Month: July 2018

Dental disease in your dog

Dental disease is very common in dogs. Surveys show that after the age of three years, about seven out of ten pets have some kind of tooth disorders. If left unattended these may cause irreversible damage to the dog’s teeth, gums and jaw bones. Dental disease can be prevented by stopping the build up of plaque.

Plaque is a yellowish white deposit made up of bacteria and debris which forms around the surface of the teeth. In time it hardens to become yellowish brown tartar (sometimes called calculus) at the base of the tooth which gradually spreads until it may cover the whole of its surface.

As well as the visible tartar there may be other indications of disease. Foul breath is very common and the pain resulting from advanced dental disease may cause difficulties in eating. If your dog dribbles excessively and sometimes this is flecked with blood or shows signs of pain and discomfort such as head shaking and pawing at its mouth it may have problems with its teeth.

The tartar hidden below the gum line is the main cause of problems. It contains bacteria which will attack the surrounding gum tissue, causing painful inflammation (‘gingivitis’) and infection can track down to the tooth roots. Pus may build up in the roots and form a painful abscess. This inflammation wears away tissue from the gum, bones and teeth and, as the disease becomes more advanced, the teeth will loosen and fall out.

Bacteria and the poisons they produce can also get into the blood stream and cause damage throughout the body in organs such as the kidneys, heart and liver.

If your pet has advanced disease and is in obvious pain, your vet may need to take X-rays of your pet’s head (under general anaesthetic) to see whether there are any deep abscesses. Any loose teeth will have to be removed because the disease is too advanced to be treated. Your vet may prescribe antibiotics before doing dental work if there are signs of infection. Your vet will remove the tartar and clean the remaining teeth, usually with an ultrasonic scaling machine.

Finally, your dog’s teeth will be polished to leave a smooth surface which will slow down the build up of plaque in the future. However, it is inevitable that plaque will re-appear. To keep your dog’s teeth in good condition it is likely that they will need regular scaling and polishing, in some cases at intervals of between six and twelve months.

In the wild your pet’s teeth would be much cleaner because its diet would contain harder materials than are found in commercially tinned or packaged foods. Dogs naturally eat the bones, fur, etc. of their prey which wear away the deposits of tartar.

Replacing soft foods with dry or fibrous materials will slow the build up of plaque. The extra chewing involved helps control infection because it stimulates the production of saliva which has natural antibiotic properties. There are special diets available to help maintain clean teeth, please ask your vet for further advice.

Brushing your dog’s teeth is just as important in preventing dental disease as brushing your own. Ideally your pet should get used to having its teeth cleaned from an early age. Wrapping a piece of soft gauze around your finger and gently rubbing the pet’s teeth should get it used to the idea. You can then move on to using a toothbrush specially designed for dogs or a small ordinary toothbrush with soft bristles.

Toothbrushes which fit over the end of your finger are available. Your vet can supply you with suitably flavoured toothpaste which your pet will enjoy. There are also some mouth washes and antibacterial gels that can help reduce plaque deposits and prevent infection. Do not attempt to use human toothpaste which will froth up in the mouth, your pet will not like the taste and it could do it serious harm.

At first your pet may resist but with gentleness, patience and persistence most pets can be trained to accept having their teeth cleaned. A regular brushing every day or at least three times a week will significantly reduce the risk of your pet suffering serious problems or needing frequent general anaesthetics to treat advanced dental disease.

Preventative healthcare for your pet is very important. Regular brushing of your pet’s teeth from a young age can prevent the need for veterinary dental attention.

Fainting (syncope)

Fainting (syncope) does occur in dogs but is less common than in people. When a dog faints it briefly loses consciousness and falls to the ground motionless but in most cases recovers within a few moments without treatment. It is important, but often difficult, to differentiate between fainting and fitting because the causes and treatments for the two conditions are very different. In addition, some other medical problems (for example, reduced blood levels of glucose, or certain diseases of the nerves and muscles) can cause episodes of weakness or collapse. If your dog collapses for whatever reason contact your vet immediately for further advice.

