Archive for the ‘Dogs’ Category

Chronic Kidney Disease in Pets

Lots of cat owners know that kidney disease is a big problem for their feline friends, but it might surprise you to know that it is a problem in dogs too. Around 1 in 40 cats will be diagnosed with kidney problems, whilst in dogs, the number is much lower at around 1 in 100. This makes it one of the most common diseases we see in practice, so we thought we’d take the time to tell you a little more about it.

What is Chronic Kidney Disease?

Chronic Kidney Disease (CKD) is also known as kidney failure or renal failure- the end result of kidney damage over time. It is known as chronic because the damage is usually sustained over a long period of time, unlike Acute Kidney Injury which occurs very quickly. There is no way to prevent kidney disease specifically, although early diagnosis certainly helps. A yearly urine test in elderly pets can help to diagnose problems before symptoms start to appear- just ask our reception team for a urine collection pot.

Could my pet have CKD?

Animals with CKD often don’t show many symptoms at first, and pets can be in quite advanced stage of the disease by the time they are diagnosed. Older pets are more prone to CKD, and cats get it more commonly than dogs. Pets with heart disease, high blood pressure or severe dental disease are more prone to getting kidney problems. There is also an increased risk if your pet has had previous problems with their kidneys. The most common symptoms are an increase in drinking and urination, smelly breath, weight loss, and inappetence. However, other symptoms such as lethargy, vomiting and poor coat condition may raise suspicion of a problem.

If you think your pet is showing any of these symptoms, it’s highly recommended that you book an appointment with one of our vets.

How is CKD diagnosed?

We’ll definitely want to check your pet over to rule out other causes and confirm your suspicions. Clinical dehydration and kidneys that feel smaller or ‘knobbly’ are both evidence of a problem, but it’s also important to listen to your pet’s heart as heart disease and renal problems sometimes go hand in hand. As most of the symptoms of CKD are also symptoms of many other diseases, we’ll probably suggest a blood test to get more information. We can then check that the liver and other organs are normal. If the kidneys are struggling, we will see a rise in two chemicals in the blood- urea and creatinine. Combined, increases in these two chemicals suggest renal disease, especially if there’s other evidence. We may also see upsets in some enzymes and anaemia associated with renal failure. We also like to check a urine sample. Pets with CKD have very dilute urine because the kidneys are no longer concentrating the urine correctly. We can measure the concentration of urine, and if it is very dilute this lends further evidence to a diagnosis of renal failure. We might also send the urine to a lab for further investigation and check your pet’s blood pressure.

How is CKD treated?

Unfortunately, there is no treatment for CKD, but there are ways it can be managed. At first diagnosis your pet may be quite sick, so we often advise that we hospitalise them and put them on intravenous fluids (a drip). By doing this, we are trying to correct any dehydration and flush the toxins that have built up out of the system. This usually takes 24-48 hours.

If a pet is not too ill, or after they have been discharged from hospital, they are put on a home-management plan. The most important thing is to support the kidneys by providing a kidney-friendly diet. These diets are low in phosphorus and contain a moderate amount of high-quality protein. We will advise you on diet at discharge from hospital. Your pet may also be put on medication to lower blood pressure or stop too much protein being lost by the kidneys.

What is the prognosis for animals with CKD?

The prognosis is dependent on how ill your pet is, and how well they respond to treatment. There is no doubt that chronic kidney disease is life-limiting, but many pets can live for months or even years with the condition. The important thing to do is to monitor their quality of life and keep checking in with us to make sure they aren’t getting worse or there isn’t more we can do to help.

It’s also worth considering that some medications shouldn’t be given to animals with renal problems. Many medications pass through the kidneys and can damage them further if the kidneys are struggling to process them correctly. If your pet is on any medication that we don’t know about, such as store-bought flea treatments or supplements from an online pharmacy, it is best to check with us that they are still safe to give.

Where can I get more information?

If you want to know any more or have questions about your pet’s care, ask to speak to one of our vets. We’re always here to help you, help your pet.

Goddard Veterinary Group Wellness Screen – What are we looking at and why?

Blood testing is an incredibly useful method of gaining more information about the health of a pet. Our vets will often run blood tests when an animal is unwell to help find out the cause of their illness in order to treat them effectively. However, there are situations when it might be advisable to run blood tests, even if your pet does not seem unwell.

