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Could your cat have high blood pressure?

High blood pressure is a common problem for humans but did you know that cats can get it too? High blood pressure, also known as hypertension, is actually quite common in older cats, especially those with other diseases such as kidney disease or hyperthyroidism. The symptoms can be quite subtle or mimic those of other diseases so many cases remain undetected for quite some time. If left untreated, however, hypertension can lead to significant secondary health problems, so it’s definitely worth testing for. [caption id="attachment_4332" align="alignleft" width="288"]Bob having his blood pressure checked. Bob having his blood pressure checked.[/caption] What exactly is high blood pressure? High blood pressure occurs when the pressure within the blood vessels exceeds a certain threshold. Think of the hosepipe used to water your garden. If you turn the tap on too strongly, the water shoots out of the nozzle uncontrollably, damaging your flowers. The same is true for the body – organs like the brain and kidneys need blood to survive but if the blood pressure gets too high, it can start to damage the very organs it is trying to keep alive. To further complicate things, blood vessels have a tendency to leak under pressure and this extra fluid can cause further problems. How do cats develop high blood pressure? Many things can cause hypertension in cats from certain medications to neurological disease, but the two most common causes are kidney failure and hyperthyroidism. Both of these illnesses cause alterations in the very precise mechanisms that monitor and control blood pressure. It doesn’t always correlate with the severity of the disease (i.e., severe hypertension can be seen with only mild kidney disease) and in the case of hyperthyroidism, we sometimes see hypertension develop only after the thyroid problem has been treated. What are the symptoms of hypertension? The clinical signs associated with high blood pressure depend on which organs are most badly affected. One of the most common signs is acute blindness because the high pressure within the vessels of the eye causes the retina to detach from the nerves that tell the brain what the eye is seeing. So you may notice the cat bumping into things (although it’s amazing how many owners aren’t aware of their cat’s blindness because cats are so good at using their other senses to compensate), staying closer to home or having very dilated pupils or ‘wide eyes’. Another organ that is commonly affected is the brain so you might see serious signs such as circling and seizures or perhaps much more subtle behavioural changes such as crying out at night or being less sociable when people are around (how else would you tell if your cat had a headache?). You may see bleeding in unexpected places like nosebleeds or blood in the urine. It can also speed up the progression of kidney failure. The list goes on so any unexplained physical or behavioural change warrants a blood pressure check, especially in older cats. How is high blood pressure diagnosed? The only way to tell if a cat has high blood pressure is to measure it. The process is much the same as it is in humans – a cuff is inflated around the arm or leg (or possibly the tail) which controls blood flow to the limb. A special device (sometimes a handheld Doppler unit or sometimes an automatic sensor) then measures the blood pressure. It doesn’t hurt and isn’t usually a stressful process that is good because if the cat is stressed the reading can be artificially elevated. Sometimes the cat objects to the cuff being tightened so it can help to practice a few times before taking the reading. Some cats just plain hate going to the vet or any kind of restraint whatsoever so it isn’t always possible to get a reading, although many clinics have special protocols in place to help the cat stay as calm as possible before attempting to take a blood pressure. If all else fails in the clinic, a reading might be possible at home where they are more comfortable. Is there any treatment? Absolutely. There are several medications that can treat high blood pressure but the one that most vets use these days is called amlodipine. A very tiny dose goes a long way, and it’s important that once you start the medication, you give it regularly to avoid dangerous spikes in blood pressure. Once a cat starts the medication (usually a tiny tablet that most cats seem to tolerate relatively well) it’s important to follow up with regular blood pressure checks to ensure that they are on the correct dose. I’ve seen many cats respond very well indeed to treatment and many owners report that their cat seems years younger once their blood pressure is under control, even if they hadn’t noticed any symptoms in the first place. It is yet another example of how well cats can hide their illnesses and how important it is for owners and vets to work together to detect health problems while there is still time to treat them effectively. If you think your cat is showing signs of high blood pressure or if you have an older cat with unexplained physical or behavioural changes, please speak with your vet about having their blood pressure checked. You may never know unless you make an effort to look for it. Amy Bergs DVM MRCVS  - Visit The Cat Doctor website by clicking HERE
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Ask a vet online – is there a test for Leptospirosis?

