Stiffness in older dogs may be due to osteoarthritis which could be treated.

This week I met a lovely 12 year old Labrador called Amber, who has been suffering for some time now with osteoarthritis. She is on a combination of two treatments, which keep her quality of life good although her condition is getting worse.

This is a very common complaint in dogs, especially middle-aged and elderly ones, but the good news is that the treatments available are improving all the time.

One of the most common findings in a routine examination of an older dog is stiffness of one or more joints. On questioning the owner, we often find that there is occasional lameness or difficulty getting into the car, or stiffness for the first few minutes of exercise before the dog “gets going”. One of the most likely causes of such symptoms, although not the only one, is osteoarthritis or degenerative joint disease. Most people just call it arthritis, although there are other kinds of arthritis as well.

Medium to large breeds are most commonly affected by arthritis, but it can happen in any size of dog. Usually the onset is quite slow and may not be noticed at first by owners, or just put down to the inevitable process of ageing. Unfortunately this can mean that owners are not aware that their pet is in pain, or underestimate how much pain they have. Owners are often surprised when it is suggested that their dog has arthritis that would benefit from treatment, and equally surprised by the improvement they see when treatment starts. A very common reaction is that he/she is “like a new dog”. This is mainly because their joint pain has been removed or reduced.

Arthritis is a degenerative condition of the joints, where the cartilage overlying the bone becomes rough instead of smooth and movement of the joint becomes difficult and painful. The fibrous capsule surrounding the joint becomes thickened and restricts the amount of movement the joint can make. New pieces of bone called osteophytes can grow on the damaged surface, further restricting movement. The joints may make clicking or crunching noises when the dog walks, and the joints may also be swollen.

Diagnosis of arthritis is by a mixture of examination of the dog, history taking (asking the owner about the dog’s exercise tolerance etc) and further examinations such as x-rays. It may not always be necessary to take x-rays, but it can be very helpful to rule out other conditions which might also be treatable, but would require a completely different type of treatment. As well as helping to make the right diagnosis, the changes seen can help decide on the best treatment. While the dog is anaesthetised, the joints can be manipulated much more thoroughly than when the dog is awake, so a more thorough examination can be made.

Regular short walks are advised for affected dogs.

Once the diagnosis of arthritis has been made, treatment can begin. Before even thinking about drugs, the vet will want to consider whether changes need to be made to the dog’s weight and exercise regime. Being overweight puts increased strain on all the leg joints, so slimming down if necessary should be considered as part of the treatment. Rest can also be very important. Regular, frequent, short walks will be tolerated much more easily than an occasional long run.

Often the first line of treatment involves “chondroprotective agents” like glucosamine and chondroitin. These can be given in tablet form or can be included in the diet. They help to repair the cartilage and maintain the lubricating fluid of the joint, the synovial fluid. Two points worth remembering about these are, firstly, that the full effects may not be seen until six weeks after starting, and secondly, the formulations on sale for human use may not be as effective in dogs as those formulated for dogs.

Another very common group of drugs used to treat arthritis are called non-steroidal anti-inflammatories, or NSAIDs for short. These reduce pain and inflammation and can be given as tablets, liquids or injections. These drugs are generally very safe, but if used for a long time it is sensible to monitor the dog’s liver function as a healthy liver is needed to metabolise these drugs. A routine blood test is carried out every 6 months or as recommended by your own vet. Like all drugs there can be side effects, including the possibility of diarrhoea and vomiting in some dogs. If your dog develops any new symptoms while taking any drugs, it is advisable to seek advice from your veterinary surgery.

In some more serious cases other drugs may need to be used, such as steroids or strong painkillers.

Surgical treatments can also be used in the treatment of arthritis. Operations which have been common in human medicine for many years, like hip replacements, are now more widely available to dogs too. In severe cases of hip arthritis, this can allow enormous improvements in quality of life. In younger dogs where arthritis may be the result of a developmental problem in a joint, surgery may be recommended. Not all veterinary practices carry out these sorts of procedures so your dog might need to be referred to a local specialist in orthopaedics.

