My cat has suddenly gone lame in her hindquarters and seems to be in a lot of pain

What is Feline Aortic Thromboembolism?

Feline Aortic Thromboembolism (ATE) is a condition in cats where a big blood clot settles and blocks the main artery (the aorta) running from the heart to the cat’s hind legs.  The clot typically settles near the pelvis, where the aorta divides into the two main arteries that extend into the legs.

It is almost like the clot itself has two legs extending down into the two main arteries. This type of clot is known as a “saddle clot” or “saddle thrombus”. This condition is typically associated with heart disease in cats.

ATE most commonly occurs in cats with an enlarged left chamber (atrium). The enlarged heart chamber slows down blood flow and over time the red blood cells start clumping together and form a blood clot.

The blood clot is then pushed out of the heart and down the aorta, where it lodges at the point where the aorta branches into the two main arteries (external iliac arteries) extending into the legs. As a result of the clot obstructing the artery, the blood supply to the hind legs is cut off.

What are the symptoms of a saddle thrombus in cats?

  • Sudden Lameness/ Unsteadiness in the hind legs
  • Decreased Activity
  • Over Vocalisation (Painful ‘Meowing’)

Up to 90% of cats show no signs of heart disease before developing this condition and owners often suspect trauma. If the owner is not present right at the onset of the condition, they may come home from work and find their cat paralysed in the hindquarters and dragging its body forward with the front legs. In such instances, it makes perfect sense that one would suspect that the cat had been run over by a car.

When presented to the vet, the tell-tale signs are usually that the hind leg muscles are swollen and very painful to touch. The legs are also cool to the touch because the warm oxygen-rich blood from the heart cannot be pumped down to the legs.

The nail beds will also either be very pale or very dark. With the blood being blocked higher up, the femoral arteries, which are the main arteries on the inside of the leg taking blood to the paws, will have no pulse. The vet will try and feel this pulse on the inside of the hind legs to establish if any blood is still coming through to the legs.

The cat’s rectal temperature will be abnormally low. Many cats are still able to move their tails and control their bladder and stool functions, however, skin sensation and neurological functions i.e. reflexes are absent. Signs of heart failure (heart murmur, difficulty breathing) may accompany the signs.

How is a saddle thrombus diagnosed?

The condition is mostly diagnosed on the typical clinical signs, but to further confirm the diagnosis the vet may cut one of the toenails down to the quick to see if any blood is coming through to the extremities. With a saddle thrombus, the cut nail will either ooze dark blood or not bleed at all.

The vet may also recommend taking radiographs, performing an ECG or doing an echocardiogram (heart scan) with ultrasound to assess the extent off the condition and potential underlying heart failure.

Occasionally the blood clot may lodge further up the aorta and occlude the blood flow to the kidneys as well, in which case the vet may recommend blood tests to evaluate the kidney function.

How is Feline Aortic Thromboembolism treated?

The condition is often treated through cage rest, pain control and drugs which counter blood clots from forming (often in humans referred to as “blood thinners”) and arterial dilators.

Due to the severe pain that this condition causes, Opioids (morphine/fentanyl class) are usually the drugs of choice for controlling the pain. Additionally, the vet may decide to lightly sedate the cat if it is very distressed.

Blood-thinning drugs may theoretically prevent further blood clot formation, while ACP or hydralazine might dilate the blood vessels to aid blood flow to the affected areas. There is however no evidence that these drugs have any benefit over cage rest alone.

Surgical removal of the blood clot carries very high risks and is generally not performed. The concurrent heart failure will also need to be managed. The cat may be kept on a drip for a while and the vet will prescribe medications for it to take for the rest of its life.

If the cat survives past the first few days, it will start regaining its limb function after 10-14 days and will be fully recovered after 4-6 weeks. Some residual deficits may be permanent.

Several drugs such as aspirin, heparin, warfarin have been suggested to prevent blood clots forming in cats diagnosed with heart disease, however, there is no evidence of these drugs being effective and the side effects can be quite severe; thus your vet might opt not to use them at all.

It is important to NEVER use human medication for the treatment of cats unless the vet has prescribed it. Some human medicines like Panado is fatal to cats and one should never treat your cat with a human medication unless it was prescribed by a vet.

If the condition is left unattended, the cat may become permanently paralysed and the skin and muscles may start dying off. This may result in wounds needing surgical treatment or even amputation of a leg. In severe cases, additional blood clots may lodge at various points throughout the rest of the body, ultimately leading to death.

What is the prognosis of a saddle thrombus in cats?

The prognosis is generally guarded, with only 33-50% of affected cats surviving and recovering well enough to be discharged from the hospital. Unfortunately, recurrence of the condition is very common.

Due to the guarded prognosis, the high risk of recurrence, and the presence of heart failure, the decision to euthanise your cat (put to sleep) is often the most humane option.

© 2019 Vetwebsites – The Code Company Trading (Pty) Ltd

My pet is vomiting

Vomiting is one of the most common symptoms of disease seen in pets. It can be quite alarming to see your pet vomit up all his or her food or alternatively continuously wretch and only bring slime or bile. So should you rush your dog or cat to the vet immediately when you see them vomit, or is it safe to wait and see? Because there are so many causes of vomiting, we recommend that if you are ever in doubt, it is always better to visit the vet and have it seen to, even if it is just to put your mind at ease and prevent it from progressing to something more serious.

It is important to realise that vomiting is not a disease or medical condition in and of itself, but rather a symptom of many different underlying causes. Healthy animals should not vomit, so there will usually be some underlying disease process which causes your animal to vomit. This could be as diverse as a brain condition, kidney disease, liver disease, gastrointestinal tract problems or endocrine conditions. It may have an infectious origin, but the cause may not be infectious at all and may vary from a physical obstruction such as a lodged bone to something as sinister as cancer. Distinguishing between vomiting and regurgitation is important. While vomiting is an active process which involves contraction of the abdominal muscles to expel the gastric content, regurgitation is a completely passive process where food is expelled from the stomach or from the oesophagus without any abdominal muscle contractions. Regurgitation usually points to a problem in the upper gastrointestinal tract, like the oesophagus. Nauseous dogs will often lick their lips and start salivating. This “overproduction” of saliva is there to protect the oesophagus against the acidic vomit moving up from the stomach by neutralising it. 

