Browsing tag: rabbit

Once you relinquish your pet to the green fairies, you may be wondering what actually happens “out the back”.

Well, wonder no more. Firstly we make sure that we have an accurate weight for your pet as this is what we use to calculate the dose of the drugs that we give your pet. Once we have this we settle them in a kennel with nice squishy blankets while we go and get everything prepared.

If you have opted for, or we have recommended, a blood sample before anaesthesia then your pet is taken to a quiet part of the practice where we can safely take the sample. To take the sample, a patch of hair is shaved over the jugular vein which runs down the side of the neck, to one side of the windpipe and a needle is inserted to collect the blood. Most animals tolerate this quite well with the gentle yet firm restraint that we green fairies have down to a fine art. Some animals on the other hand object quite vociferously and may have to have the blood sample taken once they are anaesthetised. Not ideal but better if they are getting too stressed.

Once the results have come back and been received by the veterinary surgeon, they can decide what to pre-med with and whether the use of intravenous fluids is necessary. Intravenous fluids are usually considered if there is any elevation of the liver and kidney enzymes which show that these organs need a little help during anaesthesia as that is where most of the drugs used are metabolised. Some veterinary surgeons also advocate the use of fluid therapy during routine bitch spays as a spay is a fairly major and invasive procedure and fluids help maintain blood pressure and support the body during this procedure.

There are a few ways that we can induce anaesthesia in your pet. One way is to use the anaesthetic gas and get them to breathe the gas in via a mask or an anaesthetic chamber. This way is usually used with smaller creatures such as rabbits, guinea pigs and rats and they fit into the anaesthetic chamber and can have oxygen administered in this way before the gas is turned on.

Another way is to inject an anaesthetic agent called Propofol into the vein and then maintain anaesthesia directly into the airway using an endotracheal tube which is fitted into the windpipe. This is the most commonly used induction for surgeries as induction is quick, Propofol wears off quickly and then the anaesthetic can be controlled with the gas.

The final way is to inject a combination of sedative and tranquilliser drugs into the muscle, usually the lumbar muscle or the quadriceps. This way is usually used for short, less painful and less invasive procedures such as cat castrates where the animal only needs to be asleep for a short period and is reversible with another injection.

If your pet is having surgery, the affected area will have to be shaved and cleaned to maintain the sterility of the site. This is why we advise that dogs are fairly clean when they come in so that we don’t have to spend so much time cleaning them which means they spend less time under anaesthetic.

So, that answers the question of how we prepare your pet for anaesthetic or why he has so many bald patches!

If you are worried about your pet’s surgery please talk to your vet, or check any post op symptoms with our Interactive Symptom Guide to see how urgent the problem may be.

It seems a simple enough task, to be able to tell when your pet is in pain but actually it can be a lot harder than you think. Animals have been programmed over millions of years of evolution to hide when they are sore or in discomfort, otherwise predators and competitors would pick up on the signs and target them. So, as owners, we need to be vigilant to quite subtle changes in our pet’s behaviour that could indicate they are in pain, and ensure they don’t suffer in silence.

Depression

Most of us assume that if an animal is in pain they will cry out or whine but actually the opposite is true. Chronic (low grade and continual) pain is very depressing and often animals learn to cope with it and show few outward signs of a problem, other than maybe being quieter than normal or sleeping more. The problem with is that this sort of pain is common in older pets, for example with arthritis, and this is what we expect them to do anyway. However, even in excruciating pain our pets can be very quiet and withdrawn. I once saw a cat with a very badly broken leg who had managed to drag himself home, curl up in his basket and was so calm his owner didn’t think he was in any discomfort, until she saw the x-rays! Often with this type of pain, it is not until you give your pet some pain killers, and see the difference in their behaviour, that you realise how sore they were in the first place.

Lameness

A very common sign of leg pain, from pulled muscles to arthritis, is limping. Other than this the pet can seem quite well and cheerful, and often won’t respond to the leg being moved about or felt, which can lead to their owners thinking they aren’t in any pain, when nothing could be further from the truth! Lameness is a very common problem and if it lasts more than 24 hours (even if it is intermittent) the pet should always be checked over by a vet.

Smelly Breath

All pets have smelly breath to some degree (!) but halitosis can often be the only sign, without looking in their mouths, which some pets are reluctant to let their owners do, of painful teeth problems. Often people assume if their pet is eating then they aren’t in any dental pain but this isn’t the case, as an animal’s drive to eat will always overcome any soreness. In fact, if a pet does stop eating because of mouth pain, it is likely to be excruciating and will have been there for some time. Other signs of mouth pain include tartar build up on the teeth and swollen gums. If you are concerned, most vets run free dental clinics, so give them a ring and pop along.

Weight Loss

Our smaller pets, like rabbits and guinea pigs, are even better than cats and dogs at hiding when they are sore because, as prey animals, if they show any signs of being ill, they will be quickly singled out by predators. So their owners have to be even more vigilant to spot problems. In fact, it is not uncommon for these pets to be brought into our clinics close to death, their owners distraught that they have missed signs of a problem or thinking they have fallen ill very quickly, when it is more likely they have been poorly for a while but have managed to hide their symptoms. However, one thing which always happens if these animals are in pain or poorly is that they will lose weight, even if they appear to be eating normally. So, weighing your small pets regularly is a great way of monitoring them and any changes in a downward direction should always be taken seriously.

Our pets can’t speak for themselves and in many cases are too brave for their own good; trying to pretend that everything is fine when in fact they are in pain and suffering. So, all good owners should be alert to the small changes that could indicate a big problem and make sure they get them treatment they need and deserve.