Fainting occurs when there is an insufficient blood supply to the brain. When a person is standing up the head is higher than the heart and therefore blood has to be pumped uphill and so if there are any problems with the circulation it is made more obvious. In dogs their head is almost in line with the heart – this is why fainting is less common in dogs than people.

During a fainting episode your dog will fall to the ground, usually on its side. It may show involuntary muscle twitching and lose control of its bladder or bowels – these features can also be seen during a seizure and this is why some owners mistake a fainting episode for a seizure. However, during a faint, the body as a whole may be limp and floppy and the tongue and gums may be much paler than normal for your dog – these features are not typically seen during a seizure.

There are a number of different causes of reduced blood supply to the brain. Generally, reduced blood supply to the brain is caused by episodes of low blood pressure. This can be caused by the heart beating at an abnormally rapid or slow heart rate, or even stopping completely for a few seconds. Low blood pressure can also result from very weak contractions of the heart or from narrowing or excessive leakage of the heart valves.

Fainting is more common in some breeds of dog, e.g. Miniature Schnauzers, Westies, Boxers and Dobermanns because these breeds are more likely to suffer from specific cardiac diseases that can cause fainting. Many of the medical conditions that can cause fainting are more prevalent in older dogs. In younger animals fainting is occasionally associated with congenital heart disease. However, it is important to stress that some dogs, especially Boxers, can faint at any age in the absence of underlying heart disease. This often happens following excitement or a specific set of circumstances.

Some drugs can increase the likelihood of your pet fainting. If your pet is taking any medication be sure to mention it to your vet, even if you think they will already know about it.

Your vet will first want to be sure that your pet is fainting and not having a seizure. First your vet will want to know about the episodes – when they happen and what the dog is doing at the time. Although it can be very frightening the first time your dog faints you should try to stay calm and record as much information as you can to pass on to your vet.

Try to time how long your dog is unconscious (it always seems much longer than it really is) and what your dog was doing before and immediately after the episode. In between fainting episodes most animals are completely normal and so your vet may be unable to detect anything on clinical examination. If you are able to capture one of the episodes on video (for example, on your mobile phone) this can be useful for the vet.

There are enough different causes of fainting that your vet will not usually be able to tell what is wrong with your dog just by looking at them. Cardiac testing will normally be required and an ECG recording (electrical recording of the heart beat) is a vital component of this, often accompanied by ultrasound and sometimes x-rays of the heart. It is likely that blood tests will also be required.

Tests can sometimes go on for weeks or months, depending on how often your dog is fainting. In some cases your vet may arranage for your dog to be fitted with a heart monitor to wear at home. In some cases nothing abnormal will ever show up on the tests, offering reassurance that it is unlikely that a serious medical or cardiac problem was causing the fainting

The treatment for fainting depends on the underlying cause. In some cases there is no treatment and dogs may continue to have intermittent fainting episodes throughout their lives. It may be possible to determine when attacks are likely to occur (eg a dog may always have an attack when it gets very excited) and it might then be possible to avoid circumstances likely to trigger episodes.

In specific cases drug treatment may be available which will help minimise the problem and some conditions may require a surgical procedure (for example, implantation of a pacemaker) to help reduce the problem.

However, the good news is that many fainting episodes are not linked to serious underlying disease and in these dogs the frequency of episodes can often be reduced by careful management. When they do occur the episodes last less than a minute with a rapid full recovery to normal behaviour almost immediately. The biggest concern is to rule out any serious underlying disease that may be a threat to your pet and for your vet to be able to recommend the best treatment in individual cases.

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

Epilepsy (seizures)

If your dog has had a fit (convulsion) you will know how frightening it can be. Fits are not uncommon in dogs but many dogs only ever have a single fit. If your dog has had more than one fit it may be that he has epilepsy. Just as in people, there are tablets for dogs which can control the fits and allow your dog to live a long fulfilling life.

Epilepsy means repeated fits due to abnormal activity in the brain. It is caused by a problem in the brain itself. If fits occur because of a problem elsewhere in the body, for example a heart ailment which stops oxygen reaching the brain, this is not epilepsy.

