Browsing tag: antibiotics

The Kinder Cut – Castration of horses

This is the time of year when people start to look at their cute little foals, and suddenly realise they’re starting to grow up fast… As a result, it’s also when we start to get phone calls from people to talk about gelding them.

If you are considering getting a colt gelded (“cut”), my advice would be to contact your vet, who will be able to advise you on the best approach in your particlar circumstances. However, I’m going to try and go through some of the commoner questions below, so you’ve got some basic information on the decisions to be made, the procedure, and what you’ll need to consider.

The first question, of course, is whether or not to get him cut. It’s an important decision, so these are my thoughts…
The majority of male horses are castrated, and for very good reason – very few people have the facilities, the time, or the inclination to manage an entire stallion. The old adage had it absolutely right – “You can tell a gelding, you can ask a mare, but you discuss the matter with a stallion”. Although there are some superbly well mannered stallions out there, it takes years of expert training – and in my experience they’re almost always more “bolshie” than a gelding, and much less forgiving of any mistakes. They are also much more easily distracted (e.g. by a passing mare), and prone to fighting.
Does this mean you can’t train them well and keep them happily and healthily? No, of course not – but it’s a lot harder. The majority of stallions can’t be kept in groups because of the husbandry regimes on most yards, so have to live on their own. That’s not good for their mental health, or their owners and riders! If someone has the knowledge and facilities to bring up a stallion, I don’t have a problem with that, and I wish them luck, but I’ve seen too many bored, frustrated and borderline dangerous stallions who haven’t been brought up correctly, and remain a liability.
Geldings, however, can be kept in groups, can mix with other horses, and are less likely to lose the plot or throw a temper tantrum. They also don’t present you with unexpected foals in your competing mares…
If you decide not to have him done, you need to be sure that you’re doing it for the right reasons. The majority of horses are not necessarily good breeding material – you need to take an objective look at him and decide if breeding from him is actually going to benefit the breed. If you’re avoiding doing it just because you don’t like the thought of the procedure, you’ll need to think long and hard about whether thats in his best interest – or yours.

If you are getting your colt cut, the next decision is when to do it. There are two major concerns – the time of year, and the maturity of the colt. In terms of time of year, it’s best to do it when the weather is cold enough to prevent flies from infecting surgical wounds. Ideally, then, this would be in late autumn or early spring, but gelding him in winter is perfectly acceptable if the facilities are suitable. Regarding the colt’s maturity, there is an upper and a lower limit.
The lower limit is the most rigid – except in an emergency (e.g. a strangulating hernia), I would never geld a colt until both testes had descended into the scrotum – because it’s really important to make sure you’ve got both! This usually happens between 6 and 12 months old, but it is a bit variable. In addition, the colt has to be strong and mature enough to survive the surgery, although with modern anaesthetics this isn’t as much of an issue as it used to be. The upper limit is much more flexible. Stallions into their twenties are castrated fairly commonly, but once they’ve passed through puberty, a lot of the stallionish behaviour is learnt, and won’t be reversed by castration, including some forms of aggression, and mounting behaviour. Sometimes, people like to wait until a colt is 3 or 4 years old before gelding, but I think that often even that is too late – although it does allow the colt to develop more muscle, he’ll also be developing stallion traits. In addition, the younger the colt, the smaller the testicles, and the smaller the testicles, the lower the risk of bleeding during the op. During puberty, the testicles increase dramatically in size, and as a result, their blood supply increases accordingly; the bigger spermatic artery in a post-pubescent colt is much harder to control bleeding from.
As a general rule (and it’s a VERY rough rule of thumb!) I’d normally look to geld between a year and eighteen months old. That said, there are a lot of exceptions – I once had to sort out the castration of a four month old colt because he’d started mounting his mother… There are also a number of opinions about weaning – before, after or at the same time? In this case, I think it depends entirely on the colt in question, and it’s an area (one of many) where I’ll usually defer to the owner’s judgement.

Before you go any further, its a good idea to get the colt thoroughly checked out – both testicles need to be present and easily palpable; if one is “shy” and difficult to find, I usually recommend checking again in a month or so. If it’s still inaccessible, the colt may be a cryptorchid (i.e. a rig, with one undescended testis). These colts should ALWAYS be castrated, and have to be done under general anaesthetic, if possible in a clinic. This is because the retained testicle, being kept at an abnormally high temperature inside the body, is more likely to become cancerous. Also, the defect may be genetic – and if so, he’ll risk passing it on to his offspring.

Once you’ve decided when, there’s another important decision you and your vet will have to make, and that’s the details of the procedure. Basically, there are two factors to decide – firstly, do you want him done “at home or away”? Secondly (a related point), do you do him under standing sedation or down under a general anaesthetic?
Regarding the location, it depends on your practice’s policy and facilities. Many practices now offer castration at the clinic, but the majority of people still choose to have the op done at home. The advantage of having it done at a clinic is that the procedure can be cleaner, and all the equipment and apparatus is there; in addition, many practices charge a callout fee for coming to the yard. However, that’s offset by the fact that you’ll have to transport the colt to the clinic; in addition, I think it’s usually less stressful for the procedure to be done at home, assuming the appropriate facilities are available. Exactly what facilities you need depend on the technique that’s going to be used.

There’s a lot of debate as to this decision, and some frankly ridiculous comments from some badly-informed people out there. I’m going to talk through the options and the pros and cons.
The two main options that you’ll need to think about for the procedure itself are whether to have the op done under standing sedation or general anaesthetic. In some cases, the decision is easy – miniature horses and small shetlands should almost never be done standing, because they’re too small for the surgeon to get good access and control the site, for example. Draft breeds are at a higher risk of eventration (see below, when abdominal contents escape through the castration wound), and so need a different surgical technique, which may be easier under a general; and fully adult stallions bleed more so may need better surgical access – again, a general anaesthetic makes this easier. However, most colts can be done either way, so you and the vet need to decide which you prefer.

