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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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A Christmas story from a vet on call & a reminder that if you do have a pet crisis over the holiday, a vet is always there to help

It was Christmas morning. The phone rang at 6.30am. It was the Barrs of Lauder Hill. ' Sorry about this, but we've a heifer stuck calving'. I was in my car within 10 minutes, and carrying out the Caesarian operation to remove the calf within half an hour. The Barrs welcomed me into their farmhouse afterwards for a Christmas breakfast. The calf had been a strong, healthy bull calf, and the farmers were delighted with their Christmas present. We were settling down to enjoy the full glory of a Scottish farmhouse breakfast when my bleeper sounded. It was only 8.30 a.m. and already another emergency had to be dealt with - a calf with bloat 15 miles away, at the Buchanans in Melrose. By lunchtime I had seen a horse with colic, six calves with acute pneumonia, a dairy cow with severe mastitis and a dog with a sudden onset choking cough. The afternoon was just as busy, and I was finally able to sit down with the family at seven in the evening. Two hours later there was another call to another difficult calving. Veterinary surgeons have an obligation to provide a full time emergency service for animals in need of their care, all year round, 24 hours a day. If an animal is in distress, then help is needed - illnesses and accidents do not know that it is Christmas Day. The mixed veterinary practice where I worked in the Scottish Borders was busy - there were six vets. We worked an 'on-duty' roster, with duties shared equally between all of the vets, so at least a hectic Christmas day was only experienced once in six years. And the Christmas Day service was certainly not taken for granted by anybody - everybody who telephoned spent as long apologising for disturbing the vet as they did explaining the problem with their animal. Small animal veterinary practice is less frantic out-of-hours compared to large animal. People tend to stay at home on Christmas Day, so pets are generally safely indoors, curled up by the fireside. There are still unpredictable emergencies - from bitches whelping to dogs having epileptic fits to cats collapsing from kidney failure. In the past decade, many small animal vets have referred their emergency work to dedicated Emergency Clinics, where vets and nurses are employed specially to work all the time during after-hours periods: their “working day” means night time and bank holidays. If you phone your local vet, you will be given clear advice on the arrangements for emergency service. Most vet clinics are closed for routine service on Christmas Day and Boxing Day. This year, the fact that Boxing Day is a Saturday means that the bank holiday is taking place on Monday 28th December, so many vets do not start back with routine clinics until Tuesday 29th December. If you aren't sure whether or not your vet is open, visit their website or Facebook page, or phone the normal clinic number. If you are not transferred directly to the vet on call, there will be an answer machine message giving you details of opening hours. The first day back after Christmas tends to be a busy time, with a build up of cases that have accumulated over the holiday break. There are some typical seasonal cases that we expect to see at this time of year. First, there is the 'turkey tummy syndrome'. People do not like to feel that they are leaving their pets out of the Christmas celebrations. Dogs and cats enjoy eating turkey, and many people make up a Christmas Dinner for their pets, using leftovers from the family celebration. Animals' stomachs are not well adapted to dealing with a sudden flood of an entirely new foodstuff, and the consequences are often a severe tummy upset soon after Christmas. Second, there is the 'Walking It Off' syndrome. Many people feel an urge to expend some energy after Christmas Day - so what better way to do this than taking the dog for a walk. The result is that hundreds of dogs congregate in popular dog walking areas. Inevitably there are the usual incidents, such as dog fights, dogs lacerated by sharp objects in rivers and animals involved in road accidents. Public holidays can be busy times for vets. The important message to remember is that if you do have an animal in real distress, your vet is never closed. And if the vet has to do a house call on Christmas or Boxing Day morning, a Christmas breakfast will always be appreciated! For peace of mind over the holiday period, if you are not sure whether your pet needs a visit to a vet, the Symptom Checker can also help!
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Grapes and raisins can kill dogs. Read this to find out how to keep your pet safe this Christmas.

Does your dog enjoy mince pies and Christmas cake? Beware: you could accidentally poison them.

