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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 Whippy’s broken leg (including a course of hydrotherapy) while fellow presenter Justin Webb admitted that it had cost £5000 to save the life of his dog Toffee after he’d swallowed a sock.
In both cases, the costs had been covered by insurance (as it is for around half of British pet owners), but the incidents provoked a debate about the size of vets’ bills, and the ethical dilemma about how much should be spent on treating pets.
As Davis put it: “When we got the dog, I thought… he’s like a watch – if the repair is going to cost more than the new one – he cost £500 … then you basically throw the dog away and replace it with a new one. But of course, once you’ve got the dog, you don’t think that way”. The presenters then discussed how much they’d be prepared to spend of their own money if their pets weren’t insured, and Davis summed his view up neatly: “If you compare the dog’s leg to the life of a small child in a poor country, obviously the child prevails. But if you compare the dog’s leg to a holiday, I would pay for the dog’s leg any day.”
I suspect that most pet owners would share this view. Dogs become part of the family, worthy of significant sacrifices in our personal lives.
Davis then came up with an interesting idea: just as the National Health Service has the National Institute for Care Excellence (NICE) providing national guidance and advice to improve health care, why isn’t there a pet equivalent – perhaps a Veterinary Institute for Clinical Excellence (VICE). The presenters pointed out that there is a financial temptation for vets towards to do unethical treatments at huge costs, extending the life by not very much, possibly causing suffering. So should there be some way of countering this temptation? Should there be some guidance body to make judgements on how far it is right to go?
The problem, of course, is that every case is individual. And the wisdom of proceeding with a case can only be judged properly with the benefit of hindsight, when it’s all over.

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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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Growling terriers: a challenge for the vets who have to try to help them

When I first met Jacko, he growled at me. I had gone out to the waiting room to see who was next. Mr Malone, Jacko’s owner, smiled and said ‘Hello.’ I bent down to greet the little terrier dog, and that is when the growl started. It was a deep, throaty growl, and as I looked into his eyes, I could see no sign of friendliness. I realised at once that this was not a frightened growl. It was an angry, belligerent, trouble-seeking growl. His dilated pupils and flattened ears told me that he wanted to attack. He was keen to have a fight with me. I took two steps back, but the growl did not stop. Instead it grew louder.

On that occasion, Jacko was simply having his annual health check and vaccination. I had the advantage of being in control. and he did not know what to expect. He was walked swiftly into the consulting room and the door was shut behind him. A rapidly applied muzzle took him by surprise, and before he realised that he had been hoodwinked, he had been checked all over, injected and released. As his owner led him out of the consulting room, Jacko kept glancing back at me, as if he was imprinting my image in his memory for future reference.

One month later, Mr Malone was on the phone, in a panic. He had been out for a walk with Jacko, and two big collie dogs had approached them. The dogs had been friendly enough, but Jacko, with his usual impetuosity, had flung himself at the dogs, snarling and growling. The dogs reacted with defensive aggression, and one of them had picked Jacko up by the back of his neck and shaken him. The dog fight had lasted no more than half a minute, and there were no other injuries, but Jacko was now looking very sorry for himself.

When he arrived at the clinic shortly later, Jacko was dripping blood from injuries around his shoulders, and he was breathing very rapidly. It looked as if he might have serious injuries to his chest, with the risk of his lungs been punctured. Yet he still managed to growl as soon as he saw me.

He needed urgent medical treatment, and a full examination was essential. so a swift injection of sedative was the first stage. Jacko was soon deeply asleep. His breathing was comfortable, but he was not moving otherwise. Working quickly, a nurse helped me to clip away the fur from his injuries. There were several deep puncture wounds on both sides of his chest, and there was a large firm swelling beneath one wound. We took some X-rays of his chest, expecting broken ribs and possibly damaged internal organs.

Surprisingly, the X-rays showed that Jacko had escaped serious injury. He was simply very badly bruised, with torn skin and lacerated muscles. Treatment was simple. We flushed the bite wounds to minimise any infection, and he was given a course of antibiotics and strong painkillers. He was then placed back into the kennel for recovery.

We did not need to look at him to monitor his breathing for long, because as soon as the growl started again, we could hear from a distance that he was alive and ready for action.

Jacko has been healthy since that incident. He still comes back once a year for his annual health check. He is the same as ever, although the dog fight episode did change him in one way. Instead of just growling, Jacko has started to howl as soon as he enters our waiting room.…

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What makes dogs lame, and how can they be helped?

Why is a lame dog lame? The obvious, but incorrect, answer to the question is ‘because it has a sore leg’. The correct answer is more complicated, but also quite obvious when you think about it.

Firstly, what is a lameness? Everybody knows what a lame animal looks like – they ‘walk wrongly’. But what is happening to make them walk wrongly? There are three main reasons why lameness may occur.

