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What is health? Putting the Principles of Holistic Care into Veterinary Practice

Are you and your pet healthy? dog walkIt’s an odd question, which you’ll probably answer depending on how you feel, especially if you’re suffering with, say, a cold or a broken leg. And if your pet is currently having treatment, it’s easy to say that he or she isn’t healthy, but would that automatically be the case? Is a contented cat with well-controlled hyperthyroidism any worse off than a depressed horse? Is a puppy with a rash any healthier than a very old dog without any obvious issues? Defining health is like trying to catch fog in a net. To start, there are lots of different viewpoints of what it actually means, and it soon becomes apparent that perfect health is an impossible ideal, faced as we are by so many challenges every second of our lives. Unless you’re holding your breath, you’ll have breathed in a lot of germs just since you started reading this, one of which may make you ill next Tuesday. How depressing – unless, of course, you were hoping to avoid that work meeting next Tuesday, in which case the world is suddenly a brighter place. Context matters with these things: a gut full of bacteria is normal; a lung full of bacteria isn’t. Worms aren’t something you’d want to have, but it’s not that long since diet pills for ladies contained tapeworm eggs, in order to maintain that ‘healthy’ figure. We spend more time, effort and money on polyfilla to mask signs of ageing than we do on exercise and decent diet, because we think that a wrinkle-free face on an unfit body is healthier-looking than someone who looks their age only from the neck up. So what might it mean to be healthy? Is there one theory which brings it all together? Can it be defined without a blood test? More to the point, how does your vet define it, and can he or she explain it to you? I’d like to discuss three theories of health which could really alter your perception of what it means, for you and your pet. They might seem complicated to look at, but in reality they’re very simple, like all the best ideas:
  • Biomedical Health
  • Activities of Living
  • Self-Care Deficit
Biomedical refers to the presence of disease: imagine if I had a Star Trek type scanner, which I could wave at you and it would tell me if you were biomedically healthy in terms of infection or organ function. But I wouldn’t have a clue about how happy you were, how many friends you had and whether you played sport last Saturday. Aren’t these important as part of a healthy life? So three very clever people called Roper, Logan and Tierney came up with the Activities of Living. These are twelve basic activities (since expanded by other theorists), ranging from eating, drinking and breathing, through social interactions and sexual expression, to dying, as normal parts of a healthy life. It’s not enough to be free of disease: in order to be truly healthy, one has to be able to take part in all of the activities (even dying, but hopefully only at the end of a long and fruitful life). JunoDorothea Orem produced the wonderful Self-Care Deficit Theory, which simply means that anything you can’t do to look after yourself is called a self-care deficit: so if you can’t put your own socks on, that would be a deficit. Orem considered that where a deficit was identified, enough help should be given to overcome it, but no more. So, when my collie Juno was recently struggling with getting out of her basket after a vestibular attack, she got just enough support to make it happen, but that was all. She had to make some effort herself, and that meant that she overcame the problem more quickly. These are brilliant theories, but what really made them great was combining them and incorporating them into medical care. You often hear the term holistic applied to alternative therapies and lifestyles, but its true definition has its roots in this kind of care: veterinary medicine shouldn’t just be about curing disease, but about enabling patients to live as full a life as possible. The veterinary profession has identified with this ideology since it first evolved, but the recent introduction of these theories into the education of young vet nurses and vets has cemented their importance. So, there’s now a very good chance that your local vet practice is already putting the principles of holistic care into practice:
  1. We do, of course, look at your pet’s health from a biomedical point of view
  2. Then we may go further and look at how they get on with the Activities of Living.
  3. If there are any that they can’t manage (apart, usually, from sexual expression), we may look at their inability to do it – or self-care deficit – and work out how we can help to put it right.
In this way, health is about more than just a negative lab test, and the common presentation of “he’s just not right” can be looked at more fully. Ginger catIf Tiger, the car-chasing cat, is hospitalised with a broken pelvis, his care won’t just be about pain relief: it’s possible to put food into a cat even against his will, but the real trick is to make him happy enough to want to eat it. So the team will look at what activities would make him a whole, happy cat again, and what his self-care deficits for each activity are. And they’ll give him the help to bridge those gaps: so if he can’t self-groom all over, they’ll do the bits he can’t reach; if he can’t wee, they’ll take care of that. When the gaps between what he can do and what he needs to be able to do have dwindled to nothing, he’ll be healthy again. A lot of that work can be done at home, so when Tiger is discharged, there should be a good chat about what can be done to carry on the process. Labrador crop If Tess, the old Labrador with arthritis, has lost her spark even with painkillers, the practice may have ways to get that spark back – finding new ways to play and to interact, stimulating (as though a Lab would ever need it) interest in food and people. We should look at her expectations out of life – and she won’t want to run for ten miles in the rain each day – and make sure that she’s not being limited by her routine. Curious bunnyAnd for concepts designed for a rabbit, look no further. Rabbit welfare in terms of general lifestyle and care is one of the most pressing problems we face in veterinary medicine: the lives of some (but by no means all) of these creatures are simply miserable. So if you’ve got a rabbit stuck in a small hutch all day, dig out a copy of the Activities of Living and see how you score as an owner. We’re pretty good at keeping our pets free of disease. Where we might need some work is in making sure they’re truly healthy. Dogs can’t tell the difference between a cheap collar and an expensive one, but they do know all about quality time and the importance of a good play session. So it might be that looking at our pets’ health helps us to look at our own, and who knows where that could lead? If you are worried about any aspect of your pet's health, talk to your vet or use our Interactive Symptom Guide to help assess the urgency of the problem.
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Chronic Diarrhoea in Cats – Could it be Tritrichomonas foetus?

