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Difficult decisions towards the end of life.

A few weeks ago I was asked by a close friend to put her dog to sleep at home. Timmy was a farm dog really, who slept in a stable, but just as much of a family member as any house-dog and much loved. I trusted Timmy’s owners’ judgement completely as to when the “right time” came to part with Timmy, and I was already familiar with his medical history. I was glad to be able to carry out the euthanasia in the way in which his owners wanted. Timmy was in familiar surroundings, greeted me like an old friend and showed no distress at all. With his owners beside him, I clipped some hair from his front leg and injected a strong solution of anaesthetic into his vein. He went so peacefully that there were only a few tears, mixed with feelings of relief. Timmy was buried on the farm. Amber curled upOne of the questions people commonly ask when they first know that you are a vet is “How can you bear to put animals to sleep?” The answer is that it is still one of the most difficult parts of veterinary practice, even after many years. You become used to the technicalities of carrying out the procedure in various different circumstances, because you have to. You never become immune to the feelings of owners at this time, and never should. If you are satisfied that what you are doing is in the animals best interests and you carry it out with as little distress as possible, then you feel that you have done a necessary service. Not everyone is fortunate enough to be able to plan exactly when, where and how their pet’s life might end, but sometimes considering some of the options in advance can be a good idea. We would all prefer it if our dog or cat would live a happy life and then die at home in bed at an old age. Unfortunately this does not always happen, and many owners are faced with the difficult decision whether to have their pet put to sleep (euthanased) in order to prevent suffering. Deciding when the right time has come can be difficult. No-one wants to cause unnecessary suffering by leaving it too late, but equally it would be regretted later if a hasty decision was made. Vets can advise what the likely outcome of any illness is going to be and what treatments, if any, could help. If everything has been done that should be done, then it may come down to the small things in life: does your dog still enjoy a walk, recognise members of the family, enjoy their food; does your cat show an interest in surroundings and people? Home visits for euthanasia are often requested, and if this is your wish it would be worth talking to your veterinary practice in advance. Sometimes, however, it is easier and safer to do this at the surgery because of the availability of experienced helpers, and the availability of other drugs, if for example sedation was needed in a scared animal. The other big factor could be the time of day. In a night-time emergency, it may not be possible for the vet and nurse on duty to travel far from the surgery because of other patients. Labrador cropEuthanasia in most cases is quick and painless. An injection is usually given into the vein because this will work more quickly than if given by other routes. Sometimes a sedative may be needed first, if an animal is nervous or aggressive. The decision whether to be present or not is an entirely personal one for the owner. Some people will feel they want to be present and others will prefer to leave after signing the consent form. If you are not present, your pet will be handled by gentle, caring, experienced staff on your behalf. If present, it may be better for both the owner and the animal if the holding is done by the veterinary nurse, who can raise the vein for the injection at the same time. This leaves the owner free to be where the dog or cat can see and hear them. Most practices will use the services of a pet crematorium who will offer various different types of cremation or burial, depending on individual wishes. For example, you may wish to have your pets ashes returned so that you can keep them or scatter them in a favourite place. If you have a suitable place you may choose to bury your pet at home. There is no right or wrong way to grieve. The bonds that exist between people and their pets are strong and the loss of a pet can cause a similar sense of loss to any other bereavement. Many people like to remember their pet with photos, by planting a tree or placing a plaque in a special place. Some practices keep a book of remembrance or a wall of photos of past and present pets. Vets and nurses also like to remember their patients. Some practices have staff who have been specially trained in supporting clients who are going through bereavement and if you would like this help, do ask at your surgery. If not directly available within the surgery, counselling services are available including support from the national charity the Blue Cross. It can be especially important to help children talk about their loss as it may be their first experience of death. Other pets may also grieve. Some people think it helps to allow other pets to see the body of the pet who has died, and I have certainly no reason to think this is harmful or distressing to them. Euthanasia and death are subjects that all of us would prefer not to have to consider, but sometimes things can be made a little easier for everyone by thinking ahead, so that if the worst happens, we are as prepared as possible, and left with happy memories.
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Epilepsy in dogs and cats

