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Sometimes in quieter moments, the past weighs heavily on me. What makes being a vet great is also what makes it so tough. It’s also one of the main reasons why so many young vets walk away from the job. Being a vet means being responsible for a patient’s care in a way that perhaps only your GP will understand.
Continue reading “When Vets Make Mistakes”
It’s not what you think. Once I tell you you’ll wonder why you didn’t see the problem straight away, and I bet you’ll never take the risk again. In fact, even after my mother pointed it out, I nearly made the same mistake as you’ll see later.
Continue reading “Why Kids Should Never Walk Dogs Alone”‘At A Glance (Details Below)’ What to do
Have a look at the video below and pay close attention to how Rickey is walking. That’s not a limp caused by a sore leg. To a vet, that’s an emergency. If your dog ever starts walking like this, especially after a jump or fall, keep them very still and see a vet immediately. Their life may depend on it.
Rickey is ataxic. That means he’s lost some control over how his legs are moving, and it’s a hallmark of neurological disease. Something is interfering with his nervous system’s ability to move his legs.
Later I’ll give you a long list of possible reasons for ataxia, but one cause stands head and shoulders above the rest…
Intervertebral disks are the flexible pads that sit between the spinal vertebral bones in the back. They act both as joints and cushions, and are yet another marvel of nature. IVDD is when the disk fails, and although it’s often called a ‘slipped disk’, that’s not really what happens in dogs.
Rickey’s disk didn’t slip, it burst after he jumped off a chair. In Type I IVDD, the disk itself degenerates and the ring of fibres that holds it together weakens. Eventually it gets weak enough that a sudden compressive force, usually from jumping off furniture, causes the outer fibres to split and the inner disk content to be violently expelled.
The bad news is that when it ruptures, contents of the disk often travel towards the spinal cord. That’s Rickey’s xrays showing which disk is the likely culprit. You can see that the spinal canal containing the cord runs just above the disk. What we can’t see on the xray is that some of that disk material is now pressing on the spinal cord hard enough to stop the flow of nerve signals.
IVDD is mostly associated with certain dog breeds. These include:
What all these breeds have in common is a genetic defect called chondrodystrophy. The same thing that causes their cute body shape also causes premature degeneration of intervertebral discs. IVDD is always more common in overweight dogs of these breeds.
In our clinic, IVDD also occurs in very excitable and energetic dogs of any breed. This may explain an increased prevalence observed in male dogs. There is a higher risk in desexed (neutered) females that could be explained by increased weight.
Rickey was lucky; his cord injury was only partial, his owner brought him straight down and he responded well to treatment. All three of these factors can easily go the other way.
If a dog has lost all voluntary movement and pain sensation to the hind legs, there’s still a chance that rapid surgical decompression can save them. However, if paralysis can’t be reversed there’s not much hope for quality of life. I know from bitter experience that no matter what people say about how good their dog is on a cart, the reality of their life is very different.
I can’t stress enough that the diagnosis must be confirmed by a vet. Many diseases of the nervous system can look exactly the same, such as:
Visit this page for non-neurological causes of lameness in dogs.
Dogs with IVDD often have back pain at the time of the spinal injury, shown by arching of the back, shivering and lethargy. It’s especially important to be aware of signs of the disease in susceptible breeds such as the Dachshund, Beagle, Shih Tzu, Lhasa Apso or Pekingese. Sometimes the main problem is pain from nerve root compression, not neurological dysfunction.
Confirmation of the diagnosis is only possible with advanced imaging such as CT scans or MRI. However, in most cases the combination of the history and examination plus plain x-rays are enough for vets to be confident. X-rays such as Rickey’s often show a narrow disk space and/or calcified disk material visible in the spinal canal.
There are two options for treatment:
For dogs with mild to moderate signs, and no further worsening, conservative treatment is often very successful. However, I have personally seen too many dogs get worse with poorly managed conservative treatment.
The theory behind cage rest is that if the dog is kept extremely still, the disk material will stop moving and the body is able to wall off and repair the damage. Dogs must be confined in a cage that is only just big enough to fit their bed plus food and water.
