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Ask a vet online – is there a test for Leptospirosis?

Berry Wilkinson asked: I was wondering if you can titre test for leptospirosis? Or is it only useful when you are testing sick dogs? Thanks. Answer: Hi Berry, thanks for your question about testing for Leptospirosis. To answer it, I'll briefly discuss Leptospirosis as a disease, then talk about the different diagnostic techniques available. Finally, I'll discuss vaccination and the implications for diagnosis. What is Leptospirosis? Leptospirosis ("Lepto") is a disease caused by bacteria of the genus Leptospira. There are more than 300 strains (technically called serovars) of the bacteria. In the UK, Leptospira icterohaemorrhagiae and L. canicola used to be the most common, but since widespread vaccination against these has started, it is now thought that L. interrogans and L. kirschneri may be more important. The disease is transmitted by body fluids of infected animals, including rats. The symptoms of Leptospirosis in dogs include:
  • Fever and sore muscles.
  • Loss of appetite, vomiting, diarrhoea and dehydration.
  • It may cause kidney or liver failure
  • Sometimes the only symptom is sudden death.
  • Infected dogs may shed the bacteria in their urine for months or years without showing any clinical signs.
  • Leptospirosis is highly zoonotic - i.e. it is a high risk pathogen for infecting humans.
How is Leptospirosis diagnosed? There are four methods to test for Leptospira in clinical samples, of which two are clinically useful. They are:
  • Darkfield microscopy - looking for the bacteria themselves. This is very siple, but is notoriously unreliable, unfortunately!
  • Bacterial culture - attempting to grow the bacteria; however, in many cases the bacteria are very hard to culture, so even in confirmed infections, this test may come back negative.
  • Serology - looking for antibodies produced by the immune system in response to the presence of the bacteria. However, vaccination will often lead to a positive response, and low-positive titres (levels of antibody) may persist for a prolonged period. In addition, the levels of antibodies often won't be significant in the first week of infection.
  • PCR - testing blood (early infection) or urine (later stages of infection or carrier status) for genetic material from the Leptospira bacteria; this is a very sensitive and specific test. However, a negative PCR result doesn't rule out carrier status because the bacteria are only shed intermittently in the urine, and will not be present in the bloodstream; and it can also appear negative in some milder infections.
So how is serology interpreted?
  • The normal screening test for Lepto is an antibody test ("ELISA testing") that gives a simple positive or negative result.
    • If this is negative, then in general either:
      • The dog doesn't have Lepto, or
      • The dog has only been infected in the last week or so.
    • If the result is positive, then:
      • The dog has Lepto, or
      • The dog has had Lepto in the past, or
      • The dog has been vaccinated and still has high levels of circulating antibody.
  • If the ELISA-test is positive; or if the symptoms are suspicious but PCR (genetic) testing is negative, the next phase is to use a different type of antibody testing ("MAT serology") to determine the level of antibodies in the blood (the titre).
    • On a single test:
      • Low titres are most likely to represent vaccination or past infection.
      • Moderate titres may indicate vaccination or infection.
      • High titres usually represent acute infection.
    • However, it is far more useful to carry out paired serology - 2 tests 7-10 days apart:
      • In a genuine infection, the titre would normally be expected to rise by at least four-fold.
      • In chronic infection, or asymptomatic shedding, diagnosis can be really difficult, but a persistent moderate titre that doesn't decay over time is highly suggestive of chronic infection; however, demonstration of the organism's genetic material by PCR in repeated urine samples is often more practical.