Marla is an older cat who has recently had the displeasure of becoming a frequent visitor to our practice. She was adopted not long ago from an animal shelter and now lives with a lovely woman who thankfully has a lot of patience! Marla first came to see us because she had developed diarrhoea and a red, irritated rear end. She had a type of diarrhoea called ‘colitis’ (which simply means inflammation of the large intestine or colon), that caused her to strain frequently to produce small amounts of sometimes bloody stool. She was treated with antibiotics and her diet was changed to something that was bland and easy to digest, and although sometimes her symptoms seemed to improve a little they continued. A standard stool sample was run but this was negative for all worms and harmful bacteria. After nearly a month of problems and after trying every routine treatment out there, we decided to try one last and wouldn’t you know, it came back positive! Marla had developed an infection of Tritrichomonas foetus (which I’ll call T. foetus from now on), a previously rare but becoming increasingly common infection in cats. Recent studies have shown that the infection is even more common than we think, so if you think your cat may be affected it might be worth looking into! What is T. foetus?
  • T. foetus is a single-celled protozoal parasite (bigger than a bacteria but smaller than a mite, with a very clever membrane and a few tails that help it move around). The infection was originally found in cattle, but it’s cats that have been more of a concern recently.
  • Most affected cats are less than 1 year old, but as in Marla’s case, it can affect cats of any age.
  • Purebred kittens from breeding colonies or cats in shelters or multi-cat households are more likely to get the disease.
  • Up to 30% of cats in the UK and US may test positive for the organism, but not all those that carry the disease will show symptoms.
What are the symptoms? Symptoms include (some of which you may only see if your cat uses a litter tray):
  • Fluffy BWSemi-formed to liquid faeces (diarrhoea)
  • Blood or mucus in the faeces
  • Straining or painful defecation (may lead to howling in the litter tray)
  • Increased frequency of defecation (more frequent trips out the cat flap)
  • Inflamed and painful anus (may lead to or be caused by excessive licking)
Despite the above symptoms, however, most affected cats are otherwise well in themselves and do not usually lose weight. How is it treated?
  • If your vet suspects that your cat may have T. foetus, they will recommend you bring in a fresh stool sample from your cat. They will then look at the sample under the microscope to see if they can find any of the tiny organisms or send it to a special veterinary lab where they can run a test called PCR to detect the organism.
  • Most cases will resolve on their own but it’s a slow process, sometimes taking many months, and many owners (and cats!) may want to treat the disease to get rid of it faster.
  • None of the drugs currently licensed in the UK for use in cats can kill T. foetus.  However, there is an antibiotic called ronidazole that is used to treat the disease in the United States and this drug can be used in the UK if the cat’s owner provides their informed, written consent. Not all cats will respond to the drug and a few may develop side effects (neurological problems that go away once the drug is stopped), although the vast majority of cats won’t have any problems.
If your cat has had T. foetus and is now back to normal, it is possible that they may still be carrying the disease in their body and could therefore pass it on to another cat.  The disease is unlikely to infect people, but those who have a weakened immune system should not handle any cat with diarrhoea.  Basic hygiene measures should be taken as a precaution and to stop it from spreading to other cats in the household (or shelter, cattery, breeding colony, etc.).  Always wash your hands thoroughly after handling cat faeces and after cleaning litter trays and wash all cat bites and scratches immediately with soap and water (always seek medical attention immediately if the wound develops signs of infection such as redness or swelling). Until recently, most vets probably hadn’t heard of this organism and were therefore not likely to look for it. But as we become more aware of the disease, we will hopefully be able to diagnose and treat it faster so cats like Marla can be back on their feet in no time. So if you think your cat may have T. foetus, please speak up! If you are worried about diarrhoea or any other problems with your pet, speak to your vet or use our Interactive Symptom Guide to help decide what to do next.
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Pet Emergencies Happen When You Least Expect Them