If you are worried that your pet may be in pain, please contact your vet. If any other symptoms are present why not check the urgency of the problem by using our Interactive Symptom Guide?

It is the time of year for New Year’s Resolutions but if our pets were to make them, what would they be…..?

Dog

Oh! A New Year’s resolution? That sounds fun! I can I do one? Can I, can I, please?! Right, OK, what should I try? How about slobbering less?! Could do but that would be VERY difficult and I think Mum would miss it, she always shouts with delight when I give her a big kiss, especially first thing in the morning when she hasn’t seen me for AGES! I love walks, what about going on more?! With Dad obviously, that time I tried it on my own wasn’t so successful. A lady caught me and I ended up at the VETS, yuk! But Dad soon came to collected me and said it was a good thing I was chips (I think!). I like chips, they let me eat the crunchy ones they don’t like. Anyway, yes, walks, I love them but wish I could go off the lead more (that’s why it was SO much fun when I went on my own!). Dad doesn’t let me much but I love to run. I know he gets a bit cross when I don’t come back straight away but it is so BRILLIANT to run, it’s what we dogs are made for! I suppose I would go back if he made things more interesting, like playing games or having some treats. Also, I am not very good at commands but then again we don’t practice them much and my doggy brain needs to be reminded otherwise I forget stuff. So, more walks where I can run, yes, that would be it! Now, where’s Mum, I feel a good slobber coming on!

Cat

A New Year’s resolution? That sounds like hard work, can’t I just lie here and sleep? I like sleeping, I am very good at it, maybe I should resolve to do it more, I think I could just about manage another hour or so a day, it is a very busy life you know. I used to run around when I was younger but it is much easier now to lie still now, the staff say that is because I am slightly larger than I used to be but I know that I am perfect. There is always a full bowl of biscuits down, but what is a cat to do, ignore them? I don’t think so! Obviously I don’t always eat everything I am given, sometimes I just lick the gravy or jelly from the meat course but that is mainly to keep the staff on their toes and the menu varied. I did hear mention if I stay this cuddly I could get problems like arthritis or diabetes, which don’t sound very nice, so maybe I should try to slim down a bit. Hmm, I shall sleep on it, zzzz.

Rabbit

Well, yes, a New Year’s resolution, I think I could manage that. Let me just clean my paws while I think. It would be nice to nose twitch to a friend about it but I don’t have one. nibble nibble I do get lonely on my own, the people come to see me every day, especially the little one, but it isn’t the same as having somebun here all the time. nibble nibble We bunnies naturally get on together well, think how many friends I would have if I lived in a burrow! One thing I know I should do is eat more hay, it is good for my teeth and tummy, nibble sniff nibble, but when there is a full bowl of yummy pellets around all the time, it is very difficult to resist them and then I don’t have any room for hay! nibble, clean ears, sniff, nibble So, I will try to eat more hay, but what I would really love is a friend! nibble, nibble, nose twitch, big sigh!

Our pets have simple needs and wants and it would be so easy in most cases to help them! Maybe that could be your New Year’s Resolution and then everyone’s a winner!

Why not take a look at our Pet Care Advice pages? Or if you are worried about your pet, check the problem with our Interactive Symptom Guide.

The nights have drawn in, Merry Hill is heaving and the carols have already been playing for weeks – it’s Christmas! If you are anything like me and leave everything to the last minute, you don’t have much time to plan the ideal gifts and sometimes you buy things that aren’t always that suitable. Now, I can’t tell you what not to buy for your Dad (although I’m guessing he doesn’t really want socks again) but I can tell you what not to buy for your pets!

Dogs are intelligent, social, active creatures who are, and this is important, in possession of extremely efficient furry coats. This means that they do not need an extensive wardrobe of clothes! The range of outfits you can buy for them is truly astonishing and yes they might look cute dressed up as a Christmas fairy or in a t-shirt that says ‘The Dogfather’ (!) but who is it really for? Not the dog, who invariably looks miserable trussed up, but for their owner.
The irony of course is that although these outfits are bought as an expression of love for the pet, they are often over-indulged animals who, as a consequence of being spoiled, are not always that pleasant to be around. Of course, some dogs do feel the cold but a simple padded jacket is fine, or (and this is a ground breaking suggestion) once you are out, get them running around, they’ll soon be warm then! Doggy accessories that are worth purchasing are decent collars and leads, haltis for those who pull and a few sturdy toys to keep them occupied on walks or in the home.

Cats could not be more different to dogs (good luck to anyone who tries to put an outfit on their moggy!) but they are still valued members of the family and often have something under the tree! However, don’t buy them one big expensive toy, get them several cheaper ones instead. Cats will play with anything new that appears but once they have done this for a couple of days, they are likely to ignore it. So, having a box of lots of toys and changing them round regularly will ensure they always have something to keep them interested.
Also, don’t buy your cats a double feeder of any variety, they are truly pointless. Not only will a cat rarely drink where they also eat (an instinct from hunting which stops them drinking from water near where they catch their prey, would you want to drink where a rat had probably wee’d?!), they also hate to eat with other cats and forcing them to share from a double feeder encourages them to gorge on their food so they don’t have to stay long and increases stress levels. Great buys for cats include activity toys like fishing rods or anything on a string, igloo beds (cats love to hide but make sure you put them somewhere high up) and water fountains.

Finally, rabbits. There are loads of great activity toys in the shops for rabbits so there is absolutely no excuse to fall back on the usual Christmas failsafe of treats! Obesity is a big health problem in bunnies and causes all sorts of issues from dirty bottoms to arthritis. Also, too many treats can mean they don’t eat enough hay which can cause problems with their teeth. Great gifts for rabbits include willow chew toys and the biggest cage and run you can afford! Alternatively you could give a gift to yourself and rabbit-proof all the wires if they are kept indoors, which should ensure there are no unexpected interruptions during the Christmas TV scheduling!