Amber is a lucky dog in that her symptoms are well controlled even though her exercise is restricted. She has an examination and a weight check every 3 months and a blood test every 6 months. She spent a lot of our consultation lying on her back having her tummy tickled, and I had no doubts that she is still leading an enjoyable life.

If you are concerned about arthritis, stiffness or lameness in your dog, or any other health issues, contact your vet or use our Interactive Dog Symptom Guide to help you decide what to do next.

When Harvey the spaniel came in for his routine 6 month check up he looked the picture of health – tail wagging, eyes bright and full of enthusiasm – so neither his owner nor myself were expecting anything other than a straightforward check over. And for the first five minutes of the examination, I found nothing untoward whatsoever – Harvey was clearly a fit and healthy young dog with a strong heart, clear eyes, wet nose, healthy lungs and a good coat. However the final stage of my examination did show that he wasn’t quite 100% perfect and there was a problem that was likely to require treatment, as I explained to his owner, Mrs Mann;

‘Hmm,’ I started as I straightened up from the final stage of my examination at the back end of Harvey’s wriggling body, ‘I’m afraid to say Mrs Mann that there’s a bit of a problem here – Harvey’s only got one descended testicle.’

‘Oh dear,’ exclaimed Mrs Mann, obviously taken aback by the suggestion that all was not right with her beloved dog, ‘only one testicle – is that a serious problem for him, I mean I’m not planning on breeding from him so it shouldn’t really matter should it?’

‘Well, it’s not a major problem but if the testicle doesn’t come down in the next few months it will need to be surgically removed as there is a risk of cancer developing if it is left inside his body long term,’ I explained. ‘What I’d advise is that we check him again in 2 months time and see what’s happened. If it’s still not down then I would strongly recommend that we do operate to remove it at that stage.’

Two months later and Harvey was back, this time with less of his puppyish enthusiasm and a little more grown up dog suspicion of vets in his demeanour. And unfortunately my examination revealed that there had been no change and he still only had one testicle descended. I explained to Mrs Mann that there was a tiny chance that he did only have one testicle, but it was far more likely that there was a second testicle stuck in his abdomen – where it would be at high risk of developing cancerous growth in later life if left in place. The reason for this risk is that testicles usually sit outside the abdomen where the temperature is lower, which suits sperm production. If they are left in the abdomen the higher temperature leads to a high risk of the testicular cells turning malignant and cancer developing.

After a long discussion about the risks involved and the surgical procedure that he would need, Mrs Mann agreed to book Harvey in for the operation the following week. The operation is far more complex than a straightforward neutering procedure as it involves a game of hide and seek for the missing testicle which can be anywhere in the abdomen from the kidney right down to the groin. Finding testicles in these situations can be a real challenge and I have known operations like this one take hours as the elusive organ evades the surgeon.

Thankfully in Harvey’s case the missing testicle was relatively easy to find and the whole procedure was over in a little under half an hour. Despite this relatively speedy operation, it was still around three times as long as a routine castration, and Harvey’s recovery will be slower and more uncomfortable that normal.

I suspect that when I see Harvey for his post op check his character will have become even more suspicious where vets are concerned – but for me saving him from a risk of cancer later in life is well worth any grudge he may bear me personally!

If you are concerned about your dogs health, please contact your vet or use our interactive Dog Symptom Checker to help you decide what to do next. For more information about insurance which could ensure the cost of operations like this one are covered, please see our pet insurance pages.

Wally relaxing at home

Some cases stick in your mind because they are unusual or because the patient is a bit of a character, or both. One such case was Wally the collie, who needed a major operation a few years ago.

Wally was well known at the surgery, partly because he had epilepsy, so he made regular visits for check-ups and blood tests, and his condition was well controlled. Despite a poor start in life before his present owner acquired him as a rescue dog from the Blue Cross, he had become a lovely dog with such a good temperament that he became a P.A.T. dog (Pets as Therapy), visiting residential homes for the elderly where I am sure he brought a lot of pleasure into the lives of the residents.

Wally was 9 years old, well past the age when dogs normally chew things up, but he had a long history of such misdemeanours. Since his owner had him he had chewed up and swallowed many items. He had previously chewed the electric cable to the pump in an outside pond, even though the cable was encased in hosepipe and insulation.