Under standing sedation, the colt is given intravenous sedatives (see my blog on sedatives) so he becomes very dopey. He will continue standing up, but his head will drop, and he is likely to adopt a wide-based stance (which makes surgical access easier!). However, its important to remember that he is still to some extent aware of what’s going on, so local anaesthetic is injected into the testicles (perhaps 20ml into each one, plus some under the skin of the scrotum) or into the spermatic cord (although I find that that’s easier said than done, with most colts pulling the testicles up tight to the body wall so the cord is difficult to access from outside) to numb the area. The castration is then performed with the vet working from standing beside the horse. This approach avoids the risk of a general anaesthetic, and means the horse will recover from the sedative faster. However, the degree of sedation achieved is variable, and some colts appear to be more aware of the procedure than one would like, no matter how much sedative you pour into them. There’s also a MUCH higher risk of the vet or their assistants being injured – unsurprisingly, some colts object violently if they realise what you’re doing…
In addition, the surgical access is poorer (the vet is having to work upside down, and largely by feel) so if there is a complication, it is harder to control it.

Under a general anaesthetic approach, the colt is sedated and then given an injection of a general anaesthetic. He’ll become very sleepy, and then lie down. Once he’s out, an assistant lifts up the top leg, giving the surgeon access. The disadvantage is that most vets will only do a GA on a horse if there’s another vet along to monitor the anaesthetic, which may affect the cost. In addition, a GA is a risk in its own right – one study suggested that the average mortality rate from GA in a horse is 1% (although this includes colics and emergency operations – the risk for a young, healthy colt is much lower). On the other hand, the risk of injury to the vet or assistants is much lower, and the risk of surgical complications is also much reduced, as the surgeon can see exactly what they’re doing.

Is either one definitively better than the other? No. However, it is a decision to take WITH your vet, as they may have a preference that will affect their efficiency. For what its worth, I’ve done geldings both ways, and personally I prefer to do them under general, because its safer for me and everyone else around – and if there was to be a complication, I’ve got a better chance of finding and fixing it at the time.

The procedure itself is pretty much the same whichever way up the horse is. Along with sedation, I give an injection of an anti-inflammatory and painkiller, and antibiotic cover (no procedure done on a yard or in a field can ever be truly sterile, so I’d prefer to make sure there are antibiotics on board when we start). In the past, vets didn’t routinely give painkillers as well as the sedation (which contains a painkilling component), but personally I don’t think its fair not to.

There has historically been quite a mystique about the procedure itself – probably because people are a bit shy to discuss it. As a result, there is sometimes serious confusion – remember, gelding is NOT the same as a vasectomy, and it can’t be reversed… Not even (as apparently happened to a colleague of mine) if the client stops you as you’re about to drive off and, holding up a neatly severed pair of testicles, asks the vet to reattach them because she’s changed her mind…

So, here’s a quick run through the procedure:
The area of the groin is scrubbed with a skin disinfectant, and a final check is made that both testes are accessible. Whichever one is held closer to the body is the one I’ll start with, just in case it is retracted later. I’ll then scrub up so my hands are sterile. Some vets wear gloves, others don’t – I don’t think it really matters as long as they’ve scrubbed thoroughly. Gloves add an additional sterile barrier; but on the other hand they can reduce your feel and grip, so it depends on what the vet is happiest with.
Once the scrotal area is scrubbed, the vet will use a scalpel blade to cut through the skin of the scrotum. There are a couple of different options from here on, but the principle is the same; to cut down through the tissue to the vaginal tunic (the membranes that surround the testis itself) and then gently pull the testicle down and out. In an “open” castration, the tunic will be opened, in a “closed” technique, it gets left intact and the testicle pulled down still inside. Once there’s enough slack in the spermatic cord (containing the blood vessels, nerves etc that supply the testicle), the emasculators are applied across the cord, with or without the tunic, depending on the technique. These are a clever bit of kit that crush the cord, preventing it from bleeding, while at the same time cutting off the testicle itself.
(Quick aside here – I was doing a gelding once and, as is customary, I showed the removed testicle to the owner to show it had been done; he was a teenage lad and he fainted dead away. Interesting ethical problem there – do I try and help the unconscious boy, or do I just keep working on the anaesthatised horse who’ll soon wake up? Fortunately, he recovered on his own before I had to scrub out, but he was pretty green around the gills for the rest of the morning…)
In an older stallion, most vets will put a suture through the cord to ligate the artery, but this increases the risk of infection, so we don’t always put one in if doing an Open procedure. After removing the emasculators, the vet will check closely for bleeding from the stump. If there isn’t any, they’ll repeat the procedure on the other side. If the surgery is taking place in the field, the vet will usually leave the incision open for drainage; closing it seriously increases the risk of post op swelling and infection.

As a note, there is always a bit of bleeding after the operation. The rule of thumb is, if you can count the drops, its fine! There’s also invariably some swelling of the sheath, but again, it isn’t usually anything to worry about. If in any doubt though, you should contact your vet. Your vet will give you instructions for post op care, but the most important thing is to keep the new gelding moving, to reduce the swelling and encourage drainage.

The complications to be aware of are bleeding, eventration, and infection.
bleeding is pretty obvious – some oozing from around the incision is normal, but there shouldn’t be any significant haemorrhage from the stump of the spermatic cord. If there is, or if there’s a lot of blood – call your vet! Uncontrolled bleeding is an emergency that may require a repeat surgery to control it.
eventration, is when abdominal contents prolapse through the inguinal canal, and it’s more common in draft breeds. This is the main reason we’d do a Closed castration, as it ties off the tunic; but it does increase the risk of infection. Eventration usually involves some fatty tissue (the omentum) and although it needs urgent surgical repair, it isn’t usually life threatening. Very occasionally, however, it progresses to evisceration, where loops of intestine come through. This is very serious, but (touch wood) it’s also very rare.
infection is uncommon, and usually responds to antibiotics. In a few unlucky cases, though, a schirrous cord forms, where abscesses form in the canal. These take months of management, and in the end, treatment is usually surgical removal of the infected tissue.

These complications are very rare, and even if they occur, they’re usually fixable, so don’t get scared of the possibility! I only mention them so you’ve got an idea of what to look out for.

The last thing to bear in mind is that the gelding may still show sexual interest for some weeks after castration (at least, if he was before), and may even be fertile for a time: although he can’t make more sperm without testicular tissue, there will still be some “in storage” in the spermatic ducts. I always advise that a newly gelded colt or stallion should be isolated from mares for at least 6 weeks, after which any remaining sperm will have died or been flushed out, and his testosterone levels will have declined to the point where he won’t have any hormonal urges.