I hope you and all your pets have a Happy Christmas and a Healthy 2012!
If you have any questions about your pet, you should always contact your vet.

If you are worried about your pet over the Christmas period and are unsure whether your need to see a vet you can always call them for advice, or try our Interactive Symptom Guide to see how urgent the problem may be.

Rabbits are really popular pets in the UK, second only to cats and dogs, and they can make great companions. However, despite peoples best efforts their needs are often misunderstood and rather than being treated as the intelligent, social animal they are, many are condemned to a life of loneliness and boredom in a cage at the bottom of the garden. It is not difficult to look after rabbits in a way that will keep them both healthy and happy, so what do they really need?

The most important thing you can do to keep a rabbit healthy is feed them a balanced diet. The most common problems that vets see in rabbits are over-grown teeth, tummy upsets and obesity related disease, all of which are directly related to them being fed incorrectly. The vast majority of a rabbit’s diet, at least 80%, should be good quality hay. As a rough guide, every day a rabbit should eat a pile of hay as big as it is. Rabbit’s teeth grow continually and without hay to grind them down, they can develop painful spikes, which rip into the tissues of the mouth, and nasty abscesses in the roots. Hay is also required for good digestion (rabbits can easily die from upset tummies) and helps prevent them getting fat. In addition to hay rabbits should have a small amount of fresh vegetables every day, half a handful is enough and a small amount of pelleted rabbit food, no more than a tablespoon twice a day. This is often where people go wrong, leaving the rabbit with an over-flowing bowl of rabbit food, which, because it is high in calories and very tasty, it is all they eat, giving them a very unbalanced diet.

Rabbits are extremely social creatures, in the wild they live in large family groups, and they should never be kept on their own. The best thing to do is to buy sibling rabbits when they are young. You can introduce rabbits when they are adults but it has to be done with care as many will fight at first. However, it is important to persevere and get the right advice as rabbits are miserable when alone. They are also very intelligent, so make sure they have a variety of toys in their cages and runs to keep them entertained. These don’t have to be expensive, there are plenty of commercially available rabbit toys or just a couple of logs they can play on and nibble are fine.

All rabbits should be neutered, even if they are kept with others of the same sex, and this can be done from the age of 4 months for boys and 6 months for girls. Neutered rabbits make much calmer pets and are far easier to handle. They are also much less likely to fight with each other; 2 entire males kept together, even if they are siblings, can become very aggressive once their hormones kick in. Neutering also has huge health benefits, particularly for the females, of whom 80% will get uterine cancer if they are not spayed.

For most people the whole point of owning a rabbit is because they are cute and cuddly creatures but anyone who has tried to pick up a startled or poorly handled rabbit will know that they can do a lot of damage with their strong nails and back legs! So, it is important that they are played with and handled everyday so they are used to human interaction. Rabbits are prey animals in the wild and their only defence mechanism when frightened is to struggle and try to run away. This is why they don’t always make great pets for children, who can be, unintentionally, quite rough or unpredictable in their handling and it is a big reason why rabbits bought as pets for children end up forgotten and neglected at the bottom of the garden; because no child will play with a pet which has hurt it. However, with regular, careful handling from an early age rabbits can become great companions and members of the family.

Rabbits can make great pets but they need just as much care and attention as other animals and shouldn’t be seen as an ‘easy’ option. Although they are often bought for children they are not always the most suitable pet for young people and they should always be kept with at least one other rabbit. However, they can be real characters once you get to know them and really give back what you put in, provided, of course, you give them what they really need!

For details on examining a rabbit, neutering and vaccinations, take a look at our Pet Care Advice pages. If you are worried about any symptoms your rabbit may be showing, talk to your vet or use our Rabbit Symptom Checker to help decide what to do.

Pain and pain relief are massive topics which can – and do – fill several textbooks. It’s way beyond the scope of a blog to go into all of the detail surrounding the use of painkillers, and so all I really want to do is to outline some of the different types of pain control that we can use, both in the surgery and as day-to-day treatments.

Pain relief is one of the great success stories in medicine, and it’s no coincidence that some of my favourite drugs of all time are painkillers. Our advances mean that pain in our patients shouldn’t be accepted, and although sometimes we fail to control it, we should never stop trying.

We use a number of different types of painkiller:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Steroids
• Opioids and opioid-like drugs
• Others

NSAIDs

These are the most widely-used type of painkiller and include (for humans) aspirin, ibuprofen and paracetamol. They act by stopping inflammation.

They’re commonly prescribed for post-op pain and for joint problems and may be given for long periods of time. When you’re given painkillers to take home from the vets, they’re usually NSAIDs.

Three things to really take on board with these drugs:

1. Human drugs are not always safe for pets, so never give anything to your pet without talking to your vet first: half a paracetamol can kill a cat, a big dose of ibuprofen can do the same to dogs and even a solitary aspirin can be a lethal overdose for a toy breed, designed as it is for a much bigger animal (us). This is why we have veterinary-licensed drugs for our patients.
2. Increasing doses won’t give more pain relief, and may cause side effects. If they’re not working for your pet, talk to your vet about alternatives.
3. NSAIDs are most effective when given before the inflammation starts. It might seem odd to suggest giving painkillers before the pain even begins, but this is important in treating chronic, repeated and predictable pain like arthritis.

