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The story of Dan, a coughing Springer Spaniel

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

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

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

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

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

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

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

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

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

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Oscar, the grumpy cat who needed twice daily injections to treat his diabetes

[caption id="attachment_4489" align="aligncenter" width="585"]Oscar does not tolerate humans who annoy him Oscar does not tolerate humans who annoy him[/caption]

Oscar, a ten year old cat, had started to lose weight, despite the fact that he was eating well. His coat had begun to look bedraggled, as if he was not grooming himself as much as usual. His owner had noticed him visiting his water bowl more frequently, and she had needed to fill up the bowl every day, rather than every three days.

When I examined him it was clear that Oscar had lost a significant amount of weight. His ribs were prominent, and I could feel the sharp tips of the bones of his back. When I weighed him, I discovered that he had lost a kilogram since his previous visit.

Physically, I could find no obvious cause of a problem, so I decided that a blood profile was needed. Fifteen minutes later, the printout from the biochemistry analyser gave me the clear-cut diagnosis of his illness.

Oscar’s blood glucose was around four times higher than normal. The only possible reason for this was the condition known as diabetes mellitus. Oscar’s pancreas had stopped producing the hormone called insulin, and as a result, his blood glucose was not being controlled. Weight loss, ravenous appetite and copious thirst are classical signs of diabetes, in cats just as in humans and dogs.

As I explained the diagnosis to his owner, I could see a worried furrow developing across her brow. I explained that Oscar’s condition was treatable, but that he would need to have a daily injection of insulin for the rest of his life. Her shoulders slumped, and she looked at me sadly. “Nobody would dare to give Oscar an injection”, she told me. “He’d just get so annoyed with us if we tried something like that!”

I reassured her that the injection was given with an ultra-fine needle, and that only a tiny amount of liquid would be needed. For a cat of Oscar’s size, the volume of insulin would probably be around one hundredth of a teaspoonful, which is literally a single drop. It was very likely that he would barely notice the injection.

I demonstrated the injection technique, using a piece of fruit – an orange – as a practice target. It took a few attempts until she had learned to hold the syringe correctly, but soon she was able to insert the needle steadily and firmly into the orange. She was still very anxious about injecting her cat, so we decided that it would be best for her to bring him in to see me for his injection every morning for the first week.

The technique was simple. I gave Oscar a bowl of his favourite food, and as he lowered his head to eat, I quickly slipped the injection into the scruff of his neck. He stopped eating for a moment, and looked suspiciously at me before recommencing his meal. On day three, his owner gave the injection herself, and by day five, she was able to do this quickly and confidently.

After several dose adjustments over a few weeks, Oscar’s blood glucose had returned to normal. At the same time, his owner reported that his excessive thirst had disappeared. It seemed that his diabetes had been controlled.

The success of his treatment was confirmed at his final visit six weeks later. As the cage door was opened, Oscar stepped out in a confident and dignified fashion, with his head held high. He had put on weight, he was grooming himself again, and even his whiskers looked alert and bristling. He was definitely a healthy cat again.

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Kittens with passengers: ear mites

[caption id="attachment_4382" align="aligncenter" width="640"]Ear mites are very common in kittens Ear mites are very common in kittens[/caption] When a litter of rescued kittens were brought to see me recently, a careful examination of their ears was an important part of the check-up. I introduced the tip ofthe auroscope into each kitten’s ear, and by looking through the instrument I was able to see a magnified view of each ear canal. In normal animals, the pale blue-grey of the eardrum itself can often be seen. However, in these kittens, I could hardly see any normal ear canal. My view was blocked completely by thick, brown, sticky earwax. The cause of the excessive ear wax could be seen very clearly. Tiny white wriggling insect-like creatures could be seen swarming around the inside of each ear. The kittens were infected with ear mites. Ear mites are very common in kittens. They are very small mites, each measuring the size of a pin-head. They are very active, and they tend to move away from bright light. When examining an ear with an auroscope, ear mites can often be seen moving quickly out of the field of vision, as if running away from the vet. Ear mites are highly infectious, and they are especially common in feral colonies of cats. The adult mite feeds on the secretions produced by the lining of the ear. Eggs are laid inside the ear. These hatch out into tiny larvae which then mature into adults, and the life cycle continues. If one cat pushes its head against the body of another cat, ear mites can easily be transferred from one to the other. Kittens are obviously in very close contact with their mothers and with each other, so it is very common to find entire litters of kittens affected by dramatic infestations of ear mites. Most of us are familiar with the discomfort of an irritation in the ear, even from something as harmless as a small quantity of water lodging in our ears after swimming. The concept of live, wriggling insects crawling around inside the ear canal is very unpleasant! In many cases, kittens do show dramatic signs, such as repeated scratching of the ears. In other cases, an owner may have noticed the animal shaking their head more than usual,. However some cats, even with severe infestations, show no obvious external signs. Close examination of a kitten’s ears with an auroscope is essential to detect such ‘invisible’ cases. Ear mites can also affect dogs, but they are less common. Fortunately, there is no risk to humans. Those alarming, tiny, wriggly creatures are not going to crawl onto your hand, up your arm and into your own ear. However, if you have a household of dogs and cats, you do need to treat every animal individually to ensure that you have completely eradicated the infestation. Treatment of ear mites is not always easy. The mites are sensitive to most insecticides and a range of drops and ointments are available from your vet. The only complication is that the eggs of the ear mite are resistant to treatment, and these can remain unhatched for up to three weeks. This means that it may be necessary to continue to medicate affected kittens for an entire three week period, to ensure that all eggs have hatched with the resulting larvae being eradicated. Young kittens can be difficult to hold still, and they often learn how to escape from your grasp, so after the first few days of treatment it can become more difficult to continue. I saw the kittens again two weeks after their first visit. They were all in wonderful form, purring, playing with each other, and growing rapidly. Their ears were clean, both inside and out. They were ready for their new homes – with no passengers included!
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Could your cat have high blood pressure?

