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Rabbits are not like small dogs or long-eared cats. And it’s not just that they eat grass.

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When something goes wrong with an animal's nervous system, it's very upsetting, and it's easy to panic. People often make generalisations, and leap to the wrong conclusion. He's falling over! He's had a stroke! He's dragging his back legs! To help animals, it's important for vets to be as objective as possible, making a careful note of precisely which part of the nervous system has gone wrong. Vets do this using a specific examination procedure, known as the “neurological examination”. There are tick sheets available to make it easier for vets: various aspects of the nervous system are examined individually, and at the end, it's then easier to be specific about the precise diagnosis. Only then can the correct treatment and prognosis be given. At last week's London Vet Show, there was a fascinating lecture, sponsored by Supreme Pet Foods, which dealt with the subject of neurological examinations in rabbits. As many rabbit owners will know, diseases of the nervous system are common. However rabbits are very different creatures to dogs and cats: they are prey animals rather than predators, and as a consequence, their nervous system doesn't always behave in the same way. Rabbits are especially sensitive to stress, and they tend to mask their fear by staying still. Anyone who has examined rabbits will know this: they tend to stay very passive until the fear is too much, and then they panic explosively, trying to jump out of your arms. This type of temperament means that rabbits react differently when their nervous system is examined. The lecturer carried out a field study, during which she made a careful comparison of a standard neurological examination in rabbits compared to other pets, and she came up with some useful tips. First, she listed the four main types of disease of the nervous system seen in rabbits: head tilt, weakness or paralysis of the back legs (or all four legs), seizures (fitting) and “miscellaneous” (muscle weakness, strange gaits, blindness and other oddities). There's a long list of possible causes of these problems, from brain diseases (including a common fungal parasite called Encephalitozoon cuniculi), to viral and bacterial infections, to spinal problems (including broken backs and slipped discs), to heat stroke, metabolic disorders and many others. In all cases, whatever the cause, the neurological examination is a key to whittling down the list of possibilities. So how are rabbits different to dogs and cats? First and most importantly, rabbits don't show a pain response in the same way. With dogs and cats, it's easy to tell if they can feel their toes by squeezing them: if sensation is normal, they pull their foot away from you. Rabbits often don't do this: they stay utterly still, however hard you squeeze their toes. It doesn't mean they aren't feeling it: they just don't react because in the wild, it makes more sense to “play dead” in the hope that the creature that's hurting you will just go away. Secondly, some of their reflexes are exaggerated. If you tap a dog's knee with a rubber hammer, there's a similar type of small “kick” reflex to a human. In rabbits, the same test elicits a sharp, exaggerated kick, perhaps reflecting the wound up stressed nervous system of the rabbit. If a dog had a reflex kick like this, you'd think there was something strange wrong with them: it's normal in a rabbit. Third, some of their reflexes are diminished or absent: for example, rabbits don't have a “menace” reflex (if you wave your hand towards a dog's eye as if you are about to hit them, they blink automatically, like humans: this is the menace reflex. Rabbits don't do this). Other reflexes in rabbits' eyes are also different: their pupils don't always narrow and widen in the same way as other creatures.  There are two sets of take home messages here. First, if you're a vet, remember to expect different results from other pets when you're assessing rabbits with neurological problems. And second, if you're a rabbit owner, remember to take your pet to a vet with an interest in rabbits: all vets are trained in the essentials of rabbit medicine, but when it comes to complex disease, the more rabbits that a vet sees, the better they will be at rabbit-specific subtleties like neurological examinations.    
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Ask a vet online – How often should my dogs get boosters?

