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Sensationalist reporting of TB in cats is not helpful: does the media want a cat cull?

Let's start with the facts about the cats with TB, as reported in the Vet Record: perhaps surprisingly, these have not been published in full in any of the mass media outlets in the past two days: ++++++++++ BETWEEN December 2012 and March 2013, a veterinary practice in Newbury (west Berkshire) diagnosed nine cases of Mycobacterium bovis infection in domestic cats. In seven of those cases the diagnosis was confirmed by bacteriological culture. The nine affected cats belonged to different households and six of them resided within a 250 metre radius. The animals presented with mycobacterial disease of variable severity including anorexia, non-healing or discharging infected wounds, evidence of pneumonia and different degrees of lymphadenopathy. The latest information is that six of the cats have been euthanased or have died. The three surviving animals are undergoing treatment and are reported to be responding. At the time of writing, no new cases had been detected in local cats since March 2013. ++++++++++ The newspapers have missed this aspect of the story, and focussed entirely on the fact that the disease, for the first time, seems to have been passed on to two humans who had been in contact with one of the cats. The humans have responded well to treatment. Despite journalists' suggestions that the cats could have picked up TB by "fighting badgers" (has anyone ever heard of this happening?), veterinary scientists believe that most cats are infected with TB when bitten by infected small rodents while hunting. These rodents in turn would have been infected by sniffing around infected badger setts. When a cat is diagnosed with TB, an owner has always been advised that treatment of the cat may be possible, but the remote chance of a human picking up TB from the cat is something that has to be taken into account when considering doing this. For this reason, many cats diagnosed with TB are euthanased. There is nothing new about any of this: vets have (rarely) been diagnosing TB in cats for many years. The last sentence of the Vet Record report is worth repeating: here it is in capitals in case you missed it: NO NEW CASES HAVE BEEN DETECTED IN LOCAL CATS SINCE MARCH 2013. From the media coverage, you would swear that this was an immediate and present threat to human life. The facts are far less exciting. Following the episode a year ago, due to the unusually high concentration of TB in cats in the area, all humans in contact with the affected cats were offered to be screened for TB. Of 39 people who were offered this, 24 accepted screening, and two people (who had contact with the same cat) were subsequently diagnosed with active TB disease caused by the same TB organism that had affected the cats. Only one person had been showing any symptoms of TB, and both are responding to treatment.  Two other people had some broad evidence of exposure to TB, but there was no evidence to suggest that it was the same TB that had affected the cats. To summarise: two people, over a year ago, were diagnosed with TB that was linked to a cat. Two other people were diagnosed with previous exposure to TB that may or may not have been linked to cats. Meanwhile, 8751 cases of human TB were reported in the UK in 2012, picked up from humans. The message from today's media seems to be: "DANGER: YOU COULD GET TB FROM CATS". The message that they should have given out is far less dramatic: "The absence of reports of confirmed cat to human transmission of TB previously led public health practitioners to consider the risk of transmission as negligible. However, an assessment of this incident raised the risk of transmission of TB from cats to humans from negligible to very low." Or to put it more simply: Up till now, there was thought to be a minimal risk of picking up TB from cats. Based on an incident over a year ago in England, there's now thought to be a very low risk. But that wouldn't make good headlines, would it?
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Ask a vet online – ‘Can you suggest a home remedy for mites in dogs please?’

Question from Sharon Barett: Hi can you suggest a home remedy for mites in dogs please? I used the spot on treatment off the vet for 3 months but it did not make any difference she still scratches it a King Charles Spaniel 5 months old thank you .x Answer from Shanika Winters MRCVS, online vet Hi Sharon and thank you for your question regarding your itchy Cavalier King Charles Spaniel.  In order to answer your question I will discuss the possible causes of the itch, how we work out a diagnosis and then some treatment options. [caption id="attachment_3863" align="aligncenter" width="300"]Dog Scratching Flea Getting the itch![/caption] Why is my pet scratching/itchy? If your pet is scratching itself then something will be causing an irritation, most commonly this is due to the presence of external parasites such as fleas (Ctenocephalides canis or felis) or mites (e.g. cheyletiella, sarcoptes scabeii). Itchiness can also be due to the presence of an allergy to things you pets eats (food allergy), contacts (contact allergy) or inhales (atopic allergy). How to diagnose the itch It is really important to work with your vet to find out the cause of your pet’s itch. The first thing your vet will do is ask for a detailed