Month: July 2018

Brachycephalic upper airway obstruction syndrome (BUAOS)

If you are considering buying, or already own, a dog with a short nose such as a Pug, Boston terrier, Pekingese or Bulldog then you need to be aware of the welfare issues surrounding brachycephalic upper airway obstruction syndrome.

Over the past hundred years human beings have designed for themselves a huge number of different dog breeds. The conformation of some of these breeds has become more extreme and sadly many health problems have been introduced into the dog population as a consequence. The continual increased selection pressure for ‘desirable’ physical traits has resulted in many pets presenting with more severe manifestations of certain congenital conditions and at a much younger age.

Brachycephalic upper airway syndrome otherwise known as BUAOS arises from the effects of a group of congenital anatomical defects present in brachycephalic breeds. Brachycephalic breeds of dogs are those with characteristically short noses such as the Pug, Boston terrier, English and French bulldog and Pekingese. Animals with shortened noses still have the same amount of tissue in their nose and throat but this is squashed into a smaller space which causes folds and wrinkles that obstruct the airways. Animals with BUAOS may have one or more of the following defects:

  • Excessively long and thickened soft palate.
  • Narrowed laryngeal lumen caused by protruding laryngeal saccules.
  • Collapsed larynx.
  • Stenotic nostrils.
  • Excessively narrow trachea, especially common in bulldogs.

The abnormal anatomical conformation of these dogs means that airflow through airways is impeded resulting in noisy breathing and an inability to take on board sufficient oxygen to meet increased demands imposed by exercise. The nasal cavity has a huge surface area covered by richly vascularised tissue that in normal dogs cools inhaled air thus forming an important part of the body’s mechanism for temperature regulation. This is compromised in brachycephalic breeds and many breath through their mouth bypassing the nasal cavity altogether.

This explains why many of these breeds have poor heat tolerance and cope poorly with hot weather. Hot weather also causes swelling of the tissues in the nose and throat further impeding airflow and exaggerating symptoms.

Severely affected dogs may show signs of breathing problems at a very young age (4-6 months of age) although most will present with signs at around 1-3 years of age. The first signs you may notice if your dog has BUAOS are that it has noisy breathing or may snore loudly whilst sleeping. In fact many owners of dogs with short noses such as pugs and bulldogs think it is normal for their pets to snore and snuffle. However, these noises indicate that their pet’s airways are already narrowed and breathing is difficult. Dogs with BUAOS frequently have significantly disrupted sleep as every time they lie down and relax their airways become obstructed.

Many dogs with BUAOS are unwilling (or unable) to exercise normally and this can predispose them to putting on weight which further exacerbates their problems. Sudden deterioration in breathing may develop, leading to respiratory distress or sudden collapse (particularly in hot weather). This deterioration may be brought on by exercise and excitement. Severely affected animals may have almost total airway obstruction and can develop fluid build-up on the lungs. Animals that have severe bouts can die rapidly if they do not get emergency veterinary treatment.

When dogs are hot they cool themselves by panting. When they pant they move air back and forth over their hot airways and thus evaporate water and lose heat. Dogs with BUAOS are unable to move air through their airways efficiently which prevents adequate heat loss through panting. Dogs with BUAOS are at particular risk of over heating in hot weather, following exercise or when under stress.

The diagnosis is based on the clinical signs (and typical breed) but further examination may be required to confirm the diagnosis and rule out other conditions. If your vet suspects that your dog is suffering from BUAOS they will want to perform a detailed inspection of the upper airway with your dog under anaesthesia and may pass an endoscope (containing a small camera) through your dog’s airways so they can access which abnormalities your dog has and how severe each of these is. These examinations are best performed by a veterinary surgeon experienced at treating this condition so that treatment can be carried out at the same time. Anaesthesia and examination without correction poses unnecessary risk to your pet.

There have been many reports suggesting that brachycephalic dogs often have difficulty or experience pain on swallowing and some may regurgitate or vomit frequently. This may be due to reflux of fluid from the stomach but many brachycephalic dogs also have anatomical defects in the gastrointestinal tract. Some examples of these include: hiatal hernias (where part of the stomach passes through a larger than normal hole in the diaphragm into the chest), and pyloric stenosis (where the stomach exit is narrowed preventing food from leaving the stomach normally).

Always make sure you give your vet a full history of all your dog’s problems even if you think one (like breathing difficulties) is more important. In many cases treatment of the airway problem with improve the gastrointestinal symptoms but more severely affected patients may require additional medication.

