We are thankful that the crisis appears to be over. Thanks to everyone for their patience and understanding in this difficult time.

Why Were Cat Vaccines In Short Supply?

The official story is that supply chain disruption caused by COVID and diversion of resources into human vaccines made feline vaccines scarce. However, this was just the last (and worst!) in a long line of shortages that have been occurring since well before COVID. The full answer must therefore also reflect the fragility of modern global supply chains.

Please note that this only applied to cat vaccines. Dog and rabbit vaccines are in good supply.

How You Can Protect Your Cat

If your cat is overdue for vaccination and there aren’t vaccines available in your area, please don’t be too alarmed. There are three easy ways you can reduce their risk of infection:

1. Keep your cat indoors
2. Wash your hands and change in-contact clothing after patting cats from outside the home
3. Use pet sitters instead of catteries if you can

If using catteries, choose from facilities like those on our list which provide individual, easily cleaned spaces, not communal areas.

Don’t Forget Health Checks Too!

Vets have always strongly encouraged cat owners to see the value in the regular checkup itself. From our perspective, these get more and more important as a cat ages, but often it’s still the F3 vaccine reminder that prompts the visit.

At Walkerville, we were encouraging cats to still come in for their check if they hadn’t had one in the past 12 months. We gave them a full physical, plus an optional blood test. Later, when the vaccines became available, we only charged the difference if no new checkup was required.

Our attention to hygiene and quarantine means the risk of in-clinic infection was very low. Indeed, to our knowledge, it never happened!

Will My Cat Need A Booster?

A common question is what to do when vaccines are plentiful again. After a delay in vaccination, it is customary to need to give two boosters 4 weeks apart to reestablish immunity.

Whether this will be necessary will depend on the time delay, but also the needs of each cat. There are no hard and fast rules, but a good guideline would be as follows:

• No booster required if only a 3 month delay
• Booster for 3 to 6 month delays in high-risk cats (outdoors, cat boarding, new kittens in the home etc)
• Boosters for all cats after a 6 month delay

The unpredictability of vaccine protection means that even the last point will be up for negotiation. This might especially apply to cats who have had many regular vaccines in the past, giving them a solid base of immunity.

Getting a New Kitten Without Vaccines

If you plan on getting a new kitten, there are important considerations.

My view is that it would be a mistake to not adopt right now. To do this would leave a greater number of kittens in a much higher risk environment. It would be extremely concerning if the shelters were overflowing right now of all times.

Of course, the shelters will have made special rules to cope with this crisis. You’ll need to check these with your local facility before adopting.

What might be best avoided is bringing kittens into homes with existing cats if their vaccines are more than 3 months overdue. Complete avoidance of handling cats from outside the home would also be strongly recommended.

Put yourself on a waitlist at your local vet. Hopefully they will prioritise kittens needing their first vaccines once supplies resume.

That’s all for now but I strongly welcome your comments and questions below.

Related: What Cat Flu Looks Like | Feline Enteritis / Parvovirus

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

1. A poorer recognition of the signs of arthritis in cats and therefore lower demand
2. The smaller market and financial benefit to drug companies (dogs visit the vet at least twice as much as cats)
3. The difficulty in giving medications to cats
4. The increased risk due to the prevalence of kidney disease

Now, in 2023 we are witnessing the appearance of a wholly new approach to treatment that might overcome many of these concerns.

These are exciting times, but we also need to be cautious and realistic. You’ll see in this article that it is by no means a silver bullet. However, with Solensia there is real hope for cats that we have a new and effective tool to improve their quality of life.

What is Solensia?

Solensia is a trade name for frunevetmab in Australia. It neutralises nerve growth factor (NGF), which has been shown to be involved in the perception of pain. As a monoclonal antibody, it has the potential to be highly specific to its target, and block it almost completely.

In Australia, Solensia has been registered for the alleviation of pain associated with osteoarthritis in cats.

How Well Does It Work & How Quickly?

In our clinic, we have seen some cats benefit greatly after starting Solensia, but what does the evidence say? The results of a single placebo-controlled study conducted by the parent company are shown here and referenced below.

There are three important things to note here:

1. All arthritis treatments show a caregiver placebo effect, but for this particular product, it is especially large
2. The difference between the two groups is statistically significant for Months 1 and 2, so we are confident that Solensia is helping at least some cats
3. Unquestionably, there will be many others who receive insufficient benefit and require different arthritis remedies

My view is that the large placebo effect is a direct result of the difficulty we have in correctly identifying signs of pain in cats. However, it is also possible that it only brings benefit to a minority. Our own experience is that Solensia can be very effective in some cats, but hard to judge as well.

A further clue that anti-NGF treatments are helpful is in the clearer results we see for the canine equivalent, Beransa.

Based on laboratory studies, a positive response would be expected to appear at around day 6.

Solensia Dosage & How Often

Solensia is given by vets at a dose of 7 mg by subcutaneous injection for cats between 2.5kg and 7kg.. Above this, two vials are needed but I would suspect that most of these cats would benefit more from weight loss. If desired, the dose is repeated every month. It is generally recommended to try at least two doses before deciding whether it is effective enough.

NGF is important for foetal and juvenile development. Therefore, Solensia must not be used in breeding, pregnant or lactating cats, or those less than 12 months of age.

Human Health Risks

Similarly, pregnant women, women trying to conceive, and breastfeeding women should take extreme care to avoid accidental self injection or needle stick injuries. To be safe, it is best that they take no part in giving the injection or even holding their pet.

Just to be clear, a treated cat poses no risk to humans.

Solensia Side Effects

Up to 10% of cats given the injection showed signs of hypersensitivity such as skin itching, hair loss, and dermatitis. When this occurs, it is advised to stop the treatment. The itch does not respond well to normal treatments for dermatitis until the injection is stopped

If you read the comments section below, you will see that it is dominated by reports of adverse skin effects. In our clinic we have indeed seen a few reactions, but not much more than the reported 10%. My view on this is that although the rate here appears much higher, owners with affected cats will be more likely to post than those with no problems.