On the day in question Wally had taken a liking to another electric cable. This one was indoors, neatly coiled and secured with a Velcro band. Fortunately it was not plugged in to the mains supply. Wally’s owner knew that he had chewed it up but hoped he might be able to pass the bits naturally, as had always happened before. By the next day, however, it became obvious that Wally had problems as he started to vomit repeatedly.

When Wally was examined there was nothing remarkable to find, but the history meant that an x-ray would be necessary, so he was anaesthetised. The changes seen on an x-ray can be very subtle or very obvious, but they are never more obvious than when a dog has swallowed an object which does not allow x-rays to pass through it (a radio-opaque foreign body). The picture immediately confirmed our strong suspicion that Wally had overdone it this time. In the stomach were large amounts of cable, unable to move on into the intestines. A few smaller pieces which had reached the intestines also showed up clearly. The only way to remove the cable was by opening up Wally’s abdomen (a laparotomy) and then deciding which parts of the stomach and intestines needed to be opened to remove all the cable.

X-ray by kind permission of Corner House Veterinary Surgery.

Wally was given intravenous fluids by a drip into his vein because he had been vomiting repeatedly and he had to face a long operation. He was also given antibiotics because of the risk of infection involved in this type of surgery and, of course, pain-relief.

The smaller parts of cable had luckily reached the large intestine where there was a good chance that they would pass out naturally, but to make absolutely sure, they were carefully eased towards the anus by very gentle squeezing of the large intestine from inside Wally’s abdomen. A second vet assisted by working at the less pleasant end to receive each piece, making sure that there was no tearing of the delicate lining of the bowel.

Then Wally’s stomach was opened (a gastrotomy) after applying bowel clamps to seal it off. A large tangle of cable was removed, complete with Velcro band! After a thorough search to make sure nothing remained inside that shouldn’t be there, the stomach wall was sewn up in two separate layers, and then the muscle layer and finally the skin. Then Wally was allowed to wake up.

Wally made a good recovery and after spending a night at the surgery, he returned home. He had to have a light diet and reduced exercise for a while until all the internal and external stitches had healed. Fortunately he never needed another similar operation, although he did chew through the cable of the Christmas tree lights later the same year!

Wally is sadly no longer with us, but will not be forgotten.

If you are worried that your dog may have swallowed something inedible, or concerned about any other problems, please contact your vet or use our interactive Dog Symptom Guide to help you decide what to do next. For more information about insurance which could ensure the cost of operations like this one are covered, please see our pet insurance pages.

Skitzo under anaesthetic, showing the tumor on the edge of his bottom eyelid

Vets are very used to dogs, cats and small furries developing growths on various parts of their anatomy. We very often take a small sample of the growth by means of a needle (known as a fine needle aspirate or FNA) before deciding what action to take. In most cases the growth is removed surgically.

Skitzo was a 9 year old cat with something of an attitude to being handled by vets (and sometimes his owner). A fast growing lump had come up beneath his right eye and was very close to the edge of the eyelid. A fine needle aspirate was impossible in this case without him being anaesthetised so we decided to remove the lump and send it off to the lab for the pathologists to tell us what tissue type we were dealing with.

The most important thing they can tell us is whether the tumour is benign or malignant. Sometimes growths can seem to be benign but still cause problems by recurring in the same place they were removed. The worst type of tumour is one which is malignant and which has the potential to spread (metastasise) to the lungs or other organs via the blood stream.

Skitzo’s tumour was a surgical challenge because it was so near to the margin of the eyelid. If too much tissue is removed, the lower lid will turn outwards (called ectropian) leaving a gaping pocket and encouraging infection, inflammation and an overspilling of tears. On the other hand, cutting too close to the growth risks tumour cells being left behind and the growth returning very quickly.

Skitzo after the operation, still under anaesthetic

Dissolving stitches were used because Skitzo was never going to let us take them out when he was awake. We fitted him up with an Elizabethan collar so that he could not scratch or rub the stitches out. The plastic collars look unwieldy and owners are often tempted to take them off as soon as they get home but most animals adapt to them very well and it’s only a relatively short time before the stitches are removed and life returns to normal. Nylon stitches are usually removed in 8 to 10 days after the operation but this can be extended if the skin is especially thick, under tension or if the animal is receiving steroid treatment.