Two of the most common drugs we use are meloxicam and carprofen. Meloxicam usually comes as a syrup, which can be dosed very accurately, and carprofen is generally in tablet form. Both drugs may be used long term as a daily dose and both have been responsible for giving patients their lives back, sometimes for years. We’re also rediscovering paracetamol as an excellent addition to treatments in dogs.

Recently, newer NSAIDs have been introduced which are labelled either as cox-2 inhibitors (e.g. firocoxib), or else dual inhibitors (tepoxalin). Essentially, these are just descriptions of which bit of the inflammatory cascade they act upon, and they’re designed to reduce some risks of side effects that we see with other NSAIDs. It’s arguable, though, as to whether they’re better at relieving pain than some of the older drugs.

More recent still is Trocoxil, an NSAID for dogs which is only given once a month. The theory is that because it acts as a persistent block to inflammation, there’s no point where the vicious cycle of pain can really take a hold. The exact ins and outs of the drug are a bit too much to go into here, but as always, speak to your vet about this medication if you’re interested in finding out more. Do understand, though, that it’s not for every patient and your vet may have good reasons not to use it on your dog.

Steroids

Steroids are very powerful anti-inflammatories, which gives them painkilling properties. However, they also affect the immune system – many patients take them for allergies and auto-immune problems – and can have major side-effects when used long-term at high doses; they also can’t be given with NSAIDs and so for practical reasons their use as painkillers is limited. You may have experience of PLT (Predno-LeucoTropin), a medicine with a steroid component which can be great for chronic pain when other drugs seem to be failing. It’s been around for a long time, and many an experienced vet will recognise its usefulness.

Opioids

Opioids are a group of drugs which act to block the passage and brain detection of pain signals. The classic drug in this group is morphine, which still forms the basis for relief of severe pain in humans. These are very powerful painkillers indeed, although the degree of pain relief depends on whether they’re what we call a full-agonist or a partial-agonist.

Drugs like morphine, pethidine and fentanyl are full-agonists, and tend to be used only within the surgery. They are subject to close control and are never dispensed. Generally they’re given by injection, although fentanyl is available as a long-acting skin patch, which has been very successful for use in trauma patients like RTA cats.

Buprenorphine and butorphanol are partial-agonists and are often used as part of a pre-med before surgery. Buprenorphine is a great painkiller which is usually injected within the practice, but may occasionally be dispensed for oral, very short-term use. It is certainly useful in breaking pain cycles and allowing us to get onto more stable pain relief regimes. For in-patients where NSAIDs either don’t quite cut it, or else a combination therapy is needed, buprenorphine is an excellent drug.

A drug that we’ll often use long-term in out-patients is tramadol. This is a human drug which acts in a similar manner to opioids, and has a number of significant advantages:

1. It’s usually pretty safe, although it can temporarily knock some patients a little flat. Your vet should tell you about this when prescribing.
2. It’s a GOOD painkiller
3. As it has a different way of working to NSAIDs or steroids, it can be used in conjunction with many other drugs to create a better painkilling effect

Others

Other drugs that we use act in novel ways, or else are designed for other purposes but just happen to help with pain control. These are important drugs, and whilst they’re described last they’re definitely not least in importance. In brief:

• Local anaesthetics may be used in and around surgery, to numb the pain nerves. These tend to be injectable, although some creams are available which can be useful to pre-treat patients with needle phobias and the like.
• Ketamine – yes, the horse tranquiliser – has been used for years in emergency medicine as a painkiller; it’s often included in battle packs for soldiers. Its use in our patients is quite specialised and confined to hospital environments.
• Gabapentin. This is a very interesting drug indeed. It’s normally used as an anti-epileptic, but seems to have a great effect on pain of nervous origin (aka neuropathic pain), so can be useful for spinal and neurological conditions.
• Cartrophen is an anti-arthritic drug (also sometimes used in bladder problems in cats) which has a number of effects on joints. It’s usually given as four weekly injections, followed by a variable period of remission. It can be very beneficial for some arthritis patients, but may need a little forward planning in its use, as its administration isn’t recommended at the same time as NSAIDs. It’s certainly a drug worthy of close inspection in long term arthritis cases.

Integrated methods of pain control

Whilst it’s obvious that we have some great drugs for relieving pain, reliance on drugs alone in any condition is generally a limiting approach, as adding in other treatment types – or modalities – may offer greatly increased success rates.

For example, in heart disease drugs may help to keep the cardiovascular system going, but are much less effective when used by themselves than in an overall strategy including lifestyle change, weight loss, exercise programmes, regular monitoring and support networks.

Similarly, drugs may form the heart of a pain relief strategy, but shouldn’t be used as an excuse to avoid other measures that can help – and there are even times when non-drug pain control is good enough that painkillers are not needed. Whatever the non-drug modality used, the decision on when not to use painkillers is a simple one:

1. The pain is being completely controlled by non-drug methods.
2. That’s it.

Remember that phrase – pain is not acceptable in our patients. If nothing else, these blogs should have explained both why pain is a bad thing in the long run, and the sheer number of drugs that fight pain. Treating pain completely without drugs is a brilliant solution, but simply taking the edge off the pain is not enough. Equally, though, finding a number of ways to help with the pain will almost certainly mean that your pet gets more relief and is happier.