The bottom line is this: although it doesn’t seem a nice thing to do, for most colts in most situations, gelding leaves them happier and more content than they would otherwise be as entire stallions.

Rain Scald, Mud Fever and Greasy Heels – Wet Weather Care for Horses

I heard on the news recently that last year was one of the wettest on record. I don’t know if it’s true – but it certainly feels about right! The big danger to our horses from this, of course, is Rain Scald and Mud Fever.

Most people have probably come across Rain Scald on occasions – the scabs hidden away in the coat feel like mud, until you pull them up and see the characteristic “paint brush” appearance as the hair stays stuck in the scab. Rain Scald is caused by a bacterium called Dermatophilus congolensis. This usually lives (fairly) harmlessly on the skin, but if the skin gets and stays wet, the bacteria can invade and set up an infection.

Most cases are mild, with just a few scabs here and there, but (especially in older horses and those with Cushing’s disease) it can be more general and leave large raw patches. Even a mild case can put a horse “off games” if the scabs or raw patches are under the saddle.

Most cases resolve on their own with simple care – gently brush out the scabs, and most importantly keep the area dry to allow it to heal. That said, older horses and those with other diseases may need a helping hand, in which case a short course of antibiotics from your vet will usually clear it up. HOWEVER… Unless the underlying problem is sorted, it will rapidly return! Prevention is far more important, and that means keeping the skin as dry as possible. Remember, if your horse gets wet, that’s fine as long as he can then dry out thoroughly. It’s if the skin stays constantly wet that problems ensue – and watch out for rugs, especially in early autumn! When it’s wet, but not that cold, horses can easily sweat up under their rugs, and sweat seems to be even worse than rain for causing Rain Scald.

The other thing to watch out for, of course, is Mud Fever. This is an infection of the skin behind the heels (its sometimes called Greasy Heels), and is most common in horses with long feathers. It’s a far more complicated disease than rain scald, and has a large number of contributary causes. The most important is wet weather, of course – as the skin gets wet, bacteria can invade, as in rain scald – long feathers keep the water trapped in the area, slowing down the drying, so cobs and heavy horses are more prone. However, mites are also a known cause (the first signs are usually stamping of the hind legs), and its not just bacteria, because some cases include yeasts and other fungi as well. Sometimes, really aggressive bacteria like Pseudomonas can establish themselves, and they can be really difficult to manage.

The symptoms vary, but generally it first presents as scabs in the angle of the heels behind the pastern. If untreated, or as the infection gets worse, cracks in the skin can open up and start oozing fluid and pus, and the legs thicken. Eventually, lymphangitis can occur and ultimately, the skin can slough or even become gangrenous.

Initial treatment is very simple: wash the affected area with a skin disinfectant (like Hibiscrub or similar), and once the scabs are softened, gently wash them off. This may take several days of work! If the infection progresses, or doesn’t improve, you will need veterinary attention.

Most cases respond well to a course of first-line antibiotics (e.g. Penicillin/Streptomycin or Timethoprim Sulpha); however, if it doesn’t respond in a week or so, I would always take a swab for bacterial culture and sensitivity testing. This give you a much better idea what bacteria you’re dealing with, and how best to kill them – I had a case once which turned out to be a multi-resistant Pseudomonas infection, that needed some really powerful off-license antibiotics to resolve it. Sometimes you can use topical antibiotics (creams, ointments etc), and in severe cases, I have occasionally used a “bespoke” ointment that I made up from several different antibiotics and an anti-inflammatory. If there are mites involved, most vets will use an injectable anti-mite drug; however, this isn’t licensed for use in horses so has to be put up by your vet.

As usual, prevention is much better (and cheaper!) than treatment, though, so keeping the heels dry is vital. Sometimes using an aqueous cream like zinc and castor oil, or Vaseline, can be useful in encouraging the water to run off – but if you do use them, make sure you wash it off and dry it thoroughly once or twice a week before reapplying, so it doesn’t get too thick.

Of course, in an ideal world, keep the horses out of muddy fields and trackways… But given the recent weather, I fear we’re all going to have to be a lot more careful to keep our horses and ponies warm and dry this autumn.

If you are worried about any symptoms your Horse or pony may be displaying please talk to your vet or try our Interactive Equine Symptom Guide to help decide what to do next.

Chronic Diarrhoea in Cats – Could it be Tritrichomonas foetus?

Marla is an older cat who has recently had the displeasure of becoming a frequent visitor to our practice. She was adopted not long ago from an animal shelter and now lives with a lovely woman who thankfully has a lot of patience!

Marla first came to see us because she had developed diarrhoea and a red, irritated rear end. She had a type of diarrhoea called ‘colitis’ (which simply means inflammation of the large intestine or colon), that caused her to strain frequently to produce small amounts of sometimes bloody stool. She was treated with antibiotics and her diet was changed to something that was bland and easy to digest, and although sometimes her symptoms seemed to improve a little they continued. A standard stool sample was run but this was negative for all worms and harmful bacteria. After nearly a month of problems and after trying every routine treatment out there, we decided to try one last and wouldn’t you know, it came back positive!

Marla had developed an infection of Tritrichomonas foetus (which I’ll call T. foetus from now on), a previously rare but becoming increasingly common infection in cats. Recent studies have shown that the infection is even more common than we think, so if you think your cat may be affected it might be worth looking into!

What is T. foetus?

  • T. foetus is a single-celled protozoal parasite (bigger than a bacteria but smaller than a mite, with a very clever membrane and a few tails that help it move around). The infection was originally found in cattle, but it’s cats that have been more of a concern recently.
  • Most affected cats are less than 1 year old, but as in Marla’s case, it can affect cats of any age.
  • Purebred kittens from breeding colonies or cats in shelters or multi-cat households are more likely to get the disease.
  • Up to 30% of cats in the UK and US may test positive for the organism, but not all those that carry the disease will show symptoms.

What are the symptoms?

Symptoms include (some of which you may only see if your cat uses a litter tray):

  • Fluffy BWSemi-formed to liquid faeces (diarrhoea)
  • Blood or mucus in the faeces
  • Straining or painful defecation (may lead to howling in the litter tray)
  • Increased frequency of defecation (more frequent trips out the cat flap)
  • Inflamed and painful anus (may lead to or be caused by excessive licking)

Despite the above symptoms, however, most affected cats are otherwise well in themselves and do not usually lose weight.

