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Best UK Vets 2015

With only two weeks until the Best UK Vets Award 2015, we would like to encourage you to write a short review for your vet. Good honest reviews are an excellent way to help pet owners find the best local vet. They also show your vet what you value about their practice! Best UK Vet 2013 - VetHelpDirect On 10th February 2015, the Award organisers, VetHelpDirect.com, will evaluate the thousands of reviews left on all vet sites using their directory and the winning practice will be the most well reviewed practice over the last year. If your vet wins, not only will it be an amazing honour, but they will benefit from an award ceremony at the practice to thank them for all their hard work. There’s still plenty of time to help your practice win so get reviewing! To find your vet and leave a review search for the practice on our sister site Any-UK-Vet or here on VetHelpDirect
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Ebola seems to be dwindling, but look out: Avian Flu is back!

Just as the news headlines about Ebola have dampened down from boiling to a quiet simmer, Avian Flu has leapt back into the news. The Telegraph headline today sums up the media reporting: "Bird flu strain which can be passed to humans detected in Holland". Meanwhile, even closer to home, the BBC reports that a case of bird flu has been confirmed at a duck breeding farm in East Yorkshire. The ducks are being slaughtered and a 10km (6 mile) exclusion zone is in place. It all sounds as if an apocalypse along the lines of the "Contagious" movie has landed in Europe, but the truth is far less exciting. Avian Flu is a viral disease that is highly infectious between birds. This is the single fact that needs to be stressed more than anything else. It is a bird disease, and the risk to humans is minimal. The strain of avian flu that is in the news is similar as the one which was first seen in Hong Kong in 1997, and has been appearing spasmodically ever since. That one was known as H5N1(H-five-N-one), a name that describes the type of proteins on the virus particles. The Netherlands strain is the H5N8. The strain in Yorkshire has been identified as an H5 strain but further details are not yet available. It is true that humans can be infected by such strains of the virus, but the risk of this is so small as to be almost negligible. Hundreds of millions of birds have died because the disease spreads rapidly from bird to bird, and because authorities react to viral outbreaks by carrying out mass slaughtering of poultry flocks in an attempt to eliminate the virus. When humans have been infected, the virus has not spread from person to person. It has remained as a bird virus only, with humans only occasionally getting in the way, usually when they are working in close proximity to infected birds when they inhale viral particles. If Avian Flu reached the UK, everyone working with poultry would know to be ultra-careful about hygiene, so the risk of humans dying of bird flu would be minimal. There is no such thing as a human pandemic of bird flu. Readers may then wonder why there seems to be a type of hysteria around Avian Flu. The reason for this is the potential for a change in the virus which could indeed lead to a human pandemic. The avian virus could mutate into a new strain of virus that is highly infectious to humans. If this happened, the new Human Flu virus would spread across the world rapidly. This is what happened in 1918, when 50 million people worldwide died in a flu pandemic and the authorities are justifiably concerned about the risk of a repeat of this. Mutation of the virus is only likely to happen if a human who is already suffering from a normal, harmless human flu virus infection picked up an Avian Flu virus at the same time. If the two viruses were active in the same human body at the same time, they may exchange genetic material. The result could be a new mutated virus that was a combination of the harmless human flu and the dangerous bird flu. If this new virus spread from the first victim to other people, it could signal the start of a new global human pandemic similar to 1918. Modern high volume, low-cost international travel would mean that the new virus could spread very rapidly indeed. This is why the authorities take outbreaks of Avian Flu so seriously. In Hong Kong originally in 1997, 1.5 million birds were slaughtered. The pattern has been repeated elsewhere – whenever the virus, or similar ones, are discovered, the poultry population is slaughtered. These strict control measures are very effective in stopping the spread of the disease amongst birds. Despite such radical efforts to control the virus, it does continue to spread. Migrating wild birds – waterfowl such as ducks, geese and swans - are partly to blame, but infected poultry products – such as untreated manure - may also contribute when they are moved out of infected areas. International trade in poultry can also be significant, and the mass intensification of poultry meat production means that when outbreaks occur, hundreds of thousands of birds can rapidly be affected. The public in the UK do not need to worry too much about these latest outbreaks in the Netherlands, but people should be aware that if they do come across sick or dead wild waterfowl (such as swans), they should let the authorities know at once. To find out more about the UK government's response to the bird flu vet, see this link. It's a helpful government website: no frightening headlines, no nonsense: just the simple facts.
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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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Sensationalist reporting of TB in cats is not helpful: does the media want a cat cull?

Let's start with the facts about the cats with TB, as reported in the Vet Record: perhaps surprisingly, these have not been published in full in any of the mass media outlets in the past two days: ++++++++++ BETWEEN December 2012 and March 2013, a veterinary practice in Newbury (west Berkshire) diagnosed nine cases of Mycobacterium bovis infection in domestic cats. In seven of those cases the diagnosis was confirmed by bacteriological culture. The nine affected cats belonged to different households and six of them resided within a 250 metre radius. The animals presented with mycobacterial disease of variable severity including anorexia, non-healing or discharging infected wounds, evidence of pneumonia and different degrees of lymphadenopathy. The latest information is that six of the cats have been euthanased or have died. The three surviving animals are undergoing treatment and are reported to be responding. At the time of writing, no new cases had been detected in local cats since March 2013. ++++++++++ The newspapers have missed this aspect of the story, and focussed entirely on the fact that the disease, for the first time, seems to have been passed on to two humans who had been in contact with one of the cats. The humans have responded well to treatment. Despite journalists' suggestions that the cats could have picked up TB by "fighting badgers" (has anyone ever heard of this happening?), veterinary scientists believe that most cats are infected with TB when bitten by infected small rodents while hunting. These rodents in turn would have been infected by sniffing around infected badger setts. When a cat is diagnosed with TB, an owner has always been advised that treatment of the cat may be possible, but the remote chance of a human picking up TB from the cat is something that has to be taken into account when considering doing this. For this reason, many cats diagnosed with TB are euthanased. There is nothing new about any of this: vets have (rarely) been diagnosing TB in cats for many years. The last sentence of the Vet Record report is worth repeating: here it is in capitals in case you missed it: NO NEW CASES HAVE BEEN DETECTED IN LOCAL CATS SINCE MARCH 2013. From the media coverage, you would swear that this was an immediate and present threat to human life. The facts are far less exciting. Following the episode a year ago, due to the unusually high concentration of TB in cats in the area, all humans in contact with the affected cats were offered to be screened for TB. Of 39 people who were offered this, 24 accepted screening, and two people (who had contact with the same cat) were subsequently diagnosed with active TB disease caused by the same TB organism that had affected the cats. Only one person had been showing any symptoms of TB, and both are responding to treatment.  Two other people had some broad evidence of exposure to TB, but there was no evidence to suggest that it was the same TB that had affected the cats. To summarise: two people, over a year ago, were diagnosed with TB that was linked to a cat. Two other people were diagnosed with previous exposure to TB that may or may not have been linked to cats. Meanwhile, 8751 cases of human TB were reported in the UK in 2012, picked up from humans. The message from today's media seems to be: "DANGER: YOU COULD GET TB FROM CATS". The message that they should have given out is far less dramatic: "The absence of reports of confirmed cat to human transmission of TB previously led public health practitioners to consider the risk of transmission as negligible. However, an assessment of this incident raised the risk of transmission of TB from cats to humans from negligible to very low." Or to put it more simply: Up till now, there was thought to be a minimal risk of picking up TB from cats. Based on an incident over a year ago in England, there's now thought to be a very low risk. But that wouldn't make good headlines, would it?
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