What about vaccination?               There are a number of different Leptospirosis vaccines available; most of them cover 2 strains ("bivalent vaccines"), although some now cover 4 ("quadrivalent vaccines"). They are aimed at covering the most common types that cause disease, and there is relatively little cross-protection between strains (so immunity to one strain or serovar won't usually protect against another). The vaccine doesn't necessarily prevent infection, but it should reduce the risk of infection, and it does reduce the severity of clinical disease and shedding (for whichever strains or serovars are covered by that vaccine). There are some commercial tests that claim to determine whether a dog requires vaccination against Leptospira by testing circulating antibodies. This may work in some cases, but it is very limited. There are a number of problems with this approach:
  • The serological titre (level of antibodies in the blood) can only tell you how much antibody there is in the bloodstream at the specific time the test is done - it cannot tell you whether the levels will remain high for the following 12 months.
  • The link between antibody levels and protection isn't consistent - some dogs appear to utilise other parts of the immune system (cell mediated immunity) and are protected against Lepto even in the absence of significant circulating antibody titres.
  • After vaccination, titres normally drop off over 4-5 months, but protection lasts for 12 months.
As a result, it is wisest to maintain annual vaccination against Leptospirosis, to reduce the risk of infection to your dog and to you. I hope that helps! David Harris BVSc MRCVS
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Ask a vet online – my dog has skin allergies, how do I help?

Question from Leona Poppleton: my dog has skin allergies and so gets very dry skin and sometimes scabs that look quite painful is there anything that I can get or do to help this? Answer: Scabby Skin Hi Leona, thanks for your question about your dog's skin. Allergies with skin symptoms are pretty common in dogs, so I'll briefly discuss allergic disease, then go on to some of the many different treatment options. What are skin allergies? The phrase "skin allergies" refers to the itching, scratching and sore skin that allergic dogs get. However, it doesn't have to be caused by something on the skin - e.g. food allergies (although quite rare in dogs) can lead to skin symptoms - so "allergic skin disease" is a better term. Essentially what is happening is that the dog's immune system misidentifies a harmless substance as a dangerous threat, and tries to attack it, causing soreness and itching. Allergic reactions may be triggered by a wide range of substances such as pollen, certain foods, fleas, mites, plants or even some washing powders. In a large number of cases, there's no specific "allergy" involved, but the dog has a disease called Atopy (or Atopic Dermatitis), where the immune system reacts abnormally to a wide range of different stimuli. Atopy is partially genetic, and is more common in some breeds (e.g. West Highland White Terriers). How is it diagnosed? It is important to get allergic skin disease properly diagnosed by your vet because there are many contributing factors and different underlying problems. As a result, diagnosis can be long and exasperating! In addition, diagnosing Atopy requires ruling out all other possible causes. 1) Initially, its vital to make sure that there aren't any parasites (especially fleas!) on the dog - this is a LOT harder than most people think, and usually requires treatment of the affected dog, all other pets in the house, and the house itself. (A side note here - there are a lot of over-the-counter products available for treating fleas: some work, some don't work, and some are very dangerous if not used correctly. I would strongly advise talking to your vet for advice, particularly as the most effective treatments are prescription-only medicines, some of which will also act over time to treat the environment as well as killing adult fleas). 2) The next step is to make sure there aren't any skin infections that could be contributing to the symptoms, or mites burrowing into the skin. This may require skin scrapes to remove a layer of skin (it really doesn't hurt!) and tape-strip tests to check for yeasts or bacteria. 3) There are a number of allergy tests available - these mostly use blood samples; intradermal tests (injection of test substances into the skin) may be more reliable, but they are expensive and difficult to perform. 