In other ways, our prior experience with monoclonal antibodies like Cytopoint shows us that they are much safer than traditional drugs like anti-inflammatories. This is because as naturally occurring proteins, they require minimal metabolism or detoxification by the liver or kidneys.

It is therefore likely that Solensia can be used at normal doses in cats with kidney disease, unlike anti-inflammatories which become more dangerous. However, until there are studies of their use with liver or kidney disease, caution is still advisable in these cats.

Solensia appears safe when used in combination with other drugs, and at the time of vaccination. The only concern with using multiple treatments could be that if an adverse effect occurs, you may not be able to work out which one caused it.

How Much Does Solensia Cost?

The cost in 2023 for a single injection of Solensia is around $90. This is in the same region as the higher priced anti-inflammatory drugs.

Our experience so far is that for some cats, it maintains their quality of life when other choices fail. It can also be used when other treatments aren’t safe enough to use and for those cats that owners cannot easily medicate. In summary, we believe is worth a try if costs allow.

Anyone who has an arthritic cat knows that we still aren’t doing enough for them. The development of monoclonal antibodies brings us just one step closer, and just might give us more time to enjoy our lovely old cats.

Therefore, talk to your vet about whether it might be good for your cat.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

These are exciting times, but we also need to be cautious. No treatment will work on every dog, and after initial overexcitement, some new products end up being major disappointments. However, with Beransa there is real hope for dogs that we have a new and effective tool to improve their quality of life.

What is Beransa?

Beransa is a trade name for bedinvetmab, also called Librela outside of Australia. It neutralises nerve growth factor (NGF), which has been shown to be involved in the perception of pain. As a monoclonal antibody, it has the potential to be highly specific to its target, and block it almost completely.

In Australia, Beransa has been registered for the alleviation of pain associated with osteoarthritis in dogs.

How Well Does It Work & How Quickly?

In our clinic, Beransa has quickly become the number one treatment chosen by our vets for new patients with arthritis. This has been based on a number of factors:

1. A very high success rate, interestingly higher than in the trial featured below
2. Minimal to no observed side effects, especially compared with traditional anti-inflammatory drugs
3. A similar cost to other treatments, especially in larger dogs

What does the evidence say? The results of a single placebo-controlled study conducted by the parent company are shown here and referenced below.

They show that around one in two dogs show benefit after a month. Like with all arthritis treatments, there is a large caregiver placebo effect, so it is important to stay as realistic as possible about its efficacy in each patient.

How To Use Beransa

Personally, I believe the study shown here and our clinical experience are enough to recommend trying Beransa in the right dog. However, I also strongly believe that we should not forget the other tried and trusted remedies for arthritis in dogs.

This is especially because Beransa only targets pain, not the underlying disease process. Now make no mistake: treating the pain is the most important thing, but it isn’t everything. If we add the treatments known to slow down the arthritic process, our dogs should have better function in the years to come as well as right now.

In particular, I encourage all dog owners using Beransa to at least continue the Hills j/d diet and regular pentosan injections. Both are extremely safe and can slow the degenerative process.

Beransa Dosage & Frequency

Beransa is given at a dose of 0.5 – 1 mg/kg by subcutaneous injection. It comes in a variety of vial sizes to cater for dogs of different weights. If desired, the dose is repeated every month. It is generally recommended to try at least two doses before deciding whether it is effective enough.

NGF is important for foetal and juvenile development. Therefore, Beransa must not be used in breeding, pregnant or lactating dogs, or those less than 12 months of age.

Human Health Risks

Similarly, pregnant women, women trying to conceive, and breastfeeding women should take extreme care to avoid accidental self injection or needle stick injuries. To be safe, it is best that they take no part in giving the injection or even holding their pet.

Just to be clear, a treated dog poses no risk to humans.

Beransa Side Effects

Reactions such as swelling and heat may occur at the site of injection, but these seem rare. Hypersensitivity reactions are also possible but appear more common in the cat form of this drug, Solensia.

Our experience with monoclonal antibodies like Cytopoint shows us that they are much safer than traditional drugs like anti-inflammatories. This is because as naturally occurring proteins, they require minimal metabolism or detoxification by the liver or kidneys. However, until there are studies of their use with liver or kidney disease, caution is still advisable in these dogs.

Beransa appears safe when used in combination with other drugs, and at the time of vaccination. The only concern with using multiple treatments could be that if an adverse effect occurs, you may not be able to identify the cause.

How Much Does Beransa Cost?

The cost in 2023 for a single injection of Beransa is between $100 and $130 depending on the size required. This is in the same region as the higher price anti-inflammatory drugs.

Beransa or Librela may not be a silver bullet, but just having another option is a great blessing. Our experience so far is that for some dogs, it maintains their quality of life when other choices fail. It can also be used when other treatments aren’t safe enough to use.

Anyone who has an arthritic dog knows that we still aren’t doing enough for them. The development of monoclonal antibodies brings us just one step closer, and just might give us more time to enjoy our lovely old dogs.

Therefore, talk to your vet about whether it might be good for your dog.

References

Corral, M. J., Moyaert, H., Fernandes, T., Escalada, M., Tena, J. K. S., Walters, R. R., & Stegemann, M. R. (2021). A prospective, randomized, blinded, placebo-controlled multisite clinical study of bedinvetmab, a canine monoclonal antibody targeting nerve growth factor, in dogs with osteoarthritis. Veterinary anaesthesia and analgesia, 48(6), 943-955 Full Text

Kronenberger, K. (2023). In dogs diagnosed with osteoarthritis, how safe and effective is long-term treatment with bedinvetmab in providing analgesia?. Veterinary Evidence, 8(1) Full Text

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

One disease in particular, myxomatous mitral valve disease (MMVD) is said to account for 75% of heart disease and affects 85% of small dogs over 13 years old. Not all of these will need treatment, but many will. Later I’ll show you how to tell.

There is no question that recent advances have made MMVD much less of a death sentence than it once was. So it’s good to get to know pimobendan, the newest, and most commonly used of these treatments.