This week my colleagues and I treated a lovely beagle called Emily, who was rushed to the surgery in a state called “status epilepticus”. This means that she was not just having an epileptic seizure, but was having continuous repeated seizures with no real recovery in between. This is an emergency situation, and fortunately Emily’s owners knew exactly what to do: they phoned the surgery first to let us know, so that we could be ready for her arrival, and then they brought her straight in. This is not something that can be treated in the home, so although it was a bit frightening for them to have to move her, they knew that it was in her best interests. Emily has suffered from epilepsy for some time and takes tablets to prevent seizures. Since she was stabilised on her tablets she has had very few, very short seizures only, but this one was different. On arrival Emily was immediately prepared for some drugs to be given into the vein, which is the fastest route. She was first given a sedative drug, then fluids and then an anaesthetic drug. Her temperature was very high so she was also being cooled with wet towels, whilst trying to keep noise and light levels to a minimum to avoid any unnecessary stimulation to make the seizure worse. Within minutes of arrival, Emily’s distressing condition was coming under control. Emily received intensive treatment for about an hour and was admitted overnight for continuing fluids and observation. Fortunately, she was back to normal by the morning and went home looking like her old self, much to the relief of her owners. She will now have some routine blood tests to check whether her doses of medication need any adjustment. [caption id="attachment_854" align="alignleft" width="220" caption="Seizures can occur in all types of dog but are more common in some breeds."]Seizures can occur in all types of dog but are more common in some breeds.[/caption] Seizures are not uncommon in dogs, and can be very frightening, especially when first seen. Seizures are caused by abnormal electrical activity within the brain causing increased and uncoordinated muscular movements. Some possible causes are: trauma to the head causing bleeding or scar tissue, low blood sugar, poisoning or brain tumours. However in most cases the cause is unknown and if all the other possible causes have been ruled out then a diagnosis of Idiopathic Epilepsy is made (meaning epilepsy of unknown cause). In dogs it tends to run in families, with some breeds being more likely to have it than others. If epilepsy is diagnosed, it is advisable not to breed from the dog. It often starts in young adulthood, about 1-5 years old. Seizures vary from a “petit mal”, lasting just a few moments, to a generalised seizure. These may start with unusual behaviour from the dog as they anticipate that something strange is about to happen. The teeth may chatter before the muscles of the legs and body are affected. Typically in a generalised seizure the dog will go off its legs and shake or twitch with the legs making jerky paddling movements. Urine and faeces may be passed and the dog will probably be unconscious for a time. Most will then gradually recover within a few minutes but will be left feeling tired afterwards. Having a seizure uses up a lot of energy. If a seizure occurs it is important to try to diagnose the cause in order to give the best treatment. Blood tests may be useful, sometimes combined with head x-rays or scans. If there is no sign of any head damage or tumours or haemorrhages, and no abnormalities in the blood test results, the treatment may well be anti-convulsant tablets or medicine. These are not always needed after a single seizure, but if seizures are frequent then drugs will be started at a low dose and built up slowly to minimise any side-effects. The treatment will need to be given at the same time each day, and the levels in the blood checked every few months. Records of any seizures should be kept so that any change in frequency, or pattern of clusters of seizures can be seen. Most epileptic dogs can then lead a very normal life, with just a few extra routine visits to the surgery. Treatment is usually needed for life, although a few cases will go into remission and may be gradually weaned off treatment. Anti-convulsant drugs should never be stopped suddenly and only under the supervision of the vet. If complications like status epilepticus do occur, the answer may lie in using a combination of drugs instead of just one. Cats can also suffer from epilepsy but it is not as common as in dogs. They are treated in much the same way as dogs. They can be more difficult to medicate than dogs and their independent lifestyle may make it difficult to give them their medication when they need it, but I have known several treated very successfully. If your dog or cat has a seizure for the first time, it will be very frightening for the owner, but panic will make the situation worse, so try to do the following:

1. Reduce noise and light levels e.g. switch off TV or music, dim the room lights, ask unnecessary people to leave the room. Remain as calm and quiet as you can.

2. Make a mental note of the time, this is important because the vet may need to know how long the seizure has been going on, and minutes can seem very long.

3. Do not move the animal (unless told to do so by your vet), but move away any nearby objects which might injure them.

4. Do not open the mouth, put anything in the mouth or try to pull the tongue forward. An animal having a seizure may bite without meaning to.

5. If your dog is recovering to nearly normal within 10-15 minutes, they may not require any immediate treatment but of course you should ring your vet surgery for advice if you need to. They might suggest leaving it until your dog is fully recovered to examine them.

6. If your dog is still fitting after 15 minutes, or if he or she has repeated seizures without proper recovery in between, then they need urgent attention and you should ring your surgery at once.

7. If asked to bring a fitting dog to the surgery, spread out a large thick towel, blanket or bedspread beside the dog, slide them on to it and lift by the corners like a stretcher. Several people will be needed for a larger dog.

In summary, epilepsy is a very frightening condition, particularly for the owner. Treatment is aimed at managing the condition and keeping the number of seizures to a minimum, rather than cure. Treatment is usually lifelong and requires some commitment from the owner. Most dogs and cats with epilepsy will lead a very happy life in spite of their condition. Emily continues to do well. If you are concerned about fits or any other problems in your dog or cat, please contact your vet or use our Interactive Symptom Guide to help you decide what to do next.
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So you want to have a litter of pups?