Berry Wilkinson asked: I was wondering if you can titre test for leptospirosis? Or is it only useful when you are testing sick dogs? Thanks. Answer: Hi Berry, thanks for your question about testing for Leptospirosis. To answer it, I'll briefly discuss Leptospirosis as a disease, then talk about the different diagnostic techniques available. Finally, I'll discuss vaccination and the implications for diagnosis. What is Leptospirosis? Leptospirosis ("Lepto") is a disease caused by bacteria of the genus Leptospira. There are more than 300 strains (technically called serovars) of the bacteria. In the UK, Leptospira icterohaemorrhagiae and L. canicola used to be the most common, but since widespread vaccination against these has started, it is now thought that L. interrogans and L. kirschneri may be more important. The disease is transmitted by body fluids of infected animals, including rats. The symptoms of Leptospirosis in dogs include:
  • Fever and sore muscles.
  • Loss of appetite, vomiting, diarrhoea and dehydration.
  • It may cause kidney or liver failure
  • Sometimes the only symptom is sudden death.
  • Infected dogs may shed the bacteria in their urine for months or years without showing any clinical signs.
  • Leptospirosis is highly zoonotic - i.e. it is a high risk pathogen for infecting humans.
How is Leptospirosis diagnosed? There are four methods to test for Leptospira in clinical samples, of which two are clinically useful. They are:
  • Darkfield microscopy - looking for the bacteria themselves. This is very siple, but is notoriously unreliable, unfortunately!
  • Bacterial culture - attempting to grow the bacteria; however, in many cases the bacteria are very hard to culture, so even in confirmed infections, this test may come back negative.
  • Serology - looking for antibodies produced by the immune system in response to the presence of the bacteria. However, vaccination will often lead to a positive response, and low-positive titres (levels of antibody) may persist for a prolonged period. In addition, the levels of antibodies often won't be significant in the first week of infection.
  • PCR - testing blood (early infection) or urine (later stages of infection or carrier status) for genetic material from the Leptospira bacteria; this is a very sensitive and specific test. However, a negative PCR result doesn't rule out carrier status because the bacteria are only shed intermittently in the urine, and will not be present in the bloodstream; and it can also appear negative in some milder infections.
So how is serology interpreted?
  • The normal screening test for Lepto is an antibody test ("ELISA testing") that gives a simple positive or negative result.
    • If this is negative, then in general either:
      • The dog doesn't have Lepto, or
      • The dog has only been infected in the last week or so.
    • If the result is positive, then:
      • The dog has Lepto, or
      • The dog has had Lepto in the past, or
      • The dog has been vaccinated and still has high levels of circulating antibody.
  • If the ELISA-test is positive; or if the symptoms are suspicious but PCR (genetic) testing is negative, the next phase is to use a different type of antibody testing ("MAT serology") to determine the level of antibodies in the blood (the titre).
    • On a single test:
      • Low titres are most likely to represent vaccination or past infection.
      • Moderate titres may indicate vaccination or infection.
      • High titres usually represent acute infection.
    • However, it is far more useful to carry out paired serology - 2 tests 7-10 days apart:
      • In a genuine infection, the titre would normally be expected to rise by at least four-fold.
      • In chronic infection, or asymptomatic shedding, diagnosis can be really difficult, but a persistent moderate titre that doesn't decay over time is highly suggestive of chronic infection; however, demonstration of the organism's genetic material by PCR in repeated urine samples is often more practical.
What about vaccination?               There are a number of different Leptospirosis vaccines available; most of them cover 2 strains ("bivalent vaccines"), although some now cover 4 ("quadrivalent vaccines"). They are aimed at covering the most common types that cause disease, and there is relatively little cross-protection between strains (so immunity to one strain or serovar won't usually protect against another). The vaccine doesn't necessarily prevent infection, but it should reduce the risk of infection, and it does reduce the severity of clinical disease and shedding (for whichever strains or serovars are covered by that vaccine). There are some commercial tests that claim to determine whether a dog requires vaccination against Leptospira by testing circulating antibodies. This may work in some cases, but it is very limited. There are a number of problems with this approach:
  • 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 appear to utilise other parts of the immune system (cell mediated immunity) and are protected against Lepto even in the absence of significant circulating antibody titres.
  • After vaccination, titres normally drop off over 4-5 months, but protection lasts for 12 months.
As a result, it is wisest to maintain annual vaccination against Leptospirosis, to reduce the risk of infection to your dog and to you. I hope that helps! David Harris BVSc MRCVS
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Ask a vet online – my dog has skin allergies, how do I help?