We all know the old adage ‘if only they could talk’. Unfortunately, as our pets cannot speak to us, it can be difficult or impossible for both owners and vets to pick up on the subtle early signs of some illnesses, which often cause no noticeable changes in a pet at home and may not even be detected by a vet physically checking over an animal. Many chronic (long term) diseases can be ‘subclinical’ for months to years, meaning they do not cause any signs of ill health. If we are able to detect disease at an early stage, there is often more that we can do to slow down how fast that disease progresses, and in some situations even prevent an animal becoming unwell at all. Blood tests are a quick and non-invasive way of being able to find out more.

What is included in the Goddard Veterinary Group Wellness Blood Screen?

  • Haematology: This part of the blood screen counts different cell types in the blood. Many diseases can cause levels of red or white blood cells to be high or low. For example, a low red blood cell count (anaemia) can be caused by a variety of conditions. The haematology can give more information than just numbers of a type of cell – the average size of the red blood cells can provide more about the possible causes of anaemia, for instance.
  • CHEM 10 blood biochemistry: This measures ten different values. These include blood protein and sugar levels, which can indicate if a pet is diabetic, for example. ALP and ALT are liver values which can be high in primary conditions affecting the liver but can also be high for a variety of endocrine (hormonal) disorders, such as Cushing’s disease, an over or underactive thyroid, or other diseases in the abdomen, which can have secondary effects on the liver. Urea and creatinine are also checked to screen for kidney disease.
  • SDMA: This is a new biomarker of kidney disease and is something we are able to include as part of the health screen. The other kidney values of urea and creatinine are only increased when 75% (three-quarters) of kidney function has been lost, whereas SDMA increases when just 40% of kidney function has been lost. Chronic kidney disease (CKD) is a very common problem in elderly animals, particularly cats, and this test means we can pick up reduced kidney function at a much earlier stage. Whilst kidney disease will progress with time, if detected early there are many measures our vets can recommend being instituted to slow this down, such as changes in diet or medication.
  • Thyroid hormone level (Total T4 or TT4) for cats over 8 years old: hyperthyroidism (an overactive thyroid) is a common problem in geriatric cats. The thyroid gland is located in the neck and produces thyroid hormone. An overproduction of this can cause many changes such as weight loss, increases in thirst and appetite, and changes in behaviour and coat condition. It can also lead to heart disease and increased blood pressure if left untreated, meaning it is best to pick up the disease at as early a stage as possible. The condition is easily manageable and there are many options for treatment.

We recommend you discuss with our vets whether or not your pet would benefit from a screening blood test. Examples of when we might recommend blood tests would be for animals that are more senior in age, on long-term medication that has potential to affect organ function, or for an animal that has unexpectedly lost weight.

There are limitations to blood tests, and it should be noted that not all health problems can be detected with these tests. In some instances, if abnormalities are flagged up on the screening blood test, our vets may recommend further tests, such as tests on urine if kidney disease is suspected, to gain more information.

But if you want to know what’s going on inside your four-footed friend, to pick up problems before they become disasters, give us a ring!

Can I Share Food With My Pet?

Our pets love to share our food. The act of hand feeding itself is a reward because of the attention. Also, the foods we offer often have high-fat content, making them super tasty. Having their own food in a bowl is much less attractive than a higher calorie feast that has been making the kitchen smell amazing while it cooks. Fat makes food more palatable and as we need more calories, our food is often much more tempting than theirs! The focus in human nutrition is to move away from pre-prepared foods and cook from scratch. Fresh ingredients with as much variety as possible (eating a rainbow every day) are hard work but yields long term health benefits. So, as we improve our own diet, we may feel that it would be better to feed our pets in this way rather than open a can or bag.

Unfortunately, it’s not as straightforward as that. We know a lot about our calorie requirements, which nutrients we need, in what proportions and what vitamins and minerals are essential, but these are all different for our pets. All these parts of formulating a complete and balanced diet to promote health and long life are unique. If we feed a diet deficient in a specific nutrient this is likely to cause illness. For example, both cats and dogs need a protein called taurine in their diet, they cannot make it from other proteins as humans can. So, a human diet is likely to cause a taurine deficiency. Unfortunately, taurine deficiency, which used to occur more commonly before pet foods were generally fed, is now on the rise again in animals fed unbalanced diets. It is a devastating deficiency as it causes heart disease resulting in heart failure. Early cases can be rectified and then heart disease managed, it can often improve on a balanced diet. Taurine deficiency can also cause serious eye problems.