Most animals with BUAOS will be improved if they lose weight, so a dietary regime forms part of any management.

Because BUAOS is caused by congenital abnormalities of the airways the only way to resolve the problems is to correct the underlying abnormalities. Surgical procedures can open up the nostrils and remove excess tissue within the airways that is restricting airflow. Surgical correction requires a great deal of skill and is not without risks. Your vet may choose to refer you for treatment to a surgeon who specializes in these procedures.

Following surgery, the lives of affected animals should be significantly improved. Correction of the reversible primary abnormalities early in life will slow down or potentially prevent secondary irreversible changes occurring that would otherwise compromise the airway further. This emphasizes the importance of critically evaluating how well your pet can breathe early in life and seeking professional advice.

Since the condition is inherited it is important not to breed from animals that suffer from BUAOS (even if they have had surgery) as their offspring will also be affected. Unfortunately most show animals in affected breeds have been deliberately bred to produce the external appearances that are the result of these defects (such as a very short nose and flat face) so the defects are present to a greater or lesser extent in all animals within the breed.

Ultimately BUAOS is a significant welfare issue in brachycephalic breeds and the only way this can be alleviated is by breeder acceptance that extreme conformations (such as excessively short noses) are not desirable in dogs.

If your dog is registered with the Kennel Club and has had correction of any conformation abnormalities associated with BUAOS please notify the Kennel Club that these surgical procedures have been performed.

If you are worried about your pet in any way, but especially if it appears to have breathing problems, then you should contact your vet for advice.

Birth control in the bitch

Most responsible dog owners want to prevent unplanned breeding and the production of unwanted puppies. Most forms of birth control prevent the heat cycle of bitches, and so mating and conception does not occur. The cycle can be controlled permanently or temporarily. Pregnancy prevention is also possible after an unplanned mating has occurred.

The reproductive cycle in bitches is very difficult from that in women. Bitches usually undergo oestrus cycling (also known as ‘heat’ or ‘season’) between one and three times every 12 months, although there is a degree of individual variation in this. Oestrus is the time at which mating, and hence pregnancy, may occur. Bitches usually develop a regular cycle and any alteration of this cycle should be taken seriously. Occasionally, various factors such as ill health, can act to delay or suspend oestrus cycling. Unlike women, bitches do not experience a menopause and usually continue to have seasons throughout life.

The first oestrus period (puberty) occurs between 6 and 12 months of age, when the bitch has reached 80% of her adult size. Large breed bitches may be older, e.g. 12-18 months, when their first oestrus period occurs. Sometimes, this initial oestrus is missed by owners as the physical signs may be subtle and not last for long.

The normal oestrus cycle lasts around 3 weeks in the bitch, and can be divided into a number of distinct stages:

  • Pro-oestrus usually lasts for around 9 days. In pro-oestrus the vulva becomes swollen with a red (bloody) discharge. Male dogs may show interest in bitches in pro-oestrus, but the bitch will not allow mating.
  • Oestrus also lasts around 9 days. The bloody discharge typical of pro-oestrus is reduced. This is the time when bitches will allow mating.
  • Dioestrus lasts around 45 days. After oestrus the same hormonal changes occur in the bitch whether or not she is pregnant. During dioestrus levels of progesterone rise. Dioestrus ends spontaneously in the non-pregnant state, and with whelping in the pregnant state. It is this part of the cycle that can result in a ‘false-pregnancy’.

Anoestrus is the 3-4 month period between oestrus cycles. In this period the uterus shrinks down and repairs. The reproductive system is outwardly inactive during this time.

There are 4 ways to prevent pregnancy in the bitch:

  • Avoidance of male dogs whilst in heat.
  • Neutering (spaying).
  • Chemical prevention of the oestrus cycle.
  • Chemical intervention after unintended mating.

Avoiding male dogs

This is a possible method of natural birth control. It relies on a firm understanding of the normal oestrus cycle on the part of the owner of an entire bitch. Extreme care must be taken during the receptive oestrus period. Not only are male dogs very resourceful at gaining access to bitches in heat, but the bitches themselves may stray during this period if they get the opportunity. Nevertheless, with responsible dog ownership on the part of owners of both bitches and male dogs, this should be a possible method of birth control. This method of birth control is often used by owners who wish to breed from their bitch at some time in the future.

