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A vet in Delhi day 7: summary and conclusion

[caption id="attachment_3824" align="aligncenter" width="560"]ASHA gave me the opportunity to give a talk to their community health volunteers on rabies ASHA gave me the opportunity to give a talk to their community health volunteers about rabies[/caption] I've spent my final day in the slum and it's time to draw it all together and reach some conclusions. What's it all been about, what have I achieved, and what's going to happen next? First, to explain: the rationale behind my work has primarily been human health. It's shocking that rabies is still a major killer in India, despite the fact that it's completely preventable. If 70% of the street dogs in an area are vaccinated, the disease dwindles and disappears to insignificant levels. Surely this is a goal that is achievable? The current estimated incidence in India of around 3 deaths per 100000 people per year means that over 20000 people, mostly children, die unnecessarily every year. In a slum like Mayapuri, with a population of 12000, there's probably around one death every three years. Feedback from my questionnaire suggested that this may be close to the truth. Rabies is common enough to be a constant threat, but rare enough that it's easy for people to forget about it. Yet it is such an horrific, unnecessary death that everything possible must be done to prevent even one fatality. ASHA deals effectively with many health and welfare issues in the slums, vaccinating children with BCG, MMR, Hepatitis, Tetanus and Polio: before ASHA arrived 15 years ago, no babies were being vaccinated – the uptake is now 100%.  ASHA also treats adults for TB under the DOTS programme, and offers a range of birth control methods. There's no doubt that the charity's work has transformed the lives of the slum dwellers. But what about rabies? When I asked this question last year, it seemed that it was a bit of a grey area: ASHA is so busy with other priorities that it's easy for rabies to slip under the radar. When I discovered this, I felt that there was an opportunity for me to use my background as a vet to look into the issue when visiting the slum with a group of volunteers from my local church. Mission Rabies – who are already in the process of vaccinating millions of dogs around India – do not have an immediate plan to focus on the Delhi area, but they were exceptionally helpful in assisting me with this project. They drafted a questionnaire for me to use while here, and they advised me on important aspects such as informed consent and male/female interpreters. So what did I discover? Well, I found out how difficult it is to do social research. I had thought I might gather several hundred questionnaires over 3 days, but the process took longer than I had expected: up to 15 minutes for each interview via an interpreter, then time spent seeking out the next candidate. I ended up with just 40 completed questionnaires: not as many as I'd have liked, not enough to be significant in a formal sense, but still perhaps enough to gather valuable feedback about the subject. What did I learn? First, I discovered some interesting socioeconomic facts.
  • 75% of households live in just one room, shared between an average of four people: no kitchen, no bathroom, no hot water
  • 95% of slum dwellers own a mobile phone
  • 90% own a television
  • 65% own a bicycle.