During the clinical exam, the vet will try to establish why your pet is vomiting and will decide after the clinical exam to either carry on with further diagnostic tests if he or she finds anything out of the ordinary, or send your pet home with the appropriate treatment. A full history from a vomiting animal’s owner is often the most useful diagnostic tool, so try and answer any questions the vet may have to the best of your ability. Common questions your vet may ask are: 

  • How many times has your dog or cat vomited?
  • How long has the vomiting been going on for?
  • What did your dog or cat vomit up?
  • Has your dog or cat lost any weight?
  • Is your dog or cat still eating?
  • Has their diet changed in any way?
  • What does the vomit look like?

It is important to know if there is a runny tummy (diarrhoea) associated with the vomiting and if so, to establish your pet’s hydrations status. An animal that is not keeping any fluids down, and vomits throughout the day together with losing fluids through diarrhoea can dehydrate quickly. The vet will most likely feel (palpate) your animal’s abdomen to establish if there is any pain, or perhaps a foreign body stuck somewhere which may be palpable. Depending on the size or the location of a foreign body, it may not always be possible for the vet to feel it. Severe pain in the abdomen will alert the vet to a more serious problem like pancreatitis. Dogs and cats can swallow the strangest things which may cause a blockage in the narrower parts of the digestive tract. This can become a life-threatening condition depending on the type of blockage and the length of time the foreign body is entrapped. Some foreign bodies can perforate the gut which can cause the animal to go into septic shock.

The majority of pets presenting with vomiting is due to dietary indiscretions and will recover within 24 – 48 hours. In these cases, the animal will show minimal abdominal pain, and hydration status will be normal, and temperature will be within normal limits. They are usually not severely depressed, but stay bright and alert. If the animal is bright and alert and healthy in all other respects, the vet may recommend skipping a meal or providing a liquid critical care diet together with access to fresh water. Food can then be introduced slowly over the next 12 hours. A bland diet of chicken and rice can be fed, or a veterinary therapeutic diet that is easily digestible and which has a low-fat content. 

In some cases of animals vomiting, there will be certain things that indicate to the vet that there is a more severe problem than a simple dietary indiscretion. If the vomiting has been carrying on for more than a couple of days, continuous or intermittent, further investigation is always required. Severe weight loss, dry coat and general weakness are some of the danger signs. Raised or decreased body temperature, severe abdominal pain, and accompanying bloody diarrhoea should also raise concern. These animals should ideally be admitted at the veterinary practice and rehydrated with a drip. Animals that are losing fluids by vomiting and diarrhoea often also develop electrolyte imbalances. Glucose may be low due to anorexia lasting a couple of days, and the vet will need to assess what kind of electrolyte supplementation is required with the fluid therapy. While the animal is being treated symptomatically, the vet will start with further diagnostic tests. After a basic blood smear and microscopic examination, the vet may recommend a urinalysis and faecal analysis as part of a minimum database. If the diagnosis cannot be made with these basics diagnostic tests, more comprehensive blood tests may be required which will include a full blood count, biochemistry and electrolytes. If a definitive diagnosis cannot be made with these tests, further investigation with the help of diagnostic imaging which may include X-rays and or ultrasound may be recommended. Even with extensive testing and diagnostic aids, it may not be possible to make a definitive diagnosis immediately, and in these cases, the vet will discuss the merits of further diagnostic tests or procedures, or referral to a specialist vet, with you. 

Some of the more common conditions that can present with vomiting are:

  • “Garbage disease” – where the animal eats leftover food or other items from a knocked over garbage bin 
  • Foreign bodies varying from stones to clothing garments, to anything other than pet food which the animal may have chewed and accidentally swallowed part or all of. Depending on the size and the type of foreign body it may either cause a partial obstruction or alternatively could cause a complete obstruction of the intestinal tract, which may only be rectified with surgery. 
  • Hairballs in cats
  • Pancreatitis or pancreatic tumours
  • Chronic or acute kidney disease
  • Chronic or acute liver disease including liver tumours
  • Inflammation of any part of the intestine including the mouth, oesophagus, stomach, small intestine or large intestine 
  • Megaoesophagus which may be due to auto-immune disease or other causes
  • Any tumours pressing on to, or causing an obstruction in the digestive tract
  • Gastric ulcers

The most important thing to remember is that vomiting is merely a symptom of an underlying problem which may or may not have anything to do with the intestinal tract. If your animal is vomiting and does not stop after a single episode, it is worth a visit to the vet to have it checked out.  

©2018 Vetwebsites The Code Company (Pty) Ltd

 

My older German Shepherd Dog seems to be getting weak in its hindquarters

This article outlines a genetic disorder that mainly German Shepherd dogs are prone to. There are other breeds affected by this condition too like Chesapeake Bay Retrievers, Corgis, Boxers, Wirehaired Fox Terriers and Rhodesian Ridgebacks, however, the disease is mostly seen in German Shepherds.

If one breaks down the name of the disease it describes what happens with the disease. Degeneration refers to a breaking down or deterioration of something. That “something” in this case is myelin which is the insulating sheath around neurons in the spinal cord. Neurons are the “electrical wires” of the nervous system and one can compare myelin to the insulating plastic around the wires, almost like one would find with an electrical cord. Whenever a term is followed by “pathy” it refers to a disease or disorder in a certain part of the body. In this case the spinal cord.

Degenerative Myelopathy is a debilitating condition for which there is no cure but only the potential to slow down the progress.

The occurs typically in older German Shepherd Dogs. The average age at which clinical signs start and progress is from 8 to 12 years of age. This is not a condition with rapid onset but instead is slowly progressive with clinical signs worsening with time. Degenerative myelopathy starts out as a very slowly progressive hind limb weakness and loss of function of the back legs called paresis. It is commonly confused with hip pain because the symptoms can mimic hip dysplasia, another debilitating condition with a high incidence in German Shepherds.

The condition is the result of a demyelination (loss of protective cover) and nerve degeneration of the spinal cord in the region of the mid to hind back. This degeneration is something referred to as an ascending lesion meaning that it starts at the tail end of the spinal cord and works its way towards the head. The underlying cause of the disease is thought to be a genetic mutation (change) of the SOD1 gene. This gene is responsible for the protection of cells against certain particles that damage the DNA of cells. The name given to the damaging particles are free radicles. Under normal circumstances the SOD1 gene produces a free radicle scavenger i.e. it helps to clean up the system and prevents damage to the sheath surrounding the nerves.