Neutering (spaying)

This is the most common method of birth control in pet dogs, and is a permanent, surgical method of preventing oestrus cycling and therefore pregnancy. An operation known as ovariohysterectomy is usually performed, i.e. the ovaries and uterus are removed surgically. Ovariectomy (removal of the ovaries only) is a less common method of surgical neutering that is performed in some countries. In either case removal of the ovaries stops reproductive cycling and conception is impossible.

Surgical neutering is a major procedure but most veterinarians perform the procedure frequently, and the risk is relatively low. Most animals being neutered are young and fit. The procedure can safely be performed before puberty, (even in dogs as young as 6 weeks of age). Early neutering has an additional health benefit – it results in a diminished chance of mammary (breast) cancer occurring later in life.

 

Chemical prevention of oestrus cycles

Birth control can be employed using various drugs similar to natural reproductive hormones. The drugs are administered by injection or as tablets at specified intervals, and it is very important that veterinary advice is followed as regards the treatment programme. The drugs used can prevent or shorten oestrus cycles but many have potentially serious side-effects which should be discussed with your vet.

This method is similar to human contraception, but the potential risks mean that it is not generally considered desirable for on-going, long-term birth control in pet dogs. It may be used as a short-term measure, or as a permanent measure only in dogs that for some reason cannot undergo conventional surgical neutering.

Chemical intervention after unintended mating

If your bitch has been mated unintentionally contact your vet as soon as possible. Your vet will be able to discuss the options for terminating pregnancy if it occurs. Immediate treatment can be given (similar to the use of the ‘morning after’ pill in human females). All drugs used in the prevention of pregnancy have potentially serious side-effects and should be used as a last resort rather than a method of birth control.

If your bitch has been mated unintentionally your vet may advise neutering your bitch to prevent this and future pregnancies. If you want to breed from your bitch later, treatment should be delayed until pregnancy has been confirmed.

Bitches should be neutered when their reproductive tract is inactive (during the anoestrus phase). The best time is around two to three months after the end of the previous oestrus. There is more risk of bleeding if the operation is performed during oestrus, and the surgery is technically more difficult at this time. Early spaying of bitches helps prevent mammary (breast) cancer in later life.

This is a serious infection of the womb, seen most commonly in older un-neutered bitches. Bitches with pyometra are often very seriously ill and emergency treatment is usually required. Pyometra is best treated by surgical removal of the womb, but the risks of the operation are higher than those for routine neutering as the bitch is already sick. Medical treatment is usually only tried in valuable breeding animals.

False pregnancy occurs ‘naturally’ at the end of dioestrus. Some dogs have very exaggerated symptoms and may show:

  • Poor appetite, lethargy and depression
  • Nest building behaviour and ‘adopt’ toys
  • Behavioural changes, including aggression
  • Mammary development and milk production

Such bitches tend to have recurring false pregnancies at every oestrus and symptoms may last for weeks. Drug treatment can help during the false pregnancy, but the best solution is spaying after the false pregnancy has ended. If your bitch has suffered a false pregnancy discuss the options for treatment with your vet.

The reproductive cycle in the bitch is complicated and during this time your dog will undergo many hormonal changes which can alter her health and temperament. If your bitch is not neutered you should be familiar with all the natural changes in her cycle so that you can be alert to any signs of problems. If you do not plan to breed from your bitch discuss the option of permanent neutering with your vet.

Arthritis

Arthritis is a familiar problem for most vets. A large number of dogs are diagnosed with arthritis. Arthritis simply means an inflammation of joints and animals with arthritis usually suffer with pain and stiffness in their joints. Arthritis is typically a problem in older pets. However, many animals with arthritis will have had signs of disease from an early age if their arthritis is caused by problems with joint development.

In the normal joint the bone surfaces are covered with a thin layer of smooth cartilage. This is lubricated with a small amount of joint fluid. This structure allows the two surfaces of the joint to slide freely over one another.

In animals with arthritis (also known as osteoarthritis) the cartilage in the joint degenerates and becomes damaged and thinned. The bone surfaces begin to rub together (rather than gliding) causing discomfort as well as further damage to the cartilage. With time new bone may form around the joint and this can cause the joint to become stiff and limit joint movement. Depending on the cause arthritis may affect just one or any number of joints.

In most cases arthritis develops as a consequence of abnormal wear within the joint. This can be due to:

  • Instability of the joints, e.g. when ligaments have been damaged.
  • Damage to or abnormal development of the cartilage in the joint.
  • Damage caused by trauma such as joint fractures and chronic sprains.