Second, I discovered that street dogs are a significant part of the slum community, with an average estimate of one dog per 17 humans (the range was one per 5 to one per 20 people). The only way to get a more accurate figure would be to do a detailed dog census, which would be a major logistical challenge in itself, but the estimates are enough to make the point that there is a substantial population of dogs.. While only 15% of people said that they “owned” a dog, 57.5% said that they feed local dogs at least once a week. This ties in with the reported attitudes to dogs: 40||% said that they “liked” dogs, 15% were indifferent t while 45% of interviewees said that they “did not like dogs” (presumably the latter never feed them). Third, I investigated the local people's knowledge about rabies. I found a low level of awareness of the disease. 80% of respondents had not heard of rabies, and only half of the 20% who said that they had heard of rabies were able to explain the disease to someone else. Some people thought that rabies would make them “bark like a dog”. Furthermore, only 45% of people thought a dog bite could be fatal, with 55% of people disbelieving this. There's clearly a need for community education about rabies in order to prevent future cases. More positively, despite the lack of knowledge about rabies, 90% of people would go to hospital if bitten by a dog (where they would be given the post-exposure rabies vaccination). As well as doing this, some people would take other action, including putting red chilli powder on the wound, and resorting to “witchcraft”. The 10% who “did not know what to do” if they were bitten by a dog are worrying: they would be very vulnerable to developing clinical rabies if bitten. What's going to happen next? If nothing is done, nothing will happen. The situation will remain the same, and people will continue to die of rabies at a rate of around one person every three years. Clearly this cannot be allowed to happen. ASHA already have an effective network of community health volunteers on the ground, keeping an eye on the health of inhabitants in their local area, and passing on information to them about health and disease using handouts and flash cards. On my last day in the slum, ASHA kindly arranged for me to give a presentation to a dozen community health volunteers from Mayapuri and another nearby slum. I was able to pass on the initial results of my survey, and to discuss the challenge of rabies awareness with them. I explained the issues of rabies and street dogs in detail, and handed out several hundred picture-based colour information leaflets about “Getting Along With Dogs” (designed by Mission Rabies). These volunteers will go back to their own areas and will talk to local parents and children, stressing the importance of avoiding dog bites by interacting appropriately with dogs. They'll also mention rabies, the importance of wound cleaning and the need for a visit to a medical centre if a dog bite does happen. So far, so good. But what about the other 58 slum areas (housing 400000 people) under ASHA's care? And what about the other 500-plus slums (with millions of inhabitants) that ASHA has not yet reached? There is a massive population in Delhi that's still unaware of the ongoing threat of rabies. What can be done to reach them? This is where Alliance of Animals and People (AAP) may come in. In an earlier blog, I outlined a visit I made at the start of my Delhi trip to one of their slum programmes in a different part of the city. AAP has a stated aim of working with NGO partners to help children in need: their founder, Bondana Dutta, is an ex-regional director of CRY, a major children's charity. The concept is simple: AAP sends a volunteer to nominated slums to teach groups of children about awareness of the risk of dog bites and the importance of rabies prevention and treatment. AAP also works with local communities to lobby municipal authorities to provide other helpful measures such as rabies vaccination and population control of street dogs. Could an AAP staff member visit ASHA slums like Mayapuri to give regular classes to children, raising awareness of these issues and helping to prevent future cases of rabies? If this generation of young people are educated now about the subject, they will soon grow into a well-informed generation of adults, and the entire slum community will then become rabies-aware. This suggestion may sound sensible, but it isn't always so easy on the ground. In particular, funding is a challenge. AAP staff members are already over-stretched. If extra work was scheduled (such as visiting ASHA slums), a new staff member would need to be recruited, costing at least €3000 per year. And a new initiative like this might also incur extra costs for ASHA. If funding is not there, new projects like this cannot happen. So what do we do about it – people like you and I? Finish this blog and walk away? Or take some positive action to help? I realise that I have just been on the front line of the slums, which makes it all very real and urgent to me. But I am heading home with a determination to follow this through by making a commitment to fund-raise for ASHA and for AAP. Over two thousand people have been viewing these blogs: if each of you donated just €2 per year, that would be enough to provide the financial resources to kick start this type of programme. With a small gift from each of us, the first steps could be taken to eradicate rabies from ASHA slums, and to help the welfare of the slums' street dogs at the same time. I'm happy to help to coordinate a plan like this, but I need your help.Visit our other ASHA-focussed blog and click on the "Donate" button on the top right of the page if you want to make a small donation. And watch this space: I'll let you know what happens.  
