Kidney Failure

The kidneys are very important organs of the animal body and play an important role in the normal day to day functioning of the Dog with kidney failure on drip receiving fluid therapybody. They act like a specialised type of filter by retaining the appropriate amount of different salts (electrolytes) to maintain fluid balance in the body. They secrete a hormone which is involved in the production of red blood cells. The kidneys are also responsible for getting rid of waste products through the urine, especially those that are produced by the breakdown of protein in food. Kidney failure starts as soon as the kidneys are damaged due to disease, damage or old age, however in animals most owners only start seeing the clinical symptoms of kidney failure once more than 70 to 75 % of the kidneys have been destroyed or damaged. This means that of two kidneys, as little as only half of one is functioning normally before the signs of kidney failure become evident.  At this stage the kidneys can no longer adapt to maintain a normal fluid and electrolyte balance in the body, and are no longer able to expel toxins as efficiently as before. The challenge with treating kidney disease is that the kidneys do not have the capacity to regenerate like other organs like the liver. This means that it is very important to look out for the symptoms of kidney failure so treatment can commence as soon as possible to preserve as much of the kidneys as possible.

Once the kidneys (the body’s filter) have become damaged, different electrolytes and nutrients are either wasted through loss in the urine, or kept in the body at levels that are too high. This leads to a variety of symptoms.

The most common sign of kidney failure is an animal which starts drinking more water than usual and urinating more often. Other signs of kidney problems in animals include weight loss and dehydration, vomiting, decreased appetite and lethargy or depression. Animals with kidney problems often have bad breath and can have ulcers in the mouth or the stomach. They may drink more or less water than usual, and urinate frequently, sometimes with discomfort. They often urinate in unusual places, and the urine may appear bloody or cloudy or have a strong smell. Animals can also develop a low red blood cell count (become anaemic) if the kidneys are no longer producing sufficient amounts of the hormone necessary for red blood cell production. Not all animals display all symptoms, but as the condition progresses the overall health of the animal will deteriorate. For this reason, monitoring your pet’s behaviour closely and visiting your vet timeously, is helpful in making an early diagnosis.

Kidney failure can be divided into two categories – acute and chronic. The acute form occurs suddenly and the affected animal deteriorates quickly. The sudden failure of kidneys can be due to consumption of toxins. These can include things like ethylene glycol (antifreeze), certain medications, raisins or grapes, lilies and raw onions amongst others. It can also occur due to shock like major trauma and compromised blood supply to the kidney; or because of a blockage or rupture in the urinary system. Acute kidney failure is seen more frequently in young animals than the chronic form.

Chronic kidney failure has a slower and more subtle progression. It is a common condition seen in older cats. Chronic kidney failure occurs due to cumulative damage to the kidneys which can include toxin exposure, infections or long-term inflammation. There is also a genetic component to the condition, with Persians and Abyssinians being very prone to kidney failure. Chronic kidney failure is irreversible, and treatment is aimed at slowing the progression of the disease and improving quality of life.

Diagnosis of kidney disease is mainly done with the help of blood tests and analysis of the urine. The blood tests screen for the accumulation of toxins in the blood. The urine tests check the concentrating ability of the kidneys as well as abnormalities in the composition of the urine; and for abnormal cells or bacteria. It is sometimes necessary to perform further tests, such as ultrasound imaging of the kidney, or taking a biopsy, to check for cancer or other abnormalities.

Animals with kidney failure need to be hospitalised for fluid therapy. This re-hydrates the animals and helps to flush out toxins that have accumulated in the blood. They also need to be fed a veterinary prescription diet. These diets contain optimal levels of protein to take pressure off the kidneys, without being so low that muscles are broken down to compensate. The diets are also low in salt, which is important because the filter action is compromised. As important as the veterinary diets are, if the animal is very reluctant to eat it is preferable to tempt it with any treat rather than trying to enforce the special diet and make the animal starve in the process. It is of paramount importance that the affected animal has access to fresh water at all times. Dehydration can dramatically worsen the condition.

Many animals with kidney failure require medication to lower blood pressure. Some animals need medication to help with nausea, and others drugs to help reduce ulceration of the gut, or to restore pH balance, or to correct low red blood cell count. There is no fixed recipe for success and your veterinarian will supply the correct medication according to the needs of the individual animal. Animals with kidney failure must return to the vet for check-ups on a regular basis. It may be necessary for intravenous fluid therapy to be repeated, or it can be carried out at home if owners are prepared to administer fluids under the skin.

As mentioned before, there is no cure for kidney failure so treatment is aimed at slowing down its progression and improving quality of life for the animal. Prognosis is worse for dogs than for cats, because in general they do not respond as well to treatment as their feline counterparts. Some cats respond very well to therapy and can be maintained on treatment for years, while others deteriorate within weeks. The earlier the condition is diagnosed, the better the prognosis, so it is important to monitor your pet for signs of ill health and make a trip to the veterinarian if you are suspicious  of kidney problems.

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Old man’s gland – Do dogs have the same problems as humans?

Prostate disease in dogsThe prostate is the only accessory sex gland in the male dog. It is a butterfly shaped structure that surrounds the urethra (the tube that connects the bladder to the outside). Due to the location of the prostate, it can affect the urinary system, the colon and the hind legs, as well as having some systemic effects. Prostatic fluid is produced continuously in the dog. Prostatic fluid makes up most of the volume of seminal fluid (the fluid that carries semen). The prostate has many nerves and blood vessels running to it but is surrounded by a thick capsule, which sometimes makes it difficult for some drugs to get deep down into the prostate. Normal prostatic function is dependent on circulating testosterone. The prostate can develop a few conditions that can result in debilitating disease in the dog.

Signs of prostatic disease

Most dogs with prostatic disease are middle aged to older intact males, as testosterone plays an important role in the function and size of the prostate. Neutered dogs are at a reduced risk but some prostatic diseases can still develop. The clinical signs that you may see at home can be divided into four different categories.

  • Urinary tract – signs may include blood in the urine, pus in the urine, difficult urination or constantly leaking urine.
  • Systemic illness – the dog may have fever episodes, weight loss, weakness and lack of appetite, drinking lots of water or vomiting.
  • Colon – the dog may appear constipated or have diarrhoea, straining or struggling to pass stool.
  • Difficult movement especially with the hindquarters – the dog may display hind limb stiffness, lameness or generalised weakness.

If any of these signs are noted in a dog, it is important to bring him to the vet where a proper clinical examination and work up can be done to diagnose the problem. A rectal exam is usually helpful in diagnosing an enlarged prostate but it is sometimes very difficult to feel, particularly in large breed dogs. X-rays will also form part of the work up as an enlarged prostate can usually be seen on X-rays. The vet may then suggest an ultrasound from the tummy’s side where the prostate can be seen and its size and shape assessed. Some animals may require further testing such as biopsies (a surgical procedure where a small part of the prostate tissue is removed and sent off to a specialist pathologist vet for microscopic examination) or even surgery to differentiate between different conditions.

Prostatitis

Prostatitis refers to inflammation, usually due to infection, of the prostate. It can affect any age or breed of dog. It can occur with or without enlargement of the prostate. Acute prostatitis is often associated with systemic illness and is more commonly seen in younger males. They may present with a very painful abdomen as well as fever and loss of appetite (anorexia). These animals may need hospitalisation and intensive treatment such as being placed on a drip, catheterisation where a special tube is inserted from outside through the penis into the bladder, and intravenous antibiotics. Chronic prostatitis has a more prolonged clinical course and is often not associated with systemic illness.  Both forms of the disease require a long course of antibiotic treatment, often four to six weeks and it is important that the choice of antibiotic is based on a culture of the urine or prostatic fluid. A culture is where a small sample of fluid is collected with a technique which is done as sterile as possible and sent off to a laboratory for tests to see exactly which bacteria or other micro-organisms may be causing the trouble. Castration, where the testicles are removed, should always be considered as it reduces testosterone which contributes to the condition and complications seen.