history of your pets condition including how long it has been going on, any changes to your pets routine, any changes to your household, what treatments have already been tried and if they have had any effect. The next step is for your vet to perform a full physical examination of your pet paying extra attention to the skin and coat, underlying diseases can have symptoms that affect the skin which include Hypothyroidism( under active thyroid gland), Cushing’s disease ( over production of steroid) and diseases of the immune system. Finally your vet may suggest performing some diagnostic test on your pet such as skin scrapes, hair plucks, sticky tape strips, skin biopsies, wet paper test, swabs and blood tests. Skin scrapes: these involve use of a sterile scalpel blade to scrape the surface of your pet’s skin to collect surface cells and debris, which is then examined under a microscope usually for parasites and or fungi.  For certain parasites such as Demodex mite (not usually itchy) a deep scrape has to be taken. Sticky tape strips: a strong sticky tape is applied to your pet’s skin and then removed, again this is examined under a microscope looking at the surface cells and debris similar to above but it is a less invasive procedure. Hair plucks: as the name suggests a clump of hair is plucked from your pet and examined as for skin scrapes and sticky tape strips, sometimes this can help to show up Demodex mites (which live down the hair shaft in the hair follicle) or ring worm (actually a fungal skin disease). Hair plucks can be cultured to try and grow bacteria and fungi; this is usually done at a laboratory. Skin biopsies: this is usually performed under general anaesthesia or sedation as a full thickness sample of the skin is cut out, put into preservative and sent to a laboratory for analysis. Often several samples are taken from different sites.  This gives a lot of information about how the skin is reacting and what types of cells and changes are present. Wet paper test: your vet will comb through your pet’s coat and collect the debris and put it onto a sheet of wet white paper, if small red dots appear this is suggestive of fleas, as the flea dirt contains digested blood and this turns red when wet. Swabs: there are sterile cotton bud tipped sticks which are wiped in any discharges present on the skin (often in the ears), the material on the swab can then be stained and examined under a microscope or sent off for culture and sensitivity to grow bacteria and see which antibiotics are affective against them. Blood test: these can be routine to check overall body function or very specific looking into what your pet is allergic to.  The test chosen will be a decision made with you and your vet depending on your pet’s condition. What treatment will help my pet? As external parasites are the most common cause of an itchy pet this is often the first treatment approach whether parasites have been detected or not.  It is important to use a product recommended by your vet that is safe for your pet and covers the suspected range of parasites.  It is also important to use the treatment correctly and repeat as advised. It can take several weeks to clear up some parasites.  Your vet may also advise you to treat other pets in your household and the home environment itself. Especially in the case of fleas as the majority of the flea population is living in the environment ant not only on your pet. Parasite treatments come in tablet, injection, spot on and spray preparations. Your vet will help to direct you to the method which is most appropriate for you and your pet. Food allergies are usually treated by feeding a low allergy or special diet (in which protein molecules are broken down so as not to cause reaction).  In some cases your vet may recommend a home cooked diet.  The diet needs to be stuck to strictly and can take 3 months or more to begin to allow improvement in your pet’s skin signs. Contact allergies usually are present on the paws and tummy, which are areas in contact with the ground.  Once the substance your pet is reacting to has been worked out it is then needs to be avoided or stop being used. Atopic allergies are usually diagnosed by a combination of examination, skin and blood tests.  There are several treatment options which include medical therapy using drugs or special vaccines.  The drugs often used to treat atopy include antihistamine (reduce allergic reactions), steroid (anti-inflammatory and suppress the immune system from reacting), immunosuppressant (which suppress the immune system form reacting) and antibiotics may be used to treat any infection present on top of the allergy. Special vaccines can be made up in some cases to try and help desensitise your pet to the individual things that he or she reacts to; these are administered in gradually increasing doses over many months by injection. I hope that I have managed to answer your question by explaining how complex an itchy dog’s condition can be.  I really recommend that you return to your vet and come up with a joint plan of attack to help your pet.  I hope that your dog is feeling much more comfortable very soon.  Shanika Winters MRCVS (Online Vet) If you are worried about your pet, please make an appointment with your vet or use our interactive symptom guide.
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Is Paul O’Grady mad to spend so much money on his terminally ill dog?