Skitzo’s tissue sample came back as a benign growth and there is every prospect that the surgery has been a complete success. Fortunately Skitzo’s pet insurance company paid the bill for the surgery and the laboratory tests which were needed.

If you are concerned about lumps or any other problems with your cat, please contact your vet or use our interactive Cat Symptom Guide to help you decide what to do next.

Gizmo and his vet, Reg.

Gizmo was a lovable cat who had been known to the practice for many years. She was one of those vocal Orientals who sounded like a baby crying. In fact she had reached the tremendous age of 21 years with no major health problems until his teeth started to loosen and she had difficulty eating.

We are always extremely cautious with giving anaesthetics to aged cats so we took some blood tests for organ function which came back completely normal. She came through his dental with flying colours.

A couple of months later she came back with a very painful leg, swollen around the left knee (stifle). When we X-rayed the leg our worst fears were confirmed: Gizmo had bone cancer. We took further X-rays and there was no sign of spread to any other part of her body.

Bone cancer in dogs is highly malignant and has often already spread by the time the diagnosis is made. Although chemotherapy and amputation are options, survival time can be very poor.

Cats are a slightly different proposition and their form of bone cancer (osteosarcoma) tends to stay more confined and is slower to spread.

My instinct with Gizmo being 21 was to recommend her being put to sleep but her owner was determined that we should do everything possible for her providing that he did not suffer. Prior to the surgery we were having great trouble keeping Gizmo free of pain and at home she was on strong oral pain relief every couple of hours. I agonised over the decision to operate but was eventually persuaded to go ahead by his owner’s dedication to him and the fact that Gizmo behaved like a cat half her age.

Gizmo after amputation of a hind leg.

The surgery went well and Gizmo recovered very quickly and was much more comfortable with the leg removed and surprisingly mobile. She lived on for another seven months when unfortunately the cancer returned in his pelvis and reluctantly at this point we had to admit defeat.

Looking back, my colleagues thought I had lost my reason undertaking this surgery on such an old cat but I think the extra quality of life which Gizmo went on to have justified going ahead. Anaesthetics and pain relief are so much better these days than they were twenty years ago. She was certainly one of those cats who seemed to inspire the old folklore about a cat having nine lives and she will never be forgotten by all of us who knew her.

If you are concerned about pain, swelling, lumps or any other problems in your cat, please contact your vet or use our interactive Cat Symptom Guide to help you decide what to do next. For more information about insurance which could ensure the cost of operations like this one are covered, please see our pet insurance pages.

Rusty with his Vet

Young Rusty the Cavalier King Charles Spaniel had an embarrassing problem. Everything was going well until he started to cock his leg at about five months of age. Instead of watering the local lampposts, Rusty had a problem which meant he urinated on the underside of his body and under his armpits. He was now over a year old with no sign of things getting better.

His owners were becoming very distraught about the problem. It meant Rusty had to be bathed at least once a day and his skin was starting to get sore where it was constantly wet. Something drastic had to be done. We all scratched our heads in the practice. Rusty had no illness problems and all his nerve reflexes were fine but he just seemed to slightly arch his back when he had a pee and everything went skywards.

I consulted a soft tissue specialist in Bristol and he said that he had only seen one other case which took two operations to correct. He talked me through the procedure and said that he thought it was something we could do without the need for referral to a specialist centre.

The result of Rusty's operation.

The plan was to close up the hole where Rusty normally peed and make a new hole a little further back but pointing downwards. Technically it’s known as a prepucial urinary diversion operation.

It’s always a little daunting to be doing an unfamiliar operation but the surgery went very well. Rusty seemed very comfortable at his three day post op check and had started to use the new hole almost immediately after going home. His owner was delighted. He even got used to wearing his Elizabethan collar whilst his stitches healed.

On the first trip up the road, Rusty cocked his leg against a car wheel which made a metallic ping when he hit the hub cap. He was so surprised, it made him jump! Now Rusty is marking his territory just like nature intended and we are all delighted.