Treatment modalities which can help in chronically painful conditions include:

• Acupuncture – there’s a reasonable body of evidence for the physical effects of acupuncture and theories of how it may ‘close the gate’ on pain. It’s now widely available around the country, but must be performed by or under the direction of a vet.
• Supplements – for joint problems, there are a number of supplements containing combinations of glucosamine, chondroitin and green-lipped mussel extract, which protect the cartilage and may even get rid of the need for painkillers in early arthritis. Additionally, essential fatty acid supplements and vitamin E are both mooted as aids to tissue repair and free-radical scavenging.
• Herbal remedies containing Devil’s Claw are widely available, but be warned that the supplement can cause side effects and that clinical trials have produced highly variable results.
• Weight loss – whilst it’s obvious that in arthritis, every excess ounce is another ounce of pain, recent work has suggested that body fat has a chemical pro-inflammatory effect which may exacerbate pain generally. Reducing body fat may reduce the body’s pain responses, particularly in chronic conditions.
• Surgery – for many painful conditions, surgery is the obvious treatment to permanently remove the pain at source.
• Physiotherapy – hydrotherapy, mobilisation, massage and PROM are all very useful in promoting recovery and dealing with chronically painful conditions. Access to these services is usually by referral from your vet, and animal physios are highly qualified professionals.
• Mood enhancement – pain is depressing, so elevating mood helps patients to cope, and also makes new pain easier to deal with. A number of products are available, from pills (including zylkene, a natural extract, and amitryptilline) to pheromone sprays and diffusers (feliway, DAP), but equally, promotion of routine and enjoyable activities can be very successful.
• Prevention –as the best pain relief is prevention, a word should be said about how we avoid seeing dogs with arthritis or cats with pancreas issues in the first place. Also perhaps timely, as the Animal Health Trust, in conjunction with Edinburgh Vet School, have just announced a project into genetic testing for hip and elbow dysplasias in Labradors. Being able to breed the conditions out of our patients will have a major impact on the wellbeing of future generations (so, if your Lab is KC registered and hip scored, the AHT might just want to hear from you).
• Magnet therapy – to this day, I still don’t know if this really works, but plenty of my clients are convinced – including a large proportion of horse owners, who are about the most hard-bitten, unpersuadable people out there.

There are, of course, countless other integrated therapies, like Reiki or Homeopathy, and each will have their champions and detractors. The important factors with any of these are choice and inclusivity – it’s fine to explore all of the possibilities, but not to the detriment of the patient. As a general rule, the vet who prescribes you meloxicam won’t demand that you stay off the Reiki during treatment, and this should work both ways.

The mainstay of pain relief will always be drug therapy, but its effectiveness can be massively enhanced by looking at integrated treatments. Pain is such a debilitating problem that anything which can help to remove it has got to be worth exploring. If you feel that your pet may be in pain, especially if you’re already giving treatment, then speak to your vet about what you can do – there are so many ways to target pain that there’s bound to be something to help.

And do remember that phrase: pain is not acceptable in our patients.

If you are worried about your pet’s health, talk to your vet or use our Interactive Symptom Guide to help assess how urgent the problem may be.

Pain. Everybody knows what it feels like, and – apart from a few determined individuals – we tend to avoid it. But what is it? The International Association for the Study of Pain (IASP) defines it as:

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Or, in other words, when you damage yourself it hurts. And if you’re feeling down already, it hurts more. And if you’re not feeling down already, then pain may make you feel down. And then it will hurt more.

The IASP mainly looks at pain in humans, but it’s a long time since we stopped trying to pretend that animals either don’t feel pain like we do, or else don’t get upset about it. They do, and their inability to communicate pain effectively (or else our inability to properly listen) means that for a lot of animals, pain is a chronic, miserable constant in their lives, despite help being close to hand.

There are tiny pain receptors all over the body, inside and out, attached to nerve fibres. When a tissue is damaged, they’re triggered to send impulses up to the brain, which senses them and registers the feeling we call pain. Hard to describe, but we all understand what it is and we’ve all got experience of it. Pain receptors are usually well embedded in tissues, and usually need a fair bit of triggering – otherwise, any form of touch would be painful.

When we describe pain in ourselves, we often use terms like sharp, jabbing, dull or throbbing, and they can give an indication of how bad it is. But in a more fundamental sense, we differentiate into two types: physiologic and pathologic.

Physiologic pain is ‘protective’ – it’s the pain we get when picking up a hot pan. Very quickly, the body registers the ‘ouch’ and the pan is dropped, hopefully before too much damage is done. Without this kind of reflexive response, we’d just keep on holding the pan until our hands were badly damaged.

Physiologic pain, more or less, is our friend.

Pathologic pain, on the other hand, is the pain that comes from existing damage, such as a broken leg or a arthritis. Whilst it can initially be useful to draw our attention to the condition, it becomes debilitating quite quickly and can be a problem in its own right. It’s this kind of pain that we need to deal with in our patients: the pain that is ever-present or recurrent, at whatever level. If we don’t, the pain becomes responsible for stress, depression and a reduced quality of life.

For example, the pain of arthritis can actually make the condition worse:

1. being unwilling to move around makes the joints stiffen up through lack of use
2. lack of exercise piles on the weight, putting more pressure on the joints
3. increased pressure on the joints means more pain, so less movement, more stiffening and more weight gain

A vicious cycle is created where the problem becomes worse and worse under its own steam – and pain is as the root of it. Whilst we can’t cure the arthritis itself, by removing pain and getting our patients moving we can reverse the stiffness and get some weight off.

Pathologic pain can have its uses, but isn’t always our friend.

How do we recognise pain?

In order to be able to keep our pets out of pain, we must be able to recognise the signs of pain. Remember, though, that absence of signs doesn’t guarantee that there’s no pain – if in doubt, assume it’s there.

Understanding how a pet feels depends on a number of things:

• Empathy
• Understanding of normal behaviour
• Observation

Some owners are just better at spotting pain. Some patients are better at showing it. But unless we look for it, we’re never going to find it.

