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Ask a vet online –‘after the vet said she had gone she gave out a cry and her body jolted’

Question from Diane Stirk: I had to have my little blind girl put to sleep Friday, she was 13 and had all symptoms off dementia, but after the vet said she had gone she gave out a cry and her body jolted, y did she do this does it mean she wasn't gone, I'm heatbrocken over this, Answer from Shanika Winters: Hi Diane firstly I am very sorry that you recently lost your pet, having a much loved pet put to sleep is always a very difficult decision.  I will try and explain what happens when a pet is put to sleep and to explain what can happen afterwards.  I hope that this can help to ease your upset over what happened with your pet. The reason we call euthanasia of a pet putting them to sleep is because your pet is actually given a very high dose of anaesthetic (drugs which are normally used to bring us to sleep for an operation).  The dose of anaesthetic given will cause your pet’s heart to stop beating; they will also stop breathing which results in them passing away. The anaesthetic drug is usually given by an injection directly into your pet’s blood stream.  With cat and dogs the injection is usually given into a vein on one of the front legs.  A small area of fur is first clipped away, the skin is then cleaned, and your pet’s leg will be supported by an assistant to enable your vet to put the injection into your pet’s vein.   You are still able to hold or hug your pet while the injection is being given if you want to.  In the case of rabbits the injection is often given into a vein on the ear, some smaller pets are given anaesthetic gas first followed by an injection. In some cases if the blood stream cannot be accessed, as your pet may have a collapsed circulation then the injection may be given into the kidney or liver.  The anaesthetic will then be absorbed into the blood stream a little slower than when injected directly into a vein. If your pet is distressed or generally frightened at the vets then they can be given a sedative before the anaesthetic injection.  The sedative is to calm your pet and reduce anxiety, which should hopefully make the process of losing your pet less stressful for both pet and owner.  Use of a sedative does however mean that the process will take a bit longer as the sedative will take time to work.  The sedative can be given as a tablet or injection into the skin or muscle. Once the anaesthetic reaches the correct concentration in your pet’s blood stream, this will cause your pets heart to stop beating and them to stop breathing.  Your pet will no longer react to sounds or touch; your vet will listen to your pet’s heart, feel for its pulse and may check its reflex by gently touching the eye.  This is all to confirm that your pet has passed away. After a pet has passed away as the muscles relax the bladder and bowels may empty, some pets also give a gasp as the air leaves the lungs.  In some animals there are jerky movements after death, called agonal movements.  These movements do not mean that your pet is alive or suffering.  The agonal movements happen as chemicals leak out of the body cells and allow muscle to contract.  Normally when alive these chemicals are kept in place until the body needs to use its muscles. Understandably it can be very distressing for a pet owner to see or hear sounds coming from their pet after he/she has been put to sleep.  If you have any concerns either before or after losing a pet then make sure you contact your vet or veterinary nurse.  We will make time to discuss things with you and do our best to help put you at ease with this very difficult situation. I hope that this answer has helped a little to explain what happened after you lost your pet and that your worries have been eased. Shanika Winters MRCVS (Online vet)
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Ask a vet online – ‘my dog has been weeing blood could it be infection or something more’

Question from Sharon Harris: My dog aged 10 has on a couple of times been weeing blood he does one long one which is ok then just walks round weeing bits but that's when the blood starts he is wanting to go out more often than he usually does ,drinking more still eating and his usual self but have noticed a lump that is inside lower stomach but has lumps all over his body but many wiems have these lumps could it be infection or something more Answer from Shanika Winters: Hi Sharon, thank you for your question regarding your 10 year old dog who is passing blood in his urine (wee) this symptom is called Haematuria. It sounds like your dog is still bright and happy in himself, it is possible that his haematuria is due to an infection but can also be related to bladder disease, kidney disease or prostate disease.  It is really important to get your dog examined by your vet as soon as possible. What will happen when I take my dog to the vet? Your vet will ask a lot of questions to form a history of what is going on with your dog, including drinking and urinating habits which you have already listed in your question.  It is very helpful to bring in a urine sample in a clean container when the condition relates to the urine.  It can be tricky to catch a urine sample from your dog, especially if they prefer to wee when off the lead but a clean bowl and some perseverance should eventually mean you can get a sample.  