A balanced diet also varies within a single species depending on what age the pet is. An adult animal will be a lot better at compensating whereas a younger pet needs specific nutrients in exact ratios which feed the growth of muscle and bone. A trend to feed meat only without any other ingredients sometimes means that a growing animal does not have enough calcium to form strong healthy bones. Although diseases like rickets are in the past for humans, we see it in young animals fed on diets without enough calcium. These puppies and kittens develop deformed limbs or fractures of their back or limbs.

These are just two examples of the problems that can arise from a diet that is not designed for the animal concerned. In this blog, we will briefly review the differing diet requirements of pets. However, if you have any concerns about the diet or health of your pet, come and see us. Together we can discuss all the needs and requirements of your individual pet and find a diet that optimises their health and enjoyment.

Calorie requirements vary between species. We may need roughly 1500-2000 calories daily, but a cat needs only 250-350 a day and a small dog under 400. So, the volume of food and calorie density is important. Obesity is very common in our pets. This results in joint disease, osteoarthritis as they age and can lead to diabetes, and liver disease in cats. When we are investigating diets, it can be best to feed a low-calorie density food, so they feel full, especially if we are going to add in the odd treat. Sometimes our pets can’t get as much exercise. For example, if the weather is terrible our cat won’t go outside and exercise as usual, or if we have surgery and can’t walk our dog. In this case, we need to reduce the calories they eat for a short time.

Protein is an important part of any diet. Cats need twice the amount of protein in their diet that we or dogs do. They are called obligate carnivores as they need animal protein in their diet to supply all the amino acids they need. Vegetarian diets can be formulated for dogs, but it is important that the diet includes a source of every one of the amino acids they need. The proportion of amino acids varies with age – for example, a growing pup needs much more arginine than an adult dog, to avoid liver problems. Fat is essential in the diet for certain fatty acids and fat-soluble vitamins which aid health and organ function. Carbohydrates need to be carefully considered in cat diets, some cats put on a lot of weight on high carbohydrate diets.

As cats are desert-adapted species, they have a low drive to drink. This can sometimes mean that they don’t feel thirsty and can become dehydrated or their urine becomes very concentrated. Some cats need some wet food in their diet to combat this. Otherwise, they can develop bladder stones. Many cats enjoy fresh water, and some will drink more if they have a water fountain.

Our small furry pets, rabbits, guinea pigs and rats love the odd high-calorie treat from us, but their dietary requirements are so different that we must take care not to make treats more than 10-20% of their diets. For rabbits and guinea pigs, it is important that the bulk of their calories comes from fibrous food so that their constantly growing teeth are kept in check. The small furry species have very small calorie requirements so can put on weight very easily, which prevents them grooming and can lead to skin problems.

We are always keen to provide the best preventative health care for your pet or pets and are always here to discuss their diet as part of keeping them well and happy. We can work together to choose the right diet that will contribute to a long and healthy life.

Leptospirosis: Fact or fiction?

Leptospirosis can make dogs very ill, cause long-term damage, and even be fatal. Incidence rates vary depending on where you live, your lifestyle and the area where you walk your dog, but most dogs are at some level of risk. The disease is seen in veterinary clinics all over the country and has been labelled ‘re-emerging’ as it seems to be on the increase. It’s also zoonotic, meaning it can spread from animals to humans. The human form (Weil’s disease) is thought to be the most widespread zoonotic disease in the world. There were 87 cases confirmed in people in 2017 in the UK alone, an increase from the previous year. Although usually treatable, fatalities can occur. British olympic rower Andy Holmes died of organ failure after contracting Weil’s disease in 2010, days after competing in a marathon rowing event.

What causes it?

Leptospirosis is a bacterial disease caused by a complex group of closely related bacteria of the genus Leptospira. Only some strains cause disease, some affect certain species more than others (cats are rarely affected), and are more prevalent in certain areas. The bacteria survive well in warm, humid areas, and are often found in stagnant water like ponds.

How is it caught?

Wild animals can carry the bacteria for years without signs, spreading it via their infected urine. Once in moist soil or stagnant water, the bacteria can remain infectious for several months. Any pet of any age, going out in any area, can be infected, but dogs that spend lots of time outside, especially in areas prone to flooding and high rainfall, are at higher risk.