By Cat Henstridge The Pet Street Vet. Breeding a dog is a big undertaking and many people underestimate the time and effort that will go into the process. Not to mention the risks to the bitch (there is no truth to the rumour that having a litter is 'good' for her) and the fact you have to find loving, responsible homes for the puppies once they are born. However, some people are determined to go ahead, so how do you ensure you breed the best possible quality puppies and keep your bitch safe and healthy? If you have a pedigree dog then the first place to start your research is the Kennel Club website. In particular you will be able to find out what sort of pre-breeding testing is required. For example, Labradors need to have their hips x-rayed (hip scoring) and eyes tested and some breeds need blood tests to ensure they are free from genetic disorders. These tests are all carried out by vets and are designed to phase out inherited problems. They are not cheap and if your dog fails then you need to give up your ambitions at that point and have them neutered. Also, pedigree dogs who are bred should be Kennel Club registered themselves. This means they will have a full pedigree history (vital to ensure close matings are avoided) and their parents will have been tested as well. If your pet is not Kennel Club registered, again, you may need to think again about breeding. If you have a cross breed and are planning on mating them, even if they are lovely dogs, then my honest reaction would be to ask you to think very carefully. When you breed dogs of unknown parentage, you never know what you are going to get and the pups may be nothing like bitch or dog. When breeding the aim should be to produce the best quality puppies possible, who have the best chance of getting good home and even though pedigrees do have problems, most people want one, not a cross breed.. The Kennel Club has come under some criticism recently but it is working hard to improve the health of all breeds and it is still the only dog breeding regulator. I think the current trend for 'designer dogs' is damaging as it has led to people thinking these are healthier creatures but while in some they may dilute pedigree dog problems, equally for others they can make them worse. Once you have had the necessary tests performed you then need to find a suitable partner! Again, the Kennel Club is the place to start with this. They will list all the registered owners of your chosen breed in your area. You could also go back to the breeder of your pet to ask their advice, they are usually more than willing to help. Especially if this is your first time breeding, having the help and support of a more experienced owner is invaluable. They will be able to talk you through what to expect and any pitfalls you may encounter. Talking to your vet is important as well, they will be able to give you an honest assessment of your dogs fitness to breed and advise on the health issues that may arise. During most of the pregnancy you can treat your bitch as normal but towards the end you will need to start changing her diet. As the pups grow inside her there will be less room for her stomach, just at the stage when her body needs all the energy it can get. You should start feeding her a good quality puppy food in the last couple of weeks of pregnancy, your vet will be able to recommend a good brand.. These are very calorie dense and also enriched with calcium. She should also be wormed regularly, again, speak to your vet for advice. Leading up to the birth you should create a welping area in your home where she can have the pups and bring them up. This should contain a large, comfy bed, a feeding area and a space for the pups to toilet once they can walk. You need to stock up on cleaning equipment, newspaper and towels, welping and looking after puppies is a messy business! Don't forget they will be with you until they are eight weeks old. You should also stock up on milk replacer, the best ones are puppy specific and available from your vet, and puppy food. You need to educate yourself about the welping process and know what to expect and when to call for help if things go wrong. Chat to your vet about their out-of-hours services, so you know who to call for advice in the middle of the night. One final point, and I hate to single out a breed this is very true, think very carefully before breeding a Staffordshire Bull Terrier. Although lovely, they are the most over-bred dog and vastly over-represented in rescue kennels, to the point where many are euthansed every week because homes can't be found. I am sure every person who breeds a Staffie, as with any dog, thinks they will 'never' end up in a kennels but the sad fact is that many do. I also know of several litters recently which have been born where the breeders struggled to find homes, the market really is saturated. I am not at all anti-breeding (after all without it I wouldn't see any cute wriggly puppies in my consulting room!) but the sad fact of the matter is there are thousands of unwanted dogs in rescue centres all over the country and irresponsible breeding only adds to their number. The only good reason to breed from your dog is if they are a good example of their type and have an excellent temperament. If you are doing it because you want a cute litter of puppies, think it would be good for your children to witness the 'miracle of birth' (a depressingly common reason) or for the money, then you really need to think again. You need to be prepared to stay up in the nights during and following the birth, have time to hand rear the puppies if you need to and, most importantly, have the funds for any complications (a caesarian will cost many hundreds of pounds), not to mention the cost of feeding, worming and caring for the pups. Breeding dogs is a messy, time consuming and expensive business. However, it is also fantastically rewarding and can be a lot of fun. If you are thinking about doing it, chat to as many people as you can who have experience, make sure you know what to expect, when to call for help, ensure you are doing it for the right reasons and if you do decide to go ahead, good luck!
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