Dogs tend to be the easiest patients in which to spot pain: their outward responses to pain are more similar to ours than for most species. They’re designed for pack-living, and their conditioning in our homes makes them more likely to be willing to show pain to us, and even to seek help with it. I have, over the years, seen a small number of ‘malingerers’ who were hopping lame at home, but completely normal when away from their owners – generally because being hopping lame at home meant cuddles and treats and all things good.

Do beware, though, of behavioural changes as the only signs of chronic pain in dogs. When our collie, Juno, was a younger dog, a combination of being overweight (yes, shame on me), hip dysplasia and the appearance of screaming toddlers with grabby hands made her mildly aggressive – which, for Spoony, was so out of character that it was immediately apparent. Early recognition of the central issue, along with pain control measures (weight loss, acupuncture, educating the kids) sorted it all out quickly.

Cats are different, very different. When in pain, they tend to isolate and may just become distant and/or grumpy. There may be aggression towards inanimate objects, or self-directed as overgrooming to the point of self-harm, and accidentally touching the sore spot will usually lead to bloodshed, none of which will be the cat’s. But cats are relatively worse at expressing pain in other ways which are immediately recognisable. Drop in food intake is, though, a classic sign of pain in cats.

Rabbits and other herbivores (traditionally, the prey animals) can be very difficult to recognise as being in pain. Their entire survival in the wild depends on not looking weak – predators will tend to go after the stragglers first, to reduce energy expenditure and risk in obtaining food. Survival in the wild depends on being invisible as a target, so hiding signs of pain is standard in these patients. Sometimes, you have to look very hard to find it, which doesn’t mean that the pain isn’t significant. It’s entirely connected that these are the species whose general welfare gives us the most worry.

General signs of pain in animals include:

• Reduced mobility or abnormal movement – if it hurts to move, pain is reduced by not moving. Equally, if a pet is moving in an odd way, then it’s because moving in a normal way hurts. A major, major problem that we encounter is the attitude that reduced mobility is a normal part of ageing – so pain is often not recognised in older patients. It’s amazing what a trial on painkillers can do to change minds.
• Guarding and defence – hiding away or trying to protect the bit that hurts. A common entry on clinical notes is ‘guarding the abdomen’ which usually relates to a tenseness in the belly when we’re trying to palpate.
• Inappetance – most animals will either eat less or stop eating altogether when in pain. When the pain is settled, we often see rebound eating, where intake is increased for a while. This can be a cardinal sign for assessing response to treatment.
• Adipsia or polydipsia – most animals will also drink less, although some, often as a response to stress, will drink too much. Patients with abdominal pain will often swallow great bowlfuls of water, possibly because of a temporary soothing effect.
• Altered interaction – many animals will hide away and reduce their interactions with other members of the household; others, particularly dogs, will become more needy and seek more interaction. Normally friendly relationships may explode into world war three and, rarely, vice-versa. It’s not so much how the interactions change, but that they change in the first place.
• General distress – other signs of distress include increased breathing rate, increased pulse rate, abnormal breathing (cats DON’T pant as a normal behaviour), vocalisation (howling, mewing, whimpering), a certain glassiness of the eyes, hunched body position, bubbling at the mouth (reptiles), fluffing of the feathers or over-stimulation and anxiety from normal noises and events.

Even allowing for all of these symptoms, pain can be a vague and difficult thing to spot. One of our classic presentations in the consult room is ‘S/he’s just not right’, where a patient just isn’t him- or herself. It’s astonishing how many of these patients have some kind of pain complex, and full marks from me to any owner who can spot when their pet is just not happy, however subtle. Nothing ever happens for no reason, and absence of any particular symptom in a depressed patient should always trigger suspicion of pain as a cause.

What factors make pain worse?

Inflammation is a big one. Inflammation is the swelling you get around, say, a cut or a sprain. It’s also the reason why a sprained ankle tends to hurt more the next day than it does at the time of injury. Inflammation is the body’s reaction to detecting damage and is its way of drawing the immune system in to start repairing things. Once damage is detected, a sequence of events is triggered called the inflammatory cascade, which goes a bit like a line of dominoes – once started, it takes on a life of its own. The end result is the release of a lot of chemicals which promote blood flow into the area and, importantly here, an increased sensitivity of the local pain receptors so that almost any pressure sets them off.

A good illustration of this is to imagine someone poking you lightly in the arm. For most of us, it’s not painful, just annoying (and strangely familiar for those with brothers and sisters). However, if you’d been to the doctors for a jab earlier in the day, suddenly the touch is extremely painful. The inflammation around the injection site has switched all the pain receptors on to the point where even light pressure sets them off. This phenomenon is at the heart of much of the chronic pain that our patients suffer from, with conditions like arthritis. Drugs which try to stop the inflammatory cascade are called anti-inflammatories.

Other things that make pain feel worse are:

• The amount of time that it’s been going on for – most of us are fairly stoic, at least at first, but sooner or later an inability to get comfortable, to sleep, to do the things we want to, all start to get us down. It’s the same for our pets.
• Having more than one painful bit – two plus two in this case tends to make five.
• Previous experience of pain. Our pets have a phenomenal memory for pain, which translates to a fear of repeating the experience. Pain at the vets can put a patient off us for life, which is why we try to make the first couple of visits as stress-free as possible.
• Being in a bad mood already. If you walk down the street on a happy day and stub your toe, it hurts. If you’re already in a bad mood, the world seems to cave in. This is where the vicious cycle of pain and depression starts to bite: being in pain causes stress and depression, and stress and depression make pain feel worse.

Pain control is one of the most progressive aspects of veterinary medicine, which means that pain in our pets is no longer acceptable. It might not always be possible to get right on top of it, but that doesn’t mean we should ever be happy about it – and there are now so many available treatments that giving up is simply not a reasonable option.