Some dogs seem to know when they are about to have a fit and may behave in a certain way which you will come to recognize as meaning that a fit is about to start. Often they just seek out their owner’s company and come to sit beside you.

Once the fit starts a dog is unconscious. They cannot hear or respond to you. Most dogs fall onto their side and make running movements with their legs. Sometimes they will cry out and may lose control of their bowels or bladder. Most fits last between 1 and 3 minutes – it is worth making a note of the time the fit starts and ends because it often seems that a fit goes on for a lot longer than it really does.

After a fit dogs behave in different ways. Some dogs just get up and carry on with what they were doing whilst others appear dazed and confused for up to 24 hours afterwards. Dogs often have a set pattern of behaviour that they follow after every fit – for example going for a drink of water or asking to go out in the garden to the toilet. If your dog has had more than one fit you may well start to notice a pattern of behaviour which is typical for your dog.

Most epileptic fits will occur while your dog is relaxed and resting quietly. It is very rare for a fit to occur at exercise. Often fits occur in the evening or at night, and again it is common for a pattern to develop which you will recognize as specific to your dog.

The first thing to remember is to stay calm. Remember that your dog is unconscious during the fit and is not in pain or distress. The fit itself is likely to be more distressing for you than your pet. Make sure that your dog is not in a position to injure himself, for example by falling down the stairs, but otherwise do not try to interfere with him. Never try to put your hand inside his mouth during a fit as you will very likely get bitten.

It is very rare for a dog to injure themselves during a fit. Occasionally they may bite their tongue and there may appear to be a lot of blood but is unlikely to be serious. If a fit goes on for a very long time (more than 10 minutes), then it is possible for the brain itself to become a bit more damaged.

When your dog starts a fit make a note of the time. If your dog comes out of the fit within 5 minutes then allow him time to recover quietly before contacting your vet. If this is the first fit your dog has had your vet may ask you to bring your dog into the next routine appointment for a check, provided he has no more fits in the meantime. It is far better for your dog to recover quietly at home rather than be bundled into the car and carted off to the vets straight away.

If your dog does not come out of the fit within 5 minutes, or has repeated fits close together, then you should contact your vet immediately and they will want to see your dog straight away. Always call your vets practice before turning up at the surgery to be sure that there is someone at the surgery who can help you.

There are many things besides epilepsy which cause fits in dogs. When your vet first examines your dog they will not know whether your dog has epilepsy or another condition. Epilepsy most commonly starts in dogs between 1 and 5 years of age, so if your dog is outside this age range then it is more likely that they have a different problem.

There are a whole range of tests which need to be done to make sure that there is no other cause of the fits. These include blood tests and possibly X-rays, or other tests such as brain scanning. If no other cause can be found then a diagnosis of epilepsy may be made.

Often there is no apparent reason why your dog should have developed epilepsy. In some breeds of dog, most notably the German Shepherd Dog, it is inherited and is most often seen in males. Sometimes it is the result of minor damage to the brain caused by a blow to the head or as a result of oxygen starvation during a difficult birth. Usually the fits would start many years after the damage had occurred so it is not easy to make a connection between the two events.

If your dog has only had one fit your vet may advise waiting before starting any treatment. The drugs used to treat epilepsy will often not stop the fits altogether but will make them less frequent. Therefore, it is important to know how often the fits would happen without treatment to be sure that the treatment is having an effect. Once your dog starts on treatment it is likely that this will have to be continued for the rest of his life. As some dogs only ever have one fit they may end up having treatment which they did not need.

Once your dog starts on tablets these must be given at roughly the same time every day. If you stop the drugs suddenly you may cause your dog to fit. It often takes a few months to get the dose of drug just right for your dog. During this time your vet will keep in regular contact with you, and may need to take a number of blood samples from your dog to check that the blood levels of the drug are not too high or too low.

It is rare for epileptic dogs to stop having fits altogether. Drugs may control the fits so that they do not affect your dogs lