Our Archives: operation

Once you relinquish your pet to the green fairies, you may be wondering what actually happens “out the back”. Well, wonder no more. Firstly we make sure that we have an accurate weight for your pet as this is what we use to calculate the dose of the drugs that we give your pet. Once we have this we settle them in a kennel with nice squishy blankets while we go and get everything prepared. If you have opted for, or we have recommended, a blood sample before anaesthesia then your pet is taken to a quiet part of the practice where we can safely take the sample. To take the sample, a patch of hair is shaved over the jugular vein which runs down the side of the neck, to one side of the windpipe and a needle is inserted to collect the blood. Most animals tolerate this quite well with the gentle yet firm restraint that we green fairies have down to a fine art. Some animals on the other hand object quite vociferously and may have to have the blood sample taken once they are anaesthetised. Not ideal but better if they are getting too stressed. Once the results have come back and been received by the veterinary surgeon, they can decide what to pre-med with and whether the use of intravenous fluids is necessary. Intravenous fluids are usually considered if there is any elevation of the liver and kidney enzymes which show that these organs need a little help during anaesthesia as that is where most of the drugs used are metabolised. Some veterinary surgeons also advocate the use of fluid therapy during routine bitch spays as a spay is a fairly major and invasive procedure and fluids help maintain blood pressure and support the body during this procedure. There are a few ways that we can induce anaesthesia in your pet. One way is to use the anaesthetic gas and get them to breathe the gas in via a mask or an anaesthetic chamber. This way is usually used with smaller creatures such as rabbits, guinea pigs and rats and they fit into the anaesthetic chamber and can have oxygen administered in this way before the gas is turned on. Another way is to inject an anaesthetic agent called Propofol into the vein and then maintain anaesthesia directly into the airway using an endotracheal tube which is fitted into the windpipe. This is the most commonly used induction for surgeries as induction is quick, Propofol wears off quickly and then the anaesthetic can be controlled with the gas. The final way is to inject a combination of sedative and tranquilliser drugs into the muscle, usually the lumbar muscle or the quadriceps. This way is usually used for short, less painful and less invasive procedures such as cat castrates where the animal only needs to be asleep for a short period and is reversible with another injection. If your pet is having surgery, the affected area will have to be shaved and cleaned to maintain the sterility of the site. This is why we advise that dogs are fairly clean when they come in so that we don’t have to spend so much time cleaning them which means they spend less time under anaesthetic. So, that answers the question of how we prepare your pet for anaesthetic or why he has so many bald patches! If you are worried about your pet's surgery please talk to your vet, or check any post op symptoms with our Interactive Symptom Guide to see how urgent the problem may be.