Prostatomegaly due to benign prostatic hyperplasia

Prostatomegaly refers to enlargement of the prostate and can be due to a number of conditions. Cysts in the prostate, cancer and infection can all lead to an enlarged prostate. Benign prostatic hyperplasia refers to an enlarged prostate without infection or cancer. Benign prostatic hyperplasia is often seen in older, intact males dogs. Castration is the treatment of choice as the benign prostatic hyperplasia is often testosterone dependent. The prostate starts to decrease in size in a few weeks following castration and the size is often back to normal in a few months.

Prostatic and paraprostatic cysts

Prostatic (within the prostatic) and paraprostatic (next to the prostate) cysts are common causes of prostate enlargement. Medical treatment is generally ineffective. Castration is recommended but surgery is usually required to reduce the cysts. It is a very specialised procedure.

Prostatic cancer

Unfortunately castration does not protect against dogs developing prostatic cancer. The signs displayed will be similar to most other prostatic diseases. A definitive diagnosis can only be made on biopsy of the prostate. There is a high rate of spread in prostate cancer and the hind legs and lungs are often affected. Surgery can be done but is difficult and has many complications. Often, supportive care is provided but unfortunately the prognosis is very poor.

In humans smart robotic surgery like the Da Vinci Surgical System have been used for removing the prostate in recent times. This surgery is less invasive than the conventional method of having to go through the abdomen. Unfortunately the cost of the equipment is prohibitive for the veterinary environment under normal circumstances. Fortunately full surgical removal of the prostate is a rare occurrence in veterinary medicine and the vet will be able to advise you which course of action would be the best, should you ever have to face this scenario.

There are many different causes of prostatic disease in dogs. It is important to be able to recognise signs of disease in your dog and further investigation is usually required. Castration remains an important control measure in prostatic enlargement but unfortunately does not completely take away the risk for the development of prostatic cancer.

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When is it more than just a tummy ache?

The pancreas is a small gland that is situated next to the stomach and first part of the small intestine in the front of the abdomen. As in humans, it performs two main functions in dogs and cats.

  1. It is responsible for producing some of the special chemicals called enzymes which aid in the digestion of food. Enzymes are usually inactive within the pancreas. They are activated when they are released into the small intestine through ducts. Enzymes break down the food into smaller particles which can then be absorbed through the intestinal wall into the blood stream.
  2. The other main function of the pancreas is to help regulate blood sugar. The pancreas produces special messengers called hormones. Insulin is one such hormone. These hormones tell the body when to release or store glucose into the cells.

Sometimes the digestive enzymes are released within the pancreas, instead of within the small intestine. When this happens, it causes severe inflammation and death of some of the pancreatic cells. This can affect surrounding abdominal organs, such as the liver. When inflammation occurs it is usually very painful and is described as pancreatitis. Pancreatitis can be acute, where the inflammation is not associated with permanent damage or it can be chronic. A chronic pancreatitis results in the pancreas becoming smaller and harder than normal and this affects the function of this important organ. Pancreatitis can become very severe very quickly and cause your pet to suffer with intense pain so it is important for your pet to receive veterinary attention as soon as you suspect there may be something wrong.

What causes pancreatitis?

One of the well-known causes for pancreatitis is when an animal eats a fatty meal. The condition normally starts fairly shortly after the animal has eaten such a high fat meal and requires urgent attention. Overweight patients have also been shown to be more at risk than those with a lean body weight. Conditions, such as shock or kidney failure that compromise the blood supply may also predispose the patient to developing pancreatitis. Certain drugs and some diseases such as tick fever or Babesia (Biliary) in dogs have been associated with causing pancreatitis. In many cases, the underlying cause cannot be found and this is described as idiopathic. Some small breeds, such as the miniature schnauzer have been found to be more prone to developing pancreatitis than other breeds.

What does pancreatitis look like?

Pancreatitis can affect any age or breed of dog or cat.

In dogs, the typical clinical signs of acute pancreatitis include:

  • Stomach cramps or abdominal pain. The pain may be so severe thatthe animal may adopt the prayer position where the head is placed on stretched front legs, the front part of the chest is on the floor and the back legs are raised
  • Vomiting
  • Loss of appetite
  • Weakness
  • Depression or listlessness
  • Diarrhoea

Dogs may not show any obvious pain until the abdomen is felt and examined. In these cases they will pull the stomach muscles together when you touch the underside of their belly or flanks and they may even groan or try and bite when you press too hard.

In cats, the most common signs include:

  • Loss of appetite
  • Dullness and being slow to move or act (Lethargy)
  • Possible vomiting and diarrhoea

Cats may also show signs of dehydration, decreased body temperature, jaundice, fever and abdominal pain in severe cases. Cats are generally more subtle at showing disease compared to dogs so clinical signs in early stages may not always be seen.

Acute pancreatitis can be very severe, causing collapse due to a drop in blood pressure. This drop in blood pressure may cause extensive damage to vital organs such as the liver, kidneys, heart and blood vessels.

How is Pancreatitis diagnosed?

Pancreatitis is not always a simple diagnosis as it may look like several other diseases and conditions affecting the abdomen. The diagnosis is usually made based on taking several things into consideration like the history, clinical signs and diagnostic tests. The history may include being fed a fatty meal or the animal being very overweight. Clinical signs would include some or all of the signs described above. The most helpful tests aiding the diagnosis, which the veterinarian may have to do include:

  • X-rays of the stomach area
  • Ultrasound of the stomach area
  • Blood tests. Apart from some general blood tests which may point to Pancreatitis there are a number of bloodtests which specifically test the pancreatic enzymes. These tests are very useful.

Some of the tests are readily available but for others the vet may need to send blood to an external lab which may delay the diagnosis. In most cases if the vet suspects pancreatitis, even before the diagnosis has been confirmed, the vet will most likely start treatment on the suspicion of pancreatitis given the clinical signs and history. The reason for this is that acute pancreatitis can deteriorate dramatically over a number of hours leading to death. Therefor no time should be wasted in starting treatment. In some cases the veterinarian may be required to do an operation and do exploratory surgery of the abdomen and take samples of the pancreas in order to confirm the diagnosis.

How is pancreatitis treated?

In cases where the cause for pancreatitis can be established, that will be removed or treated with supportive treatment provided for the organ itself. Because the cause of the pancreatitis sometime remains unknown the treatment protocol then focuses on providing supportive care. In most cases the veterinarian will advise putting the patient on a drip to provide intravenous fluid therapy. The patient will need anti-nausea medication to stop the vomiting. Often if the patient is vomiting, they will not want to eat any food for the first day or two. If the patient does want to eat, a low fat diet is recommended. In very severe cases and where available, patients may need feeding by a tube or intravenously. Pain control is very important as these patients are generally very sore. Opioids, which are drugs like morphine, provide very good pain relief. Antibiotics are not always required but if the patient is showing evidence of infection, it will be administered.