How Pimobendan Works

Pimobendan is a drug that unusually has two separate positive effects. First, it increases the strength of contraction of the heart, increasing the amount of blood delivered. Second, it dilates blood vessels in the general circulation, reducing the heart’s workload.

Pimobendan needs to be given at a dose of 0.2–0.3 mg/kg twice a day on an empty stomach, leading to the following inescapable logic. If it needs to be given one hour before any food and 12 hours apart, then even starting with a 7am dose will result in an 8pm dinner time. Now of course, we don’t recommend feeding dogs after dark…

You can picture the disappointment in peoples’ faces when they think this through. It’s definitely a drug for the early risers in the house. The only other alternative is to make their main meal in the morning.

Lifespan Of Dogs On Pimobendan

Early work demonstrated that pimobendan could help dogs with MMVD, but by how much was uncertain, and so vets like me were slow to change treatments that were already working. Then two large international studies appeared. With them came a sea-change in how we viewed this drug.

Each of them has something important to say about both effects and side effects. Both are referenced below.

2008: The QUEST Study

252 dogs with naturally occurring MMVD and congestive heart failure were divided into two groups: one taking pimobendan and another taking benazepril, the leading heart treatment at the time. Both were allowed other treatments as needed. They were then studied over the following years until one of the following three things happened:

1. sudden death
2. euthanasia for cardiac reasons
3. treatment failure

For pimobendan, the median time to this endpoint was 188 days. For benazepril it was 140. So a good result, but far from impressive. However, it’s worth pointing out here that these survival times are artificially short; many dogs in the study had already been affected for some time before beginning.

Real life is better. The point is more that in matched groups, pimobendan outperformed its rival.

2016: The EPIC Study

To my knowledge, the EPIC study was the first in veterinary medicine to be stopped early because of what was found. 354 dogs were chosen who had MMVD but were not yet in heart failure. At this earlier stage they had enlarged hearts as determined by xray and ultrasound.

Up to the time of the study, treatment was not believed to help at this stage, and so they were divided into dogs given pimobendan and dogs given a harmless placebo instead. This time the endpoint was chosen to be one of:

1. development of left-sided heart failure
2. euthanasia for a cardiac reason
3. death presumed to be cardiac in origin

The median time to this endpoint was 1228 days in the pimobendan group and 766 days in the placebo group. In other words, dogs with enlarged hearts but without heart failure had an extra 60% or 462 days of disease-free life if they took pimobendan.

This of course was a stunning result. Once it became obvious, all of the dogs were put on pimobendan.

Pimobendan Side Effects

Similar rates of adverse effects were reported for pimobendan and benazepril. This suggests that the drug is at least as safe as other heart treatments,

Pimobendan also recorded similar side effects to the placebo. Deaths in the pimobendan group were 46.4% versus 57.2% in the placebo group. This suggests that pimobendan is safe compared with any drug.

If you want to take a closer look, I’ve included the reported side effects from both studies in two tables after the references.

Help! Pimobendan Killed My Dog!

What then do we make of online reports of terrible events after dogs took pimobendan? The high rates of death and side effects in the placebo group provide the best clue. These are old dogs with a high risk of illness from any cause.

We humans are notoriously bad at separating causation from correlation. In fact, with any one dog, it’s virtually impossible to decide if a sudden death is caused by a drug or not. It’s only by looking at large groups that we can see the trend. Sometimes it’s real, other times it’s not.

Pimobendan may in fact cause deaths in some dogs. Even if so, the evidence tells us that they are heavily outweighed by the dogs that survive for longer.

When Should My Dog Take Pimobendan?

Pimobendan is a much better drug at stopping dogs going into heart failure than it is in treating them once they do. So here’s a quick summary of how to use pimobendan in 2022 and beyond:

1. Get regular checkups (at least annually) to look for early signs of heart disease. This is mainly the appearance of a heart murmur.
2. Once a murmur appears, watch fitness, coughing and resting respiratory rate closely and get a checkup at least every 6 months.
3. Follow your vet’s advice on further testing. Sooner rather than later they will want to do chest xrays and possibly cardiac ultrasound to look for the signs of heart enlargement.
4. Even if things are normal, expect things to change and so repeat the tests every 6 to 12 months based on your vet’s advice. Eventually you’re likely to spot the right time to start pimobendan.
5. Once started, most heart disease will stabilise but dose adjustments and extra medications will still be necessary as the disease slowly worsens (hopefully over years, not months). Therefore, keep attending scheduled checkups and get advice straight away if anything changes.

Most importantly, trust the science. It’s very hard to judge the efficacy of any treatment used to prevent a disease instead of treat it, but we actually have a lot to go on here.

Related: A Dog With Dilated Cardiomyopathy (also treated with pimobendan) caused by a grain-free diet

Update: Mitral Valve Repair

I hesitate to add this as I fear giving dog owners false hope, but several comments below have spurred me to also discuss the surgical option. As of 2023, there are now several centres around the world that offer open heart surgery to improve mitral valve function. It is not replacement of the valve, but instead modifying its shape or adding support so that the leak is less significant.

Costs are extreme (I would guess $40-50K) and availability currently limited to the UK, France, Japan and the USA. If you Google ‘dog mitral valve repair’ you should find useful information from these sites. There is no doubt that this procedure will become more commonplace with time, and hopefully more realistic.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

References

Boswood, A., Häggström, J., Gordon, S. G., Wess, G., Stepien, R. L., Oyama, M. A., … & Watson, P. (2016). Effect of pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly: the EPIC study—a randomized clinical trial. Journal of Veterinary Internal Medicine 30,(6), 1765-1779. Full Article.

Häggström, J., Boswood, A., O’grady, M., Jöns, O., Smith, S., Swift, S., … & DiFruscia, R. (2008). Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: the QUEST study. Journal of Veterinary Internal Medicine, 22(5), 1124-1135. Full Article.

Keene, B. W., Atkins, C. E., Bonagura, J. D., Fox, P. R., Häggström, J., Fuentes, V. L., … & Uechi, M. (2019). ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. Journal of veterinary internal medicine, 33(3), 1127-1140. Full Article.