In the next instalment, I want to discuss the various drugs that we can use in dealing with pain in animals, and how they might fit together. After that, we’ll briefly go on to integrated (non-drug) treatments and how they can make all the difference to some patients.

If you are worried about any symptoms in your pet, please talk to your vet or use our Interacitve Symptom Guide for advice on how urgent the problem may be.

Are you and your pet healthy?

It’s an odd question, which you’ll probably answer depending on how you feel, especially if you’re suffering with, say, a cold or a broken leg. And if your pet is currently having treatment, it’s easy to say that he or she isn’t healthy, but would that automatically be the case? Is a contented cat with well-controlled hyperthyroidism any worse off than a depressed horse? Is a puppy with a rash any healthier than a very old dog without any obvious issues?

Defining health is like trying to catch fog in a net. To start, there are lots of different viewpoints of what it actually means, and it soon becomes apparent that perfect health is an impossible ideal, faced as we are by so many challenges every second of our lives. Unless you’re holding your breath, you’ll have breathed in a lot of germs just since you started reading this, one of which may make you ill next Tuesday. How depressing – unless, of course, you were hoping to avoid that work meeting next Tuesday, in which case the world is suddenly a brighter place.

Context matters with these things: a gut full of bacteria is normal; a lung full of bacteria isn’t. Worms aren’t something you’d want to have, but it’s not that long since diet pills for ladies contained tapeworm eggs, in order to maintain that ‘healthy’ figure. We spend more time, effort and money on polyfilla to mask signs of ageing than we do on exercise and decent diet, because we think that a wrinkle-free face on an unfit body is healthier-looking than someone who looks their age only from the neck up.

So what might it mean to be healthy? Is there one theory which brings it all together? Can it be defined without a blood test? More to the point, how does your vet define it, and can he or she explain it to you? I’d like to discuss three theories of health which could really alter your perception of what it means, for you and your pet. They might seem complicated to look at, but in reality they’re very simple, like all the best ideas:

• Biomedical Health
• Activities of Living
• Self-Care Deficit

Biomedical refers to the presence of disease: imagine if I had a Star Trek type scanner, which I could wave at you and it would tell me if you were biomedically healthy in terms of infection or organ function. But I wouldn’t have a clue about how happy you were, how many friends you had and whether you played sport last Saturday. Aren’t these important as part of a healthy life?

So three very clever people called Roper, Logan and Tierney came up with the Activities of Living. These are twelve basic activities (since expanded by other theorists), ranging from eating, drinking and breathing, through social interactions and sexual expression, to dying, as normal parts of a healthy life. It’s not enough to be free of disease: in order to be truly healthy, one has to be able to take part in all of the activities (even dying, but hopefully only at the end of a long and fruitful life).

Dorothea Orem produced the wonderful Self-Care Deficit Theory, which simply means that anything you can’t do to look after yourself is called a self-care deficit: so if you can’t put your own socks on, that would be a deficit. Orem considered that where a deficit was identified, enough help should be given to overcome it, but no more. So, when my collie Juno was recently struggling with getting out of her basket after a vestibular attack, she got just enough support to make it happen, but that was all. She had to make some effort herself, and that meant that she overcame the problem more quickly.

These are brilliant theories, but what really made them great was combining them and incorporating them into medical care. You often hear the term holistic applied to alternative therapies and lifestyles, but its true definition has its roots in this kind of care: veterinary medicine shouldn’t just be about curing disease, but about enabling patients to live as full a life as possible. The veterinary profession has identified with this ideology since it first evolved, but the recent introduction of these theories into the education of young vet nurses and vets has cemented their importance. So, there’s now a very good chance that your local vet practice is already putting the principles of holistic care into practice:

1. We do, of course, look at your pet’s health from a biomedical point of view
2. Then we may go further and look at how they get on with the Activities of Living.
3. If there are any that they can’t manage (apart, usually, from sexual expression), we may look at their inability to do it – or self-care deficit – and work out how we can help to put it right.

In this way, health is about more than just a negative lab test, and the common presentation of “he’s just not right” can be looked at more fully.

If Tiger, the car-chasing cat, is hospitalised with a broken pelvis, his care won’t just be about pain relief: it’s possible to put food into a cat even against his will, but the real trick is to make him happy enough to want to eat it. So the team will look at what activities would make him a whole, happy cat again, and what his self-care deficits for each activity are. And they’ll give him the help to bridge those gaps: so if he can’t self-groom all over, they’ll do the bits he can’t reach; if he can’t wee, they’ll take care of that. When the gaps between what he can do and what he needs to be able to do have dwindled to nothing, he’ll be healthy again. A lot of that work can be done at home, so when Tiger is discharged, there should be a good chat about what can be done to carry on the process.

If Tess, the old Labrador with arthritis, has lost her spark even with painkillers, the practice may have ways to get that spark back – finding new ways to play and to interact, stimulating (as though a Lab would ever need it) interest in food and people. We should look at her expectations out of life – and she won’t want to run for ten miles in the rain each day – and make sure that she’s not being limited by her routine.

And for concepts designed for a rabbit, look no further. Rabbit welfare in terms of general lifestyle and care is one of the most pressing problems we face in veterinary medicine: the lives of some (but by no means all) of these creatures are simply miserable. So if you’ve got a rabbit stuck in a small hutch all day, dig out a copy of the Activities of Living and see how you score as an owner.

We’re pretty good at keeping our pets free of disease. Where we might need some work is in making sure they’re truly healthy. Dogs can’t tell the difference between a cheap collar and an expensive one, but they do know all about quality time and the importance of a good play session. So it might be that looking at our pets’ health helps us to look at our own, and who knows where that could lead?