A couple of weeks ago I was enjoying a Sunday afternoon walk along the seafront with my husband and our dog, when we came across a couple crouched over a small dog on the pavement. At first I thought they were drying the dog after a dip in the sea, but when we got close I could see that the dog was having a fit. I asked if I could help at all, and they were very relieved to find an off-duty vet on the scene. Luckily all that was needed in this case was some advice and some reassurance, and the fit soon stopped. The owners were able to take him home to rest, and I advised them to phone their own vet to discuss what to do next. Blood tests to rule out certain problems would be helpful, but could wait until Monday. If the dog continues to have fits it might need to take medication to control them. If the fit had not stopped within 10-15 minutes, then an urgent call to the nearest vets would have been needed. I have already written about fits in dogs in a previous blog, so I won’t repeat it all here. More detailed advice about dog seizures and fits can be found in the blog Epilepsy in Dogs and Cats. Emergencies can crop up at any time, wherever you are. One tip that could help to reduce the distress in an emergency is to make sure that your usual veterinary surgery’s telephone number is in your mobile phone. If you take your pet on holiday with you, it would also be worth locating the nearest vets when you arrive and take a note of their number. Even if a problem occurs out of hours it should be possible to get help quickly by dialling the usual surgery number. All veterinary practices in the UK have a duty to provide 24 hour cover for their patients, but the way in which they provide this may vary. In some practices, the regular staff will provide out of hours cover in the usual place. The advantage of this is having access to all the pet’s history, as well as familiar people and surroundings for the pet and owner. Other practices may share a rota with neighbouring practices. This might mean taking your pet to a different practice from your usual one, but each practice being on call less frequently can be a very efficient way of providing the necessary service. Another way is to use the services of a dedicated out of hours veterinary centre which is staffed by vets and nurses working shifts to cover all hours. The single most important thing to remember when you have an emergency is to telephone first. Even if you know that your pet definitely needs to be seen, it will save time if you turn up at the right place and the staff are expecting you and are prepared for your arrival. In some cases, you may find that advice is all that is needed. BrodieThe most common injuries which arise when out and about are things like cut pads, bite wounds, stick injuries and of course road accidents. Many illnesses can also have a fairly sudden onset, sometimes needing an out-of-hours visit to the vets. Carrying a small first aid kit with you can help with emergencies such as cuts, bites or torn nails. If bleeding is part of the problem, then a temporary bandage applied just until you can get to the surgery can save a lot of mess but could also stop your dog from losing so much blood. A hankie or a sock can be very useful substitutes for a bandage, or anything clean with which you can apply pressure for a few minutes. However, there is a risk of making matters worse if a bandage is too tight or applied for too long. The circulation may be reduced so much that tissue starts to die, so just use a bandage as a first aid measure until bleeding stops or you can get to your vet’s surgery. The other thing that can reduce the stress when the unexpected happens is having your pet insured. This can give peace of mind by removing concerns about the cost of emergency treatment, allowing the owner to concentrate on getting their pet better as quickly as possible. Insurance policies vary in what is covered, so do compare the cover provided and not just the cost of premiums when taking out a policy. Working as a vet seeing emergencies outside of normal working hours can be very interesting and exciting because you never know what sort of case the next one will be. As pet owners, we would all prefer not to have to make use of the emergency service but we are glad it’s there if we need it. If you think you have an emergency please contact your vet or check your pet's symptoms with our Interactive Pet Symptom Guide if you are unsure how urgent the problem may be.
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Narcolepsy in dogs – Mabel the sleeping collie