How is it treated?

  • If your vet suspects that your cat may have T. foetus, they will recommend you bring in a fresh stool sample from your cat. They will then look at the sample under the microscope to see if they can find any of the tiny organisms or send it to a special veterinary lab where they can run a test called PCR to detect the organism.
  • Most cases will resolve on their own but it’s a slow process, sometimes taking many months, and many owners (and cats!) may want to treat the disease to get rid of it faster.
  • None of the drugs currently licensed in the UK for use in cats can kill T. foetus.  However, there is an antibiotic called ronidazole that is used to treat the disease in the United States and this drug can be used in the UK if the cat’s owner provides their informed, written consent. Not all cats will respond to the drug and a few may develop side effects (neurological problems that go away once the drug is stopped), although the vast majority of cats won’t have any problems.

If your cat has had T. foetus and is now back to normal, it is possible that they may still be carrying the disease in their body and could therefore pass it on to another cat.  The disease is unlikely to infect people, but those who have a weakened immune system should not handle any cat with diarrhoea.  Basic hygiene measures should be taken as a precaution and to stop it from spreading to other cats in the household (or shelter, cattery, breeding colony, etc.).  Always wash your hands thoroughly after handling cat faeces and after cleaning litter trays and wash all cat bites and scratches immediately with soap and water (always seek medical attention immediately if the wound develops signs of infection such as redness or swelling).

Until recently, most vets probably hadn’t heard of this organism and were therefore not likely to look for it. But as we become more aware of the disease, we will hopefully be able to diagnose and treat it faster so cats like Marla can be back on their feet in no time. So if you think your cat may have T. foetus, please speak up!

If you are worried about diarrhoea or any other problems with your pet, speak to your vet or use our Interactive Symptom Guide to help decide what to do next.

Neutering dogs – Bitch spay operation: a step by step guide

Deciding whether to spay

Spaying or neutering a female dog is not a small operation, so owners should think carefully about all the pros and cons before deciding.

The main advantages of spaying are preventing pregnancy, preventing infection of the uterus (pyometra), preventing ovarian or uterine cancer and reducing the likelihood of mammary (breast) cancer, all of which can be life-threatening. It also prevents the inconvenience of having a bitch in season with unwanted attention from male dogs.

The main disadvantages are major surgery with associated risks, an anaesthetic with associated risks and the increased likelihood of urinary incontinence in later life. Fortunately, the risks involved in anaesthesia and surgery are very small indeed compared with the risks of the other conditions which are prevented by spaying. Urinary incontinence in later life is a nuisance but not very common, and can usually be controlled by drugs.

There is no medical reason to let a bitch have one litter before spay, in fact some of the benefits like protection against mammary tumours, are lost if the operation is delayed. Unless an owner is committed to having a litter, with all the work and expense that can be involved, and the bitch is also suitable in temperament and free of any hereditary problems, then breeding should not be considered.

Tilly GrinSome people expect that their bitch will get fat after spay, but in fact this is entirely preventable with a healthy diet and proper exercise.

My own opinion is that most bitches should be spayed because of the health benefits. My boxer bitch Tilly was recently spayed.

Deciding when to spay

It is not a good idea to spay when a bitch is in season or about to come into season, because the blood vessels supplying the uterus and ovaries are all larger and this will increase the risks of surgery. The other time we try to avoid is the 8 weeks after a season, when a bitch may suffer from a hormonal imbalance called a false pregnancy. If this happens, she may be acting as if she is nursing pups and the operation at this time would cause such sudden changes in hormone levels that it would be unfair to her. Also if she was producing milk, the enlargement of the milk glands would make it more difficult for the spay wound to heal.

For all of these reasons, the time chosen to spay is usually either before the first season occurs, or 3-4 months after a season. A physical examination by the vet will determine whether a 5-6 month old bitch puppy is mature enough to spay before her first season.

Before the operation

As well as timing the operation carefully to reduce any risks, it is also important that the bitch is not overweight. Because this increases the difficulty of the operation, it may well be advised that an overweight bitch should lose weight before the operation.

Another important way of spotting avoidable risks is by taking a blood test before the anaesthetic. This could be done on the day of the operation or a few days earlier. This is used to check the liver and kidney function (both vital when dealing with anaesthetic drugs) and to rule out any unsuspected illnesses.

Before going to the surgery

Before any anaesthetic the patient should be starved for a number of hours, according to the instructions of the surgery. This prevents any problems with vomiting which could be dangerous. It is also a good idea to allow the dog enough exercise to empty the bladder and bowels. Apart from that, it is best to stick as closely as possible to the normal routines of the day so that the dog does not feel anxious.

Being admitted for surgery

On arrival at the surgery, you can expect to be seen by a vet or a veterinary nurse who will check that you understand the nature of the operation and will answer any questions you may have. They will ask you to read and to sign a consent form for the procedure and ask you to supply contact phone numbers. This is very important in case anything needs to be discussed with the owner before or during the operation.

Before the anaesthetic

Your bitch will be weighed to help calculate the dosages of drugs and given a physical examination including checking her heart. If a pre-anaesthetic blood test has not already been done, it will be done now and the results checked before proceeding. If any abnormalities are found, these will be discussed with the owner before deciding whether the operation goes ahead or not. One possible outcome is that extra precautions such as intravenous fluids may be given.

A pre-med, which is usually a combination of several drugs, will be given by injection. This begins to make the dog feel a bit sleepy and ensures that pain relief will be as effective as possible.

The anaesthetic

There are several ways in which this can be given, but the most common is by an injection into the vein of the front leg. The effects of the most commonly used drugs are very fast, but don’t last for very long, so a tube is placed into the windpipe to allow anaesthetic gas and oxygen to be given. The anaesthetic gas allows the right level of anaesthesia to be maintained safely for as long as necessary.

Various pieces of equipment will then be connected up to monitor the anaesthetic. This is a skilled job which would usually be carried out by a qualified veterinary nurse. Apart from the operating table, the instruments and the anaesthetic machine, a lot of specialised equipment will be on “stand by” in case it is needed.