Some patients may recover quickly from pancreatitis but in most cases recovery takes five to seven days. Some severely affected patients may take several weeks to recover and some unfortunately may not survive. In some cases, the veterinarian may advise referring the patient to a specialist facility that can provide 24 hour care for critical patients because this condition can easily deteriorate to such a point.

What happens when your pet goes home?

Your pet will be released from hospital when the veterinarian is happy the vomiting has stopped and the animal appears more comfortable. Generally they will appear brighter and less depressed. Home treatment will depend on how sick your pet was, but it may include some form of pain medication and antibiotic treatment.

Dietary changes play an important role and a low fat diet is essential. There are a few commercial diets available which the veterinarian may prescribe. Feeding small meals frequently is often recommended and the low fat diet will reduce the work load on the pancreas, hopefully reducing the risk of the condition developing again. The diet will also help in weight loss with those pets that would benefit from it.

Some animals with severe pancreatitis may lose some function of the pancreas and this may need to be treated accordingly. Unfortunately, some patients may develop recurrent pancreatitis, even with appropriate diet changes and weight loss at home.

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Ear Infections in Your Pet

Ear infections are common in dogs, and to a lesser degree in cats. The anatomy of the animal predisposes them to this condition. The ear canal of the dog and cat follows the shape of an “L”, going first downwards and then horisontally. This shape makes it difficult for debris and water that go into the ear to come out, against the force of gravity.

Causes and diagnosis of ear infection

When the ear canal is wet and dirty, bacteria and yeast called Malassezia flourish. Other factors that can play a role less commonly are ear mites or even ticks which creep into the ear canal, any type of growth or foreign body, allergies, or a thyroid gland which malfunctions (hypothyroidism). With a bacterial overgrowth the discharge from the ear is usually yellowish in colour and resembles pus. With a yeast infection the discharge may have more of a dark brown or black colour, and has a distinct smell. It is also possible to have mixed infections within the ear. The vet will diagnose what type of infection is present by looking into the ear with an instrument called an otoscope, and by making a smear of the material accumulating in the ear by putting a small amount of the ear discharge onto a glass slide, staining it and then looking at what cells and organisms are present under the microscope. In more complex or recurring cases the vet will take some of this material from the ear and send it to a laboratory to establish exactly what type or bacteria or organisms is present (called a culture). This process of diagnosis is important as it affects the treatment plan for the animal.

Certain dogs are predisposed to ear infections, and for this reason the condition often recurs in these patients. The condition in these cases will never be totally cured and can only be managed. Dogs that love swimming, such as Labradors, are predisposed to ear infections because they have water entering the ear canal on a more frequent basis. Dogs that have large floppy ears, like Poodles and Cocker Spaniels are also predisposed as this conformation often prevents the ears from drying out properly. Dogs that have a lot of hair in the ear canal, like Schnauzers and Poodles, are also prone to infections, as debris and moisture can become trapped in the hair.

Ear infections are quite rare in cats but Persians are the most predisposed breed of this species. In cats itchy ears are usually because of an ear mite infection, rather than bacteria or yeast. An infection with bacteria or yeast in a cat is quite frequently associated with an underlying illness such as Feline Leukemia Virus, Feline Immunodeficiency Virus or diabetes. There is increased risk of infection in these animals because the immune system is depressed.

Signs of an infection commonly include scratching at the ears and shaking the head and may also include animals tilting their heads. There may be an unpleasant odour and you may notice a discharge. This is not always seen as other pets in the home may have licked at the infected ears to clean them. The ears may also become swollen or red, and even show crusting or scabbing of the skin. A common side effect of an ear infection is the formation of an othaematoma. This is a painful swelling of the ear that results from a collection of blood under the skin because of the vigorous shaking of the head which causes blood vessels in the ear to burst. Large othaematomas often require surgical correction.

In extreme cases animals may lose their sense of balance. Severe cases may also show disturbance of the nervous system such as walking in circles or unusual eye movements. Loss of hearing can also result from a severe infection. It is important to treat an ear infection promptly so that it does not progress to the more serious stages, and also to help relieve the discomfort that the infected animal is suffering.

Treatment of ear infections

One of the most common reasons for clients to change vets is because of the perception that the vet fails to get the ear infection under control permanently with treatment. It is important to understand that some ear infections will never be cured and can only be managed. This is as a result of other underlying reasons leading to ear infection. Animals which suffer with inhalant allergy, also known as Atopy, are very prone to itchy skin, called atopic dermatitis (derma-skin, -titis – inflammation). Because the ears form part of the skin, the ears and the inner parts of the ear canal will be affected leading to a red, warm and swollen surface (inflammation), which is a wonderful breeding ground for bacteria and yeasts to grow.

Treatment of ear infections therefore always start at trying to identify, address and alleviate underlying causes. If the underlying causes are addressed, the ear infection will in many cases not return after successful treatment. However in certain instances, it is not possible to completely eliminate the underlying cause. In these instances, it is important to reduce and manage the underlying cause as much as possible, which in turn will reduce the treatment required for ear infection. It may be a life-long problem which is incurable, but can be managed by periodic treatment.

Establishing the underlying cause may be quite difficult in itself and may require an extensive period (at least 8 weeks) of changing the dog or cat’s food to a very specific anti-allergenic diet. In certain cases of allergy, blood tests or other skin tests may need to be done to determine what exactly triggers the allergy, and vaccinations against these triggers can be formulated for the animal. Treatment of underlying causes in itself may be expensive and time consuming, and this does not even address the ear infection itself.

Once the underlying cause has been identified and addressed, treatment involves cleaning the ears and in most cases administering drops into the ears. If the infection is far advanced the ear canal will be very swollen and in most cases extremely painful, which means that the animal will have to have a general anesthetic to clean out the ears properly. In severe or recurring cases the vet may take a swab of the ear and send it to a laboratory to establish exactly what type or bacteria or organisms is present (called a culture). Further to this the vet may request a test to establish which antibiotics will work against the organisms found. In some cases severe resistance to medication has been developed by some organisms which will require special attention.

In mild cases the vet may prescribe a cleaning liquid which will need to be applied to “flush” the ears before medication is put into the ear. To clean the ears, the cleaning agent is squirted into the ear. The ear is then agitated by firmly rubbing the base of the ear. This is to help spread the cleaning agent and increase its contact with the inner surface of the ear. Remember to stand back when you have done this because most dogs will shake vigorously after this exercise. This shaking helps to loosen up material stuck in the ear canal. Once the animal has had a good shake, cotton wool or tissue paper is used to wipe up the cleaning agent and the wax from inside the ear. It is important that cotton wool buds are not used as these are small enough to penetrate too far into the ear and can damage the eardrum. There is no risk of this happening with a finger and cotton wool.

The cleaning agent will help to dissolve the wax present in the ears and create a healthier environment where the infective organisms are less likely to flourish. Once the ears have been flushed, medicated drops will have to in inserted which normally contain agents that act against the specific organisms demonstrated on the ear smear or culture as well as anti-inflammatory and soothing agents. In most cases treatment will have to be administered daily for a number of days or weeks.

In some cases systemic treatment like a course of antibiotics or anti-inflammatory medication to be taken by mouth may also be prescribed.  The vet may start off this treatment by giving some injections.

Ear infections are seen commonly in small animal practice. If you suspect that your pet is suffering from an ear infection there is no need for alarm, but attending to it promptly with a visit to the vet is advised. Some ear infections will never be cured and will require ongoing treatment and lifelong management.