Arthritis causes pain and stiffness in the joints. If your pet has arthritis you may notice they are not as keen to exercise as in the past and they may limp or seem to be stiff (particularly when getting up from rest). This stiffness may get better after being out for a walk, and sometimes cold and/or damp weather may appear to make signs worse.

Dogs will sometimes lick continually at a painful joint and in dogs with pale coloured coats the saliva may start to stain the fur darker over the affected joint. Occasionally the joint may appear hot or swollen but more usually you will not be able to recognise any change in the joint. The signs in some animals can be very obvious whereas other pets may just become quieter or more grumpy if they are in discomfort.

Your vet may suspect that your pet has arthritis from the signs you describe. By examining your pet’s legs your vet should be able to identify which joints are painful, stiff or swollen. In order to find out more about what is going on inside the joint your vet may need to do further tests.

X-rays of the joint will help to confirm the presence of arthritis and to identify any underlying causes. Your vet may also take a small sample of fluid from inside the joint for analysis. In some cases blood samples may be required to look for medical conditions that can affect the joints. If your vet suspects that there is an infection in the joint they will want to take samples to try to identify the cause.

The treatment for arthritis depends upon the underlying cause and the joint(s) affected. In almost all cases arthritis is worse in animals that are overweight and unfit. Treatment of osteoarthritis must be aimed at keeping the joint in use, minimising discomfort, and preserving the structures of the joint for as long as possible. Without a doubt the most important therapy for patients with osteoarthritis is the combination of weight control and exercise management, minimising the load on the joint, and maximising the range of movement and the fitness of the muscles around the joint.

Many patients will also benefit from drug therapy for a few weeks or months, and in occasional cases long-term drug therapy is useful. Initially pain relief is important and the most common veterinary analgesics used are the non-steroidal anti-inflammatory drugs (NSAIDs).

If your pet has arthritis your vet may need to treat them on numerous occasions over their lifetime. The treatment used will vary both from one patient to the next, and for an individual patient over time. Your vet may recommend using multiple treatments, singly, or more often in combination, to provide the best immediate and long-term support for each patient.

Chondroprotectants

As cartilage damage is such an important part of arthritis it is clearly a good idea to try to limit this. Some drugs may reduce cartilage damage – these are described as chondroprotective drugs. Drugs such as hyaluronic acid, polysulphated glycosaminoglycans and pentosan polysulphate are suggested to reduce cartilage degeneration, promote the repair of joint structures, and reduce inflammation. Unfortunately not all of these drugs are licensed for use in dogs and cats and some have to be injected into the joint.

There has been a recent rise in the use of the so-called nutraceuticals. These substances (primarily glucosamine and chondroitin sulphate) are building blocks for cartilage. Feeding nutraceuticals in the diet may provide the building blocks for the repair of cartilage within the joint and this may in turn promote relief from the signs of arthritis. Nutraceuticals have been used in the management of long-term osteoarthritis in people, and they may be a useful addition to other therapy in animals.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are commonly prescribed for management of arthritis as they have actions against both inflammation and pain. Occasionally these drugs can cause vomiting or diarrhoea as well as other side-effects. These side-effects mean that there are some warnings against their long-term use in dogs. NSAID use is quite restricted in cats as these drugs can be more toxic in this species.

In the short-term the drugs with the highest impact on analgesia and inflammation are likely to be the first choice. Often these drugs are not needed in the medium or long-term, or they are not licensed for such use due to the cumulative risk of side-effects. In such cases alternatives must be sought.

New drugs are becoming available and the development of a successful management plan for arthritis in the individual patient requires regular review of the current medication and how the patient is progressing.

Unfortunately once the cartilage in the joint has been damaged it rarely repairs. However, although there may still be damage in the joint many pets can be made pain free by long-term use of medication and management to control further wear on the joint.

There is a great variation in the severity of arthritis between patients. Many pets cope well with their disease, and lead a full and active life without any veterinary treatment. Some patients require treatment ranging from simple lifestyle changes to complex surgery. The signs of arthritis often vary throughout the animals life and often result in the early onset of joint problems in old age.

Addison’s disease (hypoadrenocorticism)

Although Addison’s disease can be a very serious disease the changes it causes can be very subtle in the early stages. The signs of the disease are variable and often vague. It is important to get an early diagnosis because, with treatment, affected animals can lead a normal and full life.