Minoxidil : A Baldness Treatment

Minoxidil has become extremely popular due to its ability to stimulate hair regrowth on the scalp of people. It was originally marketed as Rogaine, but is now available as an over the counter generic in liquid, foam and shampoo forms.

When cats lick even a tiny amount, it causes vomiting, drooling, low blood pressure, severe illness and often death. Because the product is applied to the skin, it can easily come into contact with cats either directly, by licking the area, or even from pillows.

I first discovered this toxin one year ago after a report from the Animal Poison Control Center that you can read here. In their list of the top causes of poisoning deaths in cats, it included a drug I had never heard of.

If I didn’t know about it, it meant many other vets didn’t either, and very few cat owners.

The message is simple: if you use minoxidil in any form, be extremely careful:

• Clean up areas carefully after use, especially spills or stray drops
• Do not allow your cat to come into contact with treated areas of skin
• Prevent access to bedrooms 
• Clean sheets and pillowcases frequently

PPD: A Hair Dye Ingredient

Para-phenylenediamine (PPD) is a fixative found in many hair dyes and henna temporary tattoos. It causes a deeper, longer lasting and more intense colour. Oral ingestion leads to intravascular hemolysis, rhabdomyolysis, myoglobinuria and acute renal failure. 

In other words, this means massive destruction of red blood cells and muscle cells. The release of their contents into the circulation causes downstream kidney damage. This is the same process you sometimes hear about with overexercise in hot conditions. 

I only heard about this toxin last week, but I saw a case a year ago that I’m now convinced was caused by it. 

Mimi’s Acute Renal Injury

Mimi’s owners came to me for a second opinion after he was diagnosed with acute kidney failure. The interesting thing is that despite an extensive search for the toxin, it was never found. However, due to the timing, Mimi‘s owners strongly suspected that a hair dye had caused it.

At the time, I conducted a search to the best of my abilities and found no link between dyes and poisoning. The case remained a mystery. Mimi survived only thanks to heroic efforts by his owners and a number of veterinary teams.

Knowledge of the toxicity of PPD is well known in human medical circles, but no documented cases of poisoning exist in animals. It’s likely that the lack of evidence is due to a lack of recognition, not occurrence. Like in Mimi’s case, it’s near impossible to prove a particular toxin causes kidney failure due to the delay between poisoning and diagnosis.

Once again, prevention is about minimising exposure:

• Use hair dyes and hennas without PPD if possible
• Use dyes and hennas in a well-ventilated place where your cat cannot join you
• After completion, clean up any spills and splashes carefully
• Rinse basins, baths and showers thoroughly since cats often like to lick these areas after use
• Don’t allow your cat to lick the dyed areas

Diclofenac (Voltaren)

A third common cause of cat poisoning deaths is the human use of potent anti-inflammatories. Once again, the risk is mainly from products applied to the skin. Products like Voltaren gel contain diclofenac, which even in small quantities will cause kidney failure.

Cats are likely to be poisoned either by licking the treated areas, or getting spilt product on their paws or coat. In addition to the methods above, prevention should also include covering the treated areas with clothing and keeping the products in a secure place.

The Common Link

All three of these toxins show us how susceptible cats are to household poisoning. This is for three reasons:

1. Cats are naturally inquisitive and will seek out and investigate new things
2. Cat seem inherently sensitive to a wide range of chemicals
3. Anything that contacts the outside of a cat will invariably be licked off and swallowed

The third point means we should add a final form of prevention: if anything not known to be safe gets on your cat’s coat or paws, you will need to give them a bath. This is not a decision taken lightly, but it may be life-saving.

Moreover, I would be careful about any medicines, dyes or other household chemicals, regardless of whether they contain diclofenac, minoxidil or PPD*. If we are learning one thing, it’s that cats will show us just how toxic a chemical can be.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Sources

Anuradha, S., Arora, S., Mehrotra, S., Arora, A., & Kar, P. (2004). Acute renal failure following para‐phenylenediamine (PPD) poisoning: a case report and review. Renal failure, 26(3), 329-332

Tater, K. C., Gwaltney-Brant, S., & Wismer, T. (2021). Topical Minoxidil Exposures and Toxicoses in Dogs and Cats: 211 Cases (2001–2019). Journal of the American Animal Hospital Association, 57(5), 225-231

* Just look at the ingredient list for a non-PPD containing hair dye for example: how many of these do you think have been tested in cats? Cetearyl Alcohol, Ammonium Hydroxide, Glyceryl Stearate, Ceteareth-20, Toluene-2,5-Diamine Sulfate, Octyldodecanol, Sodium Laureth Sulfate, Ethanolamine, Sodium Cetearyl Sulfate, Fragrance, 2-Methylresorcinol, Resorcinol, Serine, Sodium Sulfite, Oleic Acid, Potassium Stearate, Glycerin, Tetrasodium EDTA, m-Aminophenol, Carbomer, Linalool, Potassium Hydroxide, Citronellol, Ascorbic Acid, Butylphenyl Methylpropional, Linoleamidopropyl PG-Dimonium Chloride Phosphate, Propylene Glycol, Sodium Sulfate, Hexyl Salicylate, 2-Amino-3-Hydroxypyridine, Hydrogen Peroxide, PEG-40 Castor Oil, Disodium Pyrophosphate, Disodium EDTA, Sodium Benzoate, Phosphoric Acid, Behentrimonium Chloride, Dimethicone, Amodimethicone/Morpholinomethyl Silsesquioxane Copolymer, Magnesium Citrate, Magnesium Chloride, Hydrolyzed Keratin, Polyquaternium-37, Macadamia Ternifolia Seed Oil, Panthenol, Isopropyl Myristate, Citric Acid, Phenoxyethanol, Stearamidopropyl Dimethylamine, Isopropyl Alcohol, Sodium Methylparaben, Dicaprylyl Carbonate, Laureth-23, Laureth-4, Sodium Hydroxide, Hexyl Cinnamal, Benzyl Salicylate, Benzyl Alcohol, Limonene, Lauryl Glucoside, Trideceth-5, Salicylic Acid.

Here I’m going to lead you through the evidence and end with advice on how to use fish oil most effectively.