4) To rule in or out food allergies, a controlled food trial is essential. This can be done with truly novel food sources, but in general it is more effective and practical to use a hypoallergenic diet from your vet. These diets are formulated so that the proteins are broken down so small that the immune system can't recognise it. In a food trial, the dog is fed ONLY the controlled diet (no treats or snacks!) for a number of weeks. If the symptoms resolve, you reintroduce the original diet one item at a time, to determine what's causing the allergy. But why does it make my dog itch so much? Itching is what's called a "summative, threshold" experience. This means that there is a threshold level, below which itching won't be felt. Anything that stimulates an itch ("pruritic") response such as a flea bite, an allergy, or a skin infection, raises the level of "itch" until it breaks this threshold and the dog feels itchy. In most allergic dogs, several different factors combine to make the itching overpowering. Unfortunately, actually scratching makes things worse - this is called the "itch/scratch cycle". What are the scabs I can sometimes see? Scabs generally mean one of three things: 1) Flea bites 2) Skin infection 3) MOST COMMONLY - self-inflicted skin damage caused by scratching. The skin is sore because it's been scratched, and it's been scratched because its sore etc etc... Scratching also damages the skin and allows infection to become established, which makes the itching worse. What can I do about it? The bad news is that most allergies cannot be cured, only managed. However, with good management, most cases of allergic skin disease can be fully controlled the vast majority of the time. There are a number of classes of treatment, which I'll deal with in turn; however, many cases will require multiple overlapping treatments, so it is essential that you work with your vet to put together a management programme. 1) Disease modifying treatments These attempt to reduce the underlying allergic response. The most effective are licensed immune-modifying drugs such as ciclosporin*, which when used long term reduces the allergic response. There is great hope for immunotherapy, where the immune system is gradually taught to tolerate certain allergic substances; this must be made up by a lab specifically for your dog's allergies. Sometimes an allergy can be "cured" by this route, but it is more usually used to reduce the dog's sensitivity. 2) Relieving symptoms These act specifically to reduce the sensation of "itch". There are three main drugs used for this. Firstly, antihistamines; these are not licensed for use in dogs and may have noticeable side effects, but a vet can legally prescribe them under the cascade if necessary. My experience is that they aren't very reliable in dogs, but may be useful in some cases. There is also a new drug called oclacitinib which works purely to suppress a dog's itch sensation. Finally, there are steroids. These reduce inflammation, mildly suppress the immune system and are very, very effective at reducing itching. They're also inexpensive; however, if used long term, they have a wide range of side effects. They're often best used as a "rescue" treatment, although steroid creams and sprays that can be applied directly to the sore spots on the skin have fewer side effects. 3) Reducing other sources of itching This category would include products such as antibiotics for skin infections and antifungals for yeast infections (many of which are available as medicated shampoos), and parasite treatments for fleas and mites. 4) Reinforcing the skin barrier This is a relatively new area, but seems to be a really useful in some cases or in addition to other treatments. There are soothing and hydrating shampoos which work to remove allergic substances from the coat and soothe the skin; as well as oatmeal shampoos which seem to have an anti-itching effect. Finally, there are the ω-3 fatty acids which appear to help many itchy patients; they may be in the diet (particularly in "skin" or "dermatology" diets), added to food as a supplement, or used as a topical spray or spot-on. Overall, you and your vet need to find the combination of treatments that suit your dog. Managing the allergic pet is a big task, but I hope this has helped, and that you can keep your dog comfortable! David Harris BVSc MRCVS * PS - you may notice I'm using generic drug names not brand names in this article. This is because, for legal reasons, I'm not permitted to name specific brands in a blog like this. If you want to know more, check out the government's Veterinary Medicines Directorate website.
