Browsing tag: pain killers

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.

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.

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.

One recent morning, in the middle of the snowy weather, it was a real struggle to get to work. The main roads were open and gritted, but the side roads were hazardous with patches of snow and ice. After a difficult journey, I was surprised to find that the nurse was already checking in a patient. A motorist had found a seriously injured fox which had been hit by a car.

He hadn’t seen the accident happen, so he did not know how long the fox had been lying by the road, and we can only hope that no-one was injured in the accident. All the cars in front of him had pulled out round the fox, but he had stopped. On finding the fox was still alive, he picked it up and put it in his boot and brought it to the surgery.

Great care should be used if handling an injured wild animal because, understandably, they are liable to panic and to bite if frightened and in pain, and will not understand that you are trying to help them. In most cases it is better to telephone for advice first from either your local veterinary surgery or the RSPCA. If the animal is to be moved, it is much safer with the right protective clothing and equipment. However, this fox offered no resistance.

We examined the fox and found it was a young adult male which was in reasonable condition before the accident. Unfortunately it was barely conscious and had at least one hip fracture. A more detailed examination and x-rays would be needed to find out what other injuries it had, but as our fox was not yet well enough he was given pain relief by injection and placed in a warm, quiet, kennel in a darkened room.

Unfortunately this particular story does not have a happy ending because our fox died later in the morning. However, I am glad that he was not left to suffer and to freeze slowly to death by the side of the road. If he had survived the initial trauma of the accident, decisions about further treatment would have been made based on what was in his best interests, including whether he could make a successful return to the wild after a period of recovery.

Different veterinary practices may have different policies on the treatment of wildlife. Some may offer treatment in the practice, while others may refer animals to nearby treatment centres such as the RSPCA or other charities, depending on the facilities in the area. Often there are local people known to practices who may take in particular types of wildlife for rehabilitation such as injured birds, hedgehogs, badgers etc. In coastal areas there are specialist charities which deal with injured or stranded dolphins, seals and whales, and with oiled birds.

Some wild animals or birds which appear to be in difficulties may be best left where they are rather than being moved. Fledgling birds in particular are often still under the watchful eye of a parent even if they appear to be abandoned, so if you find one and are not sure what to do, try to get some telephone advice before moving or handling it.

If you are worried that your dog or cat may have been hit by a car, contact your vet or use our Interactive Pet Symptom Guide for advice on what to do next.

One of the most common problems small animal vets see in dogs, almost daily, is anal gland trouble. Although cats have anal glands too, they rarely cause trouble.

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