Addison’s disease occurs when dogs fail to produce enough of the hormone, cortisol, and in some cases the hormone, aldosterone. For this reason, the disease is sometimes called “hypoadrenocorticism” or “hypocortisolemia”. The disease is named after a 19th-century English physician, Thomas Addison, who identified and described it.

In the normal dog, cortisol and aldosterone are produced by the adrenal glands, (which are located just in front of the kidneys). Scientists think that cortisol has hundreds of possible effects in the body. Because cortisol is so vital to health, the amount of cortisol produced by the adrenal glands is precisely balanced.

Cortisol production is regulated by hormones produced in the brain (from the pituitary) which stimulate the adrenal glands. When the adrenal glands receive the signal from the pituitary they respond by producing cortisol. Cortisol’s most important job is to help the body respond to stress. In Addison’s disease the body is unable to produce enough cortisol and affected animals may become ill at times of stress.

Aldosterone helps maintain blood pressure and the water and salt balance in the body by helping the kidneys retain sodium and excrete potassium. When aldosterone production falls too low, the kidneys are not able to regulate salt and water balance, causing blood volume and blood pressure to drop.

Addison’s disease is usually caused by damage to the adrenal glands. Most cases of Addison’s disease are caused by the gradual destruction of the outer layer of the adrenal glands, by the body’s own immune system.

The signs of Addison’s disease are extremely variable and can be subtle in the early stages. Addison’s disease usually affects younger dogs and females are more at risk than males. In some breeds of dog e.g. Standard Poodles and Bearded Collies, the disease is more common.

Many owners do not recognise the signs of Addison’s disease in their pet, but are aware that their pet is ‘not quite right’. You should be suspicious if your pet suffers from recurrent illness (particularly vomiting or diarrhoea) but recovers rapidly when treated with intravenous fluids.

The steroid hormones affect almost every tissue in the body and the signs of Addison’s disease can be diverse. The signs of adrenal insufficiency usually begin gradually. Chronic, worsening fatigue and muscle weakness, loss of appetite and weight loss are characteristic of the disease. Dogs may be depressed, lethargic or unwilling to exercise (and sometimes you don’t notice how quiet they have become, confusing the signs of disease with your dog ‘maturing’).

Gastrointestinal problems (with vomiting and/or diarrhoea) that get better and then recur is a common sign. Episodes of collapse or muscle weakness may be reported. Addison’s disease can cause increased thirst. If your dog is drinking more (or is suddenly needing to get up in the night to urinate) you should always take them to the vet for a check-up. Low blood sugar can be a problem in toy breeds or young dogs. Female dogs may fail to come into season. Because the signs progress slowly, they are usually ignored until a stressful event like an illness or an accident causes them to become worse.

Sometimes, if the disease is unrecognised, a very severe form develops – this is called an Addisonian crisis. Often this begins with vomiting or diarrhoea, but progresses rapidly resulting in collapse and possibly coma. Pets can die without urgent treatment. In some dogs there are no signs at all until an Addisonian crisis develops.

In its early stages, Addison’s disease can be difficult to diagnose. A review of your dog’s medical history may make your vet suspect Addison’s disease. Although Addison’s disease can be difficult to recognise it is very easy to diagnose. Your vet may suspect the disease based on simple blood tests but specific blood tests are needed to confirm the disease. These tests measure the level of cortisol in the blood. However, because the levels of this hormone vary from hour to hour in the normal animal, the disease cannot be diagnosed on the basis of one blood test.

Your vet will need to take a number of blood samples (before and after an injection of a hormone which mimics the action of the pituitary to stimulate your dog’s adrenal glands to produce cortisol). These blood samples will need to be sent away to a veterinary laboratory for analysis. If your dog is unable to increase the amount of cortisol in the blood after the injection then it is clear that its adrenal glands are not working properly.

X-rays may also be needed to show other potential problems caused by the disease.

Addison’s disease is caused by there being too little cortisol and/or aldosterone in the blood. Treatment of Addison’s disease involves replacing, or substituting, the hormones that the adrenal glands are not making. Oral steroid tablets (prednisone, prednisolone, dexamethasone) are given to replace cortisol, and DOCP injections or Florinef tablets to replace aldosterone. Tablets are given daily to supplement the missing hormones. The doses of each of these medications are adjusted to meet the needs of individual patients.