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The BBC is wrong to allow an unqualified person to recommend unproven treatments to animals

The Hay Festival is not a place where you might expect to learn about the treatment of animals: it's an annual literature festival held in Hay-on-Wye, Powys, Wales, for ten days at the end of May every year. Caroline Ingraham has written an interesting book - "How animals heal themselves" -  which is presumably the reason she was given the opportunity to give an account of her subject at the Hay Festival last week. The BBC have created a podcast from her talk,  but I believe that the editors were wrong to give her this uncritical forum to propagate her views. Caroline has a controversial belief in the ability of animals to choose their own medicine. There's nothing wrong with her having these beliefs, but there is a problem when her views are broadcast without any "public health warning". There is a serious risk that animals could suffer unnecessarily if members of the public follow her advice to the letter. In her talk, Caroline recounts entertaining anecdotes of animals (including elephants, horses, dogs and cats) that have recovered following her approach of allowing them to choose their own treatment from vegetation and other substances in their natural environment, or from herbal products offered to them by Caroline. In her words, the animals "guide her to help them make a full recovery". Caroline stresses the importance of "letting animals lead the way" for behavioural and physical problems. As a vet in practice, I know that 70% of the animals brought to see me will recover by themselves, with no intervention or medication. Animals have evolved with strong internal natural healing capacity (it's called homoeostasis) Our aim as vets is to assist the healing process using scientific methods. There are many reasons why animals may fail to heal themselves, and science can often help. Serious bacterial infections are cured by giving antibiotics that kill the bacteria. Coughing caused by a failing heart is stopped by giving diuretics that remove the fluid gathering in the lungs. Cancer can be cured by surgical excision, followed sometimes by drugs to slow the regrowth of cancer cells. These are all treatments that are scientifically proven: in trials, it has been shown that if some animals are given the treatment, and some are not, a significantly greater number of animals improve. Caroline offers no such evidence: her treatments are all anecdotal. My concern is that she may be witnessing the "regression towards the mean"  i.e. the ability of animals to heal themselves without human intervention. Since around 70% of animals may recover naturally, if you believe that any recovery that you witness was caused by your intervention, you will believe that your treatment "works" 70% of the time. While this may sound impressive, the truth is that your intervention is having zero effect. If Caroline wants to clearly demonstrate the efficacy of her methods, she needs to do what pharmaceutical companies are obliged to do: carry out trials that compare animals receiving her treatment with animals that receive no treatment (a so-called control group). If she does this, she will be able to say without question that any extra improvement in the treated group is due to her treatment. Without doing this, her claims have no scientific validation, and it's hard for objective observers to take them seriously. At the end of the talk, the presenter did ask Caroline if she was a scientist, and if her work was "evidence based research". She replied "I am not a scientist but the subject of zoopharmacognacy is an academic science". Caroline says that in trying to develop her work, "resistance came in from a variety of different establishments that tried to make it really very difficult for me to continue this work." There is a simple reason for this resistance: there is strong legislation in the UK to protect animals. Only vets are allowed to diagnose and treat animals. The law is there to stop (often well-meaning) unqualified people who may not be aware of their own ignorance  from accidentally harming animals because of their lack of knowledge. There may be some truth in Caroline's claims: animals may be able to choose certain forms of self treatment for some physical and behavioural issues. But this has not been proven, and it is wrong to state it as fact. It just does not seem right when an unqualified person suggests that pets should be allowed to choose their own "pain relieving herbal remedies" rather than the safe proven methods of pharmaceutical pain relief recommended by the vet attending the animal. And it does not seem right that the BBC should give such a person an uncritical platform to disseminate her viewpoint. Update 25th November - Caroline has forwarded this response to the original blog: I believe that your post undervalued the importance of case reports (referred to as anecdotes) that can provide important, detailed information about individual cases that can be very valuable, and it is much better to gather this information than do nothing at all, especially as cases typically come to us after other options have been tried. In fact some successful clinical trials have been started principally because of the promising findings of a collection of related interesting case reports; a topical example is in the human medicine world where the recent FDA approval of a new viral therapy against melanoma, which was inspired by case reports of some patients with cancer going into remission after a viral infection: http://www.nature.com/news/cancer-fighting-viruses-win-approval-1.18651 (of course in this case viral therapy would have to be under the control of a qualified specialist with an appropriately modified virus!). Other observational, non-experimental approaches have also been fruitful, such as with the work by Jane Goodall, among others.  