I often find myself sympathising with my patients, and feeling for their distress and pain when they are suffering from illnesses or injuries – and never more so than when their problem involves their eyes. There’s something about injuries and diseases of eyes that really affects me more than almost any other type of problem and I can really empathise with how my patient must be feeling. Having an ulcer or other injury to an eye must be horribly painful, not to mention the psychological impact of dealing with the loss of some or all of your sense of sight.

When Sylvester the cat came into the consulting room last week and clambered miserably out of his wicker basket, my heart sank and I felt an immediate sense of shock and distress when I saw his problem. His left eye was barely recognisable, with a large grey ulcer dominating the cornea and angry red blood vessels invading the usually clear surface of the eye from the sides. This was not Sylvester’s first visit to the surgery for this problem, but it was the first time that I’d seen him, and I immediately knew that we needed to do something drastic if we were going to save his eye – and bring his obvious suffering to an end. Looking at his records it was clear that this ulcer had been grumbling on for a couple of weeks by this stage, and despite ongoing treatment with medicated drops it was getting worse rather than better.

At this stage we had a couple of options to consider. One was to refer Sylvester to an eye specialist, but this was quickly ruled out by his owner on the ground of cost and lack of pet insurance cover. The second option would be to continue with medical therapy, taking a swab to find out exactly which bacteria were causing the ongoing damage and preventing the ulcer from healing and potentially changing the eye drops once these results were known. The downside of this course of action was that it would do little to alleviate Sylvester’s discomfort in the short term, but after talking to his owner and explaining that the only other option would be surgery to remove the eye, we agreed that we would try this first.

So I took a swab from Sylvester’s eye and sent it away to the laboratory to see what they could tell us about the infection. While we waited for the results we did what we could to manage Sylvester’s discomfort with painkillers and anti-inflammatories, and then as soon as the results were in we started him on an aggressive course of antibiotics that were targeted specifically at the bacteria the swab had isolated. At this stage I was still optimistic that we could save Sylvester’s eye, but unfortunately things didn’t work out as planned and despite our new treatment regime, the ulcer stubbornly refused to respond and after a week of treatment it became clear to me that we were left with only one option – to remove Sylvester’s eye.

Breaking this news to his owner was not easy, but she did appreciate that it wasn’t fair to let him continue to suffer as he was doing given the now very slim chance that we would be able to save his eye. After a couple of long – and emotional – consultations, we agreed to go ahead and last Friday Sylvester came into the surgery for his operation.

Sylvester the cat under anaesthetic after the operation to remove his eye

Removing an eye is an operation I really don’t enjoy, as I can’t help but really feel for the poor animal that is losing such a crucial part of their anatomy, and the operation itself is also technically tricky and pretty gruesome. Sylvester’s operation went as well as I could expect, but it was not one that I finished with a sense of satisfaction – I felt good that we had brought Sylvester’s suffering to an end, but I also felt as though we’d failed him by having to resort to such a procedure.

If you have any concerns about your cat’s eye please contact your vet or use the interactive cat symptom guide to help you decide what to do next.

All dogs have two anal glands (or anal sacs) situated just inside the rectum, one on each side. The cells which line the glands produce a foul-smelling substance which dogs use as a territory- marking device. When the dog passes faeces, the anal glands get squeezed and the scent is deposited as well. The normal anal gland is about the size of a pea in a small dog or a grape in a larger dog, depending how full it is. The anal gland secretion travels down a short tube or duct to enter the rectum. It can be liquid or more like a paste in texture.

The arrows show the position of the anal glands

When everything is working properly, the anal glands empty naturally and cause no trouble. Unfortunately it is quite common for the glands to become over-full or for the duct to become blocked, and then they cause discomfort. When they do not empty naturally, they are described as impacted and the condition is called anal gland saculitis. The dog will then try to lick at the area or will “scoot” their bottom along the ground in an attempt to relieve the irritation. This may well make things worse and allow infection to enter, leading to an abscess. If things get this bad, the main sign will be pain, or a blood-stained discharge if it bursts.