Skip the next section unless you’re really interested!

Fish Oil Essential Facts

First, what exactly is fish oil, and how might it work?

Almost all the fatty acids available to land animals like dogs (and us) are omega-6. The body uses these to make arachidonic acid and from this to make various inflammatory molecules.

When the body uses an omega-3 instead of omega-6, the end result can be anti-inflammatory instead. It’s not that omega-3 is the more natural; in fact, the body in arthritis is promoting inflammation, not suppressing it. What we are doing by supplying omega-3 at high doses is ‘tricking’ the body into using it instead.

In dogs, the effective omega-3 fatty acids are eicosapentaenoic and docosahexaenoic acid (EPA & DHA). Linseed and flaxseed oils contain ALA, which is almost unavailable to dogs. EPA and DHA mostly come from certain fish, but certainly not all of them. Feeding fish without dietary analysis is very unlikely to give the same benefit.

Fish Oil & Omega 3 Dog Studies

Now to the evidence. I’ve read all the studies using fish oil in arthritic dogs that included a control group. The control group is fed a dummy diet or supplement so that the owner placebo effect can also be measured and removed.

In fact in nearly all of these studies the placebo group improved as well. It’s the difference we’re interested in. I have one concern though: fish oil is very hard to hide due to its smell!

Fish Oil As A Supplement

The first study comes from Finland³. They gave dogs with arthritis 110 mg of DHA/EPA per kilogram body weight. This gave a final dietary ratio of omega 6 : omega 3 as 11 : 1 and would equate to roughly 7 regular strength 1g capsules for a 20kg dog.

No differences in measured performance were found. The only differences were that owners were more likely to see improvement, and more likely to guess correctly when their dog had the treatment diet rather than the control.

The results of this study suggest that, if done this way, the benefit of feeding an omega 3 fish oil supplement to dogs with osteoarthritis is small. 

Purina Fish Oil Therapeutic Diet

The second paper⁴ evaluates a veterinary therapeutic diet marketed to alleviate the signs of arthritis. This diet contained 1.08% DHA/EPA with a ratio of omega 6 to omega 3 as 1.3 : 1.

In this study, there were no differences between the treatment and control groups either in measured performance or owner assessment. As the authors stated, “the present study cannot convincingly claim that VTD [= veterinary treatment diet] improved the limb function to a greater extent than a regular diet”

Interestingly, both groups improved substantially. This is almost certainly due to the study design: owners were asked to avoid any intense activities (jumping, running, throwing ball or Frisbee, etc.) during the study duration. Which just goes to show how important it is to stop high-impact activity in these dogs.

Hills Fish Oil Therapeutic Diet

Finally we have the Hills product called JD or j/d. My clients will know I recommend this, and now I hope you will see why. However, I also want you to see that the effect is still not very dramatic.

Hills Prescription Diet j/d has 3.5% DHA/EPA, with a ratio of omega 6 to omega 3 as 0.73 for the kibble and 0.68 for the canned form. Note this is the first time you have seen a diet with more 3 than 6.

There are four studies, and I’ll quickly summarise them:

• Dogs on j/d were able to have greater reductions in anti-inflammatory doses than dogs on control foods. Average final doses of carprofen were 3.5mg/kg vs 3.85mg/kg respectively¹.
• During initial investigations, a difference for lameness and weight bearing were noted between dogs on food A (0.8% omega 3) and those on food C (similar to the final product)². 
• Using floor pressure plates to measure leg use, dogs on j/d increased their peak vertical force by 5.6% at 90 days⁵.
• In a home feeding trial, owners of dogs fed j/d reported improvement in their dogs’ ability to rise from rest and play at week 6 and the ability to walk at weeks 12 and 24 after the feeding trial began⁶.

In all cases, improvements were found, but not huge ones. Each study also included many factors that did not show any change.

How Fish Oil Can Be Toxic To Dogs

Here are some of the ways fish oil could be harmful to certain dogs:

• Dogs prone to pancreatitis should not be fed diets with normal to elevated levels of fats and oils. Therefore, fish oil could cause severe illness or even death in these dogs.
• Dogs with fish-based food allergies could also react severely to fish oil.
• Even normal dogs can have unexpected gastrointestinal upsets when fed fish oil. These are usually mild vomiting or diarrhoea, and will stop if you cease giving fish oil.

What about the fact that the therapeutic diets are grain-based? As you’ll see here, vets advise against grain-free diets.

Can You Use Human Fish Oil Capsules?

A common question is whether you can use pharmacy fish oil to treat dogs. This is true for skin disease, but false for arthritis. The reason for this is that the food manufacturers, through mysterious means, reduce the levels of omega 6 before adding omega 3. It’s also just that fish oil incorporated in the diet is a lot easier to give!

As you can see from the doses above, it would be nearly impossible to achieve either a sufficient dose or an acceptable 6:3 ratio by adding fish oil to an existing diet. Such a dose would probably also be toxic.

Fish Oil Dosage Calculator

The main drawback of j/d is its price. If you find it too costly, then here is a quick formula for the maximum fish oil dose you can give. Using a scientific calculator (also my smartphone calculator if I turn it sideways), raise your dog’s body weight to the power of 0.75 and multiply by 370. As a rough idea, for a 20kg dog the answer would be 3500mg.

Now look at the fish oil jar to see how many milligrams (mg) of combined DHA and EPA each gram contains. For fish oil containing 300mg per gram, the final fish oil dose equals 3500 divided by 300, or eleven grams. Bear in mind that this will still fall short of ideal doses but it should do something.

As I hope you’ve gathered by now, whichever way you use it fish oil can be helpful, but it’s very unlikely to do enough on its own. The treatment of canine osteoarthritis is multimodal, meaning we come at it from multiple angles. So click here to see the other recommended treatments for arthritis.

And a final disclaimer: I sell Hills j/d so I can easily be accused of bias. To this I say: if I didn’t think it worked, I wouldn’t sell it or choose it for my own dogs! And in fact, you can now see why, when I can’t get j/d, I won’t sell you anything else to replace it.