As for Applied Zoopharmacognosy itself, after my lecture to veterinary students at Bristol University yesterday, many came up to me inspired by these case reports and want to explore setting up research projects, and possibly even small scale clinical trials, investigating self-medicative behaviours. I take your point about regression to the mean, but I understand this likely applies more to certain, short term conditions such acute pain, acute infections, slight anxiety etc. that in many cases would be expected to resolve spontaneously. Many of the individuals that I have worked with have long term conditions, most commonly with long standing behavioural issues but also other symptoms as well. The responses can be dramatic and remarkably fast, and so regression to the mean is a less plausible explanation in these cases. It is it important to note that we do not make medical diagnoses, and I advocate self-medicative approaches as complimentary to veterinary treatment not as a replacement; veterinarians are highly trained and highly skilled individuals and their input is typically invaluable. It would be fantastic if veterinarians were to add Applied Zoopharmacognosy as part of their skill set. Finally, I read with great concern in several veterinary blogs (though not this one) and tweets that I have been suggesting to pet owners to offer onions to dogs as a wormer. I would like to clarify that I have never offered, nor recommended giving an onion to a dog. It was merely an observation of an event that I found fascinating since it paralleled other documented occurrences of sick animals selecting typically poisonous plants including: Michael Huffman when he witnessed chimpanzees selecting Vernonia amydalina (locally known as 'Goat killer'), to rid themselves of nematodes (Huffman and Feifu, 1989; Jisaka, et al 1993), and in a study by Singer, et al. 2009, when caterpillars with parasitoid wasp larvae infestations changed their foraging on (normally) poisonous alkaloids such to rid themselves of parasites. The relationship between self-medicative behaviour and plant poisons is a complicated topic, which would take a lot of words to cover adequately. In brief, the most common plant poisons are due to certain chemicals called alkaloids and the reasons for why animals may poison themselves on these are not incompatible with self-medication (possible reasons include evolutionary separation of poisonous plants and companion animals, degradation of bitter warning compounds during drying such as with ragwort, reduced alternative foraging options etc.). Applied zoopharmacognosists typically work with extracts high in other compounds such as terpenoids, not alkaloids. My observations have been presented at a scientific conference in South Korea last year following an invitation by my colleague Michael Huffman, Associate Professor, Kyoto University as well as at Bristol university. I would be more than happy to open dialogue on the subject with any interested parties. Challenges to consider with self-medictaion and clinical trials: I would fully support clinical trials that look into the efficacy of self-medicative approaches. However, clinical trials are often prohibitively expensive and time intensive. The difficulty would also be that it is not immediately obvious how a trial that focuses on two different approaches to animal health could be set up without having to split it up into multiple, equally expensive trials that each focus on particular conditions. It is also important to remember that clinical trials are not completely fail-safe either.  
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Do vets charge too much for bitch spays?

As part of my work as a "media vet", I'm a strong advocate for spaying and neutering pets as the best way to control the problem of pet overpopulation. Accidental pregnancies still account for a high number of unwanted puppies and kittens, and routine spaying/neutering of young adult pets is the best way to prevent these. This doesn't meant that every pet needs to be spayed/neutered when young (there are some good reasons to delay or even not to do the operation for some individual animals), but it does mean that every pet owner should at least discuss the options with their vet around the time of puberty.

Why do people refuse to have their pets spayed?

People have a variety of reasons for not having the operations done on their pets, and the cost is a major factor. In a recent social media discussion, the following comment came in. "Vets should reduce their fee to £120 for a female dog. A lot of people genuinely just can't afford it."

Why don't vets reduce their fees?