During an Addisonian crisis, low blood pressure, low blood sugar and high levels of potassium can be life-threatening. Standard therapy involves intravenous injections of hydrocortisone and a saline (salt water) drip. This treatment usually brings rapid improvement. When the patient can take fluids and medications by mouth, the intravenous treatment is decreased until and maintenance therapy is begun. In fact, once stabilised, many dogs require only Florinef tablets on a daily basis.

If your vet is using injectable DOCP to replace aldosterone, your pet will likely also require supplemental oral replacement steroid tablets. Your vet may give you a supply of steroid tablets and ask you to give them only when your pet is stressed or excited. This mirrors the circumstances under which cortisol would be produced naturally.

Most dogs with Addison’s disease are relatively young and the signs of disease will get worse as they get older. Even if you haven’t really noticed a particular problem with your dog you may see dramatic improvement when treatment starts. Routine blood tests are taken two or three times a year to ensure that treatment does not need to be altered. Many dogs will go on to live a normal lifespan. Without treatment the complications can be significant and will seriously affect the quality of your pet’s life.

Exocrine pancreatic insufficiency (EPI)

Almost all dogs will suffer from diarrhoea at some point in their lives. In most cases this lasts no more than a few days and dogs generally get better without any treatment. However, in a few cases the diarrhoea is due to a more serious underlying cause and does not resolve. EPI is one of the conditions that can result in chronic diarrhoea.

EPI results in a reduced ability to digest food this means that an affected pet will suffer from chronic diarrhoea and be significantly underweight. Dogs with EPI have a good appetite but despite consuming lots of food they are literally starving.

The pancreas is a small organ located close to the stomach. It has an important role in the digestion of food and produces large volumes of digestive enzymes after each meal, which are released into the gut to help digest food as it leaves the stomach. These enzymes are normally stored in specialised storage granules in the pancreas until they are needed.

In EPI the pancreas is not able to produce sufficient quantities of these enzymes and so food is poorly digested. The undigested food cannot be absorbed into the body and passes through the gut resulting in the production of smelly greasy faeces. Despite consuming plenty of calories the dog is only able to use a small fraction of these and the rest pass out unused in the faeces.

The pancreas also has a second, and completely separate, function which is to produce the hormone insulin which helps to control levels of blood sugar. It is unusual for pancreatic damage to be so severe as to cause loss of this function along with EPI.

In certain breeds, e.g. German shepherd dogs, collies and English setters, the condition is hereditary (passed from parents to their puppies) although the parents may not show any outward signs of EPI. EPI occurs due to atrophy (shrinking or withering away) of the pancreatic tissue. There is a hereditary component to the disease but factors for the disease developing are considered multifactorial. Recent studies suggest that the immune system plays a role in destroying the pancreatic cells. In a few animals EPI may develop in later life as a consequence of long term pancreas damage due to pancreatitis.

The most obvious sign of EPI is weight loss over several months despite an increased appetite. Faeces are bulky and they may be greasy or smelly and diarrhoea is common. In most cases dogs appear to be well in themselves although the haircoat may be poor. In some animals there is a history of previous pancreatitis (abdominal pain, vomiting and diarrhoea).

Your vet may suspect that your dog has EPI from the clinical signs. However, there are lots of other diseases that cause weight loss and diarrhoea and many investigations may be necessary. Diagnosis can be confirmed by blood tests.

Fortunately the management of EPI is relatively straightforward (at least in theory). If the disease is the consequence of an insufficient production of digestive enzymes then the treatment should be to supplement these enzymes. The enzymes are available as a powder or enteric coated capsules.

Dietary changes may be necessary to restrict the fat in the diet with additional triglyceride supplementation. Improvements in consistency of faeces should be seen within a few days of treatment although it may take several months for weight and appetite to return to normal.

In some cases short courses of antibiotics are also required to stabilise the bacterial population in the intestines. When untreated EPI results in a large amount of undigested food in the bowel and this allows the bacterial population in the bowel to flourish which can also affect bowel function.

In most dogs it is possible to manage the signs of EPI to allow dogs to regain and maintain their body weight (and maybe even put on some weight). However, the underlying problem will never go away and if diagnosed your pet will require treatment for the rest of its life. It is important to consider the cost implications of this when embarking on treatment initially.

If you have any concerns about your dog contact your own vet for further advice.

Blindness in dogs

Some causes of blindness in dogs, such as cataracts, are treatable. Other causes, such as progressive retinal atrophy (PRA), are not. If there is any doubt as to whether the blindness is treatable, then referral to a veterinary ophthalmologist is recommended.