Sources

1. Fritsch, D. A., Allen, T. A., Dodd, C. E., Jewell, D. E., Sixby, K. A., Leventhal, P. S., … & Hahn, K. A. (2010). A multicenter study of the effect of dietary supplementation with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis. Journal of the American Veterinary Medical Association, 236(5), 535-539
2. Fritsch, D., Allen, T. A., Dodd, C. E., Jewell, D. E., Sixby, K. A., Leventhal, P. S., & Hahn, K. A. (2010). Dose‐titration effects of fish oil in osteoarthritic dogs. Journal of veterinary internal medicine, 24(5), 1020-1026
3. Hielm-Björkman, A., Roine, J., Elo, K., Lappalainen, A., Junnila, J., & Laitinen-Vapaavuori, O. (2012). An un-commissioned randomized, placebo-controlled double-blind study to test the effect of deep sea fish oil as a pain reliever for dogs suffering from canine OA. BMC veterinary research, 8(1), 1-14
4. Moreau, M., Troncy, E., Del Castillo, J. R. E., Bedard, C., Gauvin, D., & Lussier, B. (2013). Effects of feeding a high omega‐3 fatty acids diet in dogs with naturally occurring osteoarthritis. Journal of animal physiology and animal nutrition, 97(5), 830-837
5. Roush, J. K., Cross, A. R., Renberg, W. C., Dodd, C. E., Sixby, K. A., Fritsch, D. A., … & Hahn, K. A. (2010). Evaluation of the effects of dietary supplementation with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis. Journal of the American Veterinary Medical Association, 236(1), 67-73
6. Roush, J. K., Dodd, C. E., Fritsch, D. A., Allen, T. A., Jewell, D. E., Schoenherr, W. D., … & Hahn, K. A. (2010). Multicenter veterinary practice assessment of the effects of omega-3 fatty acids on osteoarthritis in dogs. Journal of the American Veterinary Medical Association, 236(1), 59-66

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

However, for this to happen, you need to know what to look for, and act quickly.

How To Tell If Your Cat Has Poor Vision

Here are the common signs of vision loss or blindness in cats:

• Bumping into things they should be able to see
• Dilated pupils (large black eyes)
• Sudden anxiety about moving around or going outside
• Crying or aimless wandering
• Blood in the eye or a cloudy eye

The cat pictured above has a dilated pupil, but even that is not as wide as we typically see in a blind eye. Often you can barely see any of the usual yellow or green iris colour.

The actual cause of blindness does not always come on as suddenly as it seems. Cats can cope very well with poor vision and it’s often only when the lights go out completely that you will notice.

The Causes Of Sudden Blindness In Cats

There is a long list of possible causes of blindness in adult cats, of which only two are common.

• Hypertension
• Anterior uveitis
• Damage to the eye or its nerve supply
• Tumours anywhere along the vision pathways
• Progressive retinal atrophy or PRA
• Cataracts
• Glaucoma

Of these, eye damage can be from head trauma secondary to car injury or lacerations from cat fights. PRA is a genetic disease causing retinal degeneration, and only likely in young purebreeds (I saw my first ever case just last week in a Toyger). Tumours are rare (often iris melanoma) and cataracts and glaucoma even rarer (these diseases are explained here).

Of the two common causes, anterior uveitis is seen as a red, painful or cloudy eye that’s no longer clear inside. The cause is usually an immune response to infections like FIV, FIP or toxoplasmosis. It needs to be treated quickly to avoid blindness but is usually quite obvious.

The one I want to focus on in depth is feline hypertension. This is the most likely reason for sudden blindness in older cats and its effects are often reversible.

How Hypertension Causes Blindness

Hypertension, or raised blood pressure, is common in old cats. It’s often secondary to kidney disease or hyperthyroidism, but also occurs on its own. If untreated, it can cause two things to happen the eye:

1. The retina (the light sensitive layer) separates from the rest of the back of the eye. This is retinal detachment.
2. Blood vessels burst leading to bleeding inside the eye or on the retina. The blood then blocks vision.

The picture shows a severe case of retinal detachment. You can see a widely dilated yellow pupil, and the greenish bulging retina in the middle.

Treatment Of Hypertension

My experience is this: if retinal detachment is detected while the retina is only partly peeled away, it will reattach once the blood pressure is controlled. In other words, cats who are brought in as soon as the problem is noted have a very good chance of their vision being restored.

When we see a disease known to be linked with hypertension, we will measure blood pressure. I saw such a cat a few weeks ago with blood in the eye. Within a few hours we had tested her and started her on antihypertensive medication. Her blood pressure is now normal, and she’s made a full recovery.

Medication for high blood pressure in cats is only once daily, cheap and generally very effective. Of course, we always check the response after a few weeks just to be sure.

So the take home message is not to overlook even the slightest hint of eyesight problems. While cats can live happily even after losing their sight, for many of them, it never needs to happen.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

Sometimes they’ll yelp, or limp, but other times it just looks bent or dislocated. There may even be a little bleeding. What do you do?

The dog’s nail in the picture above is a good example. His owner was told it was fine to wait for it to fix itself, but after several days she wasn’t so sure.

Will A Broken Nail Heal On Its Own?

Most broken nails will heal by themselves over 1-2 weeks. However this causes unacceptable discomfort in the meantime. The loose nail is still partly attached to the injured nailbed, and even the slightest movement creates intense pain.

Additionally, if untreated the area of separation between nail and nailbed quickly gets infected. You will notice this by the appearance of a smell around two days after the injury.

Remember the number one message from vets to dog owners is: they don’t complain.

Can I Pull The Nail Off Myself?

You will find people online advising you to remove the broken or damaged nail by pulling, cutting or snipping. Here’s why that’s a bad idea:

1. The nail fragment is often very well attached. Sometimes it also contains vital parts of the nailbed that should not be removed.
2. Pulling the nail often leaves small slivers that you cannot see still embedded in the nailbed.
3. Puling a broken nail is extremely painful. They may not complain, but it is likely that you will lose your dog’s trust in touching their nails for ever after.