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“Crocodile Mite” skin disease in dogs and cats

Demodex is a mite that lives in the hair follicles of most mammals. It is species specific which means that different types of animals, including humans, have their own type of mite. It is a normal inhabitant of the skin and is most commonly not contagious. The mite is usually passed on to puppies from their mother in the first 72 hours of life. The puppy's immune system usually copes to contain the mite but sometimes an overgrowth of the mites occurs and this is when symptoms of demodicosis also referred to as mange are seen. Mange is a collective name for skin disease caused by different types of mites of which the Demodex mite is only one.

There are two main forms of demodectic mange:

  • Localised demodex – this generally involves fewer than five lesions and is most commonly seen in puppies.
  • Generalised demodex – involves 5 or more lesions and there are most commonly one or two areas of infection. It is commonly seen on the face and muzzle or two or more feet. Generalised demodicosis always requires treatment.

Juvenile onset demodicosis occurs in animals under 18 months. Localised juvenile onset demodicosis usually involves a focal lesion. It resolves without treatment as the puppy's immune system matures. It is most commonly seen as a small patch or patches of hairloss. It is generally not itchy. It can occur anywhere on the body but is commonly seen on the head.

Generalised demodicosis needs to be treated. It is thought to develop due to a defect in the immune system and it is advisable not to breed with these animals. As vets we normally recommend sterilisation once the infection is under control. 

Adult onset demodicosis occurs in animals older than 18 months. It happens as a result of something affecting the immune system. Predisposing factors may include immunosuppresive drugs such as corticosteroids, a high burden of other parasites, such as ticks, fleas or worms, poor nutrition and stress. In cases where a cause cannot be found, this is described as idiopathic. Some breeds seem to be more predisposed demodex skin disease. Rottweilers, Pit Bulls, English Bulldogs and Chinese Sharpeis have been found to be overrepresented.

Generalised and adult onset demodicosis can become a severe chronic disease and animals may develop secondary bacterial infections. It is important to try and find the underlying cause. Some animals may require life long, chronic treatment, particularly in cases of idiopathic demodicosis.

Clinical signs

In localised cases there will be most often one or two small  lesions of hairloss also referred to as alopecia. The patient may or may not be itchy. In generalised cases you may see hairless areas, redness of the skin, darkening and thickening of the skin, increased pigmentation and draining lesions due to secondary infections. The feet and face are most commonly affected.

Diagnosis

The diagnosis is made on a deep skin scrape or biopsy. A skin scrape is a very quick procedure and involves scrapping the skin until a small amount of blood is seen. Sometimes multiple scrapes have to be made to find the parasites because they live deep inside the hair follicles. The material obtained is looked at under a microscope. The mites are easily identified by their distinct shape. The mite is sometimes described as resembling a crocodile or cigar. It has an elongated body with short legs. 

Treatment

As described before, juvenile onset, localised demodex usually resolves without treatment. Juvenile onset generalised and adult onset localised and generalised demodex needs to be treated. Treatment may include an oral or injectable antiparasiticide. The most commonly used product is ivermectin, a macrocyclic lactone. This product is actually a product registered for use in cattle and sheep and is not registered for use in dogs but it has been found to be effective and is safe (except in the Collie breeds) if it is correctly tapered up to the effective dose. Collie and Collie crossbreeds cannot always metabolise the drug, so it is important that the safety in these dogs is tested before starting treatment. This is done by testing the blood for the presence of the MDR gene. The test will need to be sent off. The vet will recommend testing these breeds before starting any treatment.

Treatment is continued for twice as long as it took to clear the infection and your pet will require regular check ups and skin scrapes. So if the infection took one month to clear, treatment will continue for another month.

The vet may also recommend using a dip in some severe cases. The dip will more often than not contain amitraz. Amitraz can be toxic so it is important to follow the instructions when mixing up the dip. It is also toxic to cats so care should be taken when you have a household with both cats and dogs.

There are also some spot on treatments available which have been registered to treat demodex in dogs. They also contain Amitraz. It is usually recommended to do six weekly treatments but this will depend on the severity of the infection and the judgement of the vet in each individual case.

Demodex in cats

Demodex is rarely diagnosed in cats. More often than not, if it is diagnosed, there is an underlying condition affecting the immune system. Feline immunodeficiency virus (FIV), Feline Leukaemia virus (FeLV), Diabetes Mellitus and cancer can predispose the cat to developing demodex. It is most commonly seen on the face and ears and presents as generalised hairloss on the head and neck with crusting and potential secondary infection. It can affect the eyelids and the region around the eyes and ear canal is often affected. Cats can be infected with two different types of demodex, of which one is contagious and can be passed on to other cats. As Amitraz is toxic to cats, the condition is treated with Macrocyclic Lactones or sulphur lime. Because the condition is often due to the presence of an immunosuppresive disease, cats will often require life long treatment.

Conclusion

Demodex is a relatively common condition in dogs and more rarely seen in cats. It is generally an easily identifiable condition and in most cases is easily treatable. Treatment does however require dedication from the owner, particularly when it occurs in adult dogs and cats. In adult onset demodicosis it is important to try and manage any underlying conditions, maintain nutrition and reduce any stressful situations. Even in these cases, demodex can be managed and your pet can lead a normal and happy life.

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The Hype about Hyperadrenocortism

Hyperadrenocorticism, or Cushing’s Disease, is a condition whereby the level of cortisol in the body is too high.  It is a condition which is also found in humans and the name Cushing’s Disease or also commonly known as Cushing’s Syndrome comes from Harvey Cushing, who in 1912, was one of the first physicians to report a patient affected with excessive cortisol hormone also otherwise known as glucocorticoid.

Cortisol is a hormone that is present normally in the body and it usually increases to a small degree in response to stressors such as illness, environmental changes or fear.  Some people call it the “fight or flight” hormone. Cortisol is a catalyst for different events to occur, such as the release of cells which fight infection and a release of sugar from the muscles in case the animal needs to utilise these stores.  Cortisol helps the animal to cope with stressors and is necessary for normal function.  Its production is closely regulated by the body’s physiological processes, so that the animal can respond as needed and remain in balance with its environment.

The pharmaceutical industry has managed to produce drugs which are almost identical to the cortisol which is produced by the body naturally. The use of these drugs is very common, because patients respond so well to their positive effects. However as with everything in life, – too much of a good thing, is not a good thing anymore. Administration of these medications can actually lead to Cushing’s syndrome as well. This is known as an exogenous cause. We will not concentrate on this type of cause on this article but rather on the internal or endogenous cause of Cushing’s disease. Cushing’s disease is a disease that occurs fairly commonly in dogs but rarely in cats.  Female dogs are slightly more predisposed than males, and it usually occurs in animals older than six years of age.  It is seen most frequently in Poodles, Dachshunds, German Shepherds and terriers of different kinds.

Cushing’s Disease is a complex syndrome with a large range of symptoms.  To fully understand it, one must first understand the normal physiology of the animal.  In every dog and cat there is a series of events that occurs to produce cortisol.  One can imagine a factory line within the body, and it starts with an area in the brain called the hypothalamus.  This region of the brain produces neuro hormones which go to the next site in the line, the pituitary gland.  The pituitary gland is a tiny gland sitting at the base of the brain which has an amazing influence on many of the body’s normal functions or homeostasis. The pituitary gland is stimulated to produce another hormone which goes to the adrenal glands which are situated very close to the kidneys. The adrenals are the final stage of the factory line and they produce cortisol.  A problem can occur at any of the points along the line.   Unlike at a factory, the cells do not go on strike and stop working.  Usually the problem is that the cells overwork (for example if a tumour is formed) and so too much of the hormone produced at that site is released.   (Wouldn’t it be nice if this occurred on an industrial level?!)  The area that overworks increases the production of hormones further down the line.  It also decreases the hormones produced before it due to negative feedback (the manager of the factory phones to tell the workers to take a break, enough is being produced!)