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

As part of my work as a "media vet", I'm a strong advocate for spaying and neutering pets as the best way to control the problem of pet overpopulation. Accidental pregnancies still account for a high number of unwanted puppies and kittens, and routine spaying/neutering of young adult pets is the best way to prevent these. This doesn't meant that every pet needs to be spayed/neutered when young (there are some good reasons to delay or even not to do the operation for some individual animals), but it does mean that every pet owner should at least discuss the options with their vet around the time of puberty.

Why do people refuse to have their pets spayed?

People have a variety of reasons for not having the operations done on their pets, and the cost is a major factor. In a recent social media discussion, the following comment came in. "Vets should reduce their fee to £120 for a female dog. A lot of people genuinely just can't afford it."

Why don't vets reduce their fees?

This is a good point. Why don't vets reduce the price of spaying? Let's look at how this could be done: what makes up the cost of an operation, and how can those items be reduced? To put this in perspective, what are the typical fees for spaying? The recent SPVS survey found that the median fee nationwide for an adult bitch spay was £204. There is significant regional variation on this, but the figure acts as a reasonable starting point for discussion. How could it be reduced to £120? If you look at the pie chart at the foot of this page, you can see that over half of the costs of vets' fees are made up of overheads that are difficult to reduce: rent, heat, light, phone, drugs, surgical supplies, cleaning, nurses' wages and administration costs. Vets already do as much as they can to keep these costs down: it's in their own interests to do so. So let's leave these alone for the sake of this discussion. So what about the obvious "top item" on the cost list for most people: the money that goes to the vet. Surely vets can manage with less? For every £10 you give the vet, typically only £2 to £2.50 goes to the vet. If a vet gives you a 20 to 25% discount, they are working for nothing. Vets are well enough paid, but their salaries are lower than most people expect. A typical new graduate vet earns around £30000, and a vet qualified for 20 years might earn £50000. Should vets work for less than that, with five years of tough training and high costs in getting through college? For the sake of this discussion, let's say yes, and agree that vets will operate for free on bitch spays: take 25% off £204, and you're left with £153. What next? What about VAT? The government charges 20% on all vet fees, making up £34 of the £204. If this was not charged, £153 minus £34 = £119. Bingo: it's less than £120. So if vets work for nothing, and the government agrees to stop charging VAT, the cost of a bitch spay would reach the desired target. Is this going to happen? Of course not.

In the real world, how can pet owners pay as little as possible for bitch spays?