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Caring for the older cat (part 1) – helping your feline friend through old age

Sammy is 12 years old.  That is a respectable age for a cat, so I was very happy to hear from his owner that he was still very well in himself and she had no concerns at all.  The purpose of my visit was a routine health check and vaccination and based on Sammy’s good report, I was expecting to issue him with a clean bill of health.  However as I began to collect a thorough history, it became apparent that things were not as simple as they had first appeared.  ‘Now that you mention it, Sammy HAS been drinking more than he used to, but I thought that was normal for older cats so I didn’t think twice.’  He had also had a great appetite lately, in fact he’d been eating an extra pouch a day, and he had been more talkative lately.  All things that his owner had associated with good health but could actually be signs of illness.  On physical exam it turned out he had lost some weight and muscle mass, and that he had a lump under his neck.  A blood test was recommended and the results confirmed hyperthyroidism.  He was started on medication and is now back to his normal self, his owner couldn’t believe the difference!  She was surprised how the changes had happened so gradually that she didn’t notice them, but was very happy to have her old cat back.  And Sammy certainly agreed. The above scenario is not at all uncommon.  Cats are experts at hiding their illnesses, and sometimes they can become very poorly on the inside whilst appearing relatively normal on the outside.  And as in Sammy’s case, sometimes the changes that do happen occur so slowly that we just assume it’s a normal part of aging. He’s turned into such a ‘grumpy old man’ One of the best examples of this is an older cat’s ‘grumpiness’.  It’s easy to assume that older cats have been through enough and now just want to be left alone, but could there be a cause for their change in attitude?  Perhaps they can’t see or hear as well as they used to and are more frightened by strange sights or sounds.  Maybe they have severe dental disease that causes them to hide away or change their eating patterns.  Is arthritis the reason behind their dislike of the brush or even your previously adored petting strokes?  These conditions frequently go unnoticed except for a change in behaviour, yet if diagnosed, there are many things we can do to make them more comfortable. She just can’t seem to ‘hold it’ anymore Another common but decidedly abnormal symptom is a change in urination or defecation patterns.  ‘She just can’t seem to make it to the litter tray anymore, bless her’ is a common complaint, yet one that doesn’t always get brought to the vet’s attention.  Cats are clean, proud creatures and don’t generally wet or soil the house without good reason.  Perhaps she has kidney disease and is having to cope with large volumes of dilute urine.  Could arthritis again be the cause behind her new dislike of the litter tray?  Small, covered or high-sided litter trays can be a nightmare for cats that find it painful to position themselves to defecate.  Maybe she has diabetes and the sugar in her urine has brought on a bladder infection.  Changes in urination or defecation should always be brought to your vet’s attention as there is usually an underlying cause. All he ever does is sleep these days Now I am the first to admit that I do not have as much energy as my 3 year old.  And my grandmother frequently complains that she’s not able to get out and about as much as she used to.  The difference between my son and I is mainly the 30 year age gap.  But my grandmother’s reasons may have more to do with her failing eyesight and worsening arthritis.  It’s certainly true that kittens are more active than their more mature housemates, and that some slowing can be expected with age.  But when your previously active older cat starts to sleep 23 hours a day instead of her usual 20, what might seem like a small change to you could indicate a big problem.  High blood pressure can cause depression and lethargy and can also result in blindness, making affected cats less likely to venture from their bed.  A cat who used to love going outdoors may find the cat flap too painful now that arthritis has set in.  Anaemia (not enough red blood cells carrying oxygen around the body) and its associated decrease in energy levels is another symptom that frequently goes unnoticed. Some alarming statistics In a recent study of older cats brought to the vet for routine vaccination, one third of those described as ‘completely healthy’ by their owners were found to be suffering from significant diseases such as kidney disease, high blood pressure or hyperthyroidism.  Two thirds had abnormally dilute urine, an early warning sign for kidney disease.