One evening whilst playing outside, a little 6 month old kitten (let’s call her Tilly) climbed up a tree. A rather inexperienced hunter, when she saw a little birdie on the end of the branch she reached out to get it and, crash! The branch was too thin to support her weight and she fell to the ground. Now what they say is often true, cats do tend to land on their feet, but not always and poor Tilly landed on her side. She got up though and ran into the house, so her owner assumed she was OK. A few hours later her owner noticed that she was quieter than normal and not interested in her dinner. She was also breathing faster than normal but otherwise seemed OK, purring and affectionate, so her owner went to bed and planned to take her to the vet if she was still not right in the morning. As you could probably guess, at 8:00 the next morning I got a phone call from Tilly’s owner, as she had not gotten any better overnight - she was still very quiet and breathing even faster than before. We told her to come straight down and we would take a look right away. A few minutes later Tilly arrived, looking quite sorry for herself, but still happy enough to give me a little purr. I did a full physical exam and found her to be in good health except for her breathing, which sounded quieter than normal through the stethoscope. Her respiratory or breathing rate was very high and she seemed to be struggling to get enough air in. She also seemed depressed, certainly not what I would expect of such a lively young kitten. Once we were certain that everything else seemed to be OK, we gave her some pain medicine and then a little bit of sedation so she would sit still while we took some x-rays of her chest. What we found was no surprise given her history, but still always comes as a bit of a shock when we see it – Tilly had a diaphragmatic hernia. What is a diaphragmatic hernia? The diaphragm is a large, thin muscle that separates the chest cavity (with the heart and lungs) from the abdomen (with the stomach, liver and intestines among other things). It is normally an air-tight barrier which allows the chest cavity to achieve negative pressure, in other words there is pressure on the lungs to expand out rather than collapse in. When the diaphragm moves down with each breath, the lungs move with it causing them to expand even further when you breathe in. And when it moves back up again, it helps the lungs to contract so the air is forced out when you exhale. Without a diaphragm or with a damaged one you can still breathe, just not very well, and this is what poor Tilly was experiencing. A hernia is the protrusion of an organ through a hole in the body cavity which normally contains it. In the case of a diaphragmatic hernia, a hole develops in the diaphragm which allows the organs of the abdomen to enter the chest cavity. As you can imagine, this is neither good for chest, as the invading organ takes up precious lung space, nor for the organ itself as sometimes its blood supply can get cut off in the process. Some diaphragmatic hernias are emergencies and need to be corrected immediately, while some can go on for weeks without anybody even noticing, it depends on the size of the hole and which organs get displaced. Some animals are even born with them. In Tilly’s case, the sudden pressure on her belly from hitting the ground caused her diaphragm to tear and some of her liver to move up through the hole. It was a serious condition but not a life-threatening emergency, and it has been shown that there is a higher success rate in some cases if surgery is done after 24-48 hours, so she was scheduled for surgery to repair the hernia the following day and kept in hospital under close observation until then. [caption id="attachment_1805" align="aligncenter" width="640" caption="This is an image of Tilly’s chest – the dotted line shows where the diaphragm usually sits and the solid line shows Tilly’s diaphragm, with the liver sitting inside the bulge. A relatively easy but dramatic diagnosis!"][/caption] So what happened? We took Tilly to surgery the following day and once we could see inside, the extent of the injury became apparent. There was a 5 cm tear in the diaphragm muscle, and about half of her liver was now sitting right next to her lungs! We were able to carefully pull the liver back into the abdomen and sew up the hole, making sure that all the organs looked happy and healthy before finishing the surgery. Our nurse did a fantastic job keeping Tilly stable under the anaesthetic, and even had to breathe for her for a few minutes while we sewed up the hole. Just before we woke her up, we inserted a needle into the chest to drain out all the extra air so that her chest cavity could regain its negative pressure. Her breathing was immediately improved, and stayed that way throughout her recovery. The next day she was eating and even trying to play with the notes on her cage, so she was able to go home. It has now been nearly a week and Tilly is still doing really well. Her owner says she is even trying to climb things, despite being told that she must stay very quiet to allow her injuries some time to heal. If only you could explain to her how she got into this trouble in the first place! All the best to brave Tilly and her brave owners, I expect she will make a full recovery and be back to her usual kitten acrobatics in no time. If you are worried about any problems with your cat, talk to your vet or try our Interactive Cat Symptom Guide to help decide what to do next.

Also known as Bloat, Twisted Stomach, Gastric Dilatation-Volvulus or GDV, this condition is one of the most serious emergencies in small animal practice, and it can make all the difference to the outcome if it is recognised immediately. There are two parts to this condition, the bloat and the torsion. Bloat is when the dog’s stomach fills up with gas, fluid, froth or a mixture of all of these, to a far greater size than normal. Torsion (volvulus) is when the whole stomach twists inside the abdomen so that it is closed off at both its entrance and its exit, just like a sausage which is twisted closed at both ends. They may both occur together, or one may lead to the other. If bloat occurs first, the enlarged stomach is at greater risk of torsion. If torsion occurs first, bloating will definitely result. No food can leave the stomach, so it ferments, and no gas can be belched up. [caption id="attachment_1592" align="alignleft" width="214"] Annie, a Gordon Setter, suffered with bloat but survived thanks to her owner spotting the signs[/caption] The effect of the swollen stomach is that it presses on all of the other vital organs close to it. The breathing will become difficult and if the large blood vessels within the abdomen get squeezed so much that they cannot allow blood flow, then other organs will begin to shut down. The stomach wall and the spleen can become necrotic or dead due to loss of blood flow, and this releases toxins into the bloodstream. It is very painful, and if not corrected, the dog will die. The reasons for this condition occurring are not fully understood, but there are some well known and definite risk factors. The condition happens mainly in larger breeds, particularly those with a deep-chested shape like Great Danes, German Shepherds, Setters, Wolfhounds and Boxers, but these are not the only breeds affected. It also happens more (but not exclusively) in dogs over 7 years of age, and it is more common in males than in females. The risks increase if the stomach is very full, either with food or with water, so a dog which is fed once daily and eats very quickly, or gets access to the food store and gorges itself, would be at higher risk. Exercising after eating or after a big drink also increases the risk. Symptoms The onset of a gastric torsion is usually very rapid. The dog can appear quite normal one minute but once symptoms start they very quickly get worse. The most common symptoms are some or all of:

• Restlessness, anxiety
• Discomfort, followed by worsening pain
• Arched back, reluctance to lie down
• Drooling saliva or froth
• Attempts to vomit (retching) with little being brought up
• Swollen abdomen, often feels hard and if tapped feels like a balloon
• Rapid breathing
• Pale coloured gums and tongue
• Collapse
• Shock, possible death

It is vital to get veterinary attention as soon as possible if you suspect bloat or torsion. Always phone your surgery or your emergency service first as it will save valuable time if you go to the right place where the staff are prepared for your arrival. Occasionally, there can be a slower onset. This may mean that the stomach has bloated without twisting, but there is still a high risk of torsion occurring so advice should be sought from your surgery. Diagnosis & Treatment Diagnosing the condition can be very straightforward if a dog is showing all of the classic symptoms. X-rays may be needed to confirm it. Blood tests will probably be taken to find out how serious the changes in the blood are, because changes in the circulating levels of salts in the blood can be life-threatening. These will be treated with intravenous fluids given quickly and at high volumes. A stomach tube may be passed, but this will not be successful if the stomach has twisted because the tube will not be able to get through the obstructed entrance. The vet may decide to decompress the stomach (let some gas out) by inserting a needle into the dog’s side. The order in which these procedures may be carried out will depend on just how ill the dog is. A surgical operation will be needed to untwist the stomach, to check for damage to the organs and to try to prevent it from happening again. Some will need immediate surgery and others will need to be stabilised first to improve their chances of survival. Some dogs have to have part of the stomach or the spleen removed if the damage has been severe. The surgery is very high risk especially if the dog is already in shock because of the effects on the circulation and breathing. When successful surgery is carried out, with the stomach and spleen returned to their normal position or repaired if damaged, it is common to perform a procedure to try to stop the condition occurring again, known as a gastropexy. There are different ways of doing this, but the aim is to anchor the stomach to the abdominal wall so that it is unable to twist. It could still bloat, but hopefully the consequences would not be so serious. The survival rate following this condition varies a lot, but sadly, many dogs die each year from gastric torsion. The survival rate is better in younger dogs and if immediate treatment is given. Prevention

• Be aware of the signs to look out for
• Feed larger dogs two or three smaller meals a day
• Do not allow your dog to exercise after eating or after a big drink
• Try to discourage rapid eating by separating competitive dogs at feeding time
• Try a specially shaped feeding bowl designed to slow eating down
• The effects of type of food and feeding from a raised bowl are under constant review and more research will show whether these are significant or not

[caption id="attachment_1596" align="alignright" width="183"] Martha with her young friend Tilly[/caption] I suspect that most vets never forget the first case of gastric torsion that they see. Mine was in a Great Dane, which I worked on all night with the help of two nurses. That one was fortunate and survived. It was a great moment for all of us when it left the surgery mid-morning the next day. The nurses jokingly told me that there was another one on the way in but I didn’t believe them, at least, not until I saw it walk in, arriving just as the first one left. Since then I have treated many dogs with gastric torsion and it is always memorable and always a challenge. My own boxer Martha died of this condition last year despite very prompt attention and all preventative measures being in place. Sadly, her age was against her and our only consolation is that her suffering was very short-lived.   If you are concerned about your dog's health, talk to your vet or use our interactive Dog Symptom Guide to help decide what to do next.

Deciding whether to spay

Spaying or neutering a female dog is not a small operation, so owners should think carefully about all the pros and cons before deciding. The main advantages of spaying are preventing pregnancy, preventing infection of the uterus (pyometra), preventing ovarian or uterine cancer and reducing the likelihood of mammary (breast) cancer, all of which can be life-threatening. It also prevents the inconvenience of having a bitch in season with unwanted attention from male dogs. The main disadvantages are major surgery with associated risks, an anaesthetic with associated risks and the increased likelihood of urinary incontinence in later life. Fortunately, the risks involved in anaesthesia and surgery are very small indeed compared with the risks of the other conditions which are prevented by spaying. Urinary incontinence in later life is a nuisance but not very common, and can usually be controlled by drugs. There is no medical reason to let a bitch have one litter before spay, in fact some of the benefits like protection against mammary tumours, are lost if the operation is delayed. Unless an owner is committed to having a litter, with all the work and expense that can be involved, and the bitch is also suitable in temperament and free of any hereditary problems, then breeding should not be considered. Some people expect that their bitch will get fat after spay, but in fact this is entirely preventable with a healthy diet and proper exercise. My own opinion is that most bitches should be spayed because of the health benefits. My boxer bitch Tilly was recently spayed.