As well as being inadvertently swallowed, contaminated water can more rarely pass on the infection through broken skin, such as cuts or scrapes.

Although infected pet dogs’ urine can be a source for humans, more often it comes from contact with infected water, often during watersports.

What signs should I look for?

The signs are not unique to this disease and can be vague. There is often a fever. The bacteria most commonly affects the kidneys, causing tiredness, lack of appetite, vomiting, abdominal pain, and changes in urination. Dogs with a poor immune system may not survive this phase or may go on to have long term kidney damage. Some will have less severe signs. The bacteria often affects the liver instead of or as well as the kidneys, causing similar signs but accompanied by yellowing of the gums or skin. Some dogs have respiratory signs such as a cough, snotty nose or eyes, and less commonly, their muscles are affected causing trembling. The bacteria can attack blood vessels, causing nosebleeds or blood in their faeces or vomiting due to clotting issues, but this is rare.

How do you diagnose leptospirosis?

If a dog presents signs of kidney and liver disease, a fever, and is either unvaccinated or at high risk, leptospirosis will be high on the list of potential diagnoses. Blood and urine tests can confirm if there is any liver and/or kidney damage and changes to red and white blood cell counts and blood clotting tests may be helpful.

There are specific blood and urine tests looking for antibodies to the bacteria itself, but if treatment has already started these can be hard to interpret. Furthermore, if vaccinated, then the immune system will often have produced antibodies in response, so results are again hard to interpret. The most reliable test may be a repeated antibody test, 2 weeks after the first (in an infection, the antibody levels will be rising) – but obviously this does not help with initial management of the patient.

What treatment options are there?

An initial course of antibiotics is given, followed by a longer course of antibiotics to reduce bacterial shedding. Importantly, damaged organs must be supported, often via intravenous fluid therapy, and medications to address any pain and respiratory or gut signs.

In all but the mildest cases, infected dogs are usually hospitalised in an isolation ward. Whether in the hospital or at home, care is needed when handling infected dogs and their blood and urine to reduce the chance of infection. We can advise you on how to disinfect your home, and how to reduce spread as dogs may shed the bacteria for some time.Washing your hands after contact, ideally wearing gloves, disinfecting frequently, and disposing of any soiled bedding are important. Pregnant women, immunosuppressed people, children and other dogs should avoid contact with the dog until at lower risk. Anyone who feels unwell while looking after a dog suspected of having leptospirosis, must seek medical advice.

The outlook is very variable. Some dogs seem to have minimal signs, while in others it is fatal, or causes lasting damage.

What’s the best way to prevent it?

Fortunately, vaccines are available – we include them in the regular primary course in dogs. Unfortunately the immunity does not seem to last as long as with many other vaccines. The manufacturers recommend yearly boosters to keep immunity at a protective level. In the past, two main strains were responsible for most disease in the UK, but recently additional strains have been implicated. Vaccines are now available covering the four most disease causing strains in Europe (L4), compared to the previous two (L2).Vaccination may reduce bacterial shedding in dogs carrying the bacteria without signs, so are of value to public health protection.

If your pet goes outside, it’s hard to eliminate the risk. Avoid stagnant, shady water, especially after flooding, as the bacteria is rapidly destroyed by light and temperatures above 20C.

Is the vaccine safe?

There have been reports in the media questioning the safety of the L4 vaccines, however, there is a risk of adverse effect with any medication or vaccine. The incidence of L2 vaccine reaction is 0.015%, and is 0.069% for the L4 vaccine. Both are statistically low when you consider the risk of actual disease. Our team are always available to discuss the pros and cons of any decision regarding the health and welfare of your pet, so if you have any further questions, please do get in touch and we’ll be happy to help you.

IMHA in dogs: What do you need to know?

IMHA stands for Immune Mediated Haemolytic Anaemia. It’s a bit of a mouthful so is often known as its less tongue-twisting abbreviation. It’s not as complicated as it sounds and here we will attempt to demystify it.

What is IMHA?

IMHA belongs to a group of diseases known as autoimmune diseases. These occur because the body’s own cells are incorrectly identified as foreign by the immune system. These cells are then attacked and destroyed. With each autoimmune disease, different cells are targeted. With IMHA, red blood cells are targeted and destroyed leading to reduced numbers (anaemia). Two thirds of dogs with IMHA also experience a similar destruction of platelet cells. Platelets are involved in clot formation, and a lack of them (known as thrombocytopenia) leads to abnormal bleeding and is known as Immune Mediated Thrombocytopenia (ITP). When the two conditions occur together we call it Evans syndrome.