For many people, it seems unbelievable that grapes and raisins can poison dogs. They're harmless to humans. We've all seen dogs occasionally eating foods containing raisins with no apparent ill effects. How can they suddenly be poisonous?

Why are grapes and raisins not always poisonous to dogs, and never poisonous to humans? First, like all poisons, the poisonous effect depends on the dose taken per kilogram of animal body weight. Large dogs can safely eat some raisins without problems. Secondly, the toxic ingredient in raisins seems only to be present intermittently, so a dog may eat raisins without problems on several occasions, then fall seriously ill the next time. What is the toxic ingredient in grapes and raisins? The actual toxic ingredient is still a mystery. The fact that grapes and raisins can be poisonous has only been deduced by circumstantial evidence, with many dogs developing acute renal failure for no obvious reason, with the only common factor being the previous ingestion of grapes or raisins. Samples of the fruit in such cases has been analysed, but a toxic agent has not yet been isolated. The best guess so far is that it is a water-soluble substance, and that it's in the flesh of the grape/raisin, but not the seed. One theory is that it is a mycotoxin (i.e. a poison produced by moulds or fungi on the grapes). The problem in dogs was first highlighted after a year with high levels of rainfall. This had led to damp grapes which were more likely to develop fungal growth. But why should humans be safe from this toxin? It's well known that cultured dog kidney cells in the laboratory are exquisitely sensitive to other types of mycotoxins. It makes logical sense that dog kidneys might also be more sensitive to damage by another mycotoxin, even its identity has yet to be established. So how much do owners need to worry about grape/raisin toxicity? If a terrier steals a mince pie, is a visit to the vet needed? If a Labrador has a slice of Christmas cake, do they need to be taken to the emergency vet? This is always a judgment that is not black and white. It seems sensible to look at the lowest recorded doses of grapes or raisins linked to acute renal failure in previous cases of poisoned dogs. This allows an estimate of the probable toxic dose depending on the animal's body weight. Grapes The lowest toxic dose is around 20g grapes per one kilogram of body weight. A typical grape weighs 2 – 5g, making a toxic dose is around 4 grapes per kg. So if a 5kg terrier eats 20 grapes, or a 30kg Labrador eats 120 grapes, there's a high chance of a serious problem, and veterinary intervention is definitely indicated. Raisins The lowest poisonous dose in confirmed cases has been around 3g/kg. An average raisin weighs around 0.5g, making a toxic dose approximately 6 raisins per kg. So if a 5kg terrier eats 30 raisins, or a 30kg Labrador eats 120 raisinsthey need to see the vet. Some studies have suggested that the toxic agent is neutralised by cooking, so cooked raisins (e.g. in pies and cakes) may not present such a high risk.

Important note

Please remember that the above doses mention quantities that have definitely caused serious kidney failure in the past. The decision on whether or not to take a pet to the vet is a personal decision, taken after balancing the possible risks. Many people prefer to take a conservative approach, to be as safe as possible. For example, if a dog has eaten even half of the above quantities, it may be safer to take them to the vet for “just in case” treatment.

What do vets do for dog that have eaten grapes/ raisins? 1) If ingestion has happened in the previous hour. This is the ideal situation: the vet can give an injection to cause the pet to vomit, emptying the stomach and removing the grapes/raisins before any toxic ingredients have had a chance to be absorbed into the bloodstream. 2) If ingestion has happened in the previous two days but the pet is still well Depending on the situation, vomiting may still be induced, activated charcoal may be given to limit absorption of the toxin, and intravenous fluids may be given to flush fluids through the kidneys in an attempt to minimise any damage. Blood and urine tests may be recommended to monitor kidney function. If the dog is well after three days, then the high risk period is over. 3) If ingestion has happened and the dog is unwell (e.g. vomiting, dull, inappetant) In such cases, the kidneys may have already been damaged by the toxin. Urine and blood tests will be carried out to assess the severity of the damage to the kidneys, and intensive care will be needed to save the pet's life, including high levels of intravenous fluids. The prognosis is guarded: unfortunately, some affected dogs die, despite the vet's best efforts.  Conclusion.
  • Keep grapes and raisins away from dogs.
  • If any dog eats them accidentally, phone your local vet (even if it's after-hours)
  • Tell your vet how many grapes/raisins were eaten along with the body weight of your pet.
  • Your vet will then advise you on the safest course of action.
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Rabbits are not like small dogs or long-eared cats. And it’s not just that they eat grass.