If you are worried about any aspect of your pet’s health, talk to your vet or use our Interactive Symptom Guide to help assess the urgency of the problem.

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.

Hot weather can be a problem for pets as they struggle to cope with extreme temperatures.

It’s been scorching here in Gloucestershire recently, and while the hot weather has been enjoyed by most of the population, it has not been so welcome for all, particularly for pets who find it difficult to cope with such extremes of temperature. In the surgery recently I’ve seen a few pets suffering from the effects of too much sun – a dog with mild heatstroke, a cat with sunburnt ear tips, and then there was Harry the bunny who was brought in last Friday in a real state by his owner, an elderly lady called Miss Jones.

‘I’ve been out all day and when I got home Harry was just lying on the ground,’ explained Miss Jones who was obviously very distressed by what had happened, ‘I don’t know what can have happened to him.’

By this point Harry had obviously improved a little and was sitting up in his cage, but he was still definitely not right, breathing heavily and looking decidedly dull and lethargic. I gently lifted him out of the cage and as soon as I did so I could tell what his problem was as his skin was burning hot to the touch.

‘He’s got heatstroke,’ I said to Miss Jones, ‘I need to get him cool quickly so I’ll take him out the back and get him in some water.’

After quickly checking his temperature (which was 3 degrees above normal) I carried the baking hot rabbit through to the back of the surgery and ran some water in a sink. I lowered Harry gently down into the refreshing water and he immediately lay down and let the cool water lap around him, obviously enjoying the experience. After ten minutes his temperature was down to just a degree above normal and he was clearly feeling much brighter so I wet down the rest of his fur and returned him to Miss Jones, who was very relieved to see him looking so much better.

‘You need to be really careful in this weather,’ I told Miss Jones before she left, ‘rabbits can easily overheat if they don’t have shade and plenty of water, so make sure he can get out of the sun and get himself wet when you are out.’’

I hope she heeds my advice, as although Harry pulled through this time, he was very close to being dangerously overheated and I suspect if he’d been left for another half hour or so in the hot sun he might have gone too far to help. Heatstroke can rapidly be fatal and I’ve seen a few cases in my career when pets have simply got too hot to treat and they have died which is always a tragic experience to deal with. The most important thing for owners to understand is the importance of shade, fresh air and water – provided pets have access to these three essentials, heatstroke shouldn’t be a problem. If pets do overheat, the best thing to do is to get them out of the sun and wet them using cool water (but not ice cold as this shuts down the circulation to the skin).

If you are worried about heatstroke or any other problems in your pet, please contact your vet or use our Interactive Symptom Guide to help you decide what to do next.

By Jenny Sheriff

In warmer weather it is important to spend time checking your rabbit carefully at least twice daily. Fly strike can become life threatening within hours

 Rabbits are becoming more and more popular as pets in this country. A well-cared for rabbit can offer a family years of fun and companionship. Rabbits are living longer, healthier lives as the care offered to them improves. They can be vaccinated against diseases which could otherwise kill them (myxomatosis and viral haemorrhagic disease) and operations, including neutering, are very much safer than they used to be. This is partly because they are more regularly carried out and partly because safer anaesthetics are constantly being developed.

Although a rabbit does not need taking out for walks like a dog, it would be wrong to think of a rabbit as a pet which does not need much time spending on it. Feeding the right diet is essential to prevent obesity and to reduce the risk of dental problems. Keeping the hutch or run clean is important. Handling the rabbit daily and grooming it if long-haired are also necessary. In warmer weather there is also another very important reason to spend time checking your rabbit carefully at least twice daily.

Rabbits are particularly prone to a condition called fly strike or myiasis, which happens when flies lay eggs on the rabbit and these develop into larvae (maggots). Usually eggs are laid where the skin is broken or soiled, especially if there is any faecal matter around the anus or any urine soiling of the coat. It can develop into a life-threatening infestation of maggots within a few hours. Particular care needs to be taken if a rabbit has a wound of any kind if the weather is very warm. Obesity increases the risk because an obese rabbit cannot reach to clean itself properly, and diarrhoea also makes soiling and fly strike more likely.

When maggots are seen on a rabbit, the veterinary surgery should be contacted at once. Don’t attempt to wash off the maggots in case the skin needs to be shaved. It is a very serious condition which develops very quickly and needs urgent treatment. In a matter of hours a few maggots can eat away at the rabbit’s skin and flesh and cause a very severe illness. If untreated it leads to shock, weakness, depression and sometimes death.

If noticed early enough, the rabbit can be treated by your vet by removing all the maggots, probably with tweezers, shaving the area and using special washes or sprays. This can be very time consuming as some may be very tiny and more will develop so the process may need to be repeated. Sometimes it can only be done under sedation or anaesthetic. This is one of the most unpleasant conditions which vets have to treat.

Prevention is by keeping the rabbit’s environment free of flies and applying topical preparations available from your veterinary surgery.

To minimise the risk of fly strike:

1. Check your rabbit all over at least twice daily looking for wounds, soiling or maggots

2. Keep your rabbit’s weight right (ask at your surgery for advice on diet and exercise)

3. Avoid feeding too much rich grass or anything else which may cause diarrhoea

4. Have urinary problems checked out to avoid wet smelly patches on the coat

5. Use a fly repellent licensed for use on rabbits

6. Clean the hutch and run regularly

7. Seek immediate veterinary advice if you see maggots on your rabbit

 We are all hoping for a long hot summer, but if it does happen, please be aware of the extra risk to your rabbit.