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Is that “veterinary nurse” really a veterinary nurse?

Language and terminology is important. Our society recognises this fact, and in some walks of life, you cannot call yourself by certain terms unless you are appropriately qualified. The medical field is the area where so-called “protected titles” are most prevalent: there's a long list from “music therapist” to “dietician” to “clinical scientist” to “physiotherapist” and “paramedic”. If you read the list, you'll be surprised, and I suspect that you'll be reassured too: it's good to know that when you go to see a “hearing aid dispenser”, under law they must be properly trained and qualified. There are serious penalties for people who try to set themselves up as one of these practitioners when they are not entitled to do so: anyone using one of these titles must be registered with the Health and Care Professions Council, or they may be subject to prosecution and a fine of up to £5,000. Interestingly, not all professional titles are protected. The words “doctor” and “nurse” have been in general use for hundreds of years to describe a variety of people, and so they are not specifically protected. The title “doctor” is used far more broadly than just for medical doctors, with a number of professions (including dentists and now vets) using it as a courtesy title, as well as people who hold academic doctorates, such as PhDs. Similarly, the title “nurse” is not protected: as well as medical nurses, it's used by nursery nurses in nursery schools, and sometimes by veterinary nurses. The fact that the terms “doctor” and “nurse” are not protected can lead to issues where the public can be mislead by individuals who use the terms to their advantage (such as a person who is an academic doctor trying to pass themselves off as a medical doctor). For this reason, the terms “doctor of medicine” and “registered nurse” are protected titles, but for the public, arguably this is not sufficient to avoid confusion. There are some professions that would like to have protected titles, but for various reasons, this is not possible. Anybody can call themselves an “engineer”, a “scientist” or a “surveyor” because these terms are said to be in such widespread use. These professions have had to add prefixes to their titles to try to minimise confusion, such as “incorporated engineers”, “biomedical scientists” or “chartered surveyors”. Only properly qualified and registered vets are allowed to call themselves “veterinary surgeons”, but there is a major anomaly in the veterinary world: anybody, even without training or qualification, is allowed to call themselves “veterinary nurse”. The veterinary nursing profession has so far had to use the protected title “registered veterinary nurse” to be used exclusively by properly trained and qualified nurses, but there's a strong argument that this is not enough. Most readers, I'm sure, would agree that if they were dealing with someone calling themselves a “veterinary nurse”, they would assume that the person was qualified. Unless something changes, it's very likely that unscrupulous individuals will use this confusion to their advantage, misleading people into believing that they are qualified. What has to change? Clearly, the term “veterinary nurse” needs to be made a protected title. The Royal College of Veterinary Surgeons, the British Veterinary Association and the British Veterinary Nursing Association all believe that this is necessary. They are asking Parliament to change the law to protect the title “veterinary nurse”, and they need as much help as possible to achieve this. Please sign the official petition to register your support. The aim is to get 100,000 signatories which will trigger the issue will be considered for a formal parliamentary debate. The petition is currently at 20,594 signatures and the petition closes on 14th February 2016 so time is running out. The engineering profession tried a similar tactic to protect the word “engineer” last year, but the attempt failed after their petition only reached 6176 signatures. It makes clear sense that the term “veterinary nurse” should be trusted as the recognised name for a skilled, trained and qualified profession. If you agree, please sign this petition now, and ask as many as possible of your friends and contacts to do the same. Please follow this link to the petition. The RCVS has also produced a short animation stating the reasons behind the petition:  watch this by clicking here. Animals are the ones who will benefit from "veterinary nurse" being protected: so if you care, take action now.