Your vet can collect a sample by passing a urinary catheter (long thin soft plastic tube placed into the bladder) but this can be uncomfortable and may require sedation/hospitalisation for your dog. Your vet will also take into consideration whether or not your pet has been neutered(castrated) as in older male dogs the influence of sex hormones(produced by the testicles) can affect the prostate gland which can lead to haematuria.  The prostate gland is found in male dogs around the neck of the bladder and it produces various secretions which go into semen (the liquid sperm is in).  The prostate gland is usually small and inactive in neutered male dogs, but in entire male dogs the prostate can become enlarged, infected and or cancerous.  Many of the diseases of the prostate gland can lead to haematuria.  Your vet can often feel the shape and size of your dog’s prostate gland by examining your dog internally and externally. The kidneys are the organ which actually produces urine, your dog has two and they filter his blood to remove toxins and waste products which are then lost in the urine.  So haematuria could be blood coming from the kidneys either due to infection, kidney stones or cancerous changes in the kidneys or the tubing from the kidneys to the bladder (the ureters). The bladder is a stretchy bag made of muscle and lined with a delicate membrane (layer) which stores the urine produced by the kidneys and empties out through a tube called the urethra.  Haematuria could be blood from the bladder or urethra due to infection, stones, polyps, trauma (accidents) or cancerous changes. Your vet will thoroughly examine your dog paying extra attention to the back end of the abdomen, will also check your dog’s penis and likely examine your dog internally (via his bottom).  This helps to give information about the kidneys, bladder and prostate gland. What will happen to the urine sample? The first thing your vet will do is look at the colour of the urine sample, this may or may not show visible blood, sometime only tiny traces of blood are present in the urine sample and can be picked up on a dip stick. A urine dip stick is a card strip that has lots of little coloured patches on it; they each detect different chemicals and substances in the urine and give a quick result.  Most veterinary practices can also examine urine samples under the microscope to look for unusual cells and or crystals. If the result and rest of your dog’s examination suggests infection then your vet may suggest trying a course of antibiotics.  If however your vet thinks there may be more going on a carefully collected urine sample may be sent for laboratory analysis which involves culture and sensitivity, this looks at what bacteria are present and which antibiotics are likely to work on them. What further test might my dog need? Your vet may suggest blood tests to check that your pet has not lost too much blood, how its general health is and how well its body organs are functioning.  Blood tests do not always show up a lot of changes but this still gives us information as to how your dog is. X-rays may be taken conscious or under sedation or general anaesthesia, this gives a picture of what is happening inside of your dog, in the case of the bladder and prostate gland we sometimes add a contrast (chemical or air) to help show up details of the tubing and bladder lining. Ultra sound scans are another way of looking more closely at what is happening inside your dog, in order for these to be performed an area of fur will be clipped away, the skin cleaned and then a gel placed onto it to help p the ultrasound probe to make good contact and pick up details.  Ultrasound scans can be particularly useful for looking at the kidneys and bladder. What possible treatments might my dog need? The exact treatment your dog has will depend on what disease process is found in in what part of your dog it is. Urine tract infection: This is usually treated with a course of antibiotics and repeat urine samples tested to see when the infection has cleared. Bladder stones/urine crystals: This can be treated using special diets to reduce stone/crystal formation, surgery to remove stones, medications to help dissolve stones/crystals along with antibiotics and pain relief as required. Bladder growths/polyps: These can be surgically removed and analysed to give an idea of they are likely to return or cause further problems. Kidney infection:  This is usually treated by intensive antibiotics along with intra venous fluid therapy (drip line into your dog) to help keep the kidneys flushed through and functioning. Kidney growth/abnormalities: If the growth is cancerous and might spread then the kidney might be surgically removed. If the kidney is diseased e.g. polycystic then it will be left in place and your dog given medications and diets to help preserve what is left of its kidney function. Prostate enlargement/growths: If your dog is entire then surgical or chemical castration might be advised along with surgery to de bulk the growth if appropriate. I hope that my answer has helped you to understand how complex something as simple as blood in the urine can be.  Hopefully with your vets help, your dog will be on his road to recovery soon. Shanika Winters MRCVS (Online vet) If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.
