The unnecessary death of the Ebola dog

Ebola virus hysteria is taking hold of the northern hemisphere. The latest victim was a cross-bred dog called Excalibur, who was euthanased by the Spanish authorities even though he showed no signs of being infected with the virus, and despite the fact that there is no evidence that dogs can transmit Ebola to humans.

The twelve year old rescued dog had the misfortune to belong to a Spanish nurse who became the first person to become infected with Ebola in Europe after nursing a Spanish missionary priest who had been repatriated from Sierra Leone to Madrid for intensive treatment. The priest died of the virus on September 25th,, and the nurse is thought to have picked up the virus after touching her face with a contaminated glove as she removed her protective suit after finishing her shift.

Excalibur was a much loved pet in perfect health, and after Madrid’s regional government obtained a court order to euthanase him, the nurse’s husband put out a call for his life to be saved. An online  petition rapidly gathered over 400000 signatures, and crowds of angry animal-loving protestors had to be restrained by police outside the apartment where the dog lived. Despite the protests, Excalibur was euthanased. The deed has been done. But was it really necessary? Did the animal present a risk, or was he just a scapegoat sacrificed to give the authorities a sense that they were doing something?

There is scanty evidence to support killing a dog in a situation like this. Bats are thought to be the natural reservoir for the Ebola virus in central Africa, carrying the virus without showing signs of illness. Monkeys and apes become infected and fall seriously ill, like humans. But despite extensive research, there’s been almost no evidence of other animals becoming infected or carrying the virus.

There is one study that casts a cloud over the innocence of dogs: researchers investigating the 2001-2002 outbreak of Ebola in Gabon found low levels of antibodies in blood samples from dogs in areas where there had been cases of Ebola in humans and apes. This confirmed that the dogs had been infected with the virus, but it was impossible to know the source of their contact: from bats, apes, or from humans? It was also not possible to determine whether the dogs could have been infectious to humans at some point. In theory, the fact that they had been infected with the virus implies that at some point they may have shed the virus in their secretions, in the same way as infected humans pass on the infection.

Some researchers believe that it would have been wiser to have kept Excalibur alive, not for sentimental reasons, but to learn more about the spread of the disease. If he had been kept in quarantine, serial blood samples could have been taken, monitoring his immune status. The question of whether or not dogs need to be included in Ebola virus control schemes could have been definitively answered in a safe environment. And if he had been clear of any sign of the virus after several months, he could have been released from quarantine to resume a normal happy doggy life.

Sorry, Excalibur: the precautionary principle and the political need for action seized the initiative: we still don’t know much about Ebola in dogs, and you’ll never enjoy another happy walk with your owners.…

Are vets more interested in the health of their patients or the money in their pockets?

I recently wrote a blog here titled “Debunking myths about “rip off” veterinary fees”, and since then, the subject of money has continued to be one of the banes of my life as a vet in practice.

My aim in life is to do a job that I enjoy, and to be paid a reasonable salary: for most people, that just means that you go to work, do your stuff, and come home at the end of each day. For vets, it’s different: every day, as part of our job, we need to ask people to give us money. Most of us would be delighted if this discomfitting task was taken away from us, but unfortunately, it’s an unavoidable part of our job description.

One recent case provided a good example of the type of daily dilemma that faces vets. An elderly terrier, Sam, had a small benign tumour on his flank. He was fourteen years of age, and his owner had been hoping that we might be able to leave the tumour alone: it’d be better to avoid a general anaesthetic unless it was absolutely necessary. When the tumour began to ooze blood, and Sam began to lick it a lot, we couldn’t leave it any longer so he was booked in for surgery. When booking the operation, I mentioned to his owner that it would be wise to take the opportunity to clean up his teeth, which were caked in tartar. And I gave a detailed estimate of the expected costs.

We took all the usual precautions to ensure Sam’s safety. He had a detailed clinical examination and pre-anaesthetic blood tests to ensure that he had no underlying illnesses that could make an anaesthetic risky. An intravenous line was set up to give him continual fluids during the procedure and to give us instant access to a vein if any emergency treatment became necessary. And a vet nurse was designated to hold his paw and to monitor him for every second of his time under anaesthesia, from induction until he was sitting up at the end.

