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BBC’s Today Programme asks a profound question: how much is a dog’s life worth?

Dogs and vets' fees took centre stage in the UK media yesterday when they featured on the BBC's Today programme, the most popular show on Radio 4, with over 7 million listeners every week. One of the presenters, Evan Davis, brought his whippet, Mr Whippy, into the studio, and a discussion on vets' fees followed. Mr Davis recounted how he'd spent £4000 on fixing Mr
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Do I need to worry about “Alabama Rot”?

You may have read in the news recently of another cluster of dogs affected with the exotically named “Alabama Rot”. Also known as “Cutaneous and Renal Glomerular Vasculopathy” (CRGV), this condition is still poorly understood. As a result, there’s a lot of worry and speculation, and vets are receiving increasing numbers of panic-stricken phone-calls from dog owners! So, what do we actually know about CRGV? What is it? Firstly, let’s specify what it isn't – for example, despite excitable media reports, it isn't a “flesh eating bug”. Nor is it a “superbug” or a variant of the Ebola (or any other) virus. Technically speaking, it is a form of thrombotic microangiopathy, a condition where blood clots form in the small blood vessels in the body, blocking off blood supply. For some reason, the skin and the kidneys are most sensitive; without a blood supply, the tissue dies, causing ulcers on the skin, and failure of the kidneys. Is it a new disease?                                      Not exactly – it was first diagnosed in the United States in the 1980s. However, the first cases in the UK were detected in November 2012; since then, cases have been seen from across the country (there’s a map of confirmed and suspected cases here). It is most common in the winter and spring – most cases are detected between November and May. What causes it? No-one knows. It is probable that a bacterial toxin (i.e. a poison made by bacteria, that causes disease even in the absence of the bacteria themselves) is involved, perhaps from E. coli; however, this has not yet been confirmed, and tests for E. coli shigatoxin (one possible culprit) have proved negative. There is, however, no evidence that it is caused by a toxic plant, heavy metal poisoning, or genetics (although it was once thought that only Greyhounds and other sighthounds were predisposed, this is not now thought to be the case). It has been suggested that contaminated pet food may be involved, but this seems improbable – there just aren't enough affected dogs for that to be likely. So what are the symptoms? Initially, the first sign is an ulcer or wound, usually on the legs. They typically look like small, round sores and usually occur on the legs, but may also be found on the body, face or tongue. The lesions range from 5 to 50mm (1/5” – 2”) in diameter. 1-9 days later (usually about 3), affected dogs will usually suffer acute kidney failure. The symptoms are of increased thirst, changes in urination (increased amounts of dilute urine, or in more severe cases, reduction or absence of urine production). This is accompanied by lethargy, anorexia, vomiting, depression and often bad breath (which may smell metallic). Once clinical signs of renal failure occur, the prognosis for recovery is poor. Dogs that, for whatever reason, do not progress beyond the skin lesion stage have a better prognosis, assuming no further complications develop. Overall, half of the dogs affected will suffer abnormal bleeding (thrombocytopaenia); about a third may show some degree of jaundice (yellow gums and eyes); and one in five are anaemic (with pale gums and difficulty catching their breath). How do dogs get it? Firstly, it doesn't seem to be contagious from dog to dog, or to or from humans. The current thinking is that there is an environmental link – most cases are associated with walking in muddy woodlands, and it may be that there is a toxin in the mud that is absorbed by the dogs. How can it be avoided? As we don’t know the exact cause, avoidance is difficult. However, thorough washing of your dog’s coat after walking in woodland (especially if muddy… like everywhere this year!) is a sensible precaution that should reduce the risk. In addition, it is likely that certain places pose a higher risk than others; if there has been a case in your area, it is probably wise to avoid areas where the affected dog(s) were walked in the days before they were diagnosed. It’s also really important to check your dogs over regularly – not just for sores or ulcers, but also for cuts, ticks, mats of hair or other injuries. How do I know if my dog is affected? Fortunately, most dogs with skin lesions don't have CRGV! However, if your dog does have any strange or unexplained sores or wounds, it’s important to get them checked out by your vet – in the vast majority of cases, they’ll be able to demonstrate a far less worrying condition. They can also do blood tests to check for kidney problems – although as it is often several days before these show up, repeating the blood tests in 48 hours may be necessary. How can CRGV be treated? Unfortunately, there is no specific treatment. However, treatment of the skin ulcers will minimise the risk of secondary infection; and if kidney failure occurs or appears imminent, hospitalisation and intensive care will maximise the affected dog’s chance of survival. In some cases, referral to a specialist hospital may be suggested, to give your dog the best available care and therefore chance of recovery. How dangerous is it? As a rough estimate, the condition is fatal in 80-90% of cases. However, early diagnosis and treatment is thought to maximise the chances of survival. Fortunately, it is still a very rare disease – in the last three months, there have only been 4 cases (in Staffordshire, Hampshire, Greater London and Lancashire). If you are concerned your dog may be affected, contact your vet for advice – however, the majority of skin lesions and sores will be due to cuts, insect bites or grazes, and are nothing to worry about. It’s also important to remember that, even if your dog is affected, prompt diagnosis and rapid treatment gives them a much better chance of survival. For more information please visit Anderson Moores Veterinary Specialists who are taking the lead in treatment and advice on the condition.
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Is that “veterinary nurse” really a veterinary nurse?