The way in which the defect is inherited determines whether a particular dog is at a high risk of getting the disease or if they are a carrier of the genetic mutation without showing clinical signs. An individual dog has to carry 2 copies of the mutation in the genes of the cells of their bodies for it to cause the disease. There is no sex predilection, so male or female dogs may be affected equally. What is interesting about the disease is that even if an individual dog has both copies of the mutated gene and they are at very high risk of developing the disease, there are still other factors that influence whether or not they do contract the disease and to what extent they do.  

As mentioned previously this a slowly progressive condition that has a time frame of about 3 years before severe debilitating disease sets in. The clinical signs noticed in dogs include the following:

After 6 to 12 months of contracting the disease, you will notice weakness and partial loss of function of the back legs. Your dog may seem weak and wobbly on the back legs and they may struggle to get up or be slower to get up that what they used to be. When they run, their back legs may sway abnormally.

After 9 to 18 months on contracting the disease, the back legs start to get even weaker and collapse under the dog from time to time. If one assesses the reflexes in the back legs like the patella reflex, you will find that they are abnormal and weakened.

After 12 to 24 months of contracting the disease, the front legs start to become affected and you may notice that your dog starts losing their normal co-ordination and function. By this point, the hind legs are very weak and your dog may struggle to stand and use their legs correctly. Unfortunately, the nerve degeneration also influences bladder and bowel control and they will start to urinate and defecate involuntarily. This is known as urine and faecal incontinence.

After 24 to 36 month of contracting the disease, and if the dog was able to come this far and still cope with the disease, they develop tetraplegia or quadriplegia which is a paralysis that causes partial or total loss of use of all their limbs and body. The loss is usually sensory and motor, which means that both sensation and control are lost, or put a different way, the dog does not know where its legs are and even if they did, they do not have the ability to correct it. Clearly a very unhappy situation.

The way in which this condition is diagnosed by the vet is through a number of tests as well as the typical clinical signs and also the breed of your dog. These, together with the thorough history of the condition, should provide the veterinarian with some very important clues to what is going on with your dog. The important diseases or differential diagnoses to rule out are spinal disc disease (like a slipped disc) and conditions affecting the lower part of the spine where the hips meet the spine, like hip dysplasia or joint disease. The biggest difference with degenerative myelopathy and the other conditions is that degenerative myelopathy is painless because it is the loss of sensation and function which underlies this disease. Special tests such as MRI’s may be done to visualise the damage within the spinal cord and there is also a DNA test available to check if your dog has the genetic mutation discussed earlier.

Unfortunately, there is no specific treatment available. Certain supplements can be used in an attempt to slow down the condition, such as vitamin E and aminocaproic acid. The vitamin E is an essential vitamin which helps various systems in the body to protect it from these damaging free radicles. The aminocaproic acid is an agent used to prevent the breakdown of clots in the bloodstream. The reasoning behind using this is that it is believed that the spinal cord may be indirectly attacked by the body’s own immune system. Antibodies in the bloodstream attach to the foreign material within the bloodstream forming complexes and these stimulate a response from the immune system. These complexes are usually removed by the liver and spleen. Sometimes they can stick to the walls of blood vessels, damage the walls and stimulate the formation of blood clots. The breakdown of these clots are associated with inflammation and this may result in damage to the surrounding tissues, so-called collateral damage. If this happens in the sensitive tissues of the spinal cord, the damage is devastating because the nervous tissue is not able to regenerate and repair itself. The thinking behind using aminocaproic acid is to inhibit clot breakdown in these delicate tissues.

Lastly and most importantly, the most effective treatment for this condition and the only one proven to actually slow down the progress is the use of physiotherapy and hydrotherapy. Another key factor is, the sooner the dog is diagnosed and treatment started, the better the progress of the disease can be slowed, and the more time the vet can give you with your dog. Unfortunately, the sad truth is that eventually, the disease will lead to complete paralysis and eventually, in most cases, euthanasia.

Genetic disorders like degenerative myelopathy can only be prevented by not breeding with animals where there is a family history of the disease. Make sure if you buy a puppy, that you get references on a breeder before you buy.

©2018 Vetwebsites The Code Company (Pty) Ltd

My dog is ravenously hungry all the time and eats like a beast but is as thin as a rake.

Why is the pancreas important?

The pancreas is a small, light pink, glandular organ that is situated between the stomach and the duodenum (part of the small intestines). It has many important functions, all of which can be classified into two main categories namely endocrine and exocrine.

The endocrine function of the pancreas refers to its hormone-producing cells. Hormones are small chemical messengers that are released into the bloodstream. Two important hormones produced by the pancreas are glucose and glucagon, both of which are important in maintaining blood sugar levels.

The exocrine function of the pancreas refers to its ability to produce enzymes. These enzymes are important in digestion and breaking down larger substances into smaller particles or molecules that the body can absorb and use. The digestive enzymes include amylase to digest starch, protease to digest proteins and lipase to digest fats. These digestive enzymes are stored in the pancreas in the inactive form (called zymogens). They are released through a small duct into the duodenum and break the food down into small molecules as it moves through the small intestine. If these enzymes are not present, food is not broken down and the nutrients in the food cannot be absorbed and utilised.

If the pancreas is unable to produce the enzymes in sufficient quantities we get the condition referred to as exocrine pancreatic insufficiency. This can also be referred to as maldigestion, which means that the food is not being processed and absorbed properly. The most common signs associated with the lack of digestive enzymes include a runny tummy or diarrhoea, which can sometimes be greasy and foul smelling and weight loss, despite an increased appetite. Other signs may include a poor coat, abdominal discomfort and increased borborygmi, which are the noises that can be heard when we say our tummy is grumbling.

What causes decreased digestive enzyme production?

There are three main causes of exocrine pancreatic insufficiency, namely acinar atrophy, chronic pancreatitis and neoplasia. These are big terms and we will take the time to explain each.