Everything went well: the tumour shelled out quickly and easily, and a line of sutures closed the wound. I carried out a thorough descale and polish of his teeth, as planned. But it was then that the dilemma arose: beneath the tartar covering his teeth, it turned out that two of his molar teeth had large diseased areas. The gum margins had recessed, exposing large parts of the tooth roots. One of the teeth had serious infection, causing the tooth to be loose: it was easily removed. The other molar tooth was more complicated: one root was seriously diseased, but the other two roots were healthy. The tooth needed to be extracted, but it would be a tedious, time consuming surgical extraction, taking over half an hour, and requiring follow up x-rays to ensure that it had been done properly. This would involve an extra cost to the owner of well over £100. I had already given an estimate, and I didn’t feel that I could go ahead with this without permission.

While Sam was still anaesthetised, I asked a nurse to phone his owner to explain the situation. There was no answer on the home line, and the mobile number wasn’t working. What should I do now?

If I went ahead, I’d be carrying out unauthorised work on someone’s pet. If there were any unexpected complications, the owner could hold me liable. And as for the extra cost? Could the owner justifiably refuse to pay?

The safest legal approach would be to make a note of what needed to be done, and then to inform Sam’s owner that he needed a follow up anaesthetic in a few weeks, during which we’d tackle his dental issues. But I knew that it would be far safer for Sam to have the entire procedure completed during this first anaesthetic, and I knew that his owner would be unlikely to agree to pay for a second anaesthetic on top of this first one. So Sam’s dental issues would probably not be treated, and he would suffer as a consequence.

I made an “on the hoof” decision to go ahead with the dental procedure. It took even longer than I had anticipated, and I had to take a series of x-rays rather than just one. By the end, I was happy that Sam had been given the best treatment, but I was nervous about the owner’s response. Would she think that I had done this just as a way of extracting more money from her? What if she genuinely couldn’t afford more than the estimate that I had given her?

I felt so uncomfortable about the situation that I gave a significant discount on the extra work that I had done. Effectively, I ended up working my lunch hour for nothing because I felt so awkward about it.

But what else could I have done? In the interest of the dog, I could not have left painful, diseased teeth untreated.

What would pet owners feel if the vet presented them with a situation like this? Should you pay the full amount of justifiable extra work if it is unauthorised?  Do you trust your vet? Or do you feel that we are working more for our own interests than for the benefit of your pet?

 …

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:
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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.
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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……..

A vet in Delhi day 7: summary and conclusion

I’ve spent my final day in the slum and it’s time to draw it all together and reach some conclusions. What’s it all been about, what have I achieved, and what’s going to happen next?

First, to explain: the rationale behind my work has primarily been human health. It’s shocking that rabies is still a major killer in India, despite the fact that it’s completely preventable. If 70% of the street dogs in an area are vaccinated, the disease dwindles and disappears to insignificant levels. Surely this is a goal that is achievable?

The current estimated incidence in India of around 3 deaths per 100000 people per year means that over 20000 people, mostly children, die unnecessarily every year. In a slum like Mayapuri, with a population of 12000, there’s probably around one death every three years. Feedback from my questionnaire suggested that this may be close to the truth. Rabies is common enough to be a constant threat, but rare enough that it’s easy for people to forget about it. Yet it is such an horrific, unnecessary death that everything possible must be done to prevent even one fatality.

ASHA deals effectively with many health and welfare issues in the slums, vaccinating children with BCG, MMR, Hepatitis, Tetanus and Polio: before ASHA arrived 15 years ago, no babies were being vaccinated – the uptake is now 100%.  ASHA also treats adults for TB under the DOTS programme, and offers a range of birth control methods.

There’s no doubt that the charity’s work has transformed the lives of the slum dwellers. But what about rabies? When I asked this question last year, it seemed that it was a bit of a grey area: ASHA is so busy with other priorities that it’s easy for rabies to slip under the radar. When I discovered this, I felt that there was an opportunity for me to use my background as a vet to look into the issue when visiting the slum with a group of volunteers from my local church.

Mission Rabies – who are already in the process of vaccinating millions of dogs around India – do not have an immediate plan to focus on the Delhi area, but they were exceptionally helpful in assisting me with this project. They drafted a questionnaire for me to use while here, and they advised me on important aspects such as informed consent and male/female interpreters.

