medication to control them. If the fit had not stopped within 10-15 minutes, then an urgent call to the nearest vets would have been needed. I have already written about fits in dogs in a previous blog, so I won’t repeat it all here. More detailed advice about dog seizures and fits can be found in the blog Epilepsy in Dogs and Cats. Emergencies can crop up at any time, wherever you are. One tip that could help to reduce the distress in an emergency is to make sure that your usual veterinary surgery’s telephone number is in your mobile phone. If you take your pet on holiday with you, it would also be worth locating the nearest vets when you arrive and take a note of their number. Even if a problem occurs out of hours it should be possible to get help quickly by dialling the usual surgery number. All veterinary practices in the UK have a duty to provide 24 hour cover for their patients, but the way in which they provide this may vary. In some practices, the regular staff will provide out of hours cover in the usual place. The advantage of this is having access to all the pet’s history, as well as familiar people and surroundings for the pet and owner. Other practices may share a rota with neighbouring practices. This might mean taking your pet to a different practice from your usual one, but each practice being on call less frequently can be a very efficient way of providing the necessary service. Another way is to use the services of a dedicated out of hours veterinary centre which is staffed by vets and nurses working shifts to cover all hours. The single most important thing to remember when you have an emergency is to telephone first. Even if you know that your pet definitely needs to be seen, it will save time if you turn up at the right place and the staff are expecting you and are prepared for your arrival. In some cases, you may find that advice is all that is needed. BrodieThe most common injuries which arise when out and about are things like cut pads, bite wounds, stick injuries and of course road accidents. Many illnesses can also have a fairly sudden onset, sometimes needing an out-of-hours visit to the vets. Carrying a small first aid kit with you can help with emergencies such as cuts, bites or torn nails. If bleeding is part of the problem, then a temporary bandage applied just until you can get to the surgery can save a lot of mess but could also stop your dog from losing so much blood. A hankie or a sock can be very useful substitutes for a bandage, or anything clean with which you can apply pressure for a few minutes. However, there is a risk of making matters worse if a bandage is too tight or applied for too long. The circulation may be reduced so much that tissue starts to die, so just use a bandage as a first aid measure until bleeding stops or you can get to your vet’s surgery. The other thing that can reduce the stress when the unexpected happens is having your pet insured. This can give peace of mind by removing concerns about the cost of emergency treatment, allowing the owner to concentrate on getting their pet better as quickly as possible. Insurance policies vary in what is covered, so do compare the cover provided and not just the cost of premiums when taking out a policy. Working as a vet seeing emergencies outside of normal working hours can be very interesting and exciting because you never know what sort of case the next one will be. As pet owners, we would all prefer not to have to make use of the emergency service but we are glad it’s there if we need it. If you think you have an emergency please contact your vet or check your pet's symptoms with our Interactive Pet Symptom Guide if you are unsure how urgent the problem may be.
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Living in a Multi-Cat Household – Why Can’t We All Just Get Along?

Many people share their homes with more than one cat, and if all the cats get along they can provide everybody with companionship and entertainment.  Sadly, however, it isn’t always that way.  Cats are relatively solitary creatures by nature and serious problems can arise when more than one cat is asked to share a small living space such as a house and garden.  Acquiring the cats at the same time can help, even more so if they are siblings.  It also helps to introduce them while they’re young, and it’s often easier to get a male and a female kitty as opposed to two of the same sex.  Just like people, newly-introduced cats need some time to get to know each other so don’t expect everybody to get along from day one.  If you and your feline family are going through a bit of a rough patch, be it the occasional stare down or full on cat fights, read on... Recognise the problem and try to identify the cause
  • Speak to your vet for advice, and to rule out any medical conditions that may be causing any excessive grumpiness.
  • Think like a cat.  Consider their how the world looks to someone their size, their likes and dislikes, and how they spend their days.  Understanding a bit more about their lives will help you recognise potential problems and come up with insightful solutions.
  • Observe their behaviour toward each other and toward you, and learn to recognise signs of feline stress (tense body posture, twitching tail, dilated pupils, hyper-vigilance or staring in an intimidating manner, etc.).
  • If you notice signs of stress after an interaction with you, try to alter your own actions accordingly.  For example, some cats love grooming, but most only appreciate it for a short period of time and on their own terms.  Also, very few cats actually enjoy being picked up and cuddled tightly although they may tolerate it well.  Trying to comfort your cat in this manner can actually add to their stress levels as they like to feel more in control of their interactions.
  • Never punish your cats for fighting with each other.  The fight undoubtedly started because of some sort of stress in the first place, and your punishment will only make the situation worse.  Stay calm and try to distract them rather than yelling or throwing a shoe at them.  Have a basket of toys at hand to distract them and break up any potential fights before they occur.
Create a less stressful and more cat-friendly environment
  • Cats like options, especially safe ones, so provide several of each resource (litter trays, feeding stations, beds etc.) around the house for them to choose from.  This will help reduce competition and therefore reduce stress.
  • Ensure there is plenty of vertical space (such as cat trees, accessible tall furniture or cat-friendly shelves) for everybody to use.  They often feel safer when they can observe things from above and it will allow them a place to escape to if they feel stressed out.
  • Home renovations and frequent visitors can be very stressful for cats so provide hiding spaces at ground level too, and even in the garden if necessary.
  • Scratching posts can be placed in particularly vulnerable areas like doorways and the top/bottom of the stairs.
  • Provide plenty of toys to play with inside the house and entertain them yourself when you’re at home, but otherwise try to keep their environment as a whole as constant as possible.
  • Create a playground of cardboard boxes, paper bags (with handles removed) or other safe objects and rotate them frequently to keep things interesting.
  • Feed cats in separate rooms, or at least on separate sides of the same room, as feeding time is a major source of competition and disagreement.
  • And last but certainly not least, try a calming pheromone product such as Feliway.  This comes in a spray or a plug-in diffuser and can really help to reduce overall stress levels in the house.  Some cats don’t seem to respond to them and it certainly won’t stop every fight, but many owners find that it makes a big difference.
Of course sometimes, in rare cases and despite your best efforts, things just aren’t going to work out.  If they simply cannot stand the sight of each other and frequently act on it to the detriment of everybody’s health and happiness, then you may have to consider finding a new home for one of them.  Some cats will solve the problem themselves by leaving home and moving in with the kind little old lady next door, but other times you may need to arrange alternate accommodation.  Don’t be too hard on yourself if this happens, as long as you’ve made every effort to fix the problem that is.  Some cats, just like some people, will just never get along and it’s better for everybody if they go their separate ways.  But if they used to get along well and have just had a falling out, be patient and work with them to try to resolve their issues.  In the vast majority of cases a reasonable harmony can be achieved and you can all once again enjoy each other’s company.
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Cats and Christmas

Yes, it’s true, Christmas is upon us yet again.  A time of fluffy white snow, happy children, beautifully wrapped gifts and exceedingly large meals.  Or, if you’re a cat owner, a time of missing ornaments, broken baubles, toppled trees, and shredded wrapping paper.  The antics of the family cat can be a welcome distraction when the discussion gets a bit too heated around the dinner table, but just as cats enjoy all the new toys there could be some hidden dangers too.  Here are some things to think about this holiday season.

Cats are curious by nature and will want to investigate the tree at least!The Christmas tree
  • “What could be better?” says the cat.  “The joys of the outdoors in the warmth of my living room!”  Christmas trees are a cat’s dream come true.  Many cats, especially kittens, find climbing the tree irresistible and will stop at nothing to try to make it to the top.  You can try all sorts of deterrents, including aluminium foil around the base (cats hate walking on it) and keeping a water spray bottle close at hand, but it usually won’t stop them trying at least once.   Many cats also hate the smell of oranges, so some people say keeping orange peels under the tree can help deter climbing.  If your cat is particularly curious, you may simply have to lock them out of the room altogether.
  • The ornaments are another endless source of feline entertainment.  Make sure all expensive, fragile or potentially dangerous ornaments are placed at the top of the tree out of easy reach.  This includes glass baubles, things that look like small furry creatures, and anything that has a string or ribbon on it.  Make sure all wires and clips are attached tightly to the branch, and try not to have any ornaments that swing from side to side where the cat can see them.
  • Where possible don’t provide your cat with a launching ramp (i.e. keep the tree away from the sofa or other furniture).
  • Beware of electric cords and light bulbs, and watch your cat carefully to make sure they do not take a rather shocking interest in them.
Poinsettia and many other favourite Christmas plants are poisonous to cats. Deck the halls, carefully!
  • As mentioned above, any decoration that swings or is otherwise attractive to the cat should be placed out of reach or avoided altogether.  Sharp, pointy decorations or those with small parts that could fall off should also be placed carefully.
  • Ribbons and string can be fatal to cats, so if you must use either in your decoration or whilst wrapping presents, make sure it’s well out of their reach and clean it up immediately after use.
  • The eating of pine needles should be discouraged whenever possible.  Citronella, Tabasco sauce, or bitter apple spray can be used on the bottom branches to discourage chewing.
  • Some plants including mistletoe, holly, lilies and poinsettias, are toxic to cats and cause serious problems if eaten so keep them out of reach or better yet, simply admire them in the homes of others.  The same goes for fake snow – best to avoid it altogether.
  • Make sure all human food is kept out of reach of your cat – they don’t need it and it could make them sick!  But if you absolutely must share, be careful with what you give them to sample as some foods such as chocolate are toxic to cats.  Never give cats (or dogs!) turkey bones as they could cause serious problems if eaten.
A joyful yet stressful time for all
  • You aren’t the only one who dreads the arrival of the in-laws.  Cats will not only pick up on your stress and act out accordingly, but can also be thrown off by all the extra activity in the house.   
  • Some cats will deal with this stress by displaying charming behaviours such as urinating on your carpet or guests’ luggage, scratching up the sofa, or becoming generally unpleasant and aggressive.  Others may spend the whole time hiding under the bed or outdoors.
  • To help ease your cat’s stress levels (and perhaps your own too!), try to spend a few moments with your cat alone each day and provide a quiet, calm area to which they can retreat if needed.  Make sure food and water bowls are well stocked and easily accessible to even the most timid kitties.  Calming pheromone sprays or plug-ins such as Feliway can be tried to help keep the peace.
  • Remember, some cats are particularly prone to urinary tract problems (such as infection or even blockage) during times of stress and cold, so monitor your cat for frequent or difficult urination.  They’re also more likely to pick up a case of the sniffles and go off their food, so ring your vet immediately if you have any concerns.   
But aside from the dangers, Christmas can be a wonderful time to share with your cat.   Some of your best photos will be of your cat interacting with the Christmas tree or popping their head out of a pile of wrapping paper.  A few devoted owners even give their cats their own stocking to open on the big day.  Do remember, however, that when buying your cat a gift, Murphy’s Law clearly states that the more expensive the gift the less interested they will be in it and the packaging is almost always more fun than the toy itself!Cat-in-the-wrapstocking-sleep         Many of the points above also apply to dogs. Also, you might want to take a look at the related blog published last Christmas entitled "The nightmare before Christmas" for more tips on keeping your pet safe at this time of year.  If you are worried about the health of your pets over Christmas, talk to your vet or use our Interactive Symptom Guide to check how urgent a problem may be.
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