The area where the surgical incision is to be made will be prepared by clipping and thorough cleaning to make it as close to sterile as possible. The site is usually in the middle of the tummy, but some vets prefer to use an incision through the side of the tummy.

The operation

While the bitch is being prepared for surgery as mentioned above, the surgeon will be “scrubbing up” and putting on sterile clothing (gown, gloves, hat & mask) just as in all television surgical drama programmes. The surgical instruments will have been sterilised in advance and are opened and laid out at the start of the operation.

The operation involves removal of the ovaries and uterus (ovario-hysterectomy). The surgeon carefully opens the abdomen by cutting through the various layers. The first ovary is located and its blood vessels are tied off before it can be cut free at one end, then this is repeated with the second ovary. It is a delicate and fiddly job, needing great care and attention. The main body of the womb or uterus is then tied off as well before the whole thing can be cut free and removed. After checking for any bleeding, the layers of the tummy can then be sewn closed again. A dressing might be applied to the wound. Further drugs may be given now as needed.

When the operation is finished, the gas anaesthetic is reduced and the bitch begins to wake up. She will be constantly monitored and the tube removed from her windpipe when she reaches the right level of wakefulness.

Recovery

Like humans, dogs are often a bit woozy as they come round, so she will be placed in a cage with soft warm bedding and kept under observation. Usually they will wake up uneventfully and then sleep it off for the rest of the day.

After-care

The bitch will not be allowed home until she is able to walk and is comfortable. Full instructions should be given by the surgery concerning after-care. The most important things would be to check the appearance of the wound, to prevent the bitch from licking it (with a plastic bucket-collar if necessary) and to limit her exercise by keeping her on the lead. Any concerns of any kind should be raised with the surgery.

Any medication supplied should be given according to the instructions. Pain relief can be given by tablets or liquid on the food. Antibiotics are not always needed, but may be supplied if there is a need for them.

Usually there will be stitches in the skin which need to be removed after about 10 days, but sometimes these are concealed under the surface and will dissolve by themselves.

tilly's wound with text

After a couple of weeks, if all goes according to plan, the bitch can be allowed to gradually increase her exercise levels. This is the stage that Tilly has now reached and she is thoroughly enjoying a good run again now that she is feeling back to normal.

“No! Not on the carpet!” – Vomiting in Cats

I knew it was going to be a rough day when I walked in and saw that three of my ten morning appointments were vomiting cats.  Second only to the chronically itchy dog, vomiting cats can be one of the most frustrating things we have to deal with as vets because there are so many possible reasons why it can happen.  Anything from what the cat had for dinner last night to metabolic diseases that may have been brewing for years could be the cause, and distinguishing between them can take a lot of time, money and effort.  And that’s just for the vet – as the owner of a cat that vomits frequently myself, I understand how unpleasant it is to walk downstairs in the middle of the night and step in a pile of cat sick.  Be it on the new white carpeting or the beat up old sofa, it’s not pretty.  It may be a harmless hairball, but it can also be a sign of serious illness in your cat so it’s definitely worth getting it checked out by your vet.  If you are unlucky enough to have a vomiting cat, here are some things you may want to consider.

Why do cats vomit so much?

Amber prowl cropVomiting in cats is extremely common, but that doesn’t mean that it’s normal.  Some cats are simply prone to hairballs, especially long-haired cats or those that groom excessively.  Others are particularly sensitive to the kinds of food they eat and may not be able to tolerate a particular protein such as beef or additive such as wheat gluten.  Intestinal worms can cause vomiting sometimes, and you may even see them wriggling around after they come up!  Poisonings are rare (cats have a much more discerning palate than dogs) but do occur.  Sometimes playful kittens will swallow things such as pieces of string which can be very dangerous indeed.  Metabolic disorders such as kidney disease, hyperthyroidism, diabetes and liver problems can all cause vomiting too as can tumours of the intestinal tract such as lymphoma.  Pancreatitis (inflammation of the pancreas, an organ which secretes digestive enzymes) or inflammatory bowel disease are other common causes which can present themselves in a wide array of confusing ways.  And of course there is one of my favourite terms, “dietary indiscretion”, which can describe the ingestion of anything from rancid rat remnants to last week’s chicken chow mein from the bin.  With such a huge range of possibilities, it’s easy to see how difficult it can be to find the underlying cause.

What should I do if my cat vomits?

Amber-drinkAs with any medical condition, the best thing to do is contact your vet.  They may tell you to simply starve your cat for a few hours (cats should never be starved for long periods of time though, and should always be brought to the vet if they go more than 24 hours without eating, as this can lead to other serious problems) and reintroduce a bland diet such as plain boiled chicken, as this may fix many acute cases of vomiting.  As always, fresh water should be available at all times.  Or, if your cat is displaying other symptoms such as lethargy, inappetence or diarrhoea they may recommend you bring him straight down to the clinic.  The vet will do a physical exam and take a detailed history, so try to remember as many details as you can about your cat’s behaviour in the past few days.  They may take a blood test or check the urine to rule out metabolic diseases.  Depending on the symptoms they may also choose to take some x-rays of the abdomen to look for anything that the cat may have swallowed, or perhaps perform an ultrasound scan to check for any tumours or other problems with the internal organs.  Because there are so many possible causes for vomiting, sometimes many different tests will be needed so it can become quite expensive at times.  Yet another case where pet insurance is a real plus!

How is vomiting treated?

As previously mentioned, if your cat is otherwise well, you may be asked to feed him something bland such as chicken or white fish with no flavourings or fats added.  Although dogs often appreciate rice or pasta mixed with their meat, cats usually do better without the addition of a carbohydrate.  Or, if you’re not up for cooking, there are a number of prescription pet foods available that can help as well.  If hairballs seem to be the problem, there are special pastes and foods that will help them pass through the body instead of being vomited up.  A worming tablet or liquid may be prescribed if there is evidence of worms.  An anti-emetic (medication that stops vomiting) can be given to help calm things for a bit, and sometimes other medications such as antibiotics or steroids are used as well.  If a foreign body is found (in other words, your cat ate something that got stuck), surgery will be performed to remove it.  Surgery can also be used to remove some types of tumours, or to take biopsy samples of different parts of the intestinal tract to help diagnose the problem.