Dogs who suffer from this problem regularly will tend to show similar symptoms each time. As well as scooting or licking under their tail, dogs which cannot easily reach the area may chew themselves on their back or their feet instead. Sometimes the first sign of trouble is a distinctive and very unpleasant fishy smell. Owners will usually recognise the signs in their own dog and have the glands emptied promptly by their groomer or vet.

Luckily the anal glands can be emptied fairly easily once the knack has been acquired, and as long as there is no infection present, this will be all that’s necessary. If an owner feels confident to do this job themselves, they could ask the vet to show them how to do it. It is not the nicest job in the world, because of the smell and because of the uncanny ability of the contents to squirt in unexpected directions! On the other hand, it is quite rewarding to bring almost instant relief to the dog in most cases.

If an abscess forms, it may have to be lanced and flushed out, and antibiotics will be needed. Pain-killers may also be advised as an abscess is very painful.

When anal glands cause repeated problems it is sometimes advisable to have them surgically removed under anaesthetic by your vet. Like any other operation, the advantages of this type of surgery need to be weighed up against the possible risks. It would not be recommended in cases where symptoms are mild and easily sorted out by manual emptying.

Prevention may be possible by changing the diet or increasing the amount of fibre to make the dog’s stool firmer, for example by adding bran to the diet. Anything which causes a soft or runny stool can cause anal gland problems.

Further advice can be obtained from your own veterinary surgery.

Jenny Sheriff BVM&S MRCVS

Joe the TV vet performs difficult pelvis surgery on a cat.

Cats lead dangerous lives, dodging traffic, fighting over territory and being chased by dogs, so it is not surprising that we vets spend a reasonable proportion of our working lives patching up the results of their adventures. Whether it’s repairing serious damage caused by road traffic accidents, or patching up less severe injuries from bite wounds, cats that have been in the wars certainly keep us vets busy everyday of the week.

Most of the time these injuries are not too severe – cat bites, and bruises and strains from over-energetic leaping and climbing usually heal well and require nothing much more than antibiotics and painkillers to help the cat recover. Sometimes, however, cats are less fortunate and that is when things get much more serious and the outcomes can be less positive. Road traffic accidents are by far and away the main cause of these more serious injuries, and repairing the damage that a tonne of car can do to 5 kilos of fragile cat can be a very involved and difficult process.

Thankfully there are now many highly specialised vets who can offer amazingly hi-tech operations and treatments that can quite literally put broken cats back together. A friend of mine from university, Toby Gemmill, is now an eminent orthopaedic surgeon in Birmingham and I truly believe that provided the pet’s head and chest are in one piece, there’s not much he couldn’t put back together successfully. Using all manner of techniques, including external fixators (metal frames that hold shattered legs back together from the outside rather than the inside), bone grafts and much more, vets like Toby can work wonders on even the most severely injured animals.

There is a problem though, and that’s the age-old issue of money. The state-of-the-art treatments that Toby and other orthopaedic vets carry out are understandably expensive with costs often reaching many thousands of pounds. This puts them out of the reach of many pet owners, unless of course they have pet insurance, leaving them faced with some very difficult decisions – should they try to beg, borrow or steal the money required for a potentially life-saving operation? Or should they simply call it a day and opt to have their pet put to sleep? These are terrible decisions to have to make, and it is one of the reasons why vets like myself, who are general practitioners rather than specialists, end up tackling complex operations that are well outside our comfort zone.

Take Portia the cat underneath the drapes in this picture for example. She was hit by a car and suffered severe injuries to her pelvis and back legs, and required a major orthopaedic operation if she was going to have any chance of surviving. However, her owner had no pet insurance and could not afford to consider visiting a specialist – but she was desperate to try and save her beloved cat, so I offered to try my best and have a go myself.

The operation Portia required was something I have attempted before, but it really is not something I’m that comfortable with, so it was a very long and stressful operation. The end result was pretty good – definitely not as good as if Toby had done the procedure, but a whole lot better than nothing and I think there’s every chance that she will pull through as a result. In fact it’s me that I’m more worried about – I need a stiff drink and a lie down to recover from the stress!

Joe Inglis BVSc MRCVS is the vet for the One Show, This Morning and BBC Breakfast. He runs his own line of natural pet food called Pet’s Kitchen