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Vestibular Syndrome – strokes in dogs

My twelve year-old collie, Juno had an attack of Vestibular Syndrome this week. These are what we used to call Strokes, but advances in imaging and investigation have led us to realise that they’re not quite the same, even though they appear just as suddenly and with some of the same symptoms. Dogs can and occasionally do have Strokes, but they tend to be less serious than in humans. In humans, Strokes - or Cerebrovascular Accidents - refer to a bleed in the brain, so that an area loses its blood supply and is starved of oxygen. Damage quickly becomes irreversible and we all know how variable and tough the aftermath can be, for the sufferer and carers alike. Dogs can, rarely, go through the same events, but are more likely to have an episode where, instead of bursting, the blood vessel spasms and shuts down for a short period. Whilst there can still be damage, recovery tends to be quicker and more complete. [caption id="attachment_1444" align="alignright" width="225" caption="Juno"]Juno[/caption] Vestibular events are slightly different again, but often something of a mystery. The vestibular system – the inner ear - is about balance and so problems lead to classic signs of dizziness. There is staggering (ataxia), flicking of the eyes (nystagmus) from side to side, up and down or even rotationally, and a head tilt to one side. Facial nerve tics or paralysis are sometimes present. Motion sickness can be obvious, or may present as reduced appetite, which is hardly helped by the confusion and anxiety that most patients experience. Juno had a sudden onset of these symptoms about four days ago, accompanied by a bit of leaking urine, and has been gradually improving for the last 48 hours. As of today, she’s not too bad when walking in a straight line, but getting out of her basket is still a bit hit and miss and sharp turns tend to become handbrake slides. She’s still eating her food, but for the first time ever seems full up before the bowl is empty. Life isn’t all bad, though – her basket has been moved in front of the fire and with the TLC she’s getting from the whole family, she’s more likely to die of happiness than from dizziness. And hopefully, over the next few days to weeks, she’ll gradually return to normal. Vestibular disease can have a number of causes: infections, from the brain itself or from the middle ear, cancer, poisonings, parasitism, immune disorders, occasionally as a sign of Hypothyroidism (underactive thyroid), and commonly as an idiopathic event. Idiopathic basically means that we don’t know the cause, but know that it isn’t due to anything else. Idiopathic Vestibular Syndrome is something that comes on unexpectedly, for unknown reason, and then usually goes away on its own, albeit often with some residual signs like a minor head tilt. Currently, it appears that Juno’s condition is the idiopathic version, and not due to something nasty lurking underneath, or else possibly thyroid-related, which is easily treated with thyroid supplements. Juno’s not otherwise ill, has no history of ear disease (although it can sometimes be silent), and doesn’t have any progressing symptoms. I ran some bloods the day after it all started, which were entirely normal. However, if she should relapse, I’ll be looking at more investigation, which may be a lot more complicated. Testing for brain disease can be very difficult: to make a definitive diagnosis, we generally need to look at sampling the fluid around the brain – the Cerebrospinal Fluid (CSF) – and/or performing an MRI. Both require a general anaesthetic, are potentially risky procedures and can be very expensive. Right now, for Juno they’re not a priority as things are looking OK, but remain as options. In the meantime, I’m supporting Juno as much as possible, whilst waiting for the results of thyroid tests. Even though we don’t usually know the cause of Vestibular Syndrome, there are a number of useful drugs which are commonly used:
  • Most vets will use anti-sickness drugs, to combat the motion sickness.
  • A fair few use steroids, a common treatment for neurological conditions, particularly when a decision has been made not to investigate further.
  • Some vets will use Vivitonin, which is often used to enhance blood flow to the brain and which we’re using more and more for heart disease. Whilst there’s no solid evidence that it works in vestibular problems, there can’t be any harm in making sure that the blood supply is topped up.
  • Sometimes we’ll prescribe a human drug called betahistine, which is used for vertigo, as it’s reported to speed up recovery.
  • In terms of general boosting of brain activity, there are supplements like Aktivait and Selgian, which are usually used to combat signs of senility in older patients, and essential fatty acids.
Equally, though, nursing and TLC is all-important for these patients:
  • Reassurance
  • Palatable and digestible food
  • Help with movement, but only enough to make up for what’s lacking - if all she needs is a hand under the bum to get up, then she gets it, but that’s all she gets.
  • Promoting the idea of ‘horizontal’ by providing strong visual cues in the house. Juno’s basket is in front of the wide, flat sofa and thin, tall objects have been removed. In severe cases, horizontal masking tape on the walls and doors may help
  • Frequent trips to the garden for balance and urination
  • Keeping pathways through the house clear of clutter, to reduce bump hazards
  • Gentle and short walks in straight lines
  • A nappy, to reduce the anxiety of leaks: purpose-made wraps are available for longer term conditions, but for now we’re using large disposables with a hole ripped for her tail.
It’s important to note that because, by definition, we don’t know what causes Idiopathic Vestibular Syndrome, treatments and care are largely based on common sense and logic. It’s true that if left alone, many patients recover by themselves, although this can take several weeks, but anything which reduces the recovery time, and makes it more bearable, must be a good thing. So far, Juno is responding well and I’m hopeful that we’ll be out of the woods before too long, but in the meantime I’m giving her every chance that I can.
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Living in a Multi-Cat Household – Why Can’t We All Just Get Along?