The only times a dog should be allowed out of the cage for at least the first two weeks is while being held to go to the toilet. Yes, it sounds cruel, but if the dog is near the owner, they are usually happy enough. The consequences of failure are just too serious to take chances.
A vital part of conservative treatment is close monitoring by the owner and vet, with the readiness to change course quickly if necessary.
Surgical referral is best if a dog is severely affected, has repeated episodes, or fails to respond to conservative treatment. The option of referral is always available even in milder cases even if only for a second opinion and advanced imaging.
Rickey responded well and will eventually be able to return to a normal life. However, he’s always at risk of a recurrence so we’ve made a few changes:
Rickey’s case was successful for more than one reason. When his owner rang for a Saturday appointment, we were already booked to 5:30pm and the nurse, to her credit, didn’t hesitate to slot him in, even though it was ‘only a leg problem’. Who could have guessed over the phone how much danger Rickey was in?
Now Read: The Link Between Neutering & IVDD In Dachshunds
Have something to add? Comments are welcome below and will appear within 24 hours of lodging.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These help topics are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story! 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.
We’ve all been in this dilemma, vets included. It’s late at night, or you’re having a busy week and something just isn’t quite right with your pet.
‘At A Glance (Details Below)’ Quick Care Guide
Getting a sick cat to start eating, or convincing a cat to try a new food is a problem most of us will face. Like Cleo’s owners did.
A few weeks ago, Cleo had a sudden turn and ended up at the emergency centre. She was falling over, wobbly, her pupils were the wrong size. Like most unwell cats, she’d also stopped eating and drinking.
The emergency care was good, but it wasn’t easy to see what was wrong. She came to us the next day, and we equally weren’t able to see the cause, but we took blood tests and tried some simple treatments that often help
In her case, she didn’t improve and by the next day she was in our hospital on a drip receiving supportive care. We had by this time decided that her signs most closely resembled a stroke, or cerebrovascular accident.
After 24 hours, Cleo’s signs had improved, but she was hating her time in hospital and becoming very stressed. We felt that her best interests now lay in being sent home for intensive TLC.
By now, she was drinking by herself; the only problem was, she still wasn’t eating. We wondered if she’d be better off by now at home where she was less stressed. She was sent home on trial, by no means out of danger. Read more about her later.
Unlike dogs, cats aren’t adapted to periods of starvation, and can get even sicker if they don’t eat. They also aren’t as motivated by food.
What if a cat needs to change foods?
So let’s talk about sick cats in more detail.
If a cat isn’t eating, there’s always something wrong. If Cleo hadn’t had veterinary care, she would certainly not have survived.
I’m amazed how often I’m asked about getting a cat to eat that I haven’t seen. I always say the same thing:
Attend to the problem that’s making your cat not want to eat first.
Mostly, they are sick with a serious illness. Sometimes it’s psychological, such as anxiety, but that doesn’t make it any less urgent.
As soon as a cat gets sick, they usually go off their food. Common causes include:
Start with a vet check and treat whatever is causing the poor appetite. Then follow these special tricks to get cats eating.
Have you noticed how cats generally prefer to eat exactly the same food every day? It isn’t that it’s the tastiest food, it’s that it’s the food they are most familiar with.
Most cats don’t like novelty, and it only gets worse when a cat is feeling sick. The best food to feed your sick cat is almost always the same food you are already using.
Of course, there are tricks:
Just like Cleo, stress in cats will switch off the appetite. That’s why we moved her to our isolation ward, but she was still too stressed to eat. We often send cats home quite early if we can see this happening.
The same thing applies at home though. Make sure that your cat is in his or her favourite place and that there are no obvious stressors. For example, although some like the company, many sick cats prefer not to be bothered by other cats, dogs or children.
I can’t state this strongly enough. TLC can be the difference between life and death for a sick cat.
Most cat owners already know the best trick to get a sick cat to eat. We pat them. In our hospital, a nurse or even a work experience student sits with them and pats them just how they like it. It’s amazing how often they will then get up and go to their food.
If they don’t, hand-feeding small tidbits often works or getting them to lick moist food from your fingers.
You’ll find that you need to do this very frequently at first. By all means leave out a few of their favourite biscuits if they want to nibble but keep trying a variety of types and textures of food. It’s best to remove these after each offering and use a fresh batch next time.