So what did I discover? Well, I found out how difficult it is to do social research. I had thought I might gather several hundred questionnaires over 3 days, but the process took longer than I had expected: up to 15 minutes for each interview via an interpreter, then time spent seeking out the next candidate. I ended up with just 40 completed questionnaires: not as many as I’d have liked, not enough to be significant in a formal sense, but still perhaps enough to gather valuable feedback about the subject.

What did I learn?

First, I discovered some interesting socioeconomic facts.

  • 75% of households live in just one room, shared between an average of four people: no kitchen, no bathroom, no hot water
  • 95% of slum dwellers own a mobile phone
  • 90% own a television
  • 65% own a bicycle.

Second, I discovered that street dogs are a significant part of the slum community, with an average estimate of one dog per 17 humans (the range was one per 5 to one per 20 people). The only way to get a more accurate figure would be to do a detailed dog census, which would be a major logistical challenge in itself, but the estimates are enough to make the point that there is a substantial population of dogs..

While only 15% of people said that they “owned” a dog, 57.5% said that they feed local dogs at least once a week. This ties in with the reported attitudes to dogs: 40||% said that they “liked” dogs, 15% were indifferent t while 45% of interviewees said that they “did not like dogs” (presumably the latter never feed them).

Third, I investigated the local people’s knowledge about rabies. I found a low level of awareness of the disease. 80% of respondents had not heard of rabies, and only half of the 20% who said that they had heard of rabies were able to explain the disease to someone else. Some people thought that rabies would make them “bark like a dog”. Furthermore, only 45% of people thought a dog bite could be fatal, with 55% of people disbelieving this. There’s clearly a need for community education about rabies in order to prevent future cases.

More positively, despite the lack of knowledge about rabies, 90% of people would go to hospital if bitten by a dog (where they would be given the post-exposure rabies vaccination). As well as doing this, some people would take other action, including putting red chilli powder on the wound, and resorting to “witchcraft”. The 10% who “did not know what to do” if they were bitten by a dog are worrying: they would be very vulnerable to developing clinical rabies if bitten.

What’s going to happen next?

If nothing is done, nothing will happen. The situation will remain the same, and people will continue to die of rabies at a rate of around one person every three years.

Clearly this cannot be allowed to happen.

ASHA already have an effective network of community health volunteers on the ground, keeping an eye on the health of inhabitants in their local area, and passing on information to them about health and disease using handouts and flash cards. On my last day in the slum, ASHA kindly arranged for me to give a presentation to a dozen community health volunteers from Mayapuri and another nearby slum. I was able to pass on the initial results of my survey, and to discuss the challenge of rabies awareness with them. I …

Caring for the older cat (part 1) – helping your feline friend through old age

Sammy is 12 years old. That is a respectable age for a cat, so I was very happy to hear from his owner that he was still very well in himself and she had no concerns at all. The purpose of my visit was a routine health check and vaccination and based on Sammy’s good report, I was expecting to issue him with a clean bill of health. However as I began to collect a thorough history, it became apparent that things were not as simple as they had first appeared. ‘Now that you mention it, Sammy HAS been drinking more than he used to, but I thought that was normal for older cats so I didn’t think twice.’ He had also had a great appetite lately, in fact he’d been eating an extra pouch a day, and he had been more talkative lately. All things that his owner had associated with good health but could actually be signs of illness. On physical exam it turned out he had lost some weight and muscle mass, and that he had a lump under his neck. A blood test was recommended and the results confirmed hyperthyroidism. He was started on medication and is now back to his normal self, his owner couldn’t believe the difference! She was surprised how the changes had happened so gradually that she didn’t notice them, but was very happy to have her old cat back. And Sammy certainly agreed…..

Ask a vet online – ‘my dog only has one testicle down – what is the best age to have him neutered?’

Question from Pam Gilmour

Hi my chi(huahua) is 6 months , he only has one testicle. I will be having him done, what would be the best age to wait to see if it will come down?

Answer from Shanika (online vet)

Hi Pam and thank you for your Question regarding the best age to have a dog castrated which has a retained testicle.

I will start by explaining a little about the testicles, what they are, where they develop and what can go wrong along the way.