This is a good point. Why don't vets reduce the price of spaying? Let's look at how this could be done: what makes up the cost of an operation, and how can those items be reduced? To put this in perspective, what are the typical fees for spaying? The recent SPVS survey found that the median fee nationwide for an adult bitch spay was £204. There is significant regional variation on this, but the figure acts as a reasonable starting point for discussion. How could it be reduced to £120? If you look at the pie chart at the foot of this page, you can see that over half of the costs of vets' fees are made up of overheads that are difficult to reduce: rent, heat, light, phone, drugs, surgical supplies, cleaning, nurses' wages and administration costs. Vets already do as much as they can to keep these costs down: it's in their own interests to do so. So let's leave these alone for the sake of this discussion. So what about the obvious "top item" on the cost list for most people: the money that goes to the vet. Surely vets can manage with less? For every £10 you give the vet, typically only £2 to £2.50 goes to the vet. If a vet gives you a 20 to 25% discount, they are working for nothing. Vets are well enough paid, but their salaries are lower than most people expect. A typical new graduate vet earns around £30000, and a vet qualified for 20 years might earn £50000. Should vets work for less than that, with five years of tough training and high costs in getting through college? For the sake of this discussion, let's say yes, and agree that vets will operate for free on bitch spays: take 25% off £204, and you're left with £153. What next? What about VAT? The government charges 20% on all vet fees, making up £34 of the £204. If this was not charged, £153 minus £34 = £119. Bingo: it's less than £120. So if vets work for nothing, and the government agrees to stop charging VAT, the cost of a bitch spay would reach the desired target. Is this going to happen? Of course not.

In the real world, how can pet owners pay as little as possible for bitch spays?

So what can impoverished pet owners do? Here are three tips. First, plan in advance. You should budget for the spay/neuter surgery when you get a pet, just as you should think about how much it will cost you to feed your new animal. If you genuinely can't afford it, perhaps you should not get a pet. For the financially disadvantaged, there are some subsidised schemes to help, but charity resources are limited, and most of the working population will not qualify for these. Second, shop around, but don't do this on price alone. You should physically visit at least three vets, eyeballing the premises (are they clean?), talking to staff (do they seem to care?) and asking some specific questions: • Do they have qualified veterinary nurses? • Do they use up-to-date anaesthetic, pain relief and monitoring equipment? • Does they monitor all pets after anaesthesia until they are awake? You may not be fully aware of the "right answers" to these questions, but even just by asking the questions and judging the tone of the response, you will learn a lot about the practice. Third, ask for a discount. Some vets may just say "no" ( this is understandable - it directly eats into the 20 - 25% that they are paid), but as in any other consumer transaction, there is no harm in asking the question. If you think a bitch spay is expensive at £200, remember that it would cost around £5000 to have a similar operation carried out on a human. And if you want to help with the pet overpopulation problem, as well as benefitting your own pet's health, it's a price that's well worth paying.
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Ask a vet online- ‘My dog has dandruff . Could it be his diet ?’

Question from Andi Jane William: My dog has dandruff . Could it be his diet . What is best to feed him . He is a 7 year old border collie Answer by Shanika Winters: Hi, thanks for your question regarding your border collie and his dandruff.  I will answer your question by discussing what dandruff is, possible causes and then possible treatment options. What is dandruff? Most people think of flaky white bits of dry skin usually found on the head and shoulders of a person when they hear the word dandruff.  Dandruff is a word used to describe flaky bits of skin, they can be dry or oily, different sizes and come from any area of skin on the body. Mostly we are talking about dry white coloured flakes when we use the word dandruff to describe the appearance of a skin condition.  The flakes can however be yellow in colour if oily or even red/brown if they also have some scabs/dried blood in them. Why does my dog have dandruff? There are various reasons why your dog may be showing the symptom of dandruff including:
  • Diet
  • Excessive shampooing- dries out the skin
  • Parasites-mites such as cheyletiella or after effect of scratching due to e.g. fleas.
  • Skin conditions- such as underactive thyroid and seborrhoea
How do we work out why my dog has dandruff? The best way to get to the root of the problem if your dog has dandruff is to take him to your vet, where he can have a thorough examination, detailed history of how long the condition has been going on for including how it has changed and have appropriate test carried out. Your vet will ask general questions about your dog's health, diet, grooming regime and parasite control.  This will be followed by a physical examination, concentrating on the area of affected skin.  Depending on their finding your vet might then suggest some tests be carried out e.g.