The last point I have seen many, many times. As a young vet I (like most back then) would just ‘pull’ the loose nails and apply a dressing. It took years of experience to see how differently the dogs related to me afterwards. Pain is the best educator.

Those people online? I can only guess that they haven’t torn one of their own toenails yet. And here are my personal observations: their use of styptics on bleeding wounds is unacceptably painful, and their home dressings are generally too tight.

When Should I Go To The Vet For A Broken Nail?

A broken nail is rarely an emergency requiring out of hours care but you should make an appointment with your vet at their soonest available in regular business hours. Preferably, go in the morning and do not feed your dog.

Most vets agree that the best humane treatment is deep sedation to abolish pain before any attempt to remove the nail. This also allows us to clip and closely inspect the injury before action. You can see in the picture above that there is some pus and bleeding around the base of the nail.

Sedation also allows us to carefully ‘peel’ the nail away without tearing the underlying tissues. Any remnant pieces of nail which will cause ongoing infection are easily identified and removed. The area is cleaned and finally a dressing is placed.

How Long Does It Take To Heal?

Once the damaged nail is removed and the infection controlled, a new nail starts growing straight away. Then, as long as it is kept clean and dry, the dressing can usually either be removed after three days, or changed and removed after six.

The last thing to consider is prevention. Most nails that get broken are dewclaws that have got a little too long.

For this reason, you will notice that I check a dog’s dewclaw by sliding my finger underneath. If it catches my finger, this means it can get caught on anything else too. That’s when I get the clippers out: not to cut it very short, just to stop it being hooked on the end.

So to finish up, read my Guide To Good, Bad & Ugly Dewclaws

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

While not all are simple to fix, after reading this you should have a good idea of what to do. I’ll rank them in rough order of frequency.

Before the list though, you need to do something unpleasant: make a close inspection of your dog’s body using both your eyes and nose. Pay particular attention to the crevices like armpits, groin, feet, ears, mouth and lips. We’ll use this information in a minute.

Skin Disease

The skin of dogs with chronic dermatitis almost always has a bad smell. You might describe it as ranging from an extreme ‘doggy’ smell to old socks. This is probably due to an overgrowth of secondary yeast and bacteria taking advantage of the skin’s weakness.

Affected skin often looks thickened or wrinkly, and may have a greasy or flaky surface. It can also become red or even black in colour.

Uncomplicated dermatitis on its own does not smell, and so an odour is a sign that the condition has progressed. The solution is never as simple as using antifungal or antibacterial shampoos. You will need to address the underlying skin problem, which you can read about here.

Ear Infections

Infections inside the ear canal are a specialised form of skin disease complicated by severe yeast or bacterial overgrowth. They nearly always smell strongly, and if you put your nose right up to the canal it there’s no mistaking the origin. Sometimes the infection is so deep that the ear canal looks normal on the outside.

Never, never just put cleaner into a smelly ear without your vet checking it first. As it’s probably infected by now, cleaning alone won’t work and it will sting harshly. Once you do this, your dog won’t trust you and treating the problem properly gets a lot harder.

Ear cleaners are great for prevention, but first read about the treatment of ear infections here.

Oral Disease

If you have identified the smell as coming from inside the mouth, there are still quite a few causes. The first is advanced periodontal disease, which is inflammation and infection of the junction between the teeth and gums. This is the most common cause of bad breath and tooth loss.

Once dental disease develops, you will need it treated under anaesthetic, but it can also be effectively prevented afterwards.

Any infection or ulceration in the mouth will also smell bad, so other causes I have seen include oral tumours, foreign material caught in the teeth or mouth ulcers from kidney disease. A smell from the mouth has never in my experience been caused by any area lower down like the stomach.

The smell from bad breath is often described as ‘fishy’ or ‘metallic’, leading to confusion with the next cause. The clue is to look at the location.

Anal Glands

Anal glands are special scent glands found just inside the anus. When a dog defaecates, they release an odour onto the poop which other dogs can detect. Anal glands malfunction when they release this scent at any other time.

The classic anal gland leakage situation is your dog sleeping on your lap and suddenly you smell a horrible rotten fishy odour. You might find a drop of brown fluid. Many of these anal glands are too full and not emptying by themselves.

If so, all you need to do is get your vet or groomer to express them every 3 months and the problem goes away. However others leak when they aren’t full, and these are much harder to fix. Some have infection inside, others just seem leaky. Read about their treatment here.

Skin Folds

Fold pyoderma is a localised infection in folded skin. It’s notorious in short-faced breeds like Bulldogs, but this is easy to see because the hair is short.

The more insidious form is found in dogs like Cocker spaniels and Golden retrievers. The lower lip often droops as they age and a fold forms which traps saliva in the hair. These can get very badly infected and smell like rotten meat.

The trick to finding them is to not just look inside the mouth, but also stretch out the skin on the upper and lower lips. Treatment involves antibiotic tablets or creams, then prevention with antibacterial wash and barrier ointments. Severe cases require a small facelift!

Flatulence

Passing smelly gas from the bowel is a common noxious odour, but at least no-one has trouble identifying it. The solution is almost always to find a food that agrees better with your dog’s digestion. Or put up with it, as the dog is usually untroubled!

Urinary Incontinence

Around 2.5-5% of dogs will develop urinary incontinence. In some females it can start very early, and may be more common after desexing. It is also common with urinary tract infections.

The stale ammonia smell is usually quite distinctive, but I see many dogs whose owners have got used to the scent until I point it out. These dogs can almost always be cured by either fixing an infection, removing a bladder stone or medications to prevent leakage.

Faecal Soiling

Having poop stuck in the hair might seem like an excessively obvious cause of bad smells. However, I see it regularly, especially with new owners of Poodles and Poodle crosses. The hair can quickly get thick and long around the anus to hide the buildup of soft faeces.

If this isn’t addressed urgently with a gentle bath and dry, you often end up at an overnight emergency vet. The faeces end up blocking the anus, and the resulting rash can be terrible.

Prevention is of course all about having a good relationship with a trusted dog groomer, and starting as early as possible. It’s also about avoiding soft faeces by the use of high quality diets.