Acinar atrophy refers to the condition where the glandular cells that produce the enzymes become shrivelled or small and are unable to function properly. This process is thought to have a genetic component and German Shepherds are the most common breed to suffer from this condition. They are not born with the condition but it develops later on in their lives, commonly around four years of age. Rough Coated Collies are another breed that may be affected by atrophy of the acinar cells.

Chronic pancreatitis refers to a long-standing inflammation of the pancreas. The pancreas scars (this is referred to as fibrosis) and loses a lot of its function. 90% of the pancreas has to be damaged before signs of the disease are seen.

Neoplasia or cancer is the third cause of exocrine pancreatic insufficiency and this is where abnormal, fast-growing cells overtake the pancreas.

In cats, chronic pancreatitis is the most common cause of the decreased production of digestive enzymes.

How is this condition diagnosed?

There are several different tests available to diagnose exocrine pancreatic insufficiency. The most accurate test available measures levels of trypsin-like enzymes in the bloodstream. This test is known as the serum trypsin-like immunoreactivity test. A blood sample needs to be taken after the dog has been fasted or starved for a certain period of time for it to be accurate. Only a single blood sample is required. There is a similar test for cats but it is not as freely available. There are tests available to measure enzyme levels in the stool but these are not as accurate as the blood tests.

How is exocrine pancreatic insufficiency treated?

Treatment of this condition requires supplementation of the digestive enzymes. If available, feeding fresh or frozen pancreas from cows or pigs is the first treatment employed. This works very well but fresh pancreas may be difficult to get hold of and not everyone likes the idea of handling uncooked animal products. There are commercial formulations available, some of which may be very expensive. Most of the supplements given are digested in the stomach but the little that is not is enough to help with digestion in the small intestine. Powdered enzymes appear to work the best. There are tablets available but their absorption and efficacy seem to be a little unpredictable. It will be important to discuss the best option for your pet with the vet at the time of diagnosis.

The supplementation of pancreatic enzymes will decrease the clinical signs of the disease but not completely control the diarrhoea. Vitamin B12 (Cobalamin) may need to be supplemented. The intestinal bacteria in dogs and cats produce this vitamin. Often there is an overgrowth of bacteria and instead of producing more Cobalamin, they end up consuming what is made. This leads to a deficiency in the dog or cat. Cobalamin is supplemented by initially weekly and then monthly injections. Patients may also suffer from inflammatory bowel disease and may need treatment for this.

Can exocrine pancreatic insufficiency be cured?

Exocrine pancreatic insufficiency is a result of the loss of functional cells within the pancreas. It is rarely cured but can be managed with appropriate therapy. Treatment is for life. With appropriate management and monitoring, the animal often gains weight, the stools improve and they can often live a normal life with a normal lifespan.

If your pet is losing weight even though it seems to be hungry all the time, it will be a good idea to bring him or her to the vet for a checkup.

© 2018 Vetwebsites – The Code Company Trading (Pty.) Ltd.

When should I be worried about my cat’s coughing?

A cough can be described as a sudden, forceful expiration of air through the glottis (part of the throat). It is usually accompanied by an audible sound (something that can be heard), which is often preceded by an exaggerated inspiratory effort (a big breath in). Cats, just like humans, may cough occasionally to clear their throat or because they have an irritation but coughing can be a clinical sign for a varying number of serious conditions in cats.

History, as well as the breed of the cat, plays an important role in determining what is causing the cough. The type of cough is also important. A cough can be moist and productive, meaning that the cat brings up a lot of phlegm and mucous or it can be dry and non-productive. This means that the cat is coughing but isn’t bringing anything up. Despite what many people may think, cats are not just little dogs. Like dogs, there are many reasons why a cat may cough but the cause of the cough may be very different from dogs. It is important to take your cat to the vet if they have a persistent cough.

Upper respiratory infections or snuffles and asthma are two common causes of coughing in cats.

Upper respiratory infections or “Snuffles”

The respiratory tract consists of the nose, throat, sinuses, windpipe (trachea) and lungs. A cat’s nose, throat and sinuses are susceptible to a number of different viral and bacterial infections. Feline calicivirus and herpes virus are two of the most common viruses causing upper respiratory infections in cats. Both viruses are transmitted through sneezing, coughing, grooming or sharing food and water bowls. The viral infections can be complicated by secondary bacterial infections.

The symptoms of snuffles in cats are varied and may include sneezing, upper respiratory congestion, runny noses and teary eyes, coughing, gagging, drooling, fever, a loss of, or decreased appetite, rapid breathing, and ulcers in the mouth. Cats with sniffles may develop conjunctivitis in their eyes; have open-mouthed breathing and they may be depressed. Age, vaccination status and physical condition all play a role in a cat’s susceptibility, but multi-cat households and shelters are most at risk. Cats who have recovered from the viruses may become life-long carriers.

Taking your cat to the vet when you suspect snuffles is important. In severe cases, cats may become dehydrated and require intravenous fluids and antibiotics. Some cats may recover by themselves but some may require antibiotics and other medications. Cats should be isolated from others as the viruses are very contagious.

Feline asthma

Asthma in cats is very similar to asthma in humans and is basically a chronic inflammation of the small passageways in the lungs. These passages become thickened and constrict, making it very difficult for the cat to breathe. The cat may become very distressed, worsening the condition and in severe cases, an asthma attack may result in death. The lungs may release mucus into the airways and this often leads to coughing and wheezing. The most common symptoms of a cat suffering from asthma include coughing, wheezing, difficulty in breathing, open mouth breathing and overall weakness and lethargy. In some cases, cats may develop blue lips, gums and tongue due to a lack of oxygen.

It is thought that asthma develops as a result of chronic allergic bronchitis. Allergic bronchitis may be caused by different allergens such as pollens, moulds, dust and cigarette smoke. Parasites, stress and obesity may also be contributing factors. Asthma is most commonly noted in cats between the ages of two and eight years old and it appears to be more common in females than males. Oriental breeds such as Siamese and Burmese cats seem to be more frequently affected.

Asthma is diagnosed on a combination of history, a clinical exam and certain diagnostics tests. It is important to rule out other possible causes of coughing. There is no cure for asthma but it can be successfully managed.

Other causes of coughing

Other causes of coughing in cats may include a cat which accidentally inhaled dust particles, respiratory parasites, heartworm (which is a disease not currently found in South Africa), tumours in the chest and pneumonia. It is rare that cats with heart failure cough.