The testicles are two oval shaped structures normally found in the scrotum (loose sac of skin near your dog’s bottom). Testicles are male sexual glands and produce the hormone testosterone along with sperm and various other secretions which assist in reproduction.

The testicles start developing while the puppy is inside the mother’s uterus (womb); they are at first located inside the abdomen (tummy) and just behind the kidneys. A few days after your puppy has been born the testicles should be in the scrotum, they travel from their starting point down through the abdomen and through an opening called the inguinal ring in order to get to the scrotum….

Ireland is living in the past: it’s about to become legal for members of public to dock puppies’ tails.

Tail docking is a illogical, nonsensical form of puppy torture, and it looks set to become legal in Ireland.  The procedure is brutal: a pair of scissors, a sharp knife or a tight ring are used to chop off a young puppy’s tail. There is no anaesthetic, and it clearly hurts a lot (they squeal loudly), but the pups are too small and helpless to do anything about it. The pup above was brought to me for treatment after the amateur tail docking job had resulted in a chronic non-healing wound.

Tail docking has been banned in the UK since 2007: it’s completely illegal in Scotland, and in England and Wales, it’s only allowed for a small number of working dogs or when the procedure is needed for medical purposes under theAnimal Welfare Act 2006 or the Welfare of Animals Act (Northern Ireland) 2011. It’s also illegal to show dogs that had their tails docked after 2007.  The subject has been debated in detail elsewhere, but the evidence is clear: tail docking causes pain to puppies, and it does not reduce the incidence of tail injuries in adult dogs, even in working animals.

Is your dog a stinker? – why your dog might be smelly!

All dogs smell, anyone who owns one knows that but there is a difference between ‘Eau de wet dog’ and a proper SMELL. Sometimes these can creep up on us unawares and it’s only after some time away from your pet or when visitors come and politely, but firmly, distance themselves from your pooch do you notice and other times they can appear overnight. However, like any other change in your pets behaviour or health, they should always be taken seriously.

So, what could cause your dog to smell (worse than usual!) and when should you worry? Lets look at our pets, if you will excuse the pun, nose to tail;

Ears

Ear infections are common in dogs, especially breeds with floppy, furry appendages, but any dog can develop odourous, painful problems. They will often shake their heads, scratch at their ears and when you inspect under the ear flap you usually find a discharge, which can vary from a thick, black waxy to a creamy pus-like consistency, red, sore skin and quite a stink! Any dog with these symptoms should be taken to a vet as soon as possible. Ear infections left to fester can cause permanent damage and will be very sore for your pet….

Fireworks in the equine world! – How to keep your horse safe this Bonfire Night

This year, 5th November is on a Tuesday – and that means we’re not expecting a Fireworks Night so much as a Fireworks Week!

As prey animals, horses are by their very nature predisposed to panic at loud noises, especially in the dark. Bright flashes of light don’t help either! And panicked horses are rather inclined to run into things and hurt themselves (I’ve spent many hours stitching up horses who have lost arguments with fences, hedges, gates and stable walls).

There are three important elements to keeping horses safe when there are fireworks in the air:

1) Help them to avoid injury

2) Distract them

3) Keep them calm

To avoid injury, I generally recommend that horses be stabled when fireworks are expected. That probably means dusk to dawn for the next fortnight or so, but if possible, find out when displays are expected in your area. You can then focus on those dates and times (but don’t forget that many people will set off a few rockets for themselves and their families). Inside their stables, horses can still become frightened, but they’re not surrounded by the scary noises, and they can’t bolt and get up so much speed, so they’re less likely to cause themselves serious injuries….

Do you want a young version of your elderly dog? Dog clones are now available in the UK

Clones- precise genetic copies of living creatures – used to be the stuff of science fiction. They are now a reality: a South Korean company has just launched its dog cloning service in the UK. For £63000, they will create a carbon-copy of your pet, either from a biopsy of a living dog, or from tissue harvested from a recently deceased animal.

If you cannot afford this, one lucky owner is being offered a genetic replica of their dog for free. An online competition is currently underway, and the entire process, from start to finish, will be filmed for a Channel 4 documentary which will be shown next year.

Animal clones have been a reality since Dolly the sheep was cloned back in 1996. The first cloned puppy was produced in 2005, and over 200 cloned dogs have now been created.

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