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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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Ask A Vet Online – Help! The fleas are revolting…

flea-63043_1280 Anne Stafferton asked: This one is a bit boring really I've spent hundreds of pounds on flea stuff only for it not to work I breed cats so it's a nightmare I'm now combing them all every day to get fleas out any suggestions on what really really works Answer: Hi Anne, thanks for your question about fleas in cats. I know exactly what you mean – they can be a real nightmare to get under control! I’m going to answer your question by (briefly!) discussing the flea life-cycle and how it can be broken, and then talking about the specific treatments that are available. As a warning, on a blog like this I am legally obliged to use the generic names for all the drugs and medicines (otherwise I would get nasty letters from the Veterinary Medicines Directorate, the government department who regulate advertising of veterinary medicines). You can, however, look up any of the generic names for the active substances and “translate” them into brand names on the VMD’s Product Information Database. What are fleas? Fleas are a group of obligate ectoparasites – this means that they live on the outside of other animals, and cannot survive in any other way but by sucking the blood of their hosts. Once an adult flea lays her eggs, they fall onto the floor, the carpet, and into the cat’s bedding. Here they hatch into larvae, which live, hidden deep in the fabric, in the dust, and in cracks in floorboards etc. The larvae survive primarily by eating the faeces of adult fleas, which fall off the cat as the “black sand” we all know and hate! This material is semi-digested blood, and is very nutritious for the larvae. After their final moult, they turn into pupae (like the chrysalis of a butterfly but less pleasant) and there they stay, waiting for a chance to hatch. Pupae can remain dormant for months or years, and in this state they are more or less impervious to virtually any treatment we can use against them (although apparently repeated steam cleaning can kill them). When they detect air movement, heat, or increased carbon dioxide levels (all indicators that a cat, dog or human is close), they hatch and leap on board, to feed, breed and repeat the cycle. Traditionally, we think of fleas as being a spring and summer problem; however, with modern insulation and central heating, nowadays we see them all year round. The flea life cycle can only complete in a relatively warm environment, but we kindly provide them with a nice warm, comfy house to grow up in. So how do you break the cycle? There are a number of points at which the cycle is vulnerable – however, it’s important to remember that if the cats go outside (even briefly) they can pick up new fleas (deposited by other cats, dogs, foxes and even small mammals such as rodents). It only takes one amorous flea couple to reinfest a whole household… The adult fleas are actually pretty easy to kill – even old-fashioned drugs like fipronil will kill most of the adults present, and many of the newer medications are much more potent. The larvae need to cut their way out of their eggs (using a special “egg tooth” made of chitin); if their synthesis of chitin is impaired (e.g. by lufenuron) they cannot hatch. The larvae cannot develop into adults in the presence of juvenile hormone – if this is chemically supplied (as an Insect Growth Regulator, e.g. S-Methoprene), they cannot make the change into adults. The number of eggs, larvae and pupae in the house can also be reduced, by washing of fabrics (especially bedding) in hot (60C) soapy water. Although it won’t kill all of them, it will reduce the numbers and wash a lot away down the drain where they can’t hurt anyone! The pupae themselves are pretty much impervious to any treatment, but they can be “tricked” into coming out as adults, which are then much easier to kill. The common method is regular vacuuming – the air movement and heat trick the pupae into hatching; you won’t catch many in the cleaner, but once out, they are vulnerable to environmental insecticides. In fact, if you keep a “closed household”, with all the cats (and dogs if you have any) living indoors 24/7, it is theoretically possible to break the life cycle without treating the adults at all… but it will take a long time (the adults may live for 4-6 months) and you’re always at risk of a new introduction (in your clothes, for example). So how do I kill them? As you’ve found, there are a huge range of different flea control products on the market! Broadly speaking, these can be divided into 5 categories: Environmental insecticides: These are products used to spray the infested house, killing adults, sometimes eggs, and larvae. They will not kill pupae, but if applied rapidly after vacuuming, they can be very effective. Most products contain permethrin, which is toxic to cats – this means that you have to be careful using them, by treating rooms one at a time and shutting the cats out until they have ventilated. The cans will explain how long to leave it for on the label, or talk to your vet, before reintroducing the cats. On-cat environmental treatments: These are applied to, or administered to, the cat, to treat the environment, and rely on the fact that the larvae are eating the flea’s droppings. There are 3 particularly important ones:
  • Lufenuron – a chitin inhibitor, available as an oral liquid, a tablet, or an injection. Does not kill adults, but prevents larvae and pupae from hatching properly.
  • Pyriproxifen – an Insect Growth Regulator, available in some prescription-only fipronil products.
  • S-methoprene - another IGR, available in some prescription-only fipronil products.
  • Imidacloprid – an insecticide available as a spot-on that kills adults and larvae in the vicinity of the treated cat.