The main signs of Cushing’s disease include an increase in appetite (polyphagia), as well as an increase in water consumption (polydipsia) and urination (polyuria).  Another common sign is an enlarged abdomen, giving the animal a potbellied appearance.  This is due to weakening of the abdominal muscles and the deposition of fat in this area, as well as an increase in size of the liver internally.  Cushingoid animals often have a symmetrical hair loss over the body and the skin can become quite dry and thin.  Other signs include lethargy, acne, weakness and a tendency to bruise easily.  Bitches can fail to cycle normally, and males may show a reduction in size of the testes.

Roughly speaking about 70% of tumours occur at the pituitary gland, and only about 30% at one of the adrenal glands.  It is important to establish where the tumour has occurred as it affects prognosis and treatment.  This can be done with a series of blood tests and also ultrasound scanning (the tumours cannot however always be seen).  The main tests performed are the Dexamethasone Suppression Test and the ACTH Stimulation Test.  These tests mimic the hormones produced by the body to assess which parts of the factory line are implicated.  Prognosis for pituitary-dependent Cushings is usually good, and for the adrenal-dependent form more guarded.

For both types of Cushings the treatment is lifelong oral medication, but it tends to be more effective in pituitary-dependent Cushings.  There are mainly two types of drugs being used to treat Cushing’s disease. The one drug acts by destroying the cells of the adrenal gland so that production of cortisol is reduced, thereby "taking workers out of the production line".  Once these cells have been destroyed they are gone forever, thus requiring cortisol replacement in the form of tablets, if too much of the adrenal glands are destroyed. The other drug acts by competing for the building block enzymes which are needed by the cells of the adrenal glands to produce cortisol thereby "reducing supplies of raw materials needed for manufacturing, resulting in less output". This drug tends to have less side effects but can be quite significantly more expensive. The choice of which drugs to use will depend on the condition of the animal, how advanced the state of the disease is and cost of medication.  Side effects  of medication may include vomiting, diarrhoea, lethargy weakness and loss of coordination.  Treatment for adrenal-dependent Cushings can also involve surgical removal of the cancerous gland.  There is a risk that the adrenal gland tumour will spread to other parts of the body before surgery takes place, which would markedly worsen prognosis. It is important to note that if the route of oral medication is chosen that it is considered chemotherapy similar to cancer treatment. The medication should be handled with care and preferably with latex gloves, because some of the medication may be absorbed through human skin and will have the same effect in humans as in animal that it will destroy the cells of the adrenal gland.

In certain cases patients who are diagnosed with Cushings are not very ill and if this is the case then the vet may decide that treatment can be optional.  However, some animals suffer more than others and all animals with Cushings are at an increased risk for developing Diabetes and bacterial infections.  When treatment is commenced it is important that the patient visits the vet frequently in the beginning to assess how effective the dosage is at controlling the syndrome. Over-medication can have serious side effects because of the destruction of the cells of the adrenal glands.   Medication may need to be adjusted over time to for the animal to cope optimally. Long term treatment may be expensive depending on the size of the dog.

The prognosis for Cushing’s disease when treated is good, especially if the tumour is of the most common type.  The average survival time for a dog after diagnosis is about two years.  This may not sound impressive but is important to note that most dogs are already middle aged or older at the time of diagnosis. 

As with the diagnosis of any serious lifelong condition in a pet, the owner must think about what he or she is prepared to commit to, in terms of costs and administration of medication.  Choices like these are highly personal and there are no “one size fits all” options for treatment with this condition.  The treatment of Cushing’s disease is however, usually very effective and rewarding.  Like a factory, if management is consistent and prepared to tweak points along the line, then production will be efficient and correct. In cases like these the factory will perform at optimal levels and the patient may continue to live a normal and happy life.  

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Cat Aids

How does Feline Immunodeficiency Virus (FIV) compare to Human Immunodeficiency virus (HIV)?

Feline immunodeficiency Virus (FIV) has similar building blocks and is related to Human Immunodeficiency Virus (HIV), but very importantly, it cannot be passed between cats and humans. The virus can also not be transmitted from cats to dogs. Both FIV and HIV viruses share a similar pattern of disease progression. Both viruses are classified as Lentivirus, which means they have a long period of showing very few clinical signs during which time the immune system deteriorates. Eventually Acquired Immunodeficiency Syndrome (AIDS) develops and this is accompanied by opportunistic infections, systemic disease and cancer. The close relationship between FIV and HIV has meant that FIV has been used as an animal study model to better understand HIV in humans.

FIV was first described in domestic cats in 1987 but data suggests that wild cats may have been affected for much longer. It has been found that the majority of lions are infected with FIV but few show clinical signs.

How is FIV transmitted?

FIV is passed between cats by contact (also referred to as horizontal transmission) and not from a mother to her unborn kittens. Male cats that have not been neutered and living outdoors have been found to be most at risk. The virus is found in the saliva of infected cats and is most commonly transmitted through bite wounds with fighting. Although it is also found in the semen of infected males, sexual transmission, unlike in HIV, is uncommon. The true prevalence of the disease is not known because testing is completely voluntary. The prevalence is highly variable and depends on the age, gender, lifestyle, physical condition and geographic location of the cat. 

What are the symptoms of Cat Aids?

Similarly with humans, infection with FIV virus does not immediately lead to full blown aids. Acute FIV infection is often associated with mild clinical signs, which usually go unnoticed by pet owners. Cats may have occasional fever, decreased white blood cell counts and enlarged lymph nodes. High concentrations of the virus can be detected in the blood as early as two weeks after infection. Initial infection is characterised by a prolonged asymptomatic phase, where no clinical signs or other symptoms are seen and there is progressive weakening of the immune system. The course of the disease following infection is dependent on a number of factors. These include the age and health at the time of infection, dose and rate of infection, dose and route of virus infection, viral strain, presence of other infections at the same time, and the immune status of the animal.

Weight loss is the most common clinical finding in symptomatic cats, followed by fever, infections of the mouth, dehydration, runny nose, conjunctivitis and abscesses. Concurrent infections with other viruses are also often identified.

How is FIV diagnosed?

The diagnosis is made in the veterinary practice by means of a blood test. This test is quick and accurate. It is important to test cats before introduction into a new household, as well as at regular intervals after that. Most cats will produce antibodies 60 days after infection so if exposure is suspected, testing should be done two months later. Antibodies, the body’s soldier cells which fight the infection, can be passed on from the queen to kittens in the colostrum, which is the first milk. This provides passive immunity to the kittens and they will test positive. This however does not mean they have the disease but will be protected from getting the disease for a short period. The development of the FIV vaccine has also complicated the diagnosis, as vaccinated cats will most likely test positive to the blood tests done in house at the vet. It is therefore very important for the veterinarian doing the test for FIV, to have a good understanding of the history and previous treatment of your cat.

How is FIV prevented?

The majority of infections occur through bite wounds sustained when fighting with infected cats. Generally, cats in households with stable social structures where housemates do not fight are at low risk for acquiring FIV infection but exceptions do occur. In multi-cat households, FIV positive cats should ideally be isolated and kept in a separate room or separately from the other cats.