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Karen Taylor asked: How often should our dogs be re-vaccinated (boosters)? Answer: Hi Karen, thanks for your question about booster vaccinations. This is an area that’s become quite controversial in the last few years, and there’s a lot of confusion about the subject. In addition, there’s a lot of very poor-quality information out there, so I’ll try to make this quite clear and obvious! To put it as simply as possible – see your vet every year for a health check, and discuss your vaccination strategy with them. For more detail... now read on! What are vaccinations? Put simply, a vaccination is a way of teaching your dog’s immune system how to recognise and defeat the micro-organism that causes an infectious disease, without the risks (of illness, potential long term health problems or death) inherent in a “natural” infection. This is achieved in one of three ways: 1)      A weakened form of the disease-causing organism. These are called “modified live” or “attenuated” vaccines, e.g. for Distemper and Parvovirus; the organism included is unable to multiply and/or cause clinical disease, but it is active enough to stimulate a strong immune response. Most modified live vaccines give a stronger and more long-lasting immune response than an inactivated vaccine; however, they aren’t suitable for every disease (because some organisms cannot be weakened enough to make them safe). 2)      An inactivated (“killed” or “dead”) form of the organism. These cannot ever cause disease, but allow the immune system to recognise the protein coat of the organism and therefore attack it next time. They may be used for particularly dangerous or unpredictable diseases such as Rabies or Leptospirosis, but don’t always give such long-lasting protection. 3)      Subunit vaccines, introducing part of the organism to teach the immune system what it “looks like”. For these, part of the protein coat of the target organism is replicated in a lab, and included in the vaccine; this means the immune response is really tightly targeted at one particular, vital, part of the organism. These are used, for example, in the Leishmania vaccine. There are 2 groups of vaccines – core and non-core. Core vaccines are those that should be given to every dog – they protect your dog and everyone else’s against dangerous, highly contagious and potentially fatal diseases. Non-core vaccines are those that are given to protect dogs that are particularly at risk of a specific condition because of their location, lifestyle, etc. The core vaccines that every dog should have are against:
  • Distemper.
  • Parvovirus.
  • Canine Infectious Hepatitis.
The vaccine against Leptospirosis is technically non-core; however, it is generally agreed that every dog in the UK is at risk of Lepto (which is spread by rat urine), and so it is treated as a core vaccine by most vets. The non-core (optional) vaccines available are:
  • Rabies (only necessary for pets travelling abroad).
  • Parainfluenza (one of the causes of kennel cough).
  • Kennel Cough (the bacterial sort, Bordetella bronchiseptica).
  • Lyme Disease (only necessary for dogs at high risk, e.g. gundogs, in high risk areas, e.g. the South West peninsula).
  • Leishmania (only necessary for dogs travelling to southern Europe).
  • Canine Coronavirus (only usually needed in breeding kennels).
If vaccines are so good, why do they need boosting? Because nothing lasts forever! Eventually, the immune system starts to “forget” how to handle a particular disease organism. Booster vaccines effectively remind the system and refresh the immunity. However, immunity to different diseases (and different types of vaccine, for that matter) lasts a variable amount of time, and that’s the problem. Some dogs will retain immunity for longer than others – unfortunately, there’s no easy way to tell which dogs are immune to what for how long. Is there any way to tell whether my dog actually needs a booster? Not really! The trouble is that although some vaccines operate by producing protective antibodies (e.g. Rabies), others rely on inducing a Cell Mediated Immune Response (immunity that doesn’t rely on antibodies in the blood, but circulating immune cells, e.g. T-lymphocytes and Natural Killer (NK) cells) – such as the Leishmania vaccine, which may not produce any antibodies at all. And most of them probably rely to some extent on both systems. It's easy to test the dog’s blood for antibodies (and there are some commercial companies that will do this and say “yes, high levels of antibody, so the dog is protected” or “no, not enough antibody, the dog needs to be vaccinated again”. However, this is not generally considered reliable, because:
  • The serological titre (level of antibodies in the blood) can only tell you how much antibody there is in the bloodstream at the specific time the test is done - it cannot tell you whether the levels will remain high for the following 12 months.
  • The link between antibody levels and protection isn't consistent - some dogs utilise other parts of the immune system (cell mediated immunity) – for example, dogs can be protected against Leptospirosis in the presence or absence of significant circulating antibody levels.
So how long does immunity actually last? How long the vaccine lasts depends on the exact formulation of the vaccine; at the time of writing, the three Core vaccines generally need boosting 1 year after the initial course, then every 3 years. Most Rabies vaccines needs boosting only every 3 years; and the others usually require annual boosters. To get a license for a vaccine, the manufacturer has to demonstrate that the product has a protective effect, however that is defined. For Core vaccines, they have to demonstrate onset and duration of immunity such as to fulfil the license claim to:
  • “Prevent mortality and clinical signs caused by canine distemper virus infection”.
  • “Reduce clinical signs of infectious hepatitis and viral excretion due to canine adenovirus type 1 infection”.
  • “Prevent mortality, clinical signs and viral excretion following canine parvovirus infection”.
If this cannot be demonstrated to the regulator (in the UK, the Veterinary Medicines Directorate - VMD), they won’t get a license for the product. This means that manufacturer’s recommendations for duration of immunity are those that will protect the vast majority of dogs for the quoted time (3 years or 12 months, depending on the vaccine). To make life a little more complex, any vet who uses a different vaccination interval, unless they can document a good clinical justification, is technically acting illegally by using the vaccine off-license (i.e. not as licensed by the manufacturer). This sort of behaviour tends to lead to unpleasant interviews with the VMD and has led to vets being struck off (although not, to my knowledge, for vaccine infringements as yet). Can over-vaccination harm my dog? There’s no reliable evidence that it can. In cats, every subcutaneous injection (of anything, even saline!) slightly increases the risk of an Injection Site Sarcoma, but despite a lot of scientists, vets and owners trying to find a link, there’s no evidence that it causes any problems in dogs. That said, absence of evidence is not necessarily evidence of absence, so a responsible approach would be to vaccinate as infrequently as the current evidence suggests is sufficient to provide protection – in other words: 1)      Get a health check for your dog at the vets every year. 2)      Follow the manufacturer’s recommendations (unless your vet has a particular clinical reason not to):
  1. Distemper, Parvo and Infectious Hepatitis – boosters every 3 years.
  2. Lepto – annual booster.
  3. Rabies – boost every 3 years.
  4. Other Non-core vaccines – usually every year.
  I hope that helps; this is a really controversial area in some quarters, but the evidence base for the current vaccination protocols is pretty secure, and it is what I’d advise you to follow. David Harris BVSc MRCVS
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The story of Dan, a coughing Springer Spaniel