Pain is the most common and most important cause of lameness. If an animal damages a limb, any further pressure causes more pain, and so the instinctive response is to rest the limb, by carrying it, or at least by not putting full weight on it. The type of damage can vary widely from a bruise to a laceration. The damage can be anywhere in the limb, from the toe to the shoulder or hip, and the result is the same – a lame animal. Long term diseases such as arthritis can also involve considerable pain.

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Pet food: what does the label tell you, and how much does it matter to your pet?

Do you ever wonder what actually goes into pet food? Everyone with a pet has to provide food for them every day, but most of us are unaware of the background to what we are feeding. That’s not to say that we don’t care about it: pet food manufacturers know that we want to do the best for our pets, so labelling and packaging tends to give a sense of wholesome ingredients and tastiness. But what’s going on behind the scenes?

There’s an anti-corporate trend in the modern online world, with an underlying emotion of distrust in big companies. While this may sometimes be justified, the truth is that most companies are just bigger versions of small businesses, doing their best to provide products and services in an efficient, effective way. Pet food companies are no different: while some pet owners may dislike the idea of mass produced pet food, it’s still the method that most pet owners use to feed their pets, and for the most part, it works very well. Pet food production is regulated by law to ensure that it’s safe and nutritious. Recent research showed that 70% of owners and 85% of vets agreed that commercially prepared pet food provides optimum nutrition. Almost 60% of owners and 95% vets would go as far as to say pets are living longer as a result of advanced nutrition. Of course there are individual animals that have special nutritional needs, just as some humans do. But for most pets, commercial pet food does a good job.

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Murder mystery after Crufts: what to do when malicious poisoning is suspected as the cause of death

It’s rare for the death of a dog to make international headlines. Jagger was a good-looking three year old Irish Setter who died on Friday, just hours after returning from Crufts, where he had won a prize for being second in his class. The reason for the interest from the mass media is this: Jagger’s owner claims that his death was caused by deliberate poisoning.

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Best UK Vets 2015

With only two weeks until the Best UK Vets Award 2015, we would like to encourage you to write a short review for your vet. Good honest reviews are an excellent way to help pet owners find the best local vet. They also show your vet what you value about their practice!

Best UK Vet 2013 - VetHelpDirect

On 10th February 2015, the Award organisers, VetHelpDirect.com, will evaluate the thousands of reviews left on all vet sites using their directory and the winning practice will be the most well reviewed practice over the last year.

If your vet wins, not only will it be an amazing honour, but they will benefit from an award ceremony at the practice to thank them for all their hard work. There’s still plenty of time to help your practice win so get reviewing!

To find your vet and leave a review search for the practice on our sister site Any-UK-Vet or here on VetHelpDirect

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Ebola seems to be dwindling, but look out: Avian Flu is back!

Just as the news headlines about Ebola have dampened down from boiling to a quiet simmer, Avian Flu has leapt back into the news. The Telegraph headline today sums up the media reporting: “Bird flu strain which can be passed to humans detected in Holland”. Meanwhile, even closer to home, the BBC reports that a case of bird flu has been confirmed at a duck breeding farm in East Yorkshire. The ducks are being slaughtered and a 10km (6 mile) exclusion zone is in place. It all sounds as if an apocalypse along the lines of the “Contagious” movie has landed in Europe, but the truth is far less exciting. Avian Flu is a viral disease that is highly infectious between birds. This is the single fact that needs to be stressed more than anything else. It is a bird disease, and the risk to humans is minimal.

The strain of avian flu that is in the news is similar as the one which was first seen in Hong Kong in 1997, and has been appearing spasmodically ever since. That one was known as H5N1(H-five-N-one), a name that describes the type of proteins on the virus particles. The Netherlands strain is the H5N8. The strain in Yorkshire has been identified as an H5 strain but further details are not yet available. It is true that humans can be infected by such strains of the virus, but the risk of this is so small as to be almost negligible.
Hundreds of millions of birds have died because the disease spreads rapidly from bird to bird, and because authorities react to viral outbreaks by carrying out mass slaughtering of poultry flocks in an attempt to eliminate the virus. When humans have been infected, the virus has not spread from person to person. It has remained as a bird virus only, with humans only occasionally getting in the way, usually when they are working in close proximity to infected birds when they inhale viral particles. If Avian Flu reached the UK, everyone working with poultry would know to be ultra-careful about hygiene, so the risk of humans dying of bird flu would be minimal. There is no such thing as a human pandemic of bird flu.
Readers may then wonder why there seems to be a type of hysteria around Avian Flu. The reason for this is the potential for a change in the virus which could indeed lead to a human pandemic. The avian virus could mutate into a new strain of virus that is highly infectious to humans. If this happened, the new Human Flu virus would spread across the world rapidly. This is what happened in 1918, when 50 million people worldwide died in a flu pandemic and the authorities are justifiably concerned about the risk of a repeat of this.

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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.…

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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?

 …

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