The exposed virus (outside the cat’s body) is easily deactivated by routine hygiene procedures so disinfection and cleaning are important in controlling the spread. It is important to regularly clean and discard litter box contents as the virus can survive in dried biological material, such as stools, for several weeks. Cats should have separate feed and water bowls. Introducing additional cats into a positive household is discouraged because it disturbs the existing social structure and may result in increased aggression between animals.

In the animal hospital environment, all blood donors are tested regularly to ensure a negative status. Hospitalised infected cats are isolated due to their compromised immune status.

It is recommended that any new cat introduced into a household, should be tested prior to introduction. It is recommended that testing be repeated after 60 days as the disease has a long incubation period. Should a new cat test positive, then all the other cats in the household will have to be tested as well.

Although a vaccine has been developed, it has not been totally effective in preventing infection as there are several different strains of the virus. This does not mean one should give up on vaccinating. If your cats happen to be exposed to the strain used in the vaccine, it means they will enjoy protection.

Management of positive cats

General recommendations for the management of FIV positive cats include confinement indoors, stress reduction, good quality food and regular veterinary visits. There are a few antiviral drugs available, which have been found to help FIV infected cats although the study of their success has been quite limited. It is important to try and keep secondary infections under control and avoid drugs such as corticosteroids that may further compromise the immune system.

What is the prognosis of positive cats?

Testing positive to FIV is not necessarily a death sentence but it depends on the health of the animal when they are tested. Some cats can survive up to three to four years after testing positive. Keeping the positive cat isolated, providing good nutrition and managing secondary infections is vital in ensuring survival and maintaining health for as long as possible.

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Diabetes Defined

The pancreas is an organ in the body which is closely associated with the segment of intestine that leaves the stomach.  The pancreas releases enzymes involved in digestion as well as hormones with specific functions.  One of these hormones is insulin.  Insulin is released from the pancreas in response to the intake of food, especially carbohydrates and to a lesser degree fats and protein.  Insulin circulates in the bloodstream and facilitates the uptake of the ingested nutrients into the body’s own stores of energy.  

Diabetes mellitus occurs either when the pancreas cannot secrete sufficient insulin; or when the body does not respond to the released insulin that is released by the pancreas.  This means that the sugars and nutrients consumed are not taken up by the body efficiently.  They remain in the blood for a longer period of time than is normal (hyperglycaemia) and are excreted in the urine (glucosuria).    

Diabetes mellitus is a disorder which is seen at a rate of roughly one in every two hundred and fifty dogs or cats.  There are large differences in the way that the disease is presented between these species.  Virtually all dogs suffer from the insulin-dependent form; whereby insulin is not produced and must be administered.  In contrast, about fifty percent of diabetic cats have the non-insulin dependent form, whereby the body is resistant to the insulin produced, so it does not produce the physiological effects that it should.

The cause of diabetes is multifactorial.  It is more common in older animals and often occurs in association with another disease or condition such as bacterial infections, pregnancy, Cushings syndrome, kidney or liver failure.  In dogs diabetes appears to have a genetic component, with some breeds being more predisposed than others.  These include Miniature Poodles, Dachshunds, Schnauzers and Beagles.  It can be immune-mediated in some cases, where the body attacks its own cells that are necessary for insulin production.  Pancreatitis (inflammation of the pancreas) is also commonly involved in the induction of the disease in both cats and dogs.  

Feline diabetes is very often associated with obesity.  The risk of diabetes is one of the main reasons that obesity in pets must be avoided.  Frequently, in cats, and more rarely in dogs, the diabetes that is diagnosed and treated is only a temporary condition.  A stressor can create a state of high blood glucose which then suppresses insulin release.  This can become a vicious cycle.  However, when insulin is administered and blood sugar levels return to normal, then further treatment is unnecessary.  This can only be determined retrospectively after treatment has been initiated.

The main signs presented in the diabetic animal are an increased appetite for food and a greater than normal thirst for water; increased urination; and weight loss.  Cats usually are thin and their grooming is decreased so the coat appears rough and can seem to be shedding excessively. In severe cases cats may present with weakness, staggering and collapsed limbs.  Bladder infections are common due to the presence of glucose in the urine, which encourages the growth of bacteria.   Wound healing can be delayed.  With cases of prolonged disease animals may develop cataracts, which may lead to blindness
Treatment for diabetes is the administration of insulin.  Dogs generally respond better to insulin derived from pigs, and cats to insulin from cows.  An overdose of insulin leads to low blood sugar or hypoglycaemia, which causes weakness and shivering, and in extreme cases, seizures.  The dose of insulin required varies from animal to animal and the best way to ascertain the ideal dose is by performing a glucose curve.  This involves checking the blood glucose every two hours over the course of one day and putting the values into a graph format to assess the fluctuations.  The aim is to adjust the amount and frequency of feeds with insulin administration to avoid dips and crests in the curve as much as possible.  Initially, glucose curves should be made every two weeks until the glucose levels are effectively controlled by the dose of insulin given.  It can take up to six months to find the correct dose and timing of insulin administration.    

 Insulin can be given by the owner in a special insulin syringe.  Insulin must be kept in the fridge and must be given at the same time every day.  Routine is very important in the management of diabetes, with feeding times (the intake of calories) and the timing of treatment being kept constant as much as possible.  There is another drug available which helps to control diabetes and can be given orally to some cats, providing that they are otherwise healthy.  It is not given to dogs.

The management of diabetes involves other factors besides medical treatment.  Keeping the diabetic animal lean is a priority as obesity can lead to worsening of the condition.  A diet that is low in calories and high in fibre is ideal.  Complex carbohydrates slow down absorption of sugar, and minimize blood sugar fluctuations.  Veterinary prescription diets are readily available from the vet and assists greatly in the treatment and management of diabetes.

Routine exercise is also helpful in controlling blood sugar and keeping the diabetic animal healthy.  Exercise of the same duration and at the same time every day helps to maintain weight and to increase insulin sensitivity.  Taking the diabetic dog for a short walk every day is far preferable to a long walk once a week.  Strenuous exercise can lead to hypoglycaemia.  Unfortunately diet and exercise cannot be used alone to manage the diabetic patient.  Insulin administration is necessary and this treatment requires dedication and commitment on part of an owner of a diabetic animal, to be successful.

Prognosis depends on the presence of concurrent disease, response to treatment and the owner’s commitment.  Long term prognosis in cats is generally guarded, with the average survival time being two years.  Dogs can survive for a number of years after diagnosis, and similar to the treatment of diabetes in human beings, can live a relatively normal and happy life as long as the consistent treatment and management of the disease is maintained.  Once the disease has been properly diagnosed and a formal treatment and management routine has been implemented, the prognosis is quite good.  The most dangerous period is before the most efficient dosage of insulin has been found, when blood sugar is fluctuating.

Many diabetic pets respond well to therapy and with consistent and correct treatment, their quality of life is excellent.  The key to success generally lies in the hands of the owner, and how willing and able they are to give the time, effort, money and commitment needed to treat a diabetic pet.

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Feline Leukaemia Virus (FeLV) infection in cats

Introduction

Feline leukaemia (FELV) is a disease of cats caused by a virus called a retrovirus. It is called a retrovirus because of the method it uses to replicate inside the cat. It is the same type of virus as the human immunodeficiency virus and although there are a lot of disease similarities, several studies have shown that the disease is not transmissible to humans. FeLV is one of the most dangerous diseases that affect cats and is a major cause of death in cats. Fortunately the prevalence of the disease has decreased in recent years due to the use of vaccines against the disease and the ability of vets to diagnose the disease early and accurately.