Normal Doggy Smells

The last cause is the hardest and saddest. Never assume this is what is causing your dog’s bad smell unless you have consulted a vet first: it’s very rare.

Every now and again I see a dog owner who is disgusted by their dog’s terrible odour. Except that I can’t smell it at all, and neither can anyone else in the clinic.

These dogs smell normal. Nearly all of us with dogs have tuned out the natural odour of dogs and can no longer detect it. However, for an unlucky few it remains thick and intense.

I have no solutions for these people, as a bad smell can’t just be hidden under cologne or other scents. Putting a dog outside is definitely not the answer.

But let’s not be negative. Eight of the nine causes of bad smells on dogs are fixable, and the ninth isn’t a problem to the dog. Good luck working it out!

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

The food that nearly killed her is a leading brand of grain-free dog food you can buy at nearly any Australian supermarket. I wish I could tell you its name.

Here’s what happened.

Rowdie’s Collapse

That’s Rowdie in the picture. She’s a 12-year old Beagle who’s always been in good health, including at a checkup early this year.

On the 16th of May, she was having a bath when she suddenly collapsed, rolled on her side and remained stiff and unresponsive for 10 to 15 seconds. She was taken to an emergency vet and had blood taken. The cause was thought to be a seizure.

I saw Rowdie a few days later. The first thing I thought was that it probably wasn’t a seizure: these go on for at least 30 seconds and have lots of muscular activity. Her history contained a further clue: she’d recently developed a moist cough.

Heart Disease, Not Seizure

More clues came from her examination. Her heart rate and her breathing were faster than expected, and I could feel fluid in her abdomen. Most importantly, she had a grade 3 heart murmur that wasn’t there just four months earlier.

The final clue was the bath. Seizures happen at any time, even during sleep. Rowdie’s collapse on the other hand happened at a time of increased activity.

I strongly suspected a heart problem and so we took chest xrays straight away. These showed an enlarged heart with pulmonary oedema (fluid on the lungs). Heart disease was confirmed.

Why Rowdie Though?

You see, Rowdie’s problem wasn’t typical. She’s not of a breed prone to heart problems, and she’d been normal so recently. Most cases of heart failure don’t come on without warning because we’ve been listening to the murmur getting louder for months or years beforehand.

Here’s where Rowdie’s luck turned the first time. Here in Adelaide we’ve always had a shortage of vets skilled enough to offer cardiac ultrasound, called echocardiography. Well just the week earlier I’d received news that a board-certified ultrasonographer was setting up a freelance service.

We started Rowdie on heart medications and booked her in for the soonest available appointment.

Echocardiography Saves The Day

The ultrasound exam saved her life. That’s because the results showed she had a very unusual form of heart disease that I never would have predicted: dilated cardiomyopathy or DCM.

DCM is when the heart muscle gets thin and weak, and it normally has a very short survival time. However, not in Rowdie’s case. It was while I was talking over the results with her owner that she got her second lucky break.

I remembered those reports about grain free foods. And so I asked about Rowdie’s diet.

Grain Free Diets & Heart Disease

It turned out that earlier in the year, Rowdie’s owners had started buying a grain-free dog food. Like most people, they assumed that if it was being proudly marketed as grain free, it must be better.

Vets have known for some time that this is not true, but we can’t get the message out to dog owners. The reality is that grain free diets are being regularly linked to dogs like Rowdie.

You can read more here. We don’t know exactly why, but theories include B vitamin deficiency, inhibition of taurine or carnitine metabolism, or unidentified, potentially cardiotoxic compounds. 89% of DCM-associated diets reported to the FDA contained peas¹.

Treatment of Diet-Related DCM

I advised Rowdie’s owners to put her back onto a quality grain-based diet, and added a taurine supplement as a precaution. She also needed to stay on the heart medications. There was no way of knowing if my suspicions were correct except by trying.

Even when DCM is caused by the diet, not all affected dogs can recover. It depends how much damage is already done, and her case was severe.

I saw Rowdie two weeks later. She was doing very well, which was probably just the effect of the heart meds. A month later she was doing even better, which by now was not what we expected for regular cases of DCM.

By the way, the best way to tell is by measuring sleeping or resting respiratory rate.

A Stunning Response

On the 11th of August we repeated the echocardiogram. Here is a summary of what was found:

• The dilation of the left ventricle had vastly improved, but was not completely resolved
• The left atrial enlargement had completely resolved
• The measurements of heart contraction (fractional shortening and EPSS) were now normal
• The regurgitation jet at the mitral valves was no longer visible

And here are the numbers:

The improvement was so great that it was debatable whether Rowdie needed to stay on heart medications any more. We’ve got one more ultrasound exam planned and then we’ll probably stop them.

A Warning To Dog Owners

What is critical for you, the reader, to understand here is how rarely dogs receive a cardiac ultrasound. Heart disease is one of the most common problems of dogs, but we lack the skilled sonographers to do all but a tiny fraction. I only ordered this test because there was something not quite right about Rowdie.

As nearly every case of canine heart disease has just one cause, it’s reasonable for vets to make assumptions. Especially in a user-pays system where any further investigation will add costs and delays. However, for Rowdie this would have been deadly.

There is no doubt in my mind that most cases of DCM caused by grain free diets will go undiagnosed. This would have happened to Rowdie too if she was a more ‘typical’ breed or had a more typical history. Which matters because this specific form often responds well to treatment especially if recognised early.

Without a realisation that the diet was to blame, Rowdie would have died quickly. Like the more regular cases of DCM, she would have responded briefly to the medications, but then started declining again.

These days I ask a lot more about the diet every time I hear a heart murmur. And I hope that the lesson for you is to avoid these diets until we can report which ones are faulty, and either fix or remove them.

Related: Why I can’t warn you about bad dog foods (yet)

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Reference

1. Smith, C. E., Parnell, L. D., Lai, C. Q., Rush, J. E., & Freeman, L. M. (2021). Investigation of diets associated with dilated cardiomyopathy in dogs using foodomics analysis. Scientific Reports, 11(1), 1-12 Full text