At first glance that may seem like a strange question. However, dogs vary in their response to blindness. Dogs that go blind slowly usually cope better than dogs that become suddenly blind because they learn to adapt to their reducing vision. Older, slower dogs tend to cope better than younger, more boisterous ones.

Some dogs that have lost their sight over a long period of time navigate around so well that their owners do not recognise that they are blind. As dogs lose their sight they often initially become more cautious about going out in the dark and may be disorientated in dim lighting conditions.

Animals that are totally blind do not cope well in novel surroundings and may be unwilling to walk off the lead or may bump into objects.

In general, most dogs learn to cope very well with being blind, although inevitably there are exceptions. There are a number of things that you can do to help your dog adapt to blindness:

Keep their environment consistent

Blind dogs gradually develop a mental spatial map of their environment. This enables them to negotiate their way around familiar surroundings (this mental map can be accurate enough to convince many owners that their dog does retain some vision, even when totally blind).

  • Owners can help their pet develop a mental map by initially restricting their access to a small area of the house and garden before gradually extending the area. This is particularly important in cases of sudden onset blindness, or if a blind pet moves to a new home.
  • Try to keep items of furniture in familiar positions.
  • Avoid leaving objects in unfamiliar places (e.g. shopping bags on the floor).
  • Leave food and water bowls in the same place.
  • Leave the TV or radio on when your dog is left alone. The sound acts as an auditory cue to allow them to orientate themselves within the house.
  • Place tactile cues to aid orientation around the house. For example, placing mats at every room entrance allows blind dogs to feel these under their paws, thus helping them to orientate themselves within the house and negotiate their way into rooms. Likewise, in the garden they can learn to negotiate by locating paths or grass beneath their pads.
  • Take care in unfamiliar environments. It obviously makes sense to keep blind dogs on a lead or harness on walks.
  • Take particular care when meeting other dogs. Much of the initial social interaction between dogs is based on visual cues, for example determination of dominant or submissive status. Blind dogs are unable to respond to such visual cues, and as such are more at risk of attack should they encounter a dominant dog.

Consider training 

It can be helpful to consult an experienced dog trainer or behaviourist who may be able to give advice on ways that training can help improve the confidence and ability of blind dogs. Such considerations may include:

  • Positive reinforcement to increase their confidence.
  • Increasing their repertoire of auditory commands.
  • Use of training aids such as whistles.

Stimulate their other senses 

Remember that a blind dog still retains four other senses. Set aside some time to stimulate these, for example by giving your dog a daily massage and by getting used to talking to your pet more than you might to a visual dog. Whilst it is tempting to want to spoil your dog by feeding regular treats, bear in mind that blind dogs are likely to exercise less than visual ones, so try to ensure that weight control is maintained.

Bloat (gastric dilation)

Gastric dilation, or ‘bloat’ as it is often known, is a very serious condition mainly affecting large breed dogs with a deep chest. Dogs with bloat are restless and unable to settle, they may drool saliva and vomit frothy foam. If you suspect that your dog has bloat you should call your vet or emergency service at once. Time is of the essence (bloat can kill in less than an hour). Your vet will want to see your dog immediately but try not to turn up at the practice unannounced – if you call ahead they will be ready for you when you arrive.

Bloat is an accumulation of gas in the stomach. The gas can be produced from fermentation of food material in the stomach or from swallowing of air. In normal dogs, burping quickly relieves the pressure in the stomach but in some dogs there is a problem that prevents normal emptying of the stomach. Gas continues to build up causing the stomach to inflate like a balloon. As the stomach swells it may flop over to one side. This can block off the exit for gases – making the problem progress more rapidly. The stomach can also twist on itself. If this occurs the condition is termed gastric dilatation and volvulus (GDV) and this is quickly life-threatening.

Large breed dogs, particularly the German Shepherd Dog, Irish Setter and Great Dane, are most at risk from this condition. Bloat most commonly affects middle-aged or older animals.

Dogs that are highly stressed appear to be more likely to develop bloat and there is in an increased risk in any dog with a close relative that has also had bloat.

Generally the first signs noticed in a dog affected by bloat are restlessness coupled with retching and drooling of saliva. The dog may show attempts to vomit but only a little frothy foam may be produced. The abdomen may become swollen and firm to the touch (although this isnt always obvious). Affected dogs may look at their sides or show other signs of abdominal pain. Some dogs may cough and others want to drink a lot of water.