How do cats contract Feline Leukaemia?

The disease is more prevalent in cats between one and six years of age and is more often seen in males than females. The virus is present in high quantities in the saliva of an infected cat, but also in smaller quantities in the stool and urine. The virus gets transmitted through cats biting each other as well as through grooming each other. In a few circumstances it can also spread between cats by sharing food and water dishes. It can also be transmitted from the mother to a foetus inside the womb, as well as through milk from the queen to the kitten once the kittens are born. If one considers the way the virus spreads it should be clear that multi-cat households will be more affected than single cat households. Cats that roam outdoors are also more exposed in terms of getting into contact with other infected cats.  If your cat is infected with Feline Leukaemia at an age younger than 8 months it is most likely that the disease was contracted from the mother. If a cat gets sick with Feline Leukaemia after 8 months of age it is more likely that the infection was contracted from other cats in the household or roaming cats.

What does Feline Leukaemia do?

Not all cats that get infected with the FeLV virus develop severe disease. With initial infection the cat’s immune system may fight the virus and get rid of it completely. In other circumstances the cat’s immune response is not adequate and the virus infects tissues like lymph nodes and the bone marrow. The virus can lie dormant in these cells for years, not causing disease but if the cat is stressed or the immune system challenged, the virus may start replicating and cause full blown and serious disease.

There are four different subgroups of the virus causing different disease processes in the cat’s body. A cat can be infected with one, two or all four of the different types. The different types are called FeLV-A, FeLV-B, FeLV-C and FeLV-T. FeLV-A is found in almost all naturally infected cats and tends to be less severe disease than viruses of the other subgroups. FeLV-B causes cancer in cats and occurs in about 50% of cats with FeLV. FeLV-C affects the bone marrow and red blood cells and can cause severe anaemia or low red blood cell count. FeLV-T causes a severe drop in immunity because it destroys white blood cells called T-lymhpocytes which play an important role in the defence mechanisms of the cat’s body. 

The clinical signs which cats will show depend on what type of subgroup virus it is infected with. The signs seen most often are loss of appetite or anorexia, depression, weight loss, unexplained fever, poor coat, infections in the mouth like gingivitis (or gum infection), eye infections, diarrhoea and enlarged lymphnodes. Typically the virus causes a slow deterioration of the cat’s health over a number of months. Owners will often notice that the cat will be more listless, skip meals more often and show slow weight loss. The cat will have minor ailments more often due to the decreased immune system and will need to be taken to the vet more often. These symptoms will alert the vet to test for this virus.

How is Feline Leukaemia diagnosed?

Fortunately we live in an age where there are much more efficient methods to diagnose FeLV now than in the past. It can be done with a simple test at the vet, called a FELV snap test or Elisa test. All that is required for this test is for the vets to take a small blood sample from the cat and do the test with the results being available within a few minutes. If the results are not clear or definitive or if one needs to know what stage the infection is in, another test can be done at a laboratory for which blood needs to be sent away. This test is called an IFA or immunofluorescence assay test. It is important to realise that other common infections needs to be ruled out first. A full blood count and organ function test will often be done at the same time as  this will provide the vet with information on how the virus has affected the different body systems at the time of making the diagnosis. It will also serve as a reference point for future monitoring of the disease to see how the virus progresses and may serve as a prognostic indicator.

Treatment options for Feline Leukaemia

Sadly there is no cure for full blown Feline Leukaemia. Cats can only be treated symptomatically and made as comfortable for as long as possible. Infected cats will need extra attention and need to be taken to the vet more frequently for regular health checks. Their basic health care like deworming, flea treatment and vaccinations needs to be done regularly. With regular vet visits the vet can pick up any problems early and start treatment as soon as possible. Regular blood tests should be done to determine deterioration as early as possible. It is recommended to visits the vet at least every 6 months if your cat is diagnosed with FeLV infection.

Because the immune system of affected cats is compromised, these cats may often require treatment with antibiotics for secondary bacterial infections. It is important to give antibiotics for at least 7 to 14 days to prevent the build-up of antibiotic resistance. Blood transfusions can be given to anaemic patients and chemotherapy is an option for cats with cancer. It is important to remember that these treatments do not provide a cure, but alleviates the symptoms of the disease to some extent and make life more comfortable for infected cats. Unfortunately 85% of persistently infected cats die within 3 years of being diagnosed.

Infected cats should always be placed on a good quality diet. Never feed a raw diet as this can introduce infections. They should be kept indoors to protect them from any infections but also to prevent the spreading of the disease to other cats. FeLV infected cats should be kept as stress free as possible. They also tend to do better in a single-cat household rather than in a multi-cat household. Never introduce a new cat into the household with an already infected cat, as this may lead to increased stress and fighting and transfer of the disease.

How to prevent healthy cats from getting infected with FeLV?

The most important method to prevent infection is to keep cats indoors and not let them roam. There are also vaccinations available against FeLV. Before having your cat vaccinated, you have to have them tested for FeLV first. When introducing a new cat into the household, always have them tested for FeLV beforehand. When one of the cats in a multicat household is diagnosed with FeLV, have all the cats tested and vaccinate all the unaffected cats. There has been no benefit shown to vaccinate an already infected cat. If at all possible it will always be beneficial to separate an infected cat from other cats.

Feline Leukaemia may be a terrible disease but it is by no means an immediate death sentence when a cat is diagnosed with the disease. With modern advances in veterinary medicine and care, infected cats can live a good quality life for years after they were initially diagnosed.

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Cancer in pets – Part 2 of 2

The treatment of cancer in pets has become a significant part of the therapy provided by veterinarians to keep our pet population healthy and thriving. Depending on the modality used, the type and extent of cancer treated, and the size and the nature of the animal involved, cancer treatment can be very expensive. Therefore, as with any disease, the principle of prevention is better than cure holds true. Not all cancers can be prevented but there are certain types of cancers which can be prevented and others that, if treated early on, require much less invasive treatment and therapy, than cancers which are left to develop.

To understand the treatment and prevention of cancer better, one has to look at what causes cancer. Cancer is derived from the Latin and Greek word “carcinos” which means crab or crayfish. This name comes from the appearance of the cut surface of a solid malignant tumour, where the blood vessels that grow around the tumour looks like the legs of a crab which stretches out on all sides of the body of the crab. Cancer refers to an unregulated growth of cells of the body which can be brought about by a number of causes. These causes include well-known and described external causes like infections, exposure to certain chemical substances like tobacco and environmental pollutants, radiation like excessive exposure to sunlight which causes many skin cancers and poor and incorrect diet and obesity. Lesser known causes of cancer include internal causes and more poorly understood causes like hereditary proneness. External and internal causes agitate the cells of the body which can combine with existing genetic faults within cells that cause them to start growing uncontrollably. For a cell to transform from a normal cell to a cancer cell the genetic material inside the cell which regulates cell growth and differentiation is altered. External agents are often referred to as carcinogens or cancer inducing agents. These agents have the ability to change the DNA of the cells they come into contact with causing them to mutate and change character and nature, which in turn leads to these cells becoming cancerous and spread. A good example of such an agent is tobacco. Human doctors have for years warned people against the dangers of tobacco smoke because it is a well-known fact that it causes many types of cancers, most notably lung cancer. 