  • Chronic kidney disease is estimated to affect about 30% of cats over the age of 15
  • 10% of cats over the age of 9 are thought to suffer from hyperthyroidism
  • Cognitive dysfunction (a deterioration in brain function giving cats Alzheimer’s-like changes in behaviour) is estimated to affect over 50% of cats over the age of 15
And perhaps most alarmingly, a staggering 90% of cats over the age of 12 (which is not that old really) are thought to suffer from arthritis.  Only a tiny fraction of these cats are ever brought into the vet because they appear painful, and only a small percentage of those receive regular treatment for their pain. ‘Common’ does not mean ‘normal’ I think the most important thing to keep in mind is that although some things like drinking a bit more or losing a bit of weight may be COMMON in older cats, they are not NORMAL and may in fact indicate discomfort or illness.  If diagnosed (particularly if caught early), most of the above conditions can be treated successful and for those that can’t be cured, we can at least provide care that can dramatically increase the quality of their lives.  I’ll talk about some of the things we can do to help our aging feline friends next time but in the meantime, take a good long look at your older cat and think about some of the changes that might be taking place inside that they may not be telling you about.  If you discover anything that causes concern, bring it to the attention of your vet.  Sure, your grumpy old man may not enjoy being dragged out of his bed and into the vet (don’t be afraid to ask your vet if they would be willing to make a home visit), but the possibility of a more comfortable life far outweighs the temporary inconvenience.  Your cat has nothing to lose and everything to gain! If you are worried about any aspect of your cats health, please book an appointment with your vet or use our symptom guide.
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Ask a vet online – ‘my dog only has one testicle down – what is the best age to have him neutered?’

Question from Pam Gilmour Hi my chi(huahua) is 6 months , he only has one testicle. I will be having him done, what would be the best age to wait to see if it will come down? Answer from Shanika (online vet) Hi Pam and thank you for your Question regarding the best age to have a dog castrated which has a retained testicle. I will start by explaining a little about the testicles, what they are, where they develop and what can go wrong along the way. The testicles are two oval shaped structures normally found in the scrotum (loose sac of skin near your dog’s bottom). Testicles are male sexual glands and produce the hormone testosterone along with sperm and various other secretions which assist in reproduction. The testicles start developing while the puppy is inside the mother’s uterus (womb); they are at first located inside the abdomen (tummy) and just behind the kidneys. A few days after your puppy has been born the testicles should be in the scrotum, they travel from their starting point down through the abdomen and through an opening called the inguinal ring in order to get to the scrotum. When you take your puppy to the vets to have his first examination they will check for the presence of two testicles in the scrotum, if these cannot be felt then this will be checked again on future visits.  If both testicles are not present this condition is referred to as cryptorchidism (retained testicles), either one (unilateral cryptorchid) or both (bilateral cryptorchid) of the testicles may be missing from the scrotum.  In very rare cases on or both of the testicles has not actually developed at all. What should you do if your dog has cryptorchidism? Your vet is likely to suggest that you wait to see if the missing testicle comes down into the scrotum at a later date, this would usually be by 6 months of age but in some cases can occur up to 1 year of age. What to do if the testicle does not appear? Your vet will discuss a castration procedure with you in which both testicles are removed, it is a simple procedure to remove under general anaesthesia the testicle present in the scrotum, the retained one has to be located in your dog’s abdomen, and this can take some time. The surgical procedure to find and remove the testicle from the abdomen can be tricky as the testicle which has not found its way to the scrotum is often smaller and therefore not so easy to locate in amongst the contents of your dog’s abdomen. Why should I have my dog castrated if he has cryptorchidism? If the testicles are not in their correct location in the scrotum there is an increased chance of them becoming diseased, such as developing into cancerous tissue. Also a dog with cryptorchidism is likely to have reduced fertility and would not be an ideal candidate for breeding. I hope that I have managed to answer your question regarding the timing of castration in a cryptorchid dog and have managed to explain some of the reasoning behind why it happens and what the best plan of treatment is. Shanika Winters MRCVS(online vet) If you are worried about your dog please book an appointment with your vet or use our online symptom checker.
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Ireland is living in the past: it’s about to become legal for members of public to dock puppies’ tails.