Many people share their homes with more than one cat, and if all the cats get along they can provide everybody with companionship and entertainment.  Sadly, however, it isn’t always that way.  Cats are relatively solitary creatures by nature and serious problems can arise when more than one cat is asked to share a small living space such as a house and garden.  Acquiring the cats at the same time can help, even more so if they are siblings.  It also helps to introduce them while they’re young, and it’s often easier to get a male and a female kitty as opposed to two of the same sex.  Just like people, newly-introduced cats need some time to get to know each other so don’t expect everybody to get along from day one.  If you and your feline family are going through a bit of a rough patch, be it the occasional stare down or full on cat fights, read on... Recognise the problem and try to identify the cause
  • Speak to your vet for advice, and to rule out any medical conditions that may be causing any excessive grumpiness.
  • Think like a cat.  Consider their how the world looks to someone their size, their likes and dislikes, and how they spend their days.  Understanding a bit more about their lives will help you recognise potential problems and come up with insightful solutions.
  • Observe their behaviour toward each other and toward you, and learn to recognise signs of feline stress (tense body posture, twitching tail, dilated pupils, hyper-vigilance or staring in an intimidating manner, etc.).
  • If you notice signs of stress after an interaction with you, try to alter your own actions accordingly.  For example, some cats love grooming, but most only appreciate it for a short period of time and on their own terms.  Also, very few cats actually enjoy being picked up and cuddled tightly although they may tolerate it well.  Trying to comfort your cat in this manner can actually add to their stress levels as they like to feel more in control of their interactions.
  • Never punish your cats for fighting with each other.  The fight undoubtedly started because of some sort of stress in the first place, and your punishment will only make the situation worse.  Stay calm and try to distract them rather than yelling or throwing a shoe at them.  Have a basket of toys at hand to distract them and break up any potential fights before they occur.
Create a less stressful and more cat-friendly environment
  • Cats like options, especially safe ones, so provide several of each resource (litter trays, feeding stations, beds etc.) around the house for them to choose from.  This will help reduce competition and therefore reduce stress.
  • Ensure there is plenty of vertical space (such as cat trees, accessible tall furniture or cat-friendly shelves) for everybody to use.  They often feel safer when they can observe things from above and it will allow them a place to escape to if they feel stressed out.
  • Home renovations and frequent visitors can be very stressful for cats so provide hiding spaces at ground level too, and even in the garden if necessary.
  • Scratching posts can be placed in particularly vulnerable areas like doorways and the top/bottom of the stairs.
  • Provide plenty of toys to play with inside the house and entertain them yourself when you’re at home, but otherwise try to keep their environment as a whole as constant as possible.
  • Create a playground of cardboard boxes, paper bags (with handles removed) or other safe objects and rotate them frequently to keep things interesting.
  • Feed cats in separate rooms, or at least on separate sides of the same room, as feeding time is a major source of competition and disagreement.
  • And last but certainly not least, try a calming pheromone product such as Feliway.  This comes in a spray or a plug-in diffuser and can really help to reduce overall stress levels in the house.  Some cats don’t seem to respond to them and it certainly won’t stop every fight, but many owners find that it makes a big difference.
Of course sometimes, in rare cases and despite your best efforts, things just aren’t going to work out.  If they simply cannot stand the sight of each other and frequently act on it to the detriment of everybody’s health and happiness, then you may have to consider finding a new home for one of them.  Some cats will solve the problem themselves by leaving home and moving in with the kind little old lady next door, but other times you may need to arrange alternate accommodation.  Don’t be too hard on yourself if this happens, as long as you’ve made every effort to fix the problem that is.  Some cats, just like some people, will just never get along and it’s better for everybody if they go their separate ways.  But if they used to get along well and have just had a falling out, be patient and work with them to try to resolve their issues.  In the vast majority of cases a reasonable harmony can be achieved and you can all once again enjoy each other’s company.
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Neutering dogs – Bitch spay operation: a step by step guide

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. Tilly GrinSome 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.

tilly's wound with text

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.
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