In most cases of cancer in animals it is very difficult to prove what caused the cancer in the first instance because there can be a combination of causes. Having said that, we know that with certain types of cancer the main culprits can be identified and, if avoided, can help to prevent cancer right from the start. A good example is cancer of the skin, like the ears of white cats or the unpigmented skin of the stomach area of dogs with short coats, called squamous cell carcinoma. This type of cancer can be prevented by daily applying sunscreen on the affected parts of the body (before any cancer starts), or alternatively putting a “sunbathing suit” on for dogs, or best of all, keeping them indoors during the part of the day when the sun causes the most harm (usually between 08h00 and 16h00). Any method used to prevent prolonged exposure to the harmful ultraviolet rays of the sun, will reduce these types of cancer.

Hormones have been proven to be significant contributors to cancer in humans and animals. Fortunately the cancers which come about as a result of reproductive hormones can be significantly reduced in animals by sterilisation. Bitches that aren’t sterilised produce extremely high levels of oestrogen and progesterone when they come on heat twice or three times a year. Over the years the body’s exposure to these high levels of hormones predisposes these animals to cancer of the mammary glands as well as severe, potentially life threatening, uterine infections. It is well documented that having an animal sterilised by removing the ovaries and uterus surgically (ovariohysterectomy commonly referred to as a spay) at a young age (before one year of age), significantly reduces the occurrence of mammary tumours later on in life. Similarly the incidence of prostatic growths and testicular cancer in male dogs are significantly reduced and even eliminated by castrating (surgically removing the testicles) of such animals at a young age.

The incidence of cancer in animals which are physically inactive and obese is also higher as a result of a weaker immune system and negative effects on the endocrine system. The endocrine system refers to many different glands in the body which ranges from small glands in the brain and abdomen like the adrenal gland, to larger glands like the pancreas. These glands secrete different kinds of hormones, which maintain the body’s different functions. Taking your dog for a regular walk or run, will not only have mental and physical health benefits for both of you, but may actually assist in preventing cancer. 

Diet forms such an important part of general health and well-being in pets that the prevention of cancer by feeding a properly formulated diet goes almost unnoticed. In humans the incidence of cancer from eating the wrong foods can be as high as 20%. For humans eating a regular helping of fresh fruits, vegetables and whole grains, reduces the incidence of cancers. Dogs are omnivores, unlike cats which are carnivores. Therefore, a properly formulated diet, which not only contains all the right nutrients in the correct proportions, but also includes added vitamins, minerals and anti-oxidants which help fight off carcinogens, can prevent cancer and help your pet live a happy healthy life.

So what do you do if you have taken all the known preventative measures and your animal still develops cancer? There are approximately 200 different types of cancer and the starting point will be to identify exactly what type of cancer your animal has and what stage that cancer is at. In nature, animals cannot afford to show symptoms of disease at an early stage because “the law of the jungle” determines that weaker animals will be “taken out” by stronger ones in the pack or by predators. This natural instinct also holds true for our domestic animals and therefore the initial symptoms of disease may go unnoticed until the disease has progressed so far that the signs can no longer be hidden. By such time the disease is usually far progressed and the prognosis becomes worse with every passing day. It is therefore absolutely vital that you have your animal checked out by the veterinarian as soon as you suspect something is wrong. Your observations and “gut-feel” about their animal is often the reason why the vet can make the diagnosis at an early stage and provide suitable treatment with a much better prognostic outcome.

External cancers which are the tumours or growth type can usually be seen with the naked eye and be attended to as soon as observed. Internal cancers which grow in organs may not be visible nor might their effects be visible until the majority of the organ is affected. It is therefore of paramount importance that your animal visits the vet at least once a year for a regular check-up and wellness examination during which the animal may also be vaccinated if needed. During this examination the vet should examine all the external structures of the body like the ears, eyes, nose and mouth, the skin and the superficial glands lying below the surface of the skin, as well as the internal organs by listening to the heart and lungs, and doing an abdominal palpation (using the hands to feel and touch the organs inside the abdomen). In certain cases a rectal exam may be needed, or certain routine laboratory tests may be performed like analysis of the urine or a stool sample examination. Many cancers have been picked up by vets during these routine yearly examinations and have been treated successfully before they blow up into full clinical disease which can either not be treated or treated at great expense with a guarded prognosis.  Not all internal cancers can be picked up during the annual wellness examination and therefore the owner’s observation of their animal’s health and well-being makes up an important part of the vet’s awareness to examine for signs of cancer.

Once the presence and type of a cancer has been confirmed and it has been staged (indicating the progression of the cancer), the vet will suggest treatment. In cases where the cancer is very far advanced, has spread to other organs, or where the prognosis even with extensive and expensive treatment may be poor, the vet may suggest euthanasia.

Treatment

In cases where the prognosis is good several types of treatment may be suggested depending on the type and stage of cancer.

Surgery still remains one of the most successful treatments for cancer. This may range from minor surgery like the removal of a small tumour under local anaesthetic to major and extensive surgery like the removal of an organ or body part. In many types of cancer surgical treatment will be combined with other modalities from radiation therapy (to “shrink” a tumour before surgery) to chemotherapy after surgery (to prevent further spread).

Even though most practices have diagnostic X-ray machines which may theoretically be used for radiation therapy, it is not a service which is available in most veterinary practices and will require you to take your animal to a specialist facility. The most common form of radiation therapy is external beam radiotherapy. Your animal will sit or lie on a couch or surface where an external source of radiation is pointed at the particular part of the body which is affected. As most animals do not sit still for extended periods of time your animal will most likely be sedated). Kilo voltage ("superficial") X-rays are used for treating skin cancer and superficial structures. Megavoltage ("deep") X-rays are used to treat deep-seated tumours (e.g. bladder, bowel, prostate, lung, or brain). Superficial X-rays can be provided through the same machines used for diagnostic purposes and the deep X-rays are provided by linear accelerators or the older type Cobalt units.

Chemotherapy refers to the use of chemical compounds or drugs to fight and kill cancer cells. Unfortunately it is very difficult for these drugs to target cancer cells only and therefore normal healthy cells of the body may also be affected, leading to significant side effects.

Chemotherapeutic drugs are available in injectable as well as tablet form. Commonly when cancer is treated with chemotherapy, a combination of both is used. The drugs given intravenously are usually injected with the aid of a drip line. As these drugs tend to be very cytotoxic (toxic to cells) they can cause significant damage to healthy tissue if not administered with great care. Therefore your animal will likely be admitted to the veterinary hospital as an in-patient for this procedure. Chemotherapy medications which are administered per mouth may require you to handle the medication with latex gloves to prevent uptake of the medication through your own skin.

Immunotherapy is where immunostimulants (drugs which boost your animals internal defence systems) are administered in certain types of cancer to stimulate the immune system to reject and destroy certain types of cancer.

Photodynamic therapy (PDT) is a form of phototherapy (exposure to specific wavelengths of light using specialised light sources) which use nontoxic light-sensitive compounds that, upon exposure to this light become toxic to targeted malignant and other diseased cells.

Complementary and alternative cancer treatments are a diverse group of health care systems, practices, and products that are not part of conventional medicine. "Complementary medicine" refers to methods and substances used along with conventional medicine, while "alternative medicine" refers to compounds used instead of conventional medicine. Most complementary and alternative medicines for cancer have not been rigorously studied or tested. Some alternative treatments have been investigated and shown to be ineffective but still continue to be marketed and promoted. It is considered to be a specialised discipline and as such may not be something you should expose your animal to unless done through a veterinarian specialising in this field.

Cancer CAN be beaten. As long as your vet has the opportunity to diagnose cancer early and treat it appropriately, your animal has the chance of living a long and healthy life.

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