If it something as trivial as inhaling dust particles, for instance when someone cleans their house and have a curious cat around them when they dust off a very dusty shelf, the coughing should stop shortly after commencing, once the particles have been removed by the coughing bout. Persistent coughing in cats is something completely different and can be an indication of some serious conditions and diseases and so it is very important that a vet examines them. An accurate history and clinical exam are vital in making a diagnosis but often further testing such as X-rays and lung fluid samples may be required.

Any coughing that persists for longer than a few hours is a cause for concern and worry and is enough reason to have your cat checked out by the vet.

© 2018 Vetwebsites – The Code Company Trading (Pty.) Ltd.

I found a lump on my animal’s skin. Is it cancer?

Finding a lump or a bump in your pet which you have never noticed before, can cause serious worry for pet owners. This article will highlight what to watch out for when to take your pet to the vet and the process veterinarians follow when approaching any lump found on a pet.

Firstly, it is always important to remember that you can never tell how serious a mass on your pet is by simply feeling it and judging by its size. Dynamite can often come in small packages and some of the most aggressive skin cancers may present as a simple small raised area on the skin. Generally, lumps on a cat tend to be more dangerous and they are not something to be ignored. All growths have to start small but may grow very rapidly. Lumps come in all shapes and sizes and for that reason, it is always best to get any lump on the skin or underneath the skin checked by the veterinarian as soon as you discover it. This will provide peace of mind to you as an owner if it is simply a dermal cyst or a small wart-like growth, both of which will not cause any major health issues for your pet. Alternatively, if it is something more aggressive and dangerous, it is always better to start treatment as soon as possible. If it is determined to be a bad type of growth (malignant), the sooner it is diagnosed the better the prognosis for both removing it surgically or starting any other form of treatment.

When you bring your animal to the vet there are a few questions the vet will ask that are essential to determine when and if the lump will be removed.

1. When did you notice the mass and has it grown since noticing it? Masses that grow quickly will invariably need to be removed regardless of the cells that make up the mass. The reason for this is that it will only continue to enlarge and may eventually lead to impaired function of the area of the body it is growing from or may cause discomfort and become more difficult to remove later on.

2. Is the lump bothering your pet, are they scratching, biting or licking it? Any lump that bothers your pet is causing them discomfort and this is the last thing we want. It also predisposes them to infections in the area as the licking and scratching will traumatise the mass with a subsequent breakdown in the skin’s protective barrier.

3. Has your pet ever had any other masses that were of concern? Certain growths on the skin, mast cell tumours for example, do have a tendency to regrow or spread to other areas. Once the vet has gained sufficient information from the pet owner, a more in-depth assessment of the lump will commence.

Usually, a visit to the vet will start with the vet obtaining a history from you regarding the pet’s health which will then be followed by a physical clinical examination of your pet. The vet will then examine the appearance of the lump and determine if there are any other lumps present on or under the skin. The appearance of a mass may give a clue as to what the mass might be. A small round firm lump may simply be a cyst. Small superficial wart-like growths on the skin surface are often benign and only need to be monitored. If they are injured or bleed, they may have to be removed. A dermal cyst may eventually rupture discharging its contents and resolve on its own.  A dermal cyst may however re-occur and the only way to get rid of it for good will be to surgically remove it. Once the vet has had a look at the appearance of the mass they will then most likely perform a fine needle aspirate. This procedure involves placing a needle into the mass with a syringe attached to the needle. The plunger of the syringe is drawn back and with some luck, a small sample of the cells making up the lump will be drawn into the needle. Once this small sample of cells is obtained it is sprayed onto a glass slide for fixing, staining and observation under a microscope. It is rare for the vet to make a definitive diagnosis of what type of growth and how aggressive it is with a single or even multiple fine needle aspirates. However, the small sample of cells obtained may give the vet an idea of the type of cells making up the growth and how urgently it needs to be removed, if at all. There are three types of lumps which can generally be identified more accurately based on these small samples which are, lipomas (which is a benign fatty growth not considered to be a cancer), mast cell tumours (which is a bad type of cancer) and a melanomas (which is a really bad type of cancer). The exclusion of these three types of growths already helps somewhat in determining a prognosis. If it does turn out to be a mast cell tumour or a melanoma, the grade and the subtype of these masses will still need to be determined so just identifying it is not enough. Generally, the vet can determine the type of cells present, for example, a round cell tumour, which may be present in a number of specific growths, but the final diagnosis of which type of round cell tumour and the stage cancer can only be definitively identified by histopathology. Histopathology is where either the full growth or a portion of it is removed surgically and sent to a specialist pathologist who then examines the tissue sample sent with high-resolution microscopy and makes a definitive diagnosis. Round cell tumours generally have to be removed surgically as they grow quickly and are locally invasive into surrounding tissues. Other cell types that may be seen are spindle cells, epithelial cells, glandular cells, fat cells etc. If a cyst is aspirated then one will only see cyst material or debris and no obvious cells. If these lumps are subsequently gently squeezed, the contents of the cysts will be extruded.

Any lump or bump which is cancerous should be surgically removed and sent for histopathology for definitive diagnosis and grading. This is also important to ensure that the surgical margins are clear which means that all cancer cells were removed and none of the growth was left behind. This is particularly important for very aggressive tumours such as mast cell tumours, as they invade the surrounding tissue easily and to a large extent. To remove these tumours, a margin of 3 cm around the entire mass, and 2 tissue planes deep have to be removed by the surgeon. The resulting wound to be closed after surgical removal of a tumour can be very extensive with a high risk of post-operative complications. It is with these masses, as you could imagine, that the smaller the growth, the better it is to catch it early.

Instances where you would not remove lumps and bumps include

  1. cases of wart-like growths on the skin called adenoma’s. Unless they have been traumatised by the animal scratching, biting or licking them or where they have grown too large, it does not have to be removed.
  2. dermal cysts come and go and unless the owner wants them permanently removed, they do not need to be surgically removed.
  3. the very common growth known as a lipoma, which is a soft lump underneath the skin which is usually not firmly attached to the underlying tissues and do not seem to bother the animal at all. A lipoma is, in essence, a tumour of fatty tissue, but it is benign and only grows locally.