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Ask a vet online- ‘my Bichon friese keeps goin for his side and making bald patchers’

Question from Shell Cottam: My Bichon friese keeps goin for his side and making bald patchers, we are have in to keep his cone on to stop it, is there anything you can recommend to stop him doin this please Answer from Shanika Winters: Hi Shell and thank you for your question regarding your dog going for his side.  I will discuss some possible reasons for your dog’s behaviour and then possible ways to tackle these. From what you are describing it sounds as though your dog is biting and or scratching at himself to the extent that he is losing his hair.  I am sure that both you and your dog would be a lot happier if he did not have to keep a cone on his head long term to prevent his hair loss.  The first think we need to do is find out the history of how your dog is in general and how long the condition has been going on.  Your vet will ask you some of the following questions: Is your dog generally well? By this we mean is he eating, drinking, toileting, happy to exercise and generally acting as normal other than the condition you have brought him in for.  We ask this as underlying illnesses can sometime show up in unexpected ways, so something you may not at first think is linked to the hair loss could be.  An example of this would be if your dog was generally listless and not as keen to exercise along with hair loss this may suggest an underactive thyroid gland. How long has the condition been present and has it changed? Your vet will want to know when the condition first started and if there were any particular changes at this time e.g. getting a new pet, change of food, starting a new job all things that can help us to work out why your dog is losing hair and if the situation is stable, improving or getting worse.  It is really important to tell your vet if you have already tried any treatments even if these are over the counter shampoos or anti parasitic treatments. What are some possible causes for the biting and hair loss? Top of the list is always parasites; they can sometimes be tricky to spot at first.  We would consider fleas(both cat and dog fleas) and mites(sarcoptes and cheyletiella) as possible causes, these can be diagnosed by examining your pet, and sometimes we need to take skin scrapes, hair combings or hair plucks to look at under the microscope. Bacterial infections can sometimes lead to irritation and hair loss, this may be seen in the form of spots, scabs, crustiness and or areas of raw wet skin.  In some cases we would take swabs or biopsies from the skin to make sure we were treating with the correct antibiotic and for the correct length of time.  The samples can be looked at by your own vet but are sometimes sent away to a laboratory to be analysed. Allergies can cause a dog to lose hair, these can be to something your pet has been in contact with such as shampoo/new bedding/plants, something your pet has eaten such as a new food or scavenged items or something inhaled such as pollen and dust (we call this atopy). Hair loss can be due to a behavioural problem such as boredom or stress. Hopefully the questions your vet asks will help narrow down the list of possible causes for the hair loss and will point to the answer or at least the most appropriate tests to carry out. What tests will they do on my dog? After the basic examination and history taking your vet may suggest doing skin scrapes, hair plucks or combings to look for parasites as mentioned above.  If examining the sample in house(at your own vets) did not give enough information they may ask if the samples can be sent away to an external laboratory, the results may take days to week to come back.  Blood test and or biopsies can give us information as to what is happening in your pet’s body/skin e.g. certain white blood cells are increased in cases of allergies, there may be bacteria present in the blood and or infection fighting cells. Specific blood tests to look for allergies and or hormone imbalances which could be causing the hair loss can also be useful.  Special diets, shampoos or medications may be tried and then the how well your dog responds to these can help us to work out the cause of the problem and if we are on the right track. What treatments are there? If parasites are suspected or detected then routine flea and mite treatment will be advised including treatment of the home environment. For some bacterial infections shampoos are very effective but they may need to be used in combination with the appropriate antibiotics also. Allergies can be treated by avoiding the substance if possible, anti-allergy drugs, special diets and special vaccines or a combination of these. Behavioural conditions may need treatment by retraining your dog, strengthening the pet owner relationship, making the home environment more stimulating and sometimes the use of behaviour modifying drugs. I hope that my answer has helped you to understand that we need to take a logical step by step approach to helping your dog, this would most likely start with ruling out parasites followed by a thorough examination and diagnostic work up by your vet. Shanika Winters MRCVS (online vet) If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.