As the condition progresses the dog may have difficulty breathing and eventually will collapse and be unable to get up. If untreated, dogs that develop a twist in the stomach will die.

If you suspect that your dog has bloat, you should call your vet or emergency service at once. Time is of the essence because bloat can kill in less than an hour. Your vet will want to see your dog immediately but try not to turn up at the practice unannounced. If you call ahead they will be ready for you when you arrive and will therefore be better prepared to deal with the emergency.

Unfortunately you cannot change many of the risk factors for bloat. However some practical measures can help to reduce the risk.

Feeding several small meals daily (instead of one large one) can help reduce the risk in susceptible breeds and individuals. Since swallowing of air is increased when dogs eat quickly, it can be helpful to separate dogs when eating so that there is no competition for food and eating is not rushed. Special barrier bowls are available that are designed to slow down a dogs eating. Exercise and excessive drinking should be restricted for an hour before and after eating.

Contrary to common belief, feeding a dog from a raised food stand actually increases the risk of bloat,so avoid doing this and feed from the floor as usual.

Stress is another factor thought to influence the development of bloat. In highly strung dogs, an upset in normal routine, eg boarding kennels, dog shows and the introduction of a new dog to the household can bring on an episode, so owners should be especially vigilant at these times if they have a susceptible dog.

The diagnosis is based on the dogs history (i.e. what you notice and tell the vet) and a physical examination. Your vet will be looking to detect a distended gas filled stomach and other signs indicating the condition. Your vet will also take into account whether your dog is of a type likely to have a gastric dilation.

Diagnosis may be confirmed with an X-ray. This can also allow your vet to see whether the stomach is twisted or not a twisted stomach is much more dangerous. If there is no twist to the stomach, your vet may be able to pass a tube into your dogs stomach to allow the trapped gas to escape. The stomach contents can also be washed out through this tube which may help to improve the dogs condition.

Your vet will also want to take blood samples and perhaps an ECG (as dogs with bloat may develop abnormal heart rhythms). In severe cases, treatment may be started before all test results are obtained as early treatment may be essential to save the dogs life.

Animals with bloat may be suffering from shock. To treat this your vet will give intravenous fluids (a drip) and other drugs. To treat the bloat itself a tube is passed into the stomach to let some gas escape and reduce pressure on the internal organs. However, this is not possible in every case sometimes the tube cannot enter the stomach due to the way the stomach has twisted. In these cases it may be necessary to operate to empty the stomach.

Unfortunately the condition is serious no matter how it is managed. About 3 dogs in 20 will not survive even with surgery. Some dogs will have widespread organ damage at the time of surgery. This may not be known until surgery has actually started and the vet is able to examine the internal organs directly. Sometimes organs, or parts of organs, may have to be removed to save your pet’s life.

In nearly all cases a procedure to fix the stomach in place will be carried out. This procedure is called gastropexy. If this is not done about 8 out of 10 dogs will get a further episode of bloat.

Once the stomach has been deflated a tube may be fitted between the stomach and the body wall (a gastrostomy tube) to allow any further gas to escape safely.

A gastrostomy tube is a rubber pipe that is placed at the time of stomach surgery. One end of the tube is attached to the inside of the stomach. The other end passes through the stomach wall and then through the body wall and fixed to the outside of the body. This tube serves 2 purposes; any gas produced in the stomach can be safely vented through the tube without risk of stomach dilation; and the stomach becomes fixed to the body wall at the point where the tube leaves. This prevents stomach twisting ever happening again.

The gastrostomy tube may be left in place for a week and can be removed without further surgery when your vet feels that your dog is making good progress. After removal a small hole will be left in the body wall but this soon heals over.

Once a dog has had gastric dilation we know that they are at risk of developing it again. In fact 8 out of 10 dogs with bloat will have a recurrence if preventative measures are not taken. At the time of surgery your vet will attach the stomach wall loosely to the inside of the body wall (known as gastropexy). This prevents the stomach from moving and twisting and significantly reduces the risk of a recurrence. In fact only 3 of a hundred dogs with bloat will have a second episode after this procedure.

If your dog had a gastrostomy tube placed then this also causes the stomach to stick to the body wall at the scar site once the tube is removed and the wound has healed.

Bloat is a life-threatening condition in dogs and emergency treatment is important to ensure the best outcome. You may want to discuss risk factors for your dog and possible preventative measures with your own vet.