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When something goes wrong with an animal's nervous system, it's very upsetting, and it's easy to panic. People often make generalisations, and leap to the wrong conclusion. He's falling over! He's had a stroke! He's dragging his back legs! To help animals, it's important for vets to be as objective as possible, making a careful note of precisely which part of the nervous system has gone wrong. Vets do this using a specific examination procedure, known as the “neurological examination”. There are tick sheets available to make it easier for vets: various aspects of the nervous system are examined individually, and at the end, it's then easier to be specific about the precise diagnosis. Only then can the correct treatment and prognosis be given. At last week's London Vet Show, there was a fascinating lecture, sponsored by Supreme Pet Foods, which dealt with the subject of neurological examinations in rabbits. As many rabbit owners will know, diseases of the nervous system are common. However rabbits are very different creatures to dogs and cats: they are prey animals rather than predators, and as a consequence, their nervous system doesn't always behave in the same way. Rabbits are especially sensitive to stress, and they tend to mask their fear by staying still. Anyone who has examined rabbits will know this: they tend to stay very passive until the fear is too much, and then they panic explosively, trying to jump out of your arms. This type of temperament means that rabbits react differently when their nervous system is examined. The lecturer carried out a field study, during which she made a careful comparison of a standard neurological examination in rabbits compared to other pets, and she came up with some useful tips. First, she listed the four main types of disease of the nervous system seen in rabbits: head tilt, weakness or paralysis of the back legs (or all four legs), seizures (fitting) and “miscellaneous” (muscle weakness, strange gaits, blindness and other oddities). There's a long list of possible causes of these problems, from brain diseases (including a common fungal parasite called Encephalitozoon cuniculi), to viral and bacterial infections, to spinal problems (including broken backs and slipped discs), to heat stroke, metabolic disorders and many others. In all cases, whatever the cause, the neurological examination is a key to whittling down the list of possibilities. So how are rabbits different to dogs and cats? First and most importantly, rabbits don't show a pain response in the same way. With dogs and cats, it's easy to tell if they can feel their toes by squeezing them: if sensation is normal, they pull their foot away from you. Rabbits often don't do this: they stay utterly still, however hard you squeeze their toes. It doesn't mean they aren't feeling it: they just don't react because in the wild, it makes more sense to “play dead” in the hope that the creature that's hurting you will just go away. Secondly, some of their reflexes are exaggerated. If you tap a dog's knee with a rubber hammer, there's a similar type of small “kick” reflex to a human. In rabbits, the same test elicits a sharp, exaggerated kick, perhaps reflecting the wound up stressed nervous system of the rabbit. If a dog had a reflex kick like this, you'd think there was something strange wrong with them: it's normal in a rabbit. Third, some of their reflexes are diminished or absent: for example, rabbits don't have a “menace” reflex (if you wave your hand towards a dog's eye as if you are about to hit them, they blink automatically, like humans: this is the menace reflex. Rabbits don't do this). Other reflexes in rabbits' eyes are also different: their pupils don't always narrow and widen in the same way as other creatures.  There are two sets of take home messages here. First, if you're a vet, remember to expect different results from other pets when you're assessing rabbits with neurological problems. And second, if you're a rabbit owner, remember to take your pet to a vet with an interest in rabbits: all vets are trained in the essentials of rabbit medicine, but when it comes to complex disease, the more rabbits that a vet sees, the better they will be at rabbit-specific subtleties like neurological examinations.    
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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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