Food aversion is when a cat develops a particular dislike to a certain food.
By all means offer food frequently, but the key word is ‘offer’. No matter how frustrated you get, don’t try to put the food in your cats mouth. This is likely to lead to food aversions which only make matters worse. Fundamentally, your cat has to feel in control.
You may also find your cat develops a food aversion by associating their usual food with the sickness of nausea they feel. We are familiar with this in humans; I can’t enjoy lemonade simply because it was given to me when I was sick as a child, even though it wasn’t the cause.
How can you be sure your cat is eating enough?
We never recommend you leave food out in large amounts for cats: the food gets stale and you usually can’t tell for a few days if your cat stops eating. Read our guide to feeding cats for more information.
There is a reasonably effective appetite stimulant for cats, but it’s not something we want to use very often. These are a last resort, and without an integrated approach are no more than a sticking plaster over the problem. Before using an appetite stimulant, the cat needs to be:
For these reasons, I’m sorry that I won’t say the name or dose of the appetite stimulant we use. The drug is not registered for use in cats, and without veterinary supervision, appetite stimulants can be dangerous.
We’ll certainly tell you when it’s time to try pharmaceutically enhancing your cat’s appetite.
Her owners worked hard to provide her with her favourite foods, tried some new tasty options as well, and kept tempting her with small, frequent meals. They certainly made her as comfortable as they could and gave her lots of her favourite attention. To begin with it was very frustrating but slowly she started showing interest in the food.
We also had her on a new medication and prescribed her an appetite stimulant, which seemed to help.
We checked on her daily, and after three days she was looking for her food by herself and starting to gain weight. She’s doing well now.
Cleo’s case also shows how animals are sometimes treated without reaching a firm diagnosis. A referral opinion was offered, as in any uncertain cases, but it was also quite logical to treat her on the basis of general support given her likely illness.
She’s not out of danger yet, but we’re all glad we gave her a chance.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These help topics are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story! The information provided here is not intended to be used as a substitute for going to the vet. If your pet has has a problem, please seek veterinary attention.
Have something to add? Comments are welcome below and will appear within 24 hours of lodging.
‘At A Glance (Details Below)’ Rapid Care
Caring for rabbits is an increasingly large part of our daily workload. Here are three of our recent cases which show the complexity and variety of rabbit diseases, and the need to treat them with special care. One story does not end well; the owner has requested we included this as a warning to other rabbit owners.
Mr Poppy is over ten years old, and still healthy and happy even if he sleeps a lot these days. Like most rabbits of his age, he needs daily treatment for arthritis, but he’s still an active bunny. As you can tell by what happened.
He came in from playing outside with his mate holding up a hind leg. When he came to us, it was clear he had multiple fractures of his metatarsal bones. Without surgery, he would be in serious trouble as a rabbit’s hind leg must be fully functional, and it wouldn’t ever heal by itself.
We scheduled surgery for the next day. Rabbits can’t and don’t vomit, so we don’t starve them before surgery. This is also to help prevent gastrointestinal stasis (see Hunny Bunny later).
We placed a drip for intravenous fluids in a marginal ear vein, and gave him a normal gas anaesthetic via endotracheal intubation, just like dogs or cats (or people!). His X-rays showed three fractures; the two central bones needed pins but the third (arrow) would heal once we aligned the other two. It may look logical from the xray but trust me: there is nothing more fiddly and needing more patience than pinning such tiny bones.
His whole anaesthetic took two hours but we are very happy with the result. At suture removal yesterday he’s looking great, moving well and even starting to ‘thump’ again. In the meantime his owners found the cause of the injury; his mate had knocked a loose brick off a pile and he was probably in the wrong place.
Hip Hop was a well-loved bunny who we not only saw for regular check ups, but would even go to board with Rachael’s bunny at times. All seemed well until Hip Hop started losing weight and going off her food.
Just like in any species, we took blood which showed tragically advanced kidney failure. Hip Hop’s x-rays showed large nephroliths (kidney stones) which were considered to be the cause of the problem. Our opinion was that he was unlikely to survive the disease, very likely to get worse, and so we recommended euthanasia to prevent suffering. Her owner was devastated.