Language and terminology is important. Our society recognises this fact, and in some walks of life, you cannot call yourself by certain terms unless you are appropriately qualified. The medical field is the area where so-called “protected titles” are most prevalent: there's a long list from “music therapist” to “dietician” to “clinical scientist” to “physiotherapist” and “paramedic”. If you read the list, you'll be surprised, and I suspect that you'll be reassured too: it's good to know that when you go to see a “hearing aid dispenser”, under law they must be properly trained and qualified. There are serious penalties for people who try to set themselves up as one of these practitioners when they are not entitled to do so: anyone using one of these titles must be registered with the Health and Care Professions Council, or they may be subject to prosecution and a fine of up to £5,000. Interestingly, not all professional titles are protected. The words “doctor” and “nurse” have been in general use for hundreds of years to describe a variety of people, and so they are not specifically protected. The title “doctor” is used far more broadly than just for medical doctors, with a number of professions (including dentists and now vets) using it as a courtesy title, as well as people who hold academic doctorates, such as PhDs. Similarly, the title “nurse” is not protected: as well as medical nurses, it's used by nursery nurses in nursery schools, and sometimes by veterinary nurses. The fact that the terms “doctor” and “nurse” are not protected can lead to issues where the public can be mislead by individuals who use the terms to their advantage (such as a person who is an academic doctor trying to pass themselves off as a medical doctor). For this reason, the terms “doctor of medicine” and “registered nurse” are protected titles, but for the public, arguably this is not sufficient to avoid confusion. There are some professions that would like to have protected titles, but for various reasons, this is not possible. Anybody can call themselves an “engineer”, a “scientist” or a “surveyor” because these terms are said to be in such widespread use. These professions have had to add prefixes to their titles to try to minimise confusion, such as “incorporated engineers”, “biomedical scientists” or “chartered surveyors”. Only properly qualified and registered vets are allowed to call themselves “veterinary surgeons”, but there is a major anomaly in the veterinary world: anybody, even without training or qualification, is allowed to call themselves “veterinary nurse”. The veterinary nursing profession has so far had to use the protected title “registered veterinary nurse” to be used exclusively by properly trained and qualified nurses, but there's a strong argument that this is not enough. Most readers, I'm sure, would agree that if they were dealing with someone calling themselves a “veterinary nurse”, they would assume that the person was qualified. Unless something changes, it's very likely that unscrupulous individuals will use this confusion to their advantage, misleading people into believing that they are qualified. What has to change? Clearly, the term “veterinary nurse” needs to be made a protected title. The Royal College of Veterinary Surgeons, the British Veterinary Association and the British Veterinary Nursing Association all believe that this is necessary. They are asking Parliament to change the law to protect the title “veterinary nurse”, and they need as much help as possible to achieve this. Please sign the official petition to register your support. The aim is to get 100,000 signatories which will trigger the issue will be considered for a formal parliamentary debate. The petition is currently at 20,594 signatures and the petition closes on 14th February 2016 so time is running out. The engineering profession tried a similar tactic to protect the word “engineer” last year, but the attempt failed after their petition only reached 6176 signatures. It makes clear sense that the term “veterinary nurse” should be trusted as the recognised name for a skilled, trained and qualified profession. If you agree, please sign this petition now, and ask as many as possible of your friends and contacts to do the same. Please follow this link to the petition. The RCVS has also produced a short animation stating the reasons behind the petition:  watch this by clicking here. Animals are the ones who will benefit from "veterinary nurse" being protected: so if you care, take action now.
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Ask a vet online – How often should my dogs get boosters?