Lipomas are generally benign, well-encapsulated growths which do not invade surrounding tissues and they can sometimes grow very large, sometimes up to the size of a rugby ball, without posing any systemic risk to the animal. The problem is that they become a physical problem which interferes with the animal’s sitting or lying down or movement. Smaller lipomas can initially be monitored and not removed, but should they continue to grow, it is advisable to get them surgically removed before they start to interfere with your pets ability to move and live a normal comfortable life.

In conclusion, when you find a lump or bump on your pet, rather take them to the vet to have it checked out so that it can be diagnosed and treated. If advised by the veterinarian to remove the growth, it is always better to do it sooner rather than later. Lastly, remember that no growth is too small to be ignored.

© 2018 Vetwebsites – The Code Company Trading (Pty) Ltd

Can I, or my dogs or cats contract bird flu from my pet birds?

The information provided here is not an official statement but is meant to provide some general information on bird flu because of the break out of bird flu in September 2017 in South Africa.

Bird flu or Avian Influenza (AI) is a family of influenza viruses that mainly affect birds. They are named according to two proteins on the surface of the virus (Haemagglutinin and Neuraminidase). The only ones of commercial concern are the H1, H5 and H7 types. There are dangerous (HP or highly pathogenic) and LP (low pathogen) strains. So when you see someone talking about HPAI H5N8 that means the dangerous type of H5N8 avian influenza.

These viruses have been around for a long time and are spread mostly via migratory waterfowl.

Many wild birds can have the viruses without becoming ill. Bird, swine and human flu are very similar viruses.

The panic at the moment is due to a HP strain of H5N8 spreading rapidly through South Africa.

This strain is rapidly fatal to chickens and ducks and could decimate our commercial poultry industry if left unchecked.

Also, one of the biggest concerns with bird flu is that it could mutate to become dangerous to people. The current strain doesn't affect humans and as far as we are aware cannot be transmitted to dogs or cats.

There have been recorded bird deaths all over South Africa, including in some of our best zoos and parks. Current government policy is to cull all poultry on an affected commercial premise, like a chicken farm, and to institute quarantine. The exact details depend on the situation.

Parrots can get bird flu but cases are rare. It is critically important that you minimise contact between wild birds and your pet birds or your bird collection to prevent infections. Keep birds indoors or under roof and prevent wild birds from getting near food and water supplies. Do not take in any injured or sick wild birds. Ideally, do not have chickens or ducks on the same premises. If you find a dead ibis, Egyptian goose etc, place it in two sealed plastic bags and send it for testing. Talk to the vet about how to submit dead wildlife to the State Vet.

Maximise your biosecurity by using F10, Virkon or other good disinfectants, and use footbaths and hand sprays before entering your aviaries. If not absolutely necessary rather do not handle your pet birds physically.

What about vaccination?

There are vaccines available overseas but vaccination is currently not allowed in South Africa. Using a vaccine in a commercial setting as with poultry could theoretically worsen the situation by increasing the chances of the virus mutating to affect people and could also theoretically adversely affect South Africa's ability to export poultry products. Some countries recommend vaccinating at-risk endangered species of birds.

Be careful of bringing wild birds that appear to be sick to the vet without a telephone call in advance to see that it is in order. This is because it may be risky if there are domestic/exotic birds which are hospitalised, which could lead to cross contamination. If you have an injured or ill waterfowl from your own collection or should you have a sick parrot that you may suspect may have bird flu, special arrangements may have to be made for seeing the bird, to prevent other birds being affected.

© 2018 Dr Dorianne Elliott – Bird and Exotic Animal Hospital Onderstepoort

 

My dog makes a strange snorting sound with funny gagging movements almost like something is stuck in his/her throat.

What is reverse sneeze?

Reverse sneezing is repetitive, forceful inspiratory (breathing in) efforts generally caused by irritation of the lining of the naso-pharynx or area at the back of the mouth and nose where these two openings join into one. Unlike a normal sneeze where air is forcefully pushed out the nose to clear the irritation, a reverse sneeze involves air being pulled forcefully and rapidly into the nose. This is commonly seen in small and toy breeds breeds with long thin nasal passages like Miniature Pinchers, Toy Poms, Chihuahuas, Malteses, Dachshunds, Poodles, Yorkshire Terriers and other Terriers, etc., and brachycephalic (short nose) breeds like Pugs, Boston Terriers, Shih Tsus, Pekingeses, etc.

How to recognise a reverse sneeze:

It is a noisy forceful inspiration of air through the nose resulting in a strange snorting sound. When seeing a reverse sneeze for the first time it can be quite a startling event for owners who often think their dog is choking or even struggling to breath. During an episode of reverse sneezing the dog will often stand still, with elbows pulled away from the body, head and neck stretched out straight, with a backwards head motion, mouth closed and lips sucked in making a loud strange snorting sound. Their eye may even be bulging adding to the shock of an owner witnessing this. These episodes may last from seconds up to a few minutes. Although reverse sneezing can be startling to observe there is no real risk to the dog and they are generally normal after the episodes. Something to remember is that some dogs may even reverse sneeze throughout their lives with no untoward effects. This may be confused with the goose honking cough noted in tracheal collapse, a common condition in certain small breed dogs. It can also be confused with stertor which is commonly associated with activity and excitement; snoring occurring during sleep, and retching and gagging involving expectoration involving an open mouth. Another common condition it may be confused with is Kennel Cough with the major difference being that Kennel Cough causes a dry honking cough usually ending up with an open mouth gagging or retching at the end of the episode (as if there is a bone stuck in the dog’s throat), whereas with reverse sneeze, the dog’s mouth tends to stay closed and it is almost like they are trying hard to swallow something, which just does not want to go down the throat. Kennel cough is caused by a number of difference viruses and bacteria and is usually a condition which will clear up over time and disappear completely, whereas reverse sneeze often seems to be a lifelong condition.

Diagnosing reverse sneeze

If these episodes are something that happen frequently, are concerning for you, or seem to distress your pet, it is better that you take them to the vet for a proper clinical examination. Generally, the veterinarian will attempt to determine the cause of the symptoms by doing a thorough work-up which may include the consideration of the age and breed of your dog, a good history of the condition and the clinical signs seen, a full clinical examination from nose to tail, a nasal work up (X-rays, flush, biopsies etc.), endoscopy (with sample collection and visualisation) and response to treatment trials. The extent of the work-up is determined by clinical signs, frequency of episodes and your willingness as an owner to go through the process. A very important point to remember is that often despite the best attempts and in-depth work-ups, a final answer or underlying cause may never be found. This may be in part because this condition may have a behavioral component to it. Please read below under Causes for more information.