On investigation, it was discovered that her diet contained a high percentage of lucerne hay. Her owner knew the importance of hay in a rabbit’s diet (see Feeding Rabbits). However, when selecting hay, it is a common and easy trap to select lucerne hay; it’s nicer looking, as you can imagine from the second picture, and rabbits prefer it.
The most important message here is that lucerne hay (identified by its oval leaves; it’s not a grass) contains an excessive amount of calcium. Kidney and bladder stones are a great risk, though until I saw HipHop’s problem I didn’t know just how high that risk was. When selecting hay for your rabbit, make sure to only feed grass hay or meadow hay.
Hunny Bunny came to me one recent Saturday lethargic, not eating and limping on a hind leg. He was clearly in pain. It was also clear that the pain had caused a secondary ‘gastrointestinal stasis’ where his gut had stopped moving. Crucially, he was no longer producing the steady supply of droppings that indicate a healthy rabbit.
To give an idea of how we think, our concern was mainly the fact that his gut had stopped. This is often fatal to rabbits even more than colic can be to horses. Rabbits are herbivores with a complex fermentation process easily disturbed by outside forces. Read more about GI stasis and rabbit digestion here.
Seeing he was not too bad, and hoping it would be a short-lived problem, I prescribed pain relief. He did improve over the weekend but deteriorated again so that several days later it was clear he needed to be hospitalised. We placed a drip and started medications to control pain and stimulate his gut, combined with syringe feeding a critical care mix. It was touch and go for several days and his full recovery was only possible when we could send him home to the continued care of his owners.
He’s back to normal now, and his owners have since found what is likely to have been the cause. A goshawk is hanging around their yard, and although they do not usually attack such large prey it does seem to have attempted to take him and caused the injuries in the process. Goshawks are one one of the rarer native species in Adelaide. I always get a thrill when I see one so I hope the two can live in peace and harmony.
Have something to add? Comments are welcome and will appear within 24 hours of lodging.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These help topics are from a series regularly posted on email and Twitter. The information provided here is not intended to be used as a substitute for going to the vet. If your pet has has a problem, please seek veterinary attention.
Have something to add? Comments are welcome below and will appear within 24 hours of lodging.
We’re so excited that one of our patients has a pacemaker that we can’t stop talking about it.
Jack came to us a few months ago with a history of falling over at home. From the moment of his first examination it was clear there was something very wrong with his cardiac rhythm. A good heart creates a rhythm you can dance to but this beat would empty the dance floor.
Continue reading “Jack gets a pacemaker”
This is Micki. He’s so happy and active that this is the best photo we could take. But he wasn’t always so perky. Last year he started having seizures and his very concerned owner brought him to us. There was nothing remarkable found on his physical exam, so we took blood for haematology and biochemistry, as we always do when dogs are having seizures.
Continue reading “How Micki’s seizures were fixed by a new diet”
‘At A Glance (Details Below)’ Emergency Care
Later I’ll explain the diagnosis and treatment of constipation in cats. However, the greatest danger is to mistake constipation for urinary obstruction. That’s why I’ll start with Dante’s story.
Dante is a middle-aged male cat who has always been healthy. One day, his owner noticed he was quieter than usual and not eating. He spent the day outside, was seen straining as if trying to poo, and when seen later was collapsed and panting.
She was sufficiently concerned to visit the emergency centre instead of waiting until the next morning to see us. Thank God she did.
Once he was assessed by the vet on duty, it was clear that his bladder was abnormally large, hard and painful. Blood was taken showing dangerous elevations in potassium, urea, and creatinine wastes normally excreted by the kidneys. A urinary obstruction was diagnosed and he was immediately admitted to relieve the blockage.
High blood potassium interferes with the function of the heart, and thus many obstructed cats die of cardiac arrest within hours. We can only imagine the excruciating pain they experience.
To continue the story, visit our page on prevention and treatment of urinary blockages in cats. From now on we’ll only discuss faecal problems.
The signs of true constipation in cats can be:
Most owners are unaware of the problem until it becomes severe and difficult to treat. However, there’s another way.