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Karen Taylor asked: How often should our dogs be re-vaccinated (boosters)? Answer: Hi Karen, thanks for your question about booster vaccinations. This is an area that’s become quite controversial in the last few years, and there’s a lot of confusion about the subject. In addition, there’s a lot of very poor-quality information out there, so I’ll try to make this quite clear and obvious! To put it as simply as possible – see your vet every year for a health check, and discuss your vaccination strategy with them. For more detail... now read on! What are vaccinations? Put simply, a vaccination is a way of teaching your dog’s immune system how to recognise and defeat the micro-organism that causes an infectious disease, without the risks (of illness, potential long term health problems or death) inherent in a “natural” infection. This is achieved in one of three ways: 1)      A weakened form of the disease-causing organism. These are called “modified live” or “attenuated” vaccines, e.g. for Distemper and Parvovirus; the organism included is unable to multiply and/or cause clinical disease, but it is active enough to stimulate a strong immune response. Most modified live vaccines give a stronger and more long-lasting immune response than an inactivated vaccine; however, they aren’t suitable for every disease (because some organisms cannot be weakened enough to make them safe). 2)      An inactivated (“killed” or “dead”) form of the organism. These cannot ever cause disease, but allow the immune system to recognise the protein coat of the organism and therefore attack it next time. They may be used for particularly dangerous or unpredictable diseases such as Rabies or Leptospirosis, but don’t always give such long-lasting protection. 3)      Subunit vaccines, introducing part of the organism to teach the immune system what it “looks like”. For these, part of the protein coat of the target organism is replicated in a lab, and included in the vaccine; this means the immune response is really tightly targeted at one particular, vital, part of the organism. These are used, for example, in the Leishmania vaccine. There are 2 groups of vaccines – core and non-core. Core vaccines are those that should be given to every dog – they protect your dog and everyone else’s against dangerous, highly contagious and potentially fatal diseases. Non-core vaccines are those that are given to protect dogs that are particularly at risk of a specific condition because of their location, lifestyle, etc. The core vaccines that every dog should have are against:
  • Distemper.
  • Parvovirus.
  • Canine Infectious Hepatitis.
The vaccine against Leptospirosis is technically non-core; however, it is generally agreed that every dog in the UK is at risk of Lepto (which is spread by rat urine), and so it is treated as a core vaccine by most vets. The non-core (optional) vaccines available are:
  • Rabies (only necessary for pets travelling abroad).
  • Parainfluenza (one of the causes of kennel cough).
  • Kennel Cough (the bacterial sort, Bordetella bronchiseptica).
  • Lyme Disease (only necessary for dogs at high risk, e.g. gundogs, in high risk areas, e.g. the South West peninsula).
  • Leishmania (only necessary for dogs travelling to southern Europe).
  • Canine Coronavirus (only usually needed in breeding kennels).
If vaccines are so good, why do they need boosting? Because nothing lasts forever! Eventually, the immune system starts to “forget” how to handle a particular disease organism. Booster vaccines effectively remind the system and refresh the immunity. However, immunity to different diseases (and different types of vaccine, for that matter) lasts a variable amount of time, and that’s the problem. Some dogs will retain immunity for longer than others – unfortunately, there’s no easy way to tell which dogs are immune to what for how long. Is there any way to tell whether my dog actually needs a booster? Not really! The trouble is that although some vaccines operate by producing protective antibodies (e.g. Rabies), others rely on inducing a Cell Mediated Immune Response (immunity that doesn’t rely on antibodies in the blood, but circulating immune cells, e.g. T-lymphocytes and Natural Killer (NK) cells) – such as the Leishmania vaccine, which may not produce any antibodies at all. And most of them probably rely to some extent on both systems. It's easy to test the dog’s blood for antibodies (and there are some commercial companies that will do this and say “yes, high levels of antibody, so the dog is protected” or “no, not enough antibody, the dog needs to be vaccinated again”. However, this is not generally considered reliable, because:
  • 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 utilise other parts of the immune system (cell mediated immunity) – for example, dogs can be protected against Leptospirosis in the presence or absence of significant circulating antibody levels.
So how long does immunity actually last? How long the vaccine lasts depends on the exact formulation of the vaccine; at the time of writing, the three Core vaccines generally need boosting 1 year after the initial course, then every 3 years. Most Rabies vaccines needs boosting only every 3 years; and the others usually require annual boosters. To get a license for a vaccine, the manufacturer has to demonstrate that the product has a protective effect, however that is defined. For Core vaccines, they have to demonstrate onset and duration of immunity such as to fulfil the license claim to:
  • “Prevent mortality and clinical signs caused by canine distemper virus infection”.
  • “Reduce clinical signs of infectious hepatitis and viral excretion due to canine adenovirus type 1 infection”.
  • “Prevent mortality, clinical signs and viral excretion following canine parvovirus infection”.
If this cannot be demonstrated to the regulator (in the UK, the Veterinary Medicines Directorate - VMD), they won’t get a license for the product. This means that manufacturer’s recommendations for duration of immunity are those that will protect the vast majority of dogs for the quoted time (3 years or 12 months, depending on the vaccine). To make life a little more complex, any vet who uses a different vaccination interval, unless they can document a good clinical justification, is technically acting illegally by using the vaccine off-license (i.e. not as licensed by the manufacturer). This sort of behaviour tends to lead to unpleasant interviews with the VMD and has led to vets being struck off (although not, to my knowledge, for vaccine infringements as yet). Can over-vaccination harm my dog? There’s no reliable evidence that it can. In cats, every subcutaneous injection (of anything, even saline!) slightly increases the risk of an Injection Site Sarcoma, but despite a lot of scientists, vets and owners trying to find a link, there’s no evidence that it causes any problems in dogs. That said, absence of evidence is not necessarily evidence of absence, so a responsible approach would be to vaccinate as infrequently as the current evidence suggests is sufficient to provide protection – in other words: 1)      Get a health check for your dog at the vets every year. 2)      Follow the manufacturer’s recommendations (unless your vet has a particular clinical reason not to):
  1. Distemper, Parvo and Infectious Hepatitis – boosters every 3 years.
  2. Lepto – annual booster.
  3. Rabies – boost every 3 years.
  4. Other Non-core vaccines – usually every year.
  I hope that helps; this is a really controversial area in some quarters, but the evidence base for the current vaccination protocols is pretty secure, and it is what I’d advise you to follow. David Harris BVSc MRCVS
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The story of Dan, a coughing Springer Spaniel