There are a number of other conditions affecting the throat, the heart and the lungs, which may mimic reverse sneeze and therefore it is important to rule out these conditions, as some of them may end up being life threatening and ignoring the symptoms and merely saying that it is a behavioral problem, may be too simplistic.

Causes:

So what may be some of the possible causes? The consensus, given current knowledge available on this conditions, seem to indicate that this is a response by the body to some form of irritation of the upper respiratory tract. These can include rhinitis and sinusitis, which is an inflammation of the tissues of nose and sinuses. The cause of the inflammation may be infectious (bacteria, viruses and fungi), environmental (dust, irritant aerosols, cleaning agents, grass awns and seeds etc.) and allergic conditions, where it’s the body’s over response to normal environmental contaminants that causes the problem. Other causes may also be eating or drinking too quickly, pulling on the lead around the neck, and even excessive excitement. Even excessive vomiting may cause inflammation of the nose and throat.

Tumours of the oro- and nasopharynx (mouth, nose and throat) and even severe dental disease may be the reason behind reverse sneezing. Excessive vomiting may also cause inflammation of the nose and throat.

The behavioural component or cause of the condition is not yet well understood but there seems to be a school of thought which says that the condition starts as a result of one of the reasons above and may have been self-limiting, had it not been for the fact that the concerned pet owner immediately pays attention to their dog during one of these episodes, which lead to some form of attention seeking behaviour from the dog with future episodes. It is unlikely to be completely voluntary (i.e. the dog “taking its owner for a ride”) but it does seem like the concern an attention shown to a dog during some of these episodes may perpetuate the problem and cause it to recur. If other pathological causes for the condition have been ruled out through a proper clinical workup by the vet, it may actually be of benefit to ignore the dog during these episodes and not make a fuss of it at all. Please discuss this with the vet before you assume this is the case with your dog.

Treatment:

In general there is no specific treatment for reverse sneezing and in most cases no treatment is required. During the episode it helps to calm your pet, stroke them gently on the head and neck in an attempt to calm and sooth them. As mentioned previously these episodes often resolve on their own with no complications and ignoring an episode may in actual fact be a better treatment that to hold and stroke your pet and talk to them. Treatment deals with the underlying cause, if it can be found. Response to treatment is often used by the vet as a cost effect diagnostic tool for the more common reasons for reverse sneezing. Treatments prescribed by the vet may include anti-inflammatories, steroidal treatment, antihistamines and even decongestants. If a specific cause is found more direct treatments may include, dental therapy, antibiotics, or even surgery.

© 2018 Vetwebsites – The Code Company Trading (Pty) Ltd.

I found a loose stool with blood and what looks like jelly on the kitchen floor this morning – what do I do?

What is Acute Colitis?

Acute colitis is a common condition in pets and is characterised by a sudden onset colonic inflammation with a diarrhoea that may contain mucous and/or fresh blood.

Clinical signs

The most common symptoms are straining when defecating, mucous (the jelly you noticed) and/or blood in the stool, and increased frequency of defecation. Systemic signs of illness are generally absent and most animals are still alert, active and have normal appetites in spite of having colitis.

What causes acute colitis?

Various parasitic (like worms), bacterial, fungal and dietary causes can be identified as the cause of acute colitis in animals.

Diagnosis

Firstly a physical examination is performed which includes the vet feeling thoroughly and as deeply as possible without hurting the animals which his or her hands up and down the stomach area (abdominal palpation) as well as physically checking the animal’s backside with their finger (digital rectal examination) and the collection of stool, if there is any present. Parasites like worms can be diagnosed with relative ease by doing a fecal flotation to check for worm eggs under the microscope. The vet may also decide to do what is called a wet prep where a small stool sample is put on a microsope slide and either examined as is or with a special stain and then examined. The main causes of acute colitis in puppies and kittens are dietary indiscretion (garbage), bacterial infections and parasites. Puppies and kittens, the same as human babies, tend to explore the world with their mouths, chewing and biting on many things in their environment, some of which are not always clean or hygienic.

Treatment

If parasites are diagnosed during the faecal examination, the veterinarian will treat your pet with the needed medication to kill the parasites. If a dietary cause for colitis is suspected the veterinarian might start your animal on a bland diet for 3to 5 days. It is best to avoid all treats and food supplements during this period. These diets are highly digestible and reduces the workload on the gastrointestinal tract. Fiber supplementation may also be beneficial in the healing and repair of colonic tissue. Bacterial colitis is best treated with antibiotics based on faecal culture results. The use of probiotics for 3 to 5 days can be beneficial. If an animal fails to respond to therapy based on initial tests, further advanced tests may need to be performed.

Prognosis

The prognosis for discovery from colitis is generally excellent with most animals recovering in a short period of time (3 to 5 days) if the correct treatment is given.

What is chronic colitis?

Chronic colitis is characterised by persistent colonic inflammation for longer than a 3 weeks duration.

What causes chronic colitis in pets?

Middle-aged and older dogs and cats are affected by infiltrative mucosal (the superficial surface of the colon) disorders such as Inflammatory Bowel Disease (IBD) and cancer (neoplasia). Infectious causes (bacteria, worms and parasites) are usually seen in younger dogs and cats, but are less common causes in chronic cases. Some diseases that affect the motility of the colon (e.g. irritable bowel syndrome in dogs and colonic constipation/obstipation in cats) can mimic signs of colonic inflammation and cause animals to present with signs such as loose stools and straining (diarrhoea and tenesmus). These symptoms are due to functional defects in the motility of the colon and there is no mucosal disease present. Colonic cancer can also cause large bowel diarrhoea in dogs.

What are the clinical signs of chronic colitis?

The most classic sign is an animal that keeps trying to pass stool but only passes a very small amount or alternatively no stool. There is continuous straining, many times looking as if something is stuck in the back end which they cannot pass.

If they manage to pass something it may contain mucous and/or blood.