So what can impoverished pet owners do? Here are three tips. First, plan in advance. You should budget for the spay/neuter surgery when you get a pet, just as you should think about how much it will cost you to feed your new animal. If you genuinely can't afford it, perhaps you should not get a pet. For the financially disadvantaged, there are some subsidised schemes to help, but charity resources are limited, and most of the working population will not qualify for these. Second, shop around, but don't do this on price alone. You should physically visit at least three vets, eyeballing the premises (are they clean?), talking to staff (do they seem to care?) and asking some specific questions: • Do they have qualified veterinary nurses? • Do they use up-to-date anaesthetic, pain relief and monitoring equipment? • Does they monitor all pets after anaesthesia until they are awake? You may not be fully aware of the "right answers" to these questions, but even just by asking the questions and judging the tone of the response, you will learn a lot about the practice. Third, ask for a discount. Some vets may just say "no" ( this is understandable - it directly eats into the 20 - 25% that they are paid), but as in any other consumer transaction, there is no harm in asking the question. If you think a bitch spay is expensive at £200, remember that it would cost around £5000 to have a similar operation carried out on a human. And if you want to help with the pet overpopulation problem, as well as benefitting your own pet's health, it's a price that's well worth paying.
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Elizabethan Collars – a necessary evil?

  [caption id="attachment_4253" align="alignleft" width="768"]Elizabethan collars are named after clothing worn in the time of Queen Elizabeth I Elizabethan collars are named after clothing worn in the time of Queen Elizabeth I[/caption] One of my clients was talking about his recently neutered bitch today. "She needs one of those Victorian Buckets" he said. I knew what he was talking about, but his terminology was not quite correct. The problem was that his bitch had been licking her operation wound, and he wanted to stop her. The item he was describing is an important tool to assist the healing of animals' wounds. It is more correctly called an 'Elizabethan Collar', because it resembles the white starched lace collars that Queen Elizabeth I and her subjects used to wear. Most people have seen animals wearing these large, lampshade-shaped cones, fastened around their necks and extending up around their heads. Animals have a strong instinct to lick their wounds. In moderation, such licking can be cleansing and beneficial. The problem is that animals do not know when to stop. Excessive licking causes redness, soreness and itchiness, and this makes an animal want to lick a wound more and more. It is a vicious circle - the more licking , the more sore a wound becomes, and the more the animal wants to lick it. In the worst cases, a wound can be completely prevented from healing. Animals have even been known to cause themselves serious open wounds by biting and chewing itchy areas. Drugs can be used to ease the itchiness, but they are seldom adequate alone. The only sure answer is the Elizabethan collar. These were originally home-made by vets, using pieces of cardboard, or by cutting the bottoms out of buckets. However, it was not always easy to create a finished product which was effective. Modern pet Elizabethan collars are custom-made from shiny lightweight plastic. They are manufactured in different sizes, to suit anything from a kitten to a Great Dane. They have become more sophisticated as time has passed, and there is now a range of different products available. The traditional collars are made from white plastic, but these restrict an animal's vision, causing animals to crash blindly around the house, bumping into people and furniture. Some modern collars are semi-transparent, to allow animals to see where they are going. We often advise people to line the outer edge of the collar with elastoplast, to blunten the sharp plastic edge which can otherwise cause painful scratches on an owner's legs as an excited animal barges past. Attaching the collar to the animal can be a fiddle - buckles and slots are fitted into place and the whole construction is strung onto the animals normal leather collar. Owners sometimes feel that it is unfair to inflict these collars on their animals, but you only need to see one example of the serious damage which self mutilation can cause to realise how important it is to stop some animals from reaching their wounds. Animals cope with the imposition of an Elizabethan collar in different ways. Most accept their fate sadly but in a quietly resigned fashion. Some Labrador-types seem to enjoy their new 'hats', and they dash around the room enthusiastically causing chaos as they bounce off walls, people and objects. Some cats do what I call an 'Elizabethan Dance', when they twist, leap and pirouette in an effort to escape the collar. After an initial uneasy settling in period, most pets do not mind this odd looking, but very effective structure. There are, of course, a number of modern alternatives, from inflatable life-ring type products to neck braces to soft floppy collars. Some of them are definitely worth trying, but as is often the case in life, I suspect that the reason there are so many alternatives is that nobody has yet found the perfect way of preventing pets from interfering with their own wounds.
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