Some cases of vomiting will resolve on their own, while others can require weeks of intensive diagnostics and treatments.  If left untreated, excessive vomiting can make the cat very ill and you also risk missing any underlying medical problems so make sure you talk to your veterinary surgeon right away if you are at all concerned.  But please be patient with your vet if they can’t fix the problem right away – and remember that we can be just as frustrated by it as you!

If you are worried about your cat vomiting, talk to your vet or use our interactice Cat Symptom Guide to check how urgent the problem may be.

What is Pyometra?

Bobbi cropPyometra is a condition affecting unspayed bitches (and less commonly cats) where the womb, or uterus, becomes infected. In mild cases it can come on fairly slowly with only slight changes in the uterus, but the worst cases happen very quickly and the womb becomes swollen like a balloon, but filled with pus. These are urgent and life-threatening.

Pyometra happens when the lining of the uterus (the endometrium) changes under the influence of the bitch’s hormonal cycle. It nearly always happens a few weeks after she has been in season and is more common in older bitches. The use of certain hormonal drugs to postpone seasons has been linked with an increased risk of pyometra. Rarely, a spayed bitch can develop a similar infection in the remaining part of the uterus, called a “stump pyometra”, but this is uncommon.

The first symptoms are not very specific, with the bitch appearing a little unwell and off her food. Usually the thirst will increase and there may be some vomiting, but not all symptoms happen in all cases. If the cervix (the junction between the uterus and the vagina) remains open, there is often an unpleasant vaginal discharge. If the cervix is closed, the discharge cannot escape and these cases are more serious. The temperature may be raised, and when toxins enter the bloodstream the bitch will become seriously ill. In a small number of cases, kidney failure and death will result.

It is usually easy to diagnose a pyometra from a combination of the history and the physical examination. If there is any doubt, x-rays or ultrasound scans can help in the diagnosis. Blood tests can also help by confirming high levels of infection-fighting white blood cells.

The treatment for pyometra is the surgical removal of the uterus and ovaries, also called ovaro-hysterectomy or spay. It is a more difficult operation in a bitch with pyometra than the regular spay operation in a young healthy bitch. The uterus is often enlarged and fragile. If it should leak or burst, there is a high risk of peritonitis. Having said that, the operation is nearly always successful. It is usually carried out immediately after diagnosis, unless the bitch needs to be stabilised first to allow her a better chance of coming through the operation.

After-care would include antibiotics and possibly fluids by drip if the bitch was very poorly. Exercise will be restricted for a minimum of 10 days while the wound heals, and pain relief will be given.

There have been attempts to treat pyometra with drugs rather than surgery, but it is unlikely that severe cases would respond to anything but surgery. In mild cases which improve for a time there is every chance that the condition will come back after the next season.

It is often said by owners after the bitch has recovered from a pyometra operation that they are healthier than they have been for years. In these cases the condition had probably been grumbling for a long time but not enough to worry anyone until recently. The changes in the bitch’s behaviour which had been put down to advancing years are reversed, often giving a whole new lease of life.

The best way to prevent pyometra is to spay whilst the bitch is young and healthy. Unless you really want puppies, with all the responsibility and expense that goes with them, it is best to spay either before the first season or about three months after it. Your own vet can advise on the best time for your particular bitch. The added advantages of spaying young are the reduced risk of mammary tumours and the avoidance of further seasons and unwanted pregnancies. There could be a slightly increased risk after spay of developing urinary incontinence, and some bitches develop a fluffy coat instead of a sleek shiny one. These drawbacks are greatly outweighed by the benefits.

It is always a good idea to take note of changes in your dog’s behaviour or general wellbeing. Noticing small changes in appetite or thirst could be crucial in diagnosing this type of condition early. If you are worried about any of these symptoms, always ring your veterinary surgery for advice.

Our Interactive Symptom Guide can help you check out any unusual symptoms and advise on how soon you should visit your vet. Earlier diagnosis usually means more successsful treatment.

The Importance of Dental Care

There are two types of dental care for pets: that given by the owner at home, and that given by the vet in the surgery. Both are very important to the wellbeing of our pets.

It is thought that two thirds of dogs and cats over 3 years old suffer from dental disease. This is not a cosmetic problem, although the appearance and smell from an affected mouth can be very unpleasant! More importantly, it is a cause of pain and ill health.

The most important type of home dental care is brushing the teeth. This is best started when the dog or cat is very young, even though we hope there will be no tooth problems at that age. This means that brushing will not hurt. Special veterinary toothpaste and a soft brush are needed, and it is important to brush every day. It might take time to get your pet used to the idea of tooth brushing, but at this age you can start gradually with paste on a finger and work up to introducing the toothbrush. Human toothpaste is not suitable for animals as they contain additives like fluoride which are meant to be spat out and not swallowed, but animals will lick their teeth and swallow the paste.

Some diets are specially formulated to help reduce dental plaque. The hardness and shape of the kibble help reduce formation of plaque and tartar.

Other products that can be used at home include mouth rinses and gels to rub into gums. Carefully designed chews and toys can also help to provide some mechanical cleaning of the teeth, but daily brushing is the most effective preventative.

Bacteria are present in all mouths, but only some of them cause a problem. They cause most problems when there is plaque on the teeth or in little crevices between the teeth and the gums. Plaque builds up over time in all mouths and is made up of substances contained in the food and the saliva. Over time, plaque hardens and mineralises to form hard calculus (or tartar).

In some breeds there is a higher likelihood of dental disease because of the shape of the head or overcrowding of the teeth. Another factor is the way the animal’s own immune system responds to the problem in the early stages, so you could have two animals with the same lifestyle and diet but with different amounts of dental disease. This immune response is particularly important in gum disease in cats (gingivitis).

Broken or cracked teeth provide a focal surface for plaque and bacteria, and so do retained temporary teeth. The so-called “baby teeth” usually fall out by about 6 months of age, to be replaced by the adult set. If a first tooth does not fall out and an adult tooth erupts alongside it, there is a crevice which traps food debris and allows bacteria to multiply.

Gum changes occur alongside dental disease, starting with redness and inflammation and mild discomfort, which can progress to the formation of pockets between the gum and tooth which will eventually destroy the attachment of the tooth.