I diagnose most cats with constipation during a routine checkup. Vets can feel the abnormal accumulation of hard faecal pellets in the abdomen. If we suspect that your cat has just been lazy on that day we can always check again later. However, our first impressions are usually correct.
If the cat is large or difficult to palpate your vet will recommend an xray, which gives a quick and definitive answer. Although the cause of constipation is often not found, we observe that it is more common in older cats and certain breeds such as Burmese, Birman and Manx.
It’s vital to start treatment as soon as possible. The longer a cat’s colon is stretched, the weaker it gets, and the harder it is to return to normal.
Start with just one (I begin with lactulose) and gradually adjust doses or add other products. The whole time you need to monitor the consistency and frequency of your cat’s droppings.
Each product shows a starting dose but these usually need to be adjusted up or down (‘titrated’) to achieve an optimal result. I recommend a soft, formed stool not unlike dog faeces. Some cats will require a combination of treatments.
Mild cases may respond to a simple change from dry biscuits to a wet-only diet. This can also be better for your cat’s health; visit our page on carbohydrate content in cat foods for more information.
More difficult cases respond better to prescription diets that increase dietary fibre, such as Hills r/d and Hills w/d. Again, these are best used in their wet forms.
An increased water intake should also be encouraged to prevent faeces drying due to low water balance. Click here for advice on getting cats to drink more.
Paraffin-containing products can assist, but in my experience rarely work well on their own. There are several products that come in tube form, usually sold as a hairball treatment. For most owners, medical grade liquid paraffin is more effective.
Paraffin is extremely dangerous if given on its own, as cats can’t swallow it easily. This leads to aspiration pneumonia and death (I have seen this happen). Therefore, if using liquid paraffin, it needs to be mixed well into a wet food. Even then, risks are not eliminated.
Starting doses are usually ¼ to ½ a teaspoon twice a day in the food. It is said that regular use can deplete fat-soluble vitamins.
These in my experience are the most effective and best tolerated. They work by remaining intact in the colon, where they draw water into the faeces. The amount of water depends on the dose given.
My favourite is lactulose. A common Australian brand, Actilax, is pictured above. It is cheap and readily available at pharmacies. Once again, doses are usually ¼ to ½ a teaspoon twice a day in the food.
I have much less experience using propylene glycol but my reading suggests it is a more hazardous and less effective option.
Soluble dietary fibre is well-known as an aid to regularity. It also works in cats, but the problem can be getting them to take it. Two such products are pictured above.
I recommend starting Metamucil or other unflavoured psyllium granules at the same doses of ¼ to ½ a teaspoon twice a day in the food. If cats refuse it, I then use Benefiber, a wheat gluten product which is usually better tolerated. Start Benefiber at much lower doses of 1/16 teaspoon twice a day and increase to effect.
Both are best mixed in the food just before feeding to avoid them turning into gel too early. These products will produce a larger stool with an almost rubbery consistency if over-used.
We shouldn’t forget the effect that ingested hair can have, especially in longer-haired breeds like Ragdoll and Birman. These benefit from frequent brushing to remove dead hair, and in some cases, cats even need full body clipping twice a year.
Many cats in the beginning, especially if the diagnosis is late, will need an enema performed under anaesthetic. Sometimes it will need to be repeated intermittently even in well-managed cases. That’s why daily cleaning of the litter tray is almost essential as an early warning.
The late stage of chronic constipation in cats is called megacolon. Everything we’ve suggested so far is an effort to avoid this. While it can still respond to medical management, megacolon often needs to be surgically treated by removal of the colon.
Have something to add? Comments are welcome below and will appear within 24 hours of lodging.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These help topics are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story! 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.
Just to to prove it happens to us all, here is Loki’s recent health emergency and some advice on how to identify and avoid pet poisons.
Four days ago Andrew’s 9 week Jack Russell Terrier was doing his usual morning routine of running around the garden seeing what could be destroyed or eaten. He was of course under supervision but all the same was darting in and out of sight among the bushes. All seemed fine but only ten minutes later he suddenly looked extremely unwell, vomited and passed diarrhoea. It was obvious something was terribly wrong so he was immediately rushed to the surgery.