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Dan was a nine year old Springer Spaniel who loved strenuous physical exercise. His owner, Dr Mullen, was a medical doctor who was an enthusiastic hill walker, so they made a good team. They would spend days off in the Dublin mountains together on six-hour hikes through the countryside. Dan was brought to see me because he had developed an irritating cough, and Dr Mullen was worried.

The cough did not affect Dan during exercise. He was still able to run for hours without any problem, but the following morning, immediately after getting up, he would cough repeatedly as he walked around the room. It seemed to be a productive cough: sometimes he swallowed after the cough, and other times Dr Mullen found patches of white phlegm on the floor. When Dan had been up and about for half an hour, the cough seemed to clear, and he’d be fine for the rest of the day.

I started by physically examining Dan. I listened carefully to his chest with my stethoscope. He had the perfect heartbeat of a fit dog, with slow steady sounds and no murmurs or irregularities. His lungs, however, sounded noisier than normal, with some wheezes and crackles. He definitely had some type of lung disease, and further tests were needed.

The following day, Dan was anaesthetised, X-rays were taken, an endoscope was used to directly view the lining of his airways, and finally tiny biopsies were taken of the many red sore areas that we could see. Dr Mullen called in three days later to discuss the full results of our investigations.

“I can say for certain that Dan is suffering from Chronic Bronchitis”, I began. “The initial X-rays suggested that that there was thickening of his lower airways, and using the endoscope, we could see that the thickening was because of inflammation of the lining of the small tubes of the lungs, known as ‘bronchi’. The biopsy of the red, swollen areas confirms that the disease process is simple inflammation, with nothing sinister going on. Finally, he has a mild bacterial infection in his lungs.”

Dr Mullen asked me if an antibiotic would completely cure his dog.

“Although antibiotics will help him, for a complete cure, he needs to go onto long term medication using other drugs. The chronic bronchitis probably started out with a simple infection, but there is now also an irritant and allergic aspect to the disease. The tiny particles of dust, smoke and pollens that are always in the air are perpetuating the bronchitis. We’ll use two drugs to help him. Firstly, a ‘broncho-dilator’, which will widen his airways and lessen the tight narrowing of the bronchi that is making them irritated. Secondly, a low dose of steroids will directly lessen the irritation. We’ll modify his dose of each drug so that he should be able to live a normal, symptom free life without side effects from medication.” There are other options for treatment, including an inhaler mask, but this treatment was my standard first stage.

Dan was sent home with three containers of tablets, and twice-daily medication ritual became part of his routine. I saw him again two weeks later, and the cough had almost completely stopped. He was suffering some side effects from the steroids, with increased thirst and appetite, but we were then able to reduce the dosage, so that he was given tablets only on every second day. When he came back a full month later, Dr Mullen was delighted.

“His cough has vanished completely”, he told me. “And he is enjoying his walks more than ever. The only problem is that he’s wearing me out! Do you know any tonic pills for a fifty-five year old human?”

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Oscar, the grumpy cat who needed twice daily injections to treat his diabetes

[caption id="attachment_4489" align="aligncenter" width="585"]Oscar does not tolerate humans who annoy him Oscar does not tolerate humans who annoy him[/caption]

Oscar, a ten year old cat, had started to lose weight, despite the fact that he was eating well. His coat had begun to look bedraggled, as if he was not grooming himself as much as usual. His owner had noticed him visiting his water bowl more frequently, and she had needed to fill up the bowl every day, rather than every three days.

When I examined him it was clear that Oscar had lost a significant amount of weight. His ribs were prominent, and I could feel the sharp tips of the bones of his back. When I weighed him, I discovered that he had lost a kilogram since his previous visit.

Physically, I could find no obvious cause of a problem, so I decided that a blood profile was needed. Fifteen minutes later, the printout from the biochemistry analyser gave me the clear-cut diagnosis of his illness.