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Ask a vet online- ‘my cat is now 18 yrs old, bit loathe to help him on his way’

Question from Susan Banfield: My cat is 18 yrs old, has lost most of his front teeth, bad breath, dribbles all the time, extremely skinny and has trouble keeping himself clean.  Bit loathe to help him on his way over the bridge as his coat still shines, bright eyes, eats well and still goes outside to toilet and explore.  Am I being fair? Thank you Answer from Shanika Winters: Hi Susan and thank you for asking one of the most delicate questions that a pet owner and vet will face ‘when is the right time to have my pet put to sleep?’ As our pets ages we are very aware that we do not want them to go on for too long and that our vet can put our pet to sleep so as to prevent unnecessary suffering.  This is however never a simple or easy decision to make and is very much specific to each individual pet, its condition and its owner.  I will go through the way in which we try to help an owner work out if that time has arrived.  Please remember that as your veterinary team we are here to help and support you any your pet through all situations even after you lose a pet we are here to talk to. From what you are describing it sounds like your cat has done very well to get to 18 years of age and still be going out, toileting correctly and eating.  Loss of teeth is to be expected as pets get older, often as vets we may have extracted teeth due to infection or damage.  You mentioned that your cat was struggling to keep clean, by this I assume that we are talking about grooming of his coat.  Cats and dogs use their front teeth to almost comb through and nibble at their coats, as you mentioned most of these are missing then it would necessary to groom your cat using a comb, brush or mitt.  If an elderly cat is skinny yet eating well this tends to make us wander if the cat may have an overactive thyroid gland, which can be diagnosed by blood test and then  can be treated using tablets or by surgery/radioactive iodine. Does my cat still have a good quality of life? There is not a simple answer as to whether a pet still has a good quality of life, we need to discuss how your pet was at its prime and take into consideration that even though it may not be able to do all those things now he can still be leading a happy, pain free life. The most basic functions are eating, drinking and being able to go to the toilet.  As cats age we may need to offer them softer foods/smaller meals more often in order for them to get enough food.  Some cats need encouragement to drink, making sure we refresh the water in their bowls regularly, have the bowl near where they rest and some cats prefer running water so a water fountain may help.  Toilet function for a cat involves getting into the correct posture which is not always easy if there is any arthritis/pain in the legs/spine and also accessing the litter box( use of lower sided litter boxes can make it easier to get in/out of them).  Minimising pain can be achieved by treating any underlying arthritis and or use of joint supplements. So even if your pet needs a few small changes to be able to perform its basic functions then it can still be having a good quality of life just with a little bit of extra help. As owners we ask ourselves whether our pets are still happy.  How happy and responsive your cat is also needs to be considered relative to how it was when younger taking into account normal changes expected with age.  Not all animals are very responsive so cannot all be measured on the same scale, also there are natural changes at different life stages e.g. juvenile cats are very playful and this will reduce as they become adult cats.  Also obesity can affect how interactive a cat is, so helping your cat to reach its optimum weight will reduce risk of diseases such as arthritis and diabetes as well as help him to be more interactive with you. Grooming is an activity which cats spend a lot of time doing, as they become older and potentially less flexible then this becomes harder for them, but as owners we can help.  If we did not brush our hair for days on end think how uncomfortable, itchy and sore we would feel. So this is a really simple area in which we can help our older cats to feel happier and more comfortable. But they may not appreciate that we are trying to help them at first so little, often and gently is the way forward. I hope that my answer has helped you to work out how you can help your cat and that the final decision is always yours as the pet owner but that your veterinary team are here to help you make such a hard decision.  We are more than happy to give you the time you need to discuss matters with us to make sure we all do the right thing for your much loved pet. Shanika Winters MRCVS (online vet) If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.
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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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