When your vet examines your pet’s mouth, he or she will be assessing a number of things. After checking the general shape and health of the whole mouth, they will look for any lost, loose, broken or retained teeth. They will assess the teeth and gums for inflammation and calculus, and may need to use a probe at the gum edge. In cats in particular, they will also be checking for resorptive lesions, which occur when the surface enamel is lost, followed by the deeper structures of the tooth, eventually exposing the sensitive nerves.

If dental treatment is recommended, it will be carried out under general anaesthetic. Even in the most co-operative of patients, it is not possible to reach every surface of every tooth with the animal awake. It is also difficult to predict whether any extractions or x-rays will be needed until the teeth have been thoroughly cleaned. This also makes it notoriously difficult to estimate the cost in advance, but your vet should be able to give you a rough estimate or a range of possible costs if you ask.

As with any anaesthetic it is usually advised to have a blood test to check the pet’s general health, and in particular how well the liver and kidneys are working. This is because they are required to metabolise, or break down, the anaesthetic drugs. However, it does not mean that anaesthetics cannot be given if there is a problem with liver or kidney function; it usually means extra precautions will be taken, the choice of drugs may be different and intravenous fluids may be given. Most patients needing dental work tend to be middle-aged or older, but this does not make it too risky to give an anaesthetic. As long as the animal has been fully examined and blood-tested, the risks of the anaesthetic are often smaller than the risks from the dental disease itself.

Sometimes owners want to delay this type of treatment for as long as possible, especially if the dog or cat still has a healthy appetite, but this can make matters worse. If the animal is off its food because of dental disease, it is already quite advanced and will need much more treatment, and the animal’s general health may have deteriorated during the delay.

Antibiotics are often needed before and after a dental procedure. If bacteria from the infected mouth enter the bloodstream, there is a risk that they may settle in places like the heart valves.

The equipment used in a vet’s surgery for dental work is very specialised. An ultrasound descaler is used to remove calculus from teeth and another attachment is used to polish the teeth. Several hand held instruments are needed to do simple extractions. More complex extractions, where teeth have several roots, may need a full surgical kit. An x-ray machine and developer is needed for many dental cases so that hidden structures can be visualised. All of this equipment has to be sharpened or maintained and sterilised between each procedure.

Although the most common dental procedures carried out by vets are descaling, polishing and extracting teeth, dentistry for animals is becoming more sophisticated all the time and there are specialists available to deal with the most complex cases.

Regular examination of your pet’s mouth, both at home and in the surgery, is important in spotting problems early and planning the right treatment. As well as dental disease this can also help with early detection of mouth and throat tumours, which are not uncommon. Ideally the mouth should be examined at least once every 6 months.

A week or two after a dental procedure, when everything is healed, is a great time to start brushing teeth again, or for the first time if it wasn’t started as a puppy/kitten. If unsure about the brushing technique, ask your vet or nurse for advice or a demonstration.

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Grissom survives cat flu.

Grissom kitten 1 crop

Grissom at 3 months old

This handsome fellow is Grissom, a lively 3 month old kitten. Like the TV character he is named after, he is extremely inquisitive and tenacious.

Grissom belongs to a good friend of mine and enjoys all the luxuries that a cat-loving household can offer. But unfortunately he had a very bad start in life when he succumbed to cat flu as a young kitten in a rescue cattery.

Cat flu is a viral illness which can affect cats of any age and breed, but the very young are most susceptible. Kittens born to unvaccinated mothers are especially vulnerable as they do not start life with good levels of immunity. The main strains of cat flu are feline viral rhinotracheitis and feline calicivirus, but there are other viruses and bacteria causing similar symptoms.

The signs of cat flu are very similar to flu in humans (although it is not caused by the same viruses). Cats will sneeze and have runny noses and sticky eyes, go off their food and generally look unwell. They are likely to have a raised temperature and become lethargic. Some strains also cause mouth ulcers. As a result of not eating and drinking they can quickly lose weight and become dehydrated. Longer term effects can include damage to the eyes or chronic snuffles. Most cats will get over the illness in 2-3 weeks, but unfortunately some will die of cat flu, sometimes in spite of receiving all the treatment possible. After infection, some cats will become carriers, which means they will intermittently shed virus, acting as a reservoir of infection for other cats. Known carriers should be isolated from other cats.

Flu viruses spread very easily between cats as virus particles are shed in the saliva and the secretions from the nose and eyes. They spread when the cat sneezes, and they can also survive on bowls and litter trays, and on the hands and clothes of people dealing with them. Disinfection is an important part of prevention of spread, and in a multi-cat household or a cattery, any affected cats should be isolated.

Grissom kitten 2

2 weeks of constant nursing care were essential to Grissom's recovery

Viruses themselves are difficult to treat and anti-viral drugs are not generally available, but most cats with cat flu will also have secondary bacterial infections of the chest, throat or eyes, which can be helped with antibiotics. In serious cases they may also need to be given fluids by a drip. Nursing care is extremely important to their recovery. I don’t think Grissom would be here today if he hadn’t had round the clock nursing care, first of all at his vets and then at home, for nearly 2 weeks. This includes cleaning the eyes and applying drops, syringe feeding, steam inhalation to clear airways and general TLC. All of this has to be done in isolation from other cats. Now that Grissom is better, he is a very well-socialised cat who enjoys human company.

Routine vaccination against cat flu is the best way to prevent it. There isn’t a 100% guarantee because of the different strains involved, but it will greatly improve the odds.  Rarely, vaccination itself can have some unwanted side effects, but I believe that the small risks involved in vaccination are outweighed many times over by the benefits. Kittens can be vaccinated from about 9 weeks of age, with the primary course requiring two injections a few weeks apart, and then an annual booster.

Boarding catteries and breeding catteries have to be particularly careful to prevent outbreaks of cat flu, which happens much more commonly where many cats are housed together. It is preferable to house cats in smaller numbers, with solid “sneeze barriers” between them to prevent spread. Boarding catteries will not accept cats which have not been vaccinated.

Cat flu is still one of the most common viral illnesses of cats and can be very serious and unpleasant. It is well worth taking all possible steps to prevent it.

If you are worried that your cat may have cat flu, or any other symptoms, please contact your vet or use our interactive Cat Symptom Guide to help you decide what to do next.

Cats get Tetanus too.