Over-the-counter adulticides (products that kill adult fleas only): These are of various effectiveness; most contain piperonyl butoxide or dimpylate (not very potent but pretty harmless) but there are still some on the market containing permethrin, which although effective is potentially lethal to cats. In general, if it is available over-the-counter without any regulation, it’s probably not that powerful. The most popular products in this group are the spot-ons containing fipronil, which is an older drug but still fairly effective. Some of these products are over the counter, and others are classified “NFA-VPS” (which means there are certain restrictions on their supply, but they still do not require a prescription) Contrary to popular opinion, there is no conclusive evidence that resistance of fleas to fipronil is widespread – however, fipronil containing products are water soluble (so may wash off if the cat gets wet) and are much less effective than the modern prescription-only products. The other commonly used active ingredient is imidacloprid, which is a different class of insecticide that is active against adult and against the larvae. Again, it doesn’t suit every cat but may be useful. There is also an interesting product available as a tablet containing nitenpyam, which is very effective at killing adults – but only lasts 24 hours after being given. It is best used to kill off the bulk of the adults when starting a flea control program. Prescription-only products: Fipronil-combos – spot-on products containing fipronil plus an Insect Growth Regulator, to treat the adults and the environment simultaneously. Last between 4 and 8 weeks, but the adulticide (killing of adults) effect tends to wear off after about 4-5 weeks. Flumethrin/Imidacloprid combo collar – this is a collar containing flumethrin (a form of permethrin that is safe for cats) and imidacloprid. It lasts about 6-8 months, and is very effective – if the cat will keep it on! Imidacloprid/Moxidectin combo – another spot-on, that treats a wide range of different parasites. Lasts about 4 weeks. Selamectin – a spot-on product, but one that is absorbed into the cats system so it cannot be washed off – very useful for outdoor cats! It also treats roundworms and both mange- and ear-mites, but does require the flea to bite before it works. Lasts about 4 weeks. Indoxacarb – Another spot-on, but one that is utterly inactive in the cat’s body, until it is “turned on” by a unique metabolic action inside the flea, and the larvae if repeated every 4 weeks. Spinosad – a tablet, given once a month, that is really effective against fleas, but does cause some cats to vomit; if given with food, however, it normally stays down - it does require the flea to bite, but kills very, very fast (in a few hours). Herbal and homeopathic remedies: Available, but no proven effectiveness. I have heard garlic recommended, but, sadly, in my experience it just doesn’t work and is potentially toxic to cats. There’s so much choice! What do I do? Bottom line – you’ll never control fleas if you only attack one stage of the life cycle. You need to kill the adults (and I’d recommend you talk to your vet about the more potent, modern, prescription products rather than rely on older and less powerful medications); however, you also need to decontaminate the environment, with regular vacuuming, insecticidal sprays, and good old fashioned washing and cleaning! If you’re still struggling to get on top of the situation, talk to your vet – not every product suits every cat, and it’s sometimes necessary to try several alternatives until you find the product, and the control methods, that suit your cats and their lifestyle. All the best – I hope you can rid your cats of their unwelcome visitors! David Harris BVSc MRCVS
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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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The structure of the heart: everything you didn’t know you wanted to know from Wikivet

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The heart is probably the most central structure in the body. Arguably, the brain could be said to be "more important" (death is classified technically as absence of brain activity rather than a motionless heart), but for most of us, a beating heart is synonymous with the presence of life. We all have a heart - whether we are dogs, cats, humans, or indeed frogs - and one of the fascinating things about veterinary science is the fact that the fundamental structure of many organs - including the heart - is surprisingly similar. There must be something intriguing about the structure of the heart: the Wikivet page on this subject has been the most visited page of all over the past year. The main page is a simple description of the various structures - the position of the heart in the chest, the ventricles, the atria and the other connected tissues. If you can read technical language for just five minutes, you can be briefed with a simple but accurate review of the gross anatomy of the heart. The Wikivet heart page also has links to some interesting visual media. Some of these are not publicly accessible: perhaps it's only necessary for vet students to see what heart muscle looks like under the microscope. But other links include a colour coded video that clearly shows the different structures, and the most remarkable three-dimensional video that shows how the heart sits in the middle of the chest. If you have always wondered about what MRI's look like, you can watch a video that shows you MRI sections of the chest, and if you have witnessed the plastinated human exhibitions, you can view a plastinated dog heart. Heart disease is common in pets: if your dog or cat is ever affected, it will help if you can easily visualise what's going on inside a pet's chest. This Wikivet page is a great place to learn all about it.  
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