Oscar’s blood glucose was around four times higher than normal. The only possible reason for this was the condition known as diabetes mellitus. Oscar’s pancreas had stopped producing the hormone called insulin, and as a result, his blood glucose was not being controlled. Weight loss, ravenous appetite and copious thirst are classical signs of diabetes, in cats just as in humans and dogs.

As I explained the diagnosis to his owner, I could see a worried furrow developing across her brow. I explained that Oscar’s condition was treatable, but that he would need to have a daily injection of insulin for the rest of his life. Her shoulders slumped, and she looked at me sadly. “Nobody would dare to give Oscar an injection”, she told me. “He’d just get so annoyed with us if we tried something like that!”

I reassured her that the injection was given with an ultra-fine needle, and that only a tiny amount of liquid would be needed. For a cat of Oscar’s size, the volume of insulin would probably be around one hundredth of a teaspoonful, which is literally a single drop. It was very likely that he would barely notice the injection.

I demonstrated the injection technique, using a piece of fruit – an orange – as a practice target. It took a few attempts until she had learned to hold the syringe correctly, but soon she was able to insert the needle steadily and firmly into the orange. She was still very anxious about injecting her cat, so we decided that it would be best for her to bring him in to see me for his injection every morning for the first week.

The technique was simple. I gave Oscar a bowl of his favourite food, and as he lowered his head to eat, I quickly slipped the injection into the scruff of his neck. He stopped eating for a moment, and looked suspiciously at me before recommencing his meal. On day three, his owner gave the injection herself, and by day five, she was able to do this quickly and confidently.

After several dose adjustments over a few weeks, Oscar’s blood glucose had returned to normal. At the same time, his owner reported that his excessive thirst had disappeared. It seemed that his diabetes had been controlled.

The success of his treatment was confirmed at his final visit six weeks later. As the cage door was opened, Oscar stepped out in a confident and dignified fashion, with his head held high. He had put on weight, he was grooming himself again, and even his whiskers looked alert and bristling. He was definitely a healthy cat again.

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Kittens with passengers: ear mites

[caption id="attachment_4382" align="aligncenter" width="640"]Ear mites are very common in kittens Ear mites are very common in kittens[/caption] When a litter of rescued kittens were brought to see me recently, a careful examination of their ears was an important part of the check-up. I introduced the tip ofthe auroscope into each kitten’s ear, and by looking through the instrument I was able to see a magnified view of each ear canal. In normal animals, the pale blue-grey of the eardrum itself can often be seen. However, in these kittens, I could hardly see any normal ear canal. My view was blocked completely by thick, brown, sticky earwax. The cause of the excessive ear wax could be seen very clearly. Tiny white wriggling insect-like creatures could be seen swarming around the inside of each ear. The kittens were infected with ear mites. Ear mites are very common in kittens. They are very small mites, each measuring the size of a pin-head. They are very active, and they tend to move away from bright light. When examining an ear with an auroscope, ear mites can often be seen moving quickly out of the field of vision, as if running away from the vet. Ear mites are highly infectious, and they are especially common in feral colonies of cats. The adult mite feeds on the secretions produced by the lining of the ear. Eggs are laid inside the ear. These hatch out into tiny larvae which then mature into adults, and the life cycle continues. If one cat pushes its head against the body of another cat, ear mites can easily be transferred from one to the other. Kittens are obviously in very close contact with their mothers and with each other, so it is very common to find entire litters of kittens affected by dramatic infestations of ear mites. Most of us are familiar with the discomfort of an irritation in the ear, even from something as harmless as a small quantity of water lodging in our ears after swimming. The concept of live, wriggling insects crawling around inside the ear canal is very unpleasant! In many cases, kittens do show dramatic signs, such as repeated scratching of the ears. In other cases, an owner may have noticed the animal shaking their head more than usual,. However some cats, even with severe infestations, show no obvious external signs. Close examination of a kitten’s ears with an auroscope is essential to detect such ‘invisible’ cases. Ear mites can also affect dogs, but they are less common. Fortunately, there is no risk to humans. Those alarming, tiny, wriggly creatures are not going to crawl onto your hand, up your arm and into your own ear. However, if you have a household of dogs and cats, you do need to treat every animal individually to ensure that you have completely eradicated the infestation. Treatment of ear mites is not always easy. The mites are sensitive to most insecticides and a range of drops and ointments are available from your vet. The only complication is that the eggs of the ear mite are resistant to treatment, and these can remain unhatched for up to three weeks. This means that it may be necessary to continue to medicate affected kittens for an entire three week period, to ensure that all eggs have hatched with the resulting larvae being eradicated. Young kittens can be difficult to hold still, and they often learn how to escape from your grasp, so after the first few days of treatment it can become more difficult to continue. I saw the kittens again two weeks after their first visit. They were all in wonderful form, purring, playing with each other, and growing rapidly. Their ears were clean, both inside and out. They were ready for their new homes – with no passengers included!
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