High blood pressure is a common problem for humans but did you know that cats can get it too? High blood pressure, also known as hypertension, is actually quite common in older cats, especially those with other diseases such as kidney disease or hyperthyroidism. The symptoms can be quite subtle or mimic those of other diseases so many cases remain undetected for quite some time. If left untreated, however, hypertension can lead to significant secondary health problems, so it’s definitely worth testing for. [caption id="attachment_4332" align="alignleft" width="288"]Bob having his blood pressure checked. Bob having his blood pressure checked.[/caption] What exactly is high blood pressure? High blood pressure occurs when the pressure within the blood vessels exceeds a certain threshold. Think of the hosepipe used to water your garden. If you turn the tap on too strongly, the water shoots out of the nozzle uncontrollably, damaging your flowers. The same is true for the body – organs like the brain and kidneys need blood to survive but if the blood pressure gets too high, it can start to damage the very organs it is trying to keep alive. To further complicate things, blood vessels have a tendency to leak under pressure and this extra fluid can cause further problems. How do cats develop high blood pressure? Many things can cause hypertension in cats from certain medications to neurological disease, but the two most common causes are kidney failure and hyperthyroidism. Both of these illnesses cause alterations in the very precise mechanisms that monitor and control blood pressure. It doesn’t always correlate with the severity of the disease (i.e., severe hypertension can be seen with only mild kidney disease) and in the case of hyperthyroidism, we sometimes see hypertension develop only after the thyroid problem has been treated. What are the symptoms of hypertension? The clinical signs associated with high blood pressure depend on which organs are most badly affected. One of the most common signs is acute blindness because the high pressure within the vessels of the eye causes the retina to detach from the nerves that tell the brain what the eye is seeing. So you may notice the cat bumping into things (although it’s amazing how many owners aren’t aware of their cat’s blindness because cats are so good at using their other senses to compensate), staying closer to home or having very dilated pupils or ‘wide eyes’. Another organ that is commonly affected is the brain so you might see serious signs such as circling and seizures or perhaps much more subtle behavioural changes such as crying out at night or being less sociable when people are around (how else would you tell if your cat had a headache?). You may see bleeding in unexpected places like nosebleeds or blood in the urine. It can also speed up the progression of kidney failure. The list goes on so any unexplained physical or behavioural change warrants a blood pressure check, especially in older cats. How is high blood pressure diagnosed? The only way to tell if a cat has high blood pressure is to measure it. The process is much the same as it is in humans – a cuff is inflated around the arm or leg (or possibly the tail) which controls blood flow to the limb. A special device (sometimes a handheld Doppler unit or sometimes an automatic sensor) then measures the blood pressure. It doesn’t hurt and isn’t usually a stressful process that is good because if the cat is stressed the reading can be artificially elevated. Sometimes the cat objects to the cuff being tightened so it can help to practice a few times before taking the reading. Some cats just plain hate going to the vet or any kind of restraint whatsoever so it isn’t always possible to get a reading, although many clinics have special protocols in place to help the cat stay as calm as possible before attempting to take a blood pressure. If all else fails in the clinic, a reading might be possible at home where they are more comfortable. Is there any treatment? Absolutely. There are several medications that can treat high blood pressure but the one that most vets use these days is called amlodipine. A very tiny dose goes a long way, and it’s important that once you start the medication, you give it regularly to avoid dangerous spikes in blood pressure. Once a cat starts the medication (usually a tiny tablet that most cats seem to tolerate relatively well) it’s important to follow up with regular blood pressure checks to ensure that they are on the correct dose. I’ve seen many cats respond very well indeed to treatment and many owners report that their cat seems years younger once their blood pressure is under control, even if they hadn’t noticed any symptoms in the first place. It is yet another example of how well cats can hide their illnesses and how important it is for owners and vets to work together to detect health problems while there is still time to treat them effectively. If you think your cat is showing signs of high blood pressure or if you have an older cat with unexplained physical or behavioural changes, please speak with your vet about having their blood pressure checked. You may never know unless you make an effort to look for it. Amy Bergs DVM MRCVS  - Visit The Cat Doctor website by clicking HERE
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Ask a vet online – is there a test for Leptospirosis?

Berry Wilkinson asked: I was wondering if you can titre test for leptospirosis? Or is it only useful when you are testing sick dogs? Thanks. Answer: Hi Berry, thanks for your question about testing for Leptospirosis. To answer it, I'll briefly discuss Leptospirosis as a disease, then talk about the different diagnostic techniques available. Finally, I'll discuss vaccination and the implications for diagnosis. What is Leptospirosis? Leptospirosis ("Lepto") is a disease caused by bacteria of the genus Leptospira. There are more than 300 strains (technically called serovars) of the bacteria. In the UK, Leptospira icterohaemorrhagiae and L. canicola used to be the most common, but since widespread vaccination against these has started, it is now thought that L. interrogans and L. kirschneri may be more important. The disease is transmitted by body fluids of infected animals, including rats. The symptoms of Leptospirosis in dogs include:
  • Fever and sore muscles.
  • Loss of appetite, vomiting, diarrhoea and dehydration.
  • It may cause kidney or liver failure
  • Sometimes the only symptom is sudden death.
  • Infected dogs may shed the bacteria in their urine for months or years without showing any clinical signs.
  • Leptospirosis is highly zoonotic - i.e. it is a high risk pathogen for infecting humans.
How is Leptospirosis diagnosed? There are four methods to test for Leptospira in clinical samples, of which two are clinically useful. They are:
  • Darkfield microscopy - looking for the bacteria themselves. This is very siple, but is notoriously unreliable, unfortunately!
  • Bacterial culture - attempting to grow the bacteria; however, in many cases the bacteria are very hard to culture, so even in confirmed infections, this test may come back negative.
  • Serology - looking for antibodies produced by the immune system in response to the presence of the bacteria. However, vaccination will often lead to a positive response, and low-positive titres (levels of antibody) may persist for a prolonged period. In addition, the levels of antibodies often won't be significant in the first week of infection.
  • PCR - testing blood (early infection) or urine (later stages of infection or carrier status) for genetic material from the Leptospira bacteria; this is a very sensitive and specific test. However, a negative PCR result doesn't rule out carrier status because the bacteria are only shed intermittently in the urine, and will not be present in the bloodstream; and it can also appear negative in some milder infections.
So how is serology interpreted?
  • The normal screening test for Lepto is an antibody test ("ELISA testing") that gives a simple positive or negative result.
    • If this is negative, then in general either:
      • The dog doesn't have Lepto, or
      • The dog has only been infected in the last week or so.
    • If the result is positive, then:
      • The dog has Lepto, or
      • The dog has had Lepto in the past, or
      • The dog has been vaccinated and still has high levels of circulating antibody.
  • If the ELISA-test is positive; or if the symptoms are suspicious but PCR (genetic) testing is negative, the next phase is to use a different type of antibody testing ("MAT serology") to determine the level of antibodies in the blood (the titre).
    • On a single test:
      • Low titres are most likely to represent vaccination or past infection.
      • Moderate titres may indicate vaccination or infection.
      • High titres usually represent acute infection.
    • However, it is far more useful to carry out paired serology - 2 tests 7-10 days apart:
      • In a genuine infection, the titre would normally be expected to rise by at least four-fold.
      • In chronic infection, or asymptomatic shedding, diagnosis can be really difficult, but a persistent moderate titre that doesn't decay over time is highly suggestive of chronic infection; however, demonstration of the organism's genetic material by PCR in repeated urine samples is often more practical.
What about vaccination?               There are a number of different Leptospirosis vaccines available; most of them cover 2 strains ("bivalent vaccines"), although some now cover 4 ("quadrivalent vaccines"). They are aimed at covering the most common types that cause disease, and there is relatively little cross-protection between strains (so immunity to one strain or serovar won't usually protect against another). The vaccine doesn't necessarily prevent infection, but it should reduce the risk of infection, and it does reduce the severity of clinical disease and shedding (for whichever strains or serovars are covered by that vaccine). There are some commercial tests that claim to determine whether a dog requires vaccination against Leptospira by testing circulating antibodies. This may work in some cases, but it is very limited. There are a number of problems with this approach:
  • 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 appear to utilise other parts of the immune system (cell mediated immunity) and are protected against Lepto even in the absence of significant circulating antibody titres.
  • After vaccination, titres normally drop off over 4-5 months, but protection lasts for 12 months.
As a result, it is wisest to maintain annual vaccination against Leptospirosis, to reduce the risk of infection to your dog and to you. I hope that helps! David Harris BVSc MRCVS
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