Deciding when to spay

It is not a good idea to spay when a bitch is in season or about to come into season, because the blood vessels supplying the uterus and ovaries are all larger and this will increase the risks of surgery. The other time we try to avoid is the 8 weeks after a season, when a bitch may suffer from a hormonal imbalance called a false pregnancy. If this happens, she may be acting as if she is nursing pups and the operation at this time would cause such sudden changes in hormone levels that it would be unfair to her. Also if she was producing milk, the enlargement of the milk glands would make it more difficult for the spay wound to heal. For all of these reasons, the time chosen to spay is usually either before the first season occurs, or 3-4 months after a season. A physical examination by the vet will determine whether a 5-6 month old bitch puppy is mature enough to spay before her first season.

Before the operation

As well as timing the operation carefully to reduce any risks, it is also important that the bitch is not overweight. Because this increases the difficulty of the operation, it may well be advised that an overweight bitch should lose weight before the operation. Another important way of spotting avoidable risks is by taking a blood test before the anaesthetic. This could be done on the day of the operation or a few days earlier. This is used to check the liver and kidney function (both vital when dealing with anaesthetic drugs) and to rule out any unsuspected illnesses.

Before going to the surgery

Before any anaesthetic, the patient should be starved for a number of hours, according to the instructions of the surgery. This prevents any problems with vomiting which could be dangerous. It is also a good idea to allow the dog enough exercise to empty the bladder and bowels. Apart from that, it is best to stick as closely as possible to the normal routines of the day so that the dog does not feel anxious.

Being admitted for surgery

On arrival at the surgery, you can expect to be seen by a vet or a veterinary nurse who will check that you understand the nature of the operation and will answer any questions you may have. They will ask you to read and to sign a consent form for the procedure and ask you to supply contact phone numbers. This is very important in case anything needs to be discussed with the owner before or during the operation.

Before the anaesthetic

Your bitch will be weighed to help calculate the dosages of drugs and given a physical examination including checking her heart. If a pre-anaesthetic blood test has not already been done, it will be done now and the results checked before proceeding. If any abnormalities are found, these will be discussed with the owner before deciding whether the operation goes ahead or not. One possible outcome is that extra precautions such as intravenous fluids may be given. A pre-med, which is usually a combination of several drugs, will be given by injection. This begins to make the dog feel a bit sleepy and ensures that pain relief will be as effective as possible.

The anaesthetic

There are several ways in which this can be given, but the most common is by an injection into the vein of the front leg. The effects of the most commonly used drugs are very fast, but don’t last for very long, so a tube is placed into the windpipe to allow anaesthetic gas and oxygen to be given. The anaesthetic gas allows the right level of anaesthesia to be maintained safely for as long as necessary. Various pieces of equipment will then be connected up to monitor the anaesthetic. This is a skilled job which would usually be carried out by a qualified veterinary nurse. Apart from the operating table, the instruments and the anaesthetic machine, a lot of specialised equipment will be on “stand by” in case it is needed. The area where the surgical incision is to be made will be prepared by clipping and thorough cleaning to make it as close to sterile as possible. The site is usually in the middle of the tummy, but some vets prefer to use an incision through the side of the tummy.

The operation

While the bitch is being prepared for surgery as mentioned above, the surgeon will be “scrubbing up” and putting on sterile clothing (gown, gloves, hat & mask) just as in all television surgical drama programmes. The surgical instruments will have been sterilised in advance and are opened and laid out at the start of the operation. The operation involves removal of the ovaries and uterus (ovario-hysterectomy). The surgeon carefully opens the abdomen by cutting through the various layers. The first ovary is located and its blood vessels are tied off before it can be cut free at one end, then this is repeated with the second ovary. It is a delicate and fiddly job, needing great care and attention. The main body of the womb or uterus is then tied off as well before the whole thing can be cut free and removed. After checking for any bleeding, the layers of the tummy can then be sewn closed again. A dressing might be applied to the wound. Further drugs may be given now as needed. When the operation is finished, the gas anaesthetic is reduced and the bitch begins to wake up. She will be constantly monitored and the tube removed from her windpipe when she reaches the right level of wakefulness.

