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

Let’s start with the facts about the cats with TB, as reported in the Vet Record: perhaps surprisingly, these have not been published in full in any of the mass media outlets in the past two days:
BETWEEN December 2012 and March 2013, a veterinary practice in Newbury (west Berkshire) diagnosed nine cases of Mycobacterium bovis infection in domestic cats. In seven of those cases the diagnosis was confirmed by bacteriological culture. The nine affected cats belonged to different households and six of them resided within a 250 metre radius. The animals presented with mycobacterial disease of variable severity including anorexia, non-healing or discharging infected wounds, evidence of pneumonia and different degrees of lymphadenopathy. The latest information is that six of the cats have been euthanased or have died. The three surviving animals are undergoing treatment and are reported to be responding. At the time of writing, no new cases had been detected in local cats since March 2013.

The newspapers have missed this aspect of the story, and focussed entirely on the fact that the disease, for the first time, seems to have been passed on to two humans who had been in contact with one of the cats. The humans have responded well to treatment……..

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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 …

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