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Tail docking is a illogical, nonsensical form of puppy torture, and it looks set to become legal in Ireland.  The procedure is brutal: a pair of scissors, a sharp knife or a tight ring are used to chop off a young puppy's tail. There is no anaesthetic, and it clearly hurts a lot (they squeal loudly), but the pups are too small and helpless to do anything about it. The pup above was brought to me for treatment after the amateur tail docking job had resulted in a chronic non-healing wound. Tail docking has been banned in the UK since 2007: it's completely illegal in Scotland, and in England and Wales, it's only allowed for a small number of working dogs or when the procedure is needed for medical purposes under theAnimal Welfare Act 2006 or the Welfare of Animals Act (Northern Ireland) 2011. It's also illegal to show dogs that had their tails docked after 2007.  The subject has been debated in detail elsewhere, but the evidence is clear: tail docking causes pain to puppies, and it does not reduce the incidence of tail injuries in adult dogs, even in working animals. Tail docking is also illegal in most European countries: the fact that it has not yet been banned in Ireland is the only reason why Ireland is unable to become the 23rd European state to ratify the Council of Europe’s European Convention for the Protection of Pet Animals. (In fact, the UK is also unable to ratify this convention because of the illogical "working dog" exemption on tail docking in England and Wales). Until last week, it seemed that tail docking was about to be phased out in Ireland. Suddenly, this has changed. A new Animal Health and Welfare Act is due to be brought in by the Irish Minister of Agriculture Simon Coveney in the next few weeks. The new law has been carefully drafted in conjunction with veterinary bodies and animal welfare groups, all of whom are strongly anti-docking. The Act specifically prohibits "surgical procedures for cosmetic reasons" and it also bans  "mutilated" dogs from being exhibited in the show ring. These clauses were introduced to stop old-fashioned and unnecessary procedures such as tail docking. So far so good. So it was a bombshell when it was made known last week that the Minister intends to allow tail docking by members of the public, by listing it in a Regulation under procedures that may be performed without the use of anaesthetics or pain relief. The other activities under this section are mostly agricultural tasks, such as ear tagging cattle, castrating sheep and removing piglets tails: these have been allowed to permit such traditional aspects of agriculture to continue (even though it can be argued that, logically, they too should be restricted). The official bodies representing animal welfare in Ireland are incensed at this news: it's worth reading the open letter that has been written to the Minister by Veterinary Ireland, the ISPCA and Dogs Trust. An online petition has been launched to gather public support against the new Regulation: you can sign it here. The petition was started on 10th November, and already has over 5000 signatures. It isn't too late to change the future for Irish puppies: the government must surely be listening to common sense and the voice of the people.
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Is your dog a stinker? – why your dog might be smelly!

All dogs smell, anyone who owns one knows that but there is a difference between ‘Eau de wet dog’ and a proper SMELL.  Sometimes these can creep up on us unawares and it’s only after some time away from your pet or when visitors come and politely, but firmly, distance themselves from your pooch do you notice and other times they can appear overnight.  However, like any other change in your pets behaviour or health, they should always be taken seriously. So, what could cause your dog to smell (worse than usual!) and when should you worry?  Lets look at our pets, if you will excuse the pun, nose to tail; Ears Ear infections are common in dogs, especially breeds with floppy, furry appendages, but any dog can develop odourous, painful problems.  They will often shake their heads, scratch at their ears and when you inspect under the ear flap you usually find a discharge, which can vary from a thick, black waxy to a creamy pus-like consistency, red, sore skin and quite a stink!  Any dog with these symptoms should be taken to a vet as soon as possible.  Ear infections left to fester can cause permanent damage and will be very sore for your pet. Teeth I have said it before and I will doubtless say it again; Doggy breath is NOT normal!  A dog with a healthy mouth should have little or no smell coming from it and if they have, there is a problem.  Smelly breath is usually due to bacteria colonising the plaque, tartar and gingivitis on the teeth and gums.  Between them these are literally rotting your pets teeth away, which is very painful and will eventually lead to teeth loss.  