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Dan was a nine year old Springer Spaniel who loved strenuous physical exercise. His owner, Dr Mullen, was a medical doctor who was an enthusiastic hill walker, so they made a good team. They would spend days off in the Dublin mountains together on six-hour hikes through the countryside. Dan was brought to see me because he had developed an irritating cough, and Dr Mullen was worried.

The cough did not affect Dan during exercise. He was still able to run for hours without any problem, but the following morning, immediately after getting up, he would cough repeatedly as he walked around the room. It seemed to be a productive cough: sometimes he swallowed after the cough, and other times Dr Mullen found patches of white phlegm on the floor. When Dan had been up and about for half an hour, the cough seemed to clear, and he’d be fine for the rest of the day.

I started by physically examining Dan. I listened carefully to his chest with my stethoscope. He had the perfect heartbeat of a fit dog, with slow steady sounds and no murmurs or irregularities. His lungs, however, sounded noisier than normal, with some wheezes and crackles. He definitely had some type of lung disease, and further tests were needed.

The following day, Dan was anaesthetised, X-rays were taken, an endoscope was used to directly view the lining of his airways, and finally tiny biopsies were taken of the many red sore areas that we could see. Dr Mullen called in three days later to discuss the full results of our investigations.

“I can say for certain that Dan is suffering from Chronic Bronchitis”, I began. “The initial X-rays suggested that that there was thickening of his lower airways, and using the endoscope, we could see that the thickening was because of inflammation of the lining of the small tubes of the lungs, known as ‘bronchi’. The biopsy of the red, swollen areas confirms that the disease process is simple inflammation, with nothing sinister going on. Finally, he has a mild bacterial infection in his lungs.”

Dr Mullen asked me if an antibiotic would completely cure his dog.

“Although antibiotics will help him, for a complete cure, he needs to go onto long term medication using other drugs. The chronic bronchitis probably started out with a simple infection, but there is now also an irritant and allergic aspect to the disease. The tiny particles of dust, smoke and pollens that are always in the air are perpetuating the bronchitis. We’ll use two drugs to help him. Firstly, a ‘broncho-dilator’, which will widen his airways and lessen the tight narrowing of the bronchi that is making them irritated. Secondly, a low dose of steroids will directly lessen the irritation. We’ll modify his dose of each drug so that he should be able to live a normal, symptom free life without side effects from medication.” There are other options for treatment, including an inhaler mask, but this treatment was my standard first stage.

Dan was sent home with three containers of tablets, and twice-daily medication ritual became part of his routine. I saw him again two weeks later, and the cough had almost completely stopped. He was suffering some side effects from the steroids, with increased thirst and appetite, but we were then able to reduce the dosage, so that he was given tablets only on every second day. When he came back a full month later, Dr Mullen was delighted.

“His cough has vanished completely”, he told me. “And he is enjoying his walks more than ever. The only problem is that he’s wearing me out! Do you know any tonic pills for a fifty-five year old human?”

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