What causes this?

Body cells have a protein on the surface called an antigen. The immune system uses this protein to identify its own cells. In IMHA, red blood cell antigens are falsely recognised as foreign which stimulates the production of an antibody by the immune system. The antibody attaches to the antigen and causes the cell to swell and burst. Cells also become more likely to clump (agglutinate) giving higher risks of abnormal clotting.

When the cause of a disease is unknown we call it idiopathic. This is the case in around 70% of IMHA, so we call it idiopathic IMHA, or primary IMHA.

In the other 30% there is an underlying cause called secondary IMHA. Certain infections, mainly spread by parasites like ticks, can lead to secondary IMHA. Most are uncommon in the UK, but should be considered, especially if your pet has travelled abroad. Certain medications have been known to trigger IMHA, such as some antibiotics and painkillers. Some forms of cancer can also trigger IMHA. Recent vaccination has been suggested to trigger the disease but lacks evidence at present. Vaccination prevents serious life-threatening diseases and in the majority of dogs the benefits vastly outweigh the risks.

There seems to be a genetic predisposition in cocker spaniels and Old English sheepdogs, but any breed can be affected.

What are the symptoms?

Symptoms are largely due to the resulting anaemia. Signs may be vague such as weakness, lethargy and a poor appetite. Red blood cells are needed to carry oxygen around the body, so there is often a fast heart rate and breathing rate as the dog tries to compensate for the lack of oxygen. Usually we see pale gums, but there may be a yellow tinge to the gums as when red blood cells rupture they are broken down into a yellow tinged product called bilirubin.

Damage through lack of oxygen within any organ can cause varied signs and, as there is a tendency for red blood cells to clump, clots may form anywhere.

How is IMHA diagnosed?

After an examination and taking a history we may be suspicious.

Firstly we confirm the presence of anaemia. Anaemia has many causes so we need to further define the type of anaemia present. Most dogs with IMHA have a regenerative anaemia, where the body is stimulated to produce more red blood cells to make up for lost ones. In rare cases where the bone marrow is affected then a non-regenerative anaemia is possible.

Next we rule out other causes of regenerative anemia, and other rarer causes of haemolysis like onion poisoning or heavy metal toxicity, and identify whether your pet has had any recent medications or vaccinations. We may carry out further tests to identify infectious causes or cancers.

We often examine the blood under the microscope, looking for certain types of cells known as spherocytes, which are small, round red blood cells often associated with IMHA. We may see more immature red blood cells (reticulocytes) telling us the anaemia is regenerative. We often send samples to a lab for confirmation alongside other specific tests such as the Coombs test, which looks for antibodies on the red blood cells. A saline agglutination test looks for clumping of red blood cells when mixed with saline. It is quick and relatively inexpensive, but can be hard to interpret.

Can this condition be treated?

The first-line treatment for many autoimmune conditions is a corticosteroid called prednisolone, which suppresses the immune system. High doses may be needed initially, aiming to lower and possibly stop medication in the long run. A second immune suppressing drug can be tried in severe cases, or if prednisolone causes severe side effects or doesn’t work. Azathioprine is most commonly used as it is inexpensive, but takes time to work and requires handling precautions. Cyclosporine is licenced for use in dogs but expensive, has an unpredictable dose range and side effects.

A last resort is to help stop red cell destruction in the spleen by removing it (splenectomy). Pets by this stage are very sick and the procedure risky. Many owners would sadly have to consider euthanasia as an alternative.

If we think there’s a risk of excessive clotting we may prescribe medications such as aspirin to mitigate this.

A blood transfusion may seem obvious, but new cells may be destroyed quickly, worsening the signs. However, damage caused by the lack of oxygen in severe anaemia may be a bigger risk, so a transfusion may be recommended.

We would monitor the response to treatment with blood tests regularly. Hopefully once a response is seen, we can taper any medication gradually, whilst continuing to sample for any worsening in parameters. We may also want to monitor for any side effects of the medications.

What is the outlook?

The prognosis with IMHA is variable, carrying a mortality rate of 30% to 70% within 1-2 months of diagnosis. If patients suffer IPT at the same time, or if the bone marrow is affected, the outlook may be worse. The condition can come back, and some animals need lifelong medication.