Not only this, these germs will escape into the blood stream, travel round the rest of the body and put the organs under serious strain.  The heart, kidneys & liver will all suffer, sometimes to the point where they are permanently damaged. Regular check-ups with your vet will pick up any problems early and often simple chews or regular brushing will prevent further issues.  However, if your dog is particularly badly affected, your vet may suggest dental work under an anaesthetic to remove all the tartar and infection, extract any teeth which are beyond saving and restore the mouth to health. Coat and Skin We all know dogs love to get wet, dirty and roll in the most disgusting things (fox poo anyone?) but normally a good shampoo or just a bit of drying out will sort most problems. However, some pooches seem to carry a distinct ‘smell’ around with them wherever they go.  In some cases these can indicate significant health problems and in others just a few tweeks to their care can make the world of difference. There are a significant minority of dogs who suffer from skin allergies, which not only make them itchy but also can make them very smelly.  The odour arises from an abnormal amount of bacteria and yeasts living on the skin and until the disease is under control, it can be very difficult to get rid of.  Medicated shampoos available from your vet can be very helpful but some pets will need oral treatments to bring the problem under control, especially in the early stages.  It also helps to keep the skin and coat in the very best condition possible.  There are several dietary supplements available for dogs which are brilliant for keeping coats and skin in tip top condition, ask your vet what they would recommend. For dogs that just have a bit of ‘BO’ again regular baths, with a proper doggy shampoo, can be very helpful, as can dietary supplements.  In many cases it is worth investing in a regular trip to the groomers as they will be able to bathe them fully, strip and clip the coat, if it is appropriate to the breed, and dry them properly afterwards. The bottom end! Flatulence ‘Silent but deadly’ is the best description for many of man’s best friend’s emanations!  Usually it is just an occasional thing or can be related to a bin raid or unsuitable treats (!) but in some pets it can be a constant (and very unsociable!) problem. Excessive gas production is caused by poor digestion, which can be related either to a problem with the guts not functioning properly or an unsuitable diet.  In most cases it is the latter and a change of food (or several until you find one that suits them) is all that is needed to settle the digestion.  The best diets to pick in these circumstances are the ‘hypoallergenic’ kind which tend to contain fewer additives and are usually wheat & gluten free, which makes them much gentler on dog’s stomachs.  Have a chat to your vet about what they would recommend you try. However, some individuals have actual gastrointestinal disease and for them flatulence is usually just one of several symptoms relating to poor gut function.  These pets often need testing (which can include blood samples, faecal samples, xrays and biopsies) to make a specific diagnosis and treatments include medications, dietary supplements and, again, hypoallergenic diets. Anal Glands For many dogs, especially the smaller breeds, these little bottom glands can be the bane of their (and their owner’s) lives!  The anal sacs are two small, thin walled glands situated on either side of the anus (people don't have them, thank goodness!) which produce a smelly, watery scent.  They are why dogs sniff each others bottoms and their mechanism of emptying is very simple; As the solid faeces slides past them, it squeezes the gland and forces out the liquid.  However, if the dog doesn't poo for a while or has diarrhoea, the gland won’t be emptied and can become blocked.  This is painful, feeling a bit like a zit that needs to be popped, and will cause many dogs to display signs including chewing at their tails, licking at their bottoms or, the classic, scooting along on their bottoms.  Sometimes they will succeed in expressing the glands, which causes a truly remarkable smell (once smelt, never forgotten!) that is often described as ‘fishy’. Most dogs with these symptoms will need their glands expressing by a vet,and trust me, this is a job best left to the professionals!  In some cases it can become a recurring problem as the glands are left thickened and scarred by repeated blocking.  For those individuals a proper flushing out of the glands under a sedation can be helpful and for particularly badly affected pets, your vet may advice removal of the sacs completely. So hopefully now you know a few of the things that can turn your beloved family pet into a truly malodorous mutt!  Why not try our Symptom Checker for further information and if you are concerned, do contact your vet. Cat Henstridge BVSc MRCVS - Read more of her blogs at www.catthevet.com
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