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

Sleep is something most of us take for granted and appreciate – there’s nothing quite like gently slipping into a deep sleep after a long day at work and letting 8 hours of peace take away all the stresses and strains of the waking day. And the same is true of our pets, with cats and dogs in particular seeming to really enjoy the pleasures of a good long nap.

However, for a very small number of animals (and people) sleep can be far from a relaxing pleasure and it can even pose a threat to their life. The condition of narcolepsy is a rare genetic disease that can affect people and animals and causes sudden bouts of deep sleep which come on out of the blue in the middle of the day. Whilst the sleep in itself is not dangerous and sufferers usually come round within 15-20 seconds, the act of losing consciousness can present dangers if the pet or person is in a potentially dangerous situation – such as swimming for example.

This kind of danger was one of the issues facing the dog I was talking about on Daybreak on ITV recently. Mabel, a rough collie cross was one of the unlucky few dogs to be born with this condition and now, aged 4, she battles against sudden attacks of deep sleep every day of her life.

‘She’s a rescue dog,’ explained Mabel’s owner Trevor as we waited to go on the show, ‘and we only knew that she had narcolepsy when she had her first attack, a couple of days after we brought her home. We were terrified as it looked as though she’d died!’

On the show, Adrian Chiles asked Trevor what happened when Mabel had an episode.

‘She wags her tail furiously and runs around yelping before she hits the ground like she's been struck by a bullet,’ explained Trevor. ‘It usually happens when she’s excited, so when the postman comes, or when she meets other dogs.’

Christine Bleakly then turned to me and asked me what caused this condition.

‘It’s thought to be caused by an imbalance of chemicals in the brain,’ I said, ‘but no-one is really sure of the exact details either in dogs or people.’

I then went on to explain how this lack of understanding meant that treating narcolepsy was not an easy task.

‘The main way we help dogs suffering from this disease is through behavioural advice such as teaching owners how to reduce stress and avoid over-exciting situations which trigger episodes,’ I explained. ‘There are some drugs available such as anti-depressants that can help but in general most cases are managed by owners rather than treated medically.’

During the interview a video of Mabel suffering from an attack of narcolepsy was shown and it really was amazing to watch – one minute she was racing around chasing her tail barking wildly, and then she just collapsed in a heap. After a few seconds she was back on her feet as if nothing had happened – but it was easy to see how distressing these episodes must be for the owners, particularly to begin with before they become used to them. Thankfully there’s no evidence that narcolepsy causes significant distress or discomfort to dogs, and as far as I could see Mabel was otherwise completely healthy and happy.

It was a fascinating case and although it’s very unlikely that Mabel will ever be completely cured, I’m sure she can look forward to a good quality of life ahead thanks to the love and care of her owner Trevor.

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