Paul O'Grady, the comedian-turned-dog-advocate, hit the news this week when he talked about spending over £8000 in vets' fees to treat his nine year old Cairn Terrier Olga for cancer of the kidney. The Daily Mail reports that Paul has ignored advice to have her put down, and instead he's paying for intensive chemotherapy and surgery to keep her alive. The story has ignited a debate about veterinary fees and pet insurance: Judith Woods, a feature writer for the Daily Telegraph, has added her own tale of spending £3600 when her Manchester Terrier, Daisy, developed a rare form of kidney disease. She had her pet insured, so her feature extols the benefits of pet insurance for these unexpected occasions. Paul and Judith are clear in their opinions, with no doubt that they have made the right decision for their own pets. It's the online comments on the stories that are interesting, with members of the public sounding off with their own thoughts on expensive treatments for pets, and the pros and cons of pet insurance. The Daily Mail readers' comments to Paul's story are mostly short and positive: "It's lovely that he's done this for his beloved dog", "Good on you, Paul, you are a true dog lover" and "If I was as rich as him, I'd do the same". Telegraph readers have responded in a predictably more loquacious way to Judith's feature. First, of course, there are many "dog lovers" who are supportive of giving pets all reasonable treatment that can be afforded, accepting that high quality veterinary care can be costly, and agreeing that pet insurance can be a sensible way of budgeting for unexpected health crises. When completing a survey of attitudes to dogs on a recent trip to a slum in Delhi, I found that around 60% of the local population "liked dogs", with 40% disliking them: I now find myself wondering if a similar proportion of attitudes exists in the UK population. For the 60% who care for their pet dogs, it's hard to consider withholding treatment. There are plenty of comments from the opposite side of the spectrum - perhaps the 40% who aren't so fond of dogs. Some of these "anti-treatment" comments are worth discussing in more detail: "All pet insurance does is persuade owners to consent to prolonged and possibly invasive treatment of their pet. Unless they own a valuable breeding animal they would be kinder and more sensible if they had a really sick pet put to sleep." While it's true that it may make objective sense to have an ailing animal euthanased, when it's your own pet, surely it's wise to analyse the options available? Once a clear diagnosis has been made, vets are often able to give a reasonably accurate estimate of treatment, prognosis and life expectancy. If you are able to pay for the treatment (via insurance or otherwise), and if the vet can reassure you that your pet will not suffer during the process, many people conclude that the correct course of action is to give the animal extra life. Why should anyone else feel that they have the right to tell them otherwise? "Look at the dog and think, 'If that was me what would I want?' Or, 'Am I keeping the dog alive for the dog's sake, for my sake or I do I lack the moral fibre to do the right thing?'" I am sure that most owners look at their pet and ask these questions before making a treatment/euthanasia decision. And most vets take time to guide owners through this process. Most vets and owners would agree that if a pet has no hope of living a good quality life, euthanasia is the kindest option. And treatment for serious disease may not be as uncomfortable as people expect in pets. Treatment modalities like surgery, chemotherapy and radiation treatment are often deliberately used in lower doses in pets compared to humans, so side effects are usually less severe. Nobody want animals to suffer pain or discomfort for the sake of a few more weeks or months of life. "These poor animals haven't a clue what is happening to them in the vets' surgeries, all the pain, trauma and strange smells..... people aren't doing it in the interests of the animals they are most of the time doing it for themselves. Better IMO to let the animal have a peaceful end - a right denied to humans. And don't get me started on animals with limb amputations." Anyone who has owned an amputee dog will know at once that the person who made this opinionated comment has not known any animals with limb amputations (they often have marvellous lives, with no discomfort or visible disability). I suspect he's also had a similar lack of experience of vets' surgeries and sick animals recovering from illness. "I have come to the conclusion that Veterinary Surgeons generally, are individuals who parasitically feed off pet-owners emotions. The fees they charge can bear no resemblance to costs incurred. Have their charges ever been investigated? I suspect this is yet another bunch of rip-off artists. They know you will pay to save a soulmate... So they take you for an expensive ride." I'm sorry that this person has such a negative view of my profession: what else can I say? "As for vets, I told my son to be either a vet or a lawyer. They make the fees up as they go along, nobody really questions the amounts and they get paid even if the client dies." This person should really do some proper research before making recommendations to his son. Vets' salaries are not as high as people may expect. In the USA,  $80460 (£50824) is the median pay, with veterinary graduates struggling to pay off huge university debts. In the UK , according to this website, "the average starting salary is between £21,800 to £33,500 a year, depending on experience. Further training and experience can increase salary to £36,500 per annum. Senior vets can earn around £44,000 to £53,000+" . So while vets may earn a substantial salary, it's nothing special compared to doctors (Salaried GPs earn between £54,319 and £81,969). solicitors (between £25,000 and £75,000)  or dentists (between £50,000 and £110,000). And did he tell his son about the high suicide rate in vets - higher than any other profession, and around four times the national average? The job of a vet is not the easy, money-spinning dream career that some people seem to believe. "I have heard that vets in England charge more if you have insurance, but it wasn't made clear if this is because they run every test necessary when the insurers are paying but stick to the bare minimum for hard up punters."  This person probably is closer to the truth than they realise. The reason why vets "stick to the minimum for hard up punters" is that these clients are unable to afford anything else. Is there anything wrong with this? Something else needs to be explained: this odd statement in Judith Wood's feature. " Vet fees have doubled in a decade, and are rising at an annual rate of 12 per cent." Vets' fees per item have certainly not "doubled in a decade", nor are they rising at 12% per year. But more advanced tests and treatments are now available to those who can pay for them, which is why the amount spent on pets may indeed have "doubled in a decade" and may be continuing to increase. The key truth that seems to have been missed by everyone writing on the subject is this: diagnostic tests are amongst the most expensive items on the veterinary menu. The specialised machinery needed to carry out laboratory tests, ultrasound scans, x-rays, MRI scans and other work-ups can cost tens or hundreds of thousands of pounds. Yet these pricey investigations are often the only way to achieve an accurate diagnosis, which is the key fact that's needed to decide on treatment and to predict the prognosis. Do you want to be able to do the best for your pet if he or she falls ill? If you do, get your pet insured so that you can give your vet the go-ahead to carry out the tests needed to give you the best advice possible. And don't listen to the "objective" scoffers who tell you that you would be better to have your pet euthanased: talk to your vet and make the decision for yourself, based on facts, not opinions.    
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