Recovery

Like humans, dogs are often a bit woozy as they come round, so she will be placed in a cage with soft warm bedding and kept under observation. Usually they will wake up uneventfully and then sleep it off for the rest of the day.

After-care

The bitch will not be allowed home until she is able to walk and is comfortable. Full instructions should be given by the surgery concerning after-care. The most important things would be to check the appearance of the wound, to prevent the bitch from licking it (with a plastic bucket-collar if necessary) and to limit her exercise by keeping her on the lead. Any concerns of any kind should be raised with the surgery. Any medication supplied should be given according to the instructions. Pain relief can be given by tablets or liquid on the food. Antibiotics are not always needed, but may be supplied if there is a need for them. Usually there will be stitches in the skin which need to be removed after about 10 days, but sometimes these are concealed under the surface and will dissolve by themselves.

After a couple of weeks, if all goes according to plan, the bitch can be allowed to gradually increase her exercise levels. This is the stage that Tilly has now reached and she is thoroughly enjoying a good run again now that she is feeling back to normal.

I knew it was going to be a rough day when I walked in and saw that three of my ten morning appointments were vomiting cats.  Second only to the chronically itchy dog, vomiting cats can be one of the most frustrating things we have to deal with as vets because there are so many possible reasons why it can happen.  Anything from what the cat had for dinner last night to metabolic diseases that may have been brewing for years could be the cause, and distinguishing between them can take a lot of time, money and effort.  And that’s just for the vet – as the owner of a cat that vomits frequently myself, I understand how unpleasant it is to walk downstairs in the middle of the night and step in a pile of cat sick.  Be it on the new white carpeting or the beat up old sofa, it’s not pretty.  It may be a harmless hairball, but it can also be a sign of serious illness in your cat so it’s definitely worth getting it checked out by your vet.  If you are unlucky enough to have a vomiting cat, here are some things you may want to consider. Why do cats vomit so much? Vomiting in cats is extremely common, but that doesn’t mean that it’s normal.  Some cats are simply prone to hairballs, especially long-haired cats or those that groom excessively.  Others are particularly sensitive to the kinds of food they eat and may not be able to tolerate a particular protein such as beef or additive such as wheat gluten.  Intestinal worms can cause vomiting sometimes, and you may even see them wriggling around after they come up!  Poisonings are rare (cats have a much more discerning palate than dogs) but do occur.  Sometimes playful kittens will swallow things such as pieces of string which can be very dangerous indeed.  Metabolic disorders such as kidney disease, hyperthyroidism, diabetes and liver problems can all cause vomiting too as can tumours of the intestinal tract such as lymphoma.  Pancreatitis (inflammation of the pancreas, an organ which secretes digestive enzymes) or inflammatory bowel disease are other common causes which can present themselves in a wide array of confusing ways.  And of course there is one of my favourite terms, “dietary indiscretion”, which can describe the ingestion of anything from rancid rat remnants to last week’s chicken chow mein from the bin.  With such a huge range of possibilities, it’s easy to see how difficult it can be to find the underlying cause. What should I do if my cat vomits? As with any medical condition, the best thing to do is contact your vet.  They may tell you to simply starve your cat for a few hours (cats should never be starved for long periods of time though, and should always be brought to the vet if they go more than 24 hours without eating, as this can lead to other serious problems) and reintroduce a bland diet such as plain boiled chicken, as this may fix many acute cases of vomiting.  As always, fresh water should be available at all times.  Or, if your cat is displaying other symptoms such as lethargy, inappetence or diarrhoea they may recommend you bring him straight down to the clinic.  The vet will do a physical exam and take a detailed history, so try to remember as many details as you can about your cat’s behaviour in the past few days.  They may take a blood test or check the urine to rule out metabolic diseases.  Depending on the symptoms they may also choose to take some x-rays of the abdomen to look for anything that the cat may have swallowed, or perhaps perform an ultrasound scan to check for any tumours or other problems with the internal organs.  Because there are so many possible causes for vomiting, sometimes many different tests will be needed so it can become quite expensive at times.  Yet another case where pet insurance is a real plus! How is vomiting treated? As previously mentioned, if your cat is otherwise well, you may be asked to feed him something bland such as chicken or white fish with no flavourings or fats added.  Although dogs often appreciate rice or pasta mixed with their meat, cats usually do better without the addition of a carbohydrate.  Or, if you’re not up for cooking, there are a number of prescription pet foods available that can help as well.  If hairballs seem to be the problem, there are special pastes and foods that will help them pass through the body instead of being vomited up.  A worming tablet or liquid may be prescribed if there is evidence of worms.  An anti-emetic (medication that stops vomiting) can be given to help calm things for a bit, and sometimes other medications such as antibiotics or steroids are used as well.  If a foreign body is found (in other words, your cat ate something that got stuck), surgery will be performed to remove it.  Surgery can also be used to remove some types of tumours, or to take biopsy samples of different parts of the intestinal tract to help diagnose the problem. Some cases of vomiting will resolve on their own, while others can require weeks of intensive diagnostics and treatments.  If left untreated, excessive vomiting can make the cat very ill and you also risk missing any underlying medical problems so make sure you talk to your veterinary surgeon right away if you are at all concerned.  But please be patient with your vet if they can’t fix the problem right away – and remember that we can be just as frustrated by it as you! If you are worried about your cat vomiting, talk to your vet or use our interactice Cat Symptom Guide to check how urgent the problem may be.