  • Skin scrapes
  • Hair plucks
  • Sticky tape strips
  • Blood tests
  • See response to parasite treatment
  • Skin biopsies
  • Diet trials
Skin scrapes are when a sterile scalpel blade is used to scrape your dog’s skin usually until the point of light bleeding; this sample is then examined under a microscope to look for parasites and signs of infection. Hair plucks are when a clump of hair is pulled out and then examined under the microscope or cultured to see if any bacteria/fungi are grown. Sticky tape strips are literally when a strong clear sticky tape is applied to your dog's skin and it then removed taking with it surface loose hairs and skin which can then be examined under a microscope. Blood tests are performed on a sample of blood taken from either a vein on your dog’s front leg (cephalic vein) or the large vein on your dog’s neck (jugular vein).  The blood is analysed at your vet practice or may be sent to a laboratory.  Your vet will be looking for conditions that can affect the skin hormonal imbalances such as hypothyroidism (underactive thyroid) and Cushing’s disease (over production of steroids). If parasites are suspected as the cause of the dandruff, even if they cannot be seen then a response to a course of antiparasitic treatment can be used to make a diagnosis. Skin biopsies are when a sample of full thickness of your dog's skin is cut out and sent to a laboratory for analysis.  Often several sites may be biopsied and sent off.  Skin biopsies will usually be performed with your pet under some form of anaesthesia to provide pain relief and to keep your pet still. A diet trial is when your dog is fed a specific diet and water to drink but nothing else for a period of time, which could be 8-12 weeks.  This is to ensure that other food substances are out of your dog’s system.  Some animals will show a dramatic improvement in their skin condition as a result of a specific diet; this could be one which has avoided a substance your dog is allergic to or perhaps one with added ingredients to support a healthy skin and coat such as omega oils. How can we treat my dog's dandruff? This will depend on the cause of the dandruff.  A good starting point is to ensure good parasite control for your pet, in contact pets and the home environment followed by a good quality diet which is appropriate to your dog's age, activity level and general body condition.  We will also sometimes recommend dietary supplements to increase the good oils in your dog's diet as these can help the skin to stay healthy and move away from the itchy pathways. Certain fish oils and evening primrose oil contain a good balance of oils, please do not use products you get from health food shops or which are designed for people unless this is under the direction of your vet. Some dogs specifically benefit from a low allergy diet, this is one where an unusual protein and carbohydrate source are used or where the molecules of protein are broken down to a point beyond which they can trigger off allergic reactions.  Low allergy diets need to be stuck to strictly and given for a long period, 8-12 weeks minimum in order to see if there is any improvement before we can say they are not working.  Low allergy diets can be bought or home cooked. If a an infection is found then the correct antibiotic or antifungal medication will be prescribed, this may be in oral form such as tablets or capsules or could be as a shampoo.  Whatever form the treatment is in, it is very important to follow instructions closely to provide the best chances of successfully treating the condition. In cases of seborrhoea your pet will have a sensitive easily irritated skin that can have dry or oily flakes.  This can be underlying due to a dietary issue which will need addressing but it can also be massively improved by use of an appropriate shampoo.  It is important that you use the shampoo as directed, allowing adequate contact time with your dog's skin for the active ingredients to do their job. The shampoo will usually need to be used more frequently at the start of the treatment and this will reduce to less often as the condition starts responding and is being more controlled. Where hormonal imbalances have been detected via blood tests then appropriate medication will be given, in cases of Hypothyroidism supplements of thyroid hormone are given, the levels of which will be monitored in your pet’s blood.  Other conditions such as Cushing’s disease require treatment to stop the overproduction of steroids in the body, these too need carefully monitoring. I hope that my answer has helped you to understand how complex dandruff can be to get to the bottom. With the help of your vet then we hope that your dog's coat soon returns to its former glory and that he is much more comfortable. Shanika Winters MRCVS (online vet) If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.
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