Large bowel diarrhoea is the most common clinical sign noted in dogs and cats where food intolerances are the cause for chronic colitis.

How is chronic colitis diagnosed?

The veterinarian will start off by doing a physical examination, where the abdomen is palpated, a rectal examination performed and a stool sample collected. The stool sample will be examined under a microscope. Abdominal imaging can be done to aid in the examination of the colon and the rest of the abdomen either through X-rays or ultrasound or sometimes both. Advanced diagnostic tests include colonoscopy and proctoscopy. Blood tests may also be performed to determine the extent of infection or to rule out other possible conditions which may present with similar symptoms. During these procedures biopsy samples of the colon can be obtained.

Treatment

The most simple and straight forward approach will be that suspected parasites must be treated. Follow-up faecal examinations are done to confirm efficacy of treatment. If your animal has a more serious condition like Inflammatory Bowel Disease (IBD) which may be related to an immune condition or a diet responsive disorder, a hypoallergenic diet is fed. Animals that do have colitis but don't need a hypoallergenic diet will benefit from being fed a low-fat, fibre rich diet. The vet will be the best person to advise on a suitable therapeutic diet and there is not a one size fits all as some animals need higher fibre whilst other may need a different type of carbohydrate or protein. Antibiotics can be used in cases that have confirmed bacterial causes of colitis. In animals with Inflammatory Bowel Disease (IBD), immunosuppressive drugs are the first  choice of drugs for therapy.

Chemotherapy and radiation can be considered for certain colonic cancers, but surgical resection would be the treatment of choice.

Anti-fungal treatment is indicated for chronic colonic diarrhoea of fungal origin. 

Prognosis

The prognosis for chronic colitis depends on the underlying cause. Acute bacterial infections tend to have a better prognosis than dietary responsive disorders and normally respond to short term treatment which may resolve the condition completely compared to dietary responsive disorders which tend to require a much longer and more intensive treatment approach where the condition may never be resolved but at the very least contained and managed. Colon cancer, as in humans, carry a much more grave prognosis and the stage and extent of the cancer at the time of making the diagnosis will determine the outcome of treatment.

© 2018 Vetwebsites – The Code Company Trading (Pty) Ltd

 

 

Is Tick Fever and Tick Bite Fever the same disease in dogs?

It is not. Tick fever or Babesios in dogs, is not the same disease as Tick bite fever or Erlichioses. Both diseases are transmitted to dogs by ticks, but they are caused by two totally different organisms or parasites and the clinical signs, progress and treatment are very different.

To further confuse the matter, Tick Bite Fever in humans is not the same as Tick Bite Fever in dogs and once again, although transmitted by ticks, is caused by a complete difference parasite. Tick Bite Fever in dogs is not transmissible to humans or vice versa.

So what is Tick Bite Fever in dogs and how can it be treated, and better yet, prevented?

Erlichiosis is a disease of the domestic dog and is common in the warm climate of South Africa. It is a tick born disease, meaning dogs can get infected when an infected tick bites and feeds on them. The organism that is responsible for this disease is called Erlichia canis, but there are many different Erlichia species worldwide.  Erlichia is neither a bacteria nor a virus, but rather something in between the two. When a tick feeds on an infected animal, the organism gets transferred to the tick. The tick can carry this organism for up to 5 months and infect many animals as they feed on them. Specific tick species carry this disease and Erlichia is prevalent in areas where these ticks are found. This disease is known worldwide and was studied extensively after the war in Vietnam when hundreds of military dogs succumbed to the disease. It was found that German Shepherd dogs are more susceptible and suffer more severely from this disease. 

Clinical signs

There are three phases in the disease process:

  • Acute phase:  The acute phase develops within 1 to 3 weeks after the bite. During this phase the organism enters and multiplies within a certain type of white blood cell, called monocytes. The clinical signs are caused by a widespread vasculitis or inflammation of the veins in the body. It causes blood cell loss or anaemia, and decreases the platelet count. Platelets are responsible for clotting of blood in the body. Signs to look out for during this phase are weakness, lethargy, depression, anorexia and enlarged lymph nodes.
  • Subclinical phase: This can last for months to years without any clinical signs noted by owners. During this phase, the animals’ immune system can clear the infection, but if not, it will progress to the next phase.
  • Chronic phase: The mortality rate can be high in this phase of the disease. Bone marrow suppression (the body’s blood cell factory) and haemorrhage or bleeding are the main causes of the clinical signs. Signs shown are nose bleeds, or any other form of bleeding and bruising. Severe weight loss, fever, difficult breathing, joint pain with inflammation, neurological signs, kidney failure, eye problems and paralysis, to name a few. If the disease is not treated, it will progress to overall organ failure and death.

Diagnosis and treatment

Because of the non–specific nature of the clinical signs, making a diagnosis of Erlichiosis is not straightforward. A detailed history of your dog’s health, whereabouts and living conditions are extremely important in the diagnostic process. A thorough clinical exam should prompt the vet to do further diagnostic steps to get to a diagnosis. The most basic diagnostic tool is a blood smear. A drop of your pets’ blood is smeared thinly onto a glass slide, stained and then examined under the microscope. The organism multiplies in the white blood cells of the affected animal, and can be seen as a purple inclusion body (almost like a bunch of grapes) in the cytoplasm of a specific type of white blood cell called monocytes. Unfortunately, inclusion bodies are  not always visible and very few dogs are dibagnosed this way, therefore other means of detection are needed. Detection of antibodies in the blood is a common way of diagnosing infection and can be done by sending blood to a lab facility. Even this is not 100% accurate and can sometimes give false positive results. Your vet will often look at a full blood count of your animal, and together with the history, clinical presentation and lab tests, will make a diagnosis of Erlichia. Response to treatment is also an important tool to make a final diagnosis. Erlichia is treated with an extended course of doxycycline, an antibiotic. Treatment needs to be continued for at least 4 to 6 weeks. If treatment is stopped prematurely, the disease can continue to the chronic stage.

Prevention

The saying, “prevention is better than cure”, rings true in this case. Because the disease is transmitted through tick bites, it can to a large extent be prevented through proper tick and flea control. Speak to the vet on your next visit about which products he/she recommends for tick control.

© 2018 Vetwebsites – The Code Company Trading (Pty) Ltd