This is one of the most commonly diagnosed endocrine (hormonal) diseases in cats. Many older cats suffer from a variety of symptoms which might just be put down to ageing, or might previously have been attributed to kidney disease, but many of these will actually be in the early stages of hyperthyroidism. Over the last 20-30 years a great deal of research has been done on this disease, and treatment has improved as a result. The thyroid glands lie in the neck, one either side of the windpipe, with occasional extra smaller glands present in some cats. The glands produce thyroid hormones which are involved in regulating metabolism, so they have an effect on most systems of the body. The glands can become enlarged and overactive, producing too much thyroid hormone. This is usually because of a benign (non-cancerous) change in the thyroid gland, but more rarely it can be caused by a tumour called a thyroid carcinoma. The typical cat with hyperthyroidism will be an older cat with some or all of the following symptoms:

• loss of weight
• increased appetite
• increased thirst
• increased heart rate
• heart murmur
• restlessness or hyperactivity
• digestive upset
• an unkempt coat
• swelling of the thyroid glands in the neck

These sorts of symptoms will arouse suspicion that hyperthyroidism is the cause, but it can only be confirmed with a blood test to measure the levels of thyroid hormones. This would usually be combined with other tests to check kidney and liver function and to check for diabetes, as all these can have similar symptoms and of course there might sometimes be more than one problem going on. If hyperthyroidism is diagnosed, treatment usually begins with tablets. The drugs reduce the production of thyroid hormone. The dose and frequency will depend on which drug is used and on how high the thyroid hormone levels were on the blood test. After 2 or 3 weeks a second blood test will show whether the levels are becoming closer to normal, at which time the dosage may be changed. If this treatment suits the patient, it can be continued long term with regular monitoring by blood tests. However, some cats are harder to give tablets to than others, and a few will suffer from side effects. Another treatment option is surgical removal of the thyroid glands, which is usually very successful and offers a more permanent solution. The operation does involve some risks, particularly the risk of damaging other small structures next to the thyroids, like the parathyroid glands. (These are important in regulating the levels of calcium in the blood, and if damaged during surgery supplementation with calcium could be needed.) A cat with heart problems may be a poor risk for surgery, but often tablets can be used first to improve health so surgery is a better option, and additional drugs to control any heart problems may be given. In most cases, cats which have had their thyroids removed will not need to take tablets, but sometimes the problem can still return later, if for example the cat has some smaller gland tissue which was not removed with the main glands. This extra thyroid tissue, known as ectopic thyroid tissue, can be located anywhere in the neck or even within the chest. In some cats only one thyroid is affected at first so only one is removed, then some years later the same condition could occur on the other side. The other main treatment available is with radioactive iodine, which is a specialist treatment only available at some centres in the UK. Radioactive iodine is given to the cat by injection and it becomes concentrated in the thyroid gland, where the radioactivity destroys the damaged tissue. One of the disadvantages of this treatment is that the cat has to be hospitalised for several weeks because of safety issues surrounding the radioactive material used. It is not dangerous to the cat itself but has to be handled safely to protect people working with it. Decisions on which treatment would be best for an individual cat are best made in conjunction with the vet who knows all the details of the case. Where complicating factors like heart disease or kidney disease are present, these need to be treated as well. Once diagnosed, the outlook for a cat with hyperthyroidism is usually very good. Whichever treatment is used, it is likely to prolong life and improve the quality of life. If you are worried that your cat is showing any of the symptoms listed, talk to your vet or use our interactive Cat Symptom Guide to help you decide what to do next.