Most people are aware of tetanus (“lockjaw”) either through having vaccinations at the health centre or perhaps if they own a horse which has to be vaccinated against the disease.

Both humans and horses are genetically susceptible to tetanus and a particularly risky combination of events is when a gardener receives a wound whilst handling horse dung. The tetanus-producing organism (Clostridium tetani) is found naturally in soil and horse manure and can exist as spores for many years.

Dogs and cats only rarely get tetanus. In fact most vets will only see one or two cases in their professional lifetime but once seen, never forgotten. Because of the years I spent in animal welfare practice with a high turnover of cases, I managed to see two dogs and two cats with the condition during a period of 37 years.

Dogs get the condition much more seriously. The disease affects the nervous system by producing a toxin which causes all the muscles to eventually go into spasm so the dog becomes almost as rigid as a rocking horse and the muscles of the mouth are drawn back in what is known as a sardonic smile (risus sardonicus). Eating, drinking and even blinking become almost impossible and in dogs the condition is often fatal if intensive care is not administered early enough.

Amber showing her rigid hind leg.

Amber showing her rigid hind leg.

Cats are a different proposition. The tetanus bacteria are often introduced from a wound or a fight and the muscle spasm is usually localised in a hind leg. Over a period of a few days the leg becomes completely rigid and can only be trailed behind the cat.

Amber was a three year old cat who enjoyed going out at night. Inevitably she got involved in a few territorial fights on her travels. Her owner brought her in because she was obviously lame.

Amber's wound, the source of the tetanus infection, with the other cat's tooth.

Amber's wound, the source of the tetanus infection, with the other cat's tooth.

When I examined her, I found another cat’s canine tooth embedded in her back leg. This deep puncture had allowed the tetanus organisms to become established in her damaged muscle tissue and the toxin then affected the muscles of the whole leg.

I started Amber on a combination of penicillin, a drug called metronidazole and diazepam to relax the muscles and reduce the discomfort for her. It took about a week for the treatment to start to work and then there was a gradual relaxation of the muscles. By three weeks after she had been diagnosed, there was no trace of stiffness. During all this time, Amber continued to eat well and was only inconvenienced by the lameness.

After the first case I saw in a cat, I reported it to our professional journal, The Veterinary Record. A few people wrote to me to say that they had seen cases in the tropics where cats had been neutered in less than ideal surgical conditions and without the benefit of antibiotics.

So while tetanus is a pretty rare occurrence in the cat and cannot be vaccinated against, perhaps this case will remind us that the potential for tetanus is always present in the environment and that we should make sure that our own tetanus vaccinations are boosted every ten years and that we get a dose of antitoxin whenever we have a contaminated puncture wound.

Horse owners should consult their vet about keeping up booster vaccinations against tetanus. Intervals vary so ask your vet for advice. It is important to remember that the antitoxin given when a horse has treatment for a wound will only give up to three weeks protection if the horse has not been vaccinated against tetanus.

If you are concerned about any health problems in your cat, please contact your vet or use our interactive Cat Symptom Guide to help you decide what to do next.

Cat Eye Operation

Joe Inglis BVSc MRCVS is the vet for the One Show, This Morning and BBC Breakfast. He runs his own line of natural pet food called Pet’s Kitchen

I often find myself sympathising with my patients, and feeling for their distress and pain when they are suffering from illnesses or injuries – and never more so than when their problem involves their eyes. There’s something about injuries and diseases of eyes that really affects me more than almost any other type of problem and I can really empathise with how my patient must be feeling. Having an ulcer or other injury to an eye must be horribly painful, not to mention the psychological impact of dealing with the loss of some or all of your sense of sight.

When Sylvester the cat came into the consulting room last week and clambered miserably out of his wicker basket, my heart sank and I felt an immediate sense of shock and distress when I saw his problem. His left eye was barely recognisable, with a large grey ulcer dominating the cornea and angry red blood vessels invading the usually clear surface of the eye from the sides. This was not Sylvester’s first visit to the surgery for this problem, but it was the first time that I’d seen him, and I immediately knew that we needed to do something drastic if we were going to save his eye – and bring his obvious suffering to an end. Looking at his records it was clear that this ulcer had been grumbling on for a couple of weeks by this stage, and despite ongoing treatment with medicated drops it was getting worse rather than better.

At this stage we had a couple of options to consider. One was to refer Sylvester to an eye specialist, but this was quickly ruled out by his owner on the ground of cost and lack of pet insurance cover. The second option would be to continue with medical therapy, taking a swab to find out exactly which bacteria were causing the ongoing damage and preventing the ulcer from healing and potentially changing the eye drops once these results were known. The downside of this course of action was that it would do little to alleviate Sylvester’s discomfort in the short term, but after talking to his owner and explaining that the only other option would be surgery to remove the eye, we agreed that we would try this first.

So I took a swab from Sylvester’s eye and sent it away to the laboratory to see what they could tell us about the infection. While we waited for the results we did what we could to manage Sylvester’s discomfort with painkillers and anti-inflammatories, and then as soon as the results were in we started him on an aggressive course of antibiotics that were targeted specifically at the bacteria the swab had isolated. At this stage I was still optimistic that we could save Sylvester’s eye, but unfortunately things didn’t work out as planned and despite our new treatment regime, the ulcer stubbornly refused to respond and after a week of treatment it became clear to me that we were left with only one option – to remove Sylvester’s eye.

Breaking this news to his owner was not easy, but she did appreciate that it wasn’t fair to let him continue to suffer as he was doing given the now very slim chance that we would be able to save his eye. After a couple of long – and emotional – consultations, we agreed to go ahead and last Friday Sylvester came into the surgery for his operation.

Sylvester the cat after the operation to remove his eye

Sylvester the cat under anaesthetic after the operation to remove his eye

Removing an eye is an operation I really don’t enjoy, as I can’t help but really feel for the poor animal that is losing such a crucial part of their anatomy, and the operation itself is also technically tricky and pretty gruesome. Sylvester’s operation went as well as I could expect, but it was not one that I finished with a sense of satisfaction – I felt good that we had brought Sylvester’s suffering to an end, but I also felt as though we’d failed him by having to resort to such a procedure.

If you have any concerns about your cat’s eye please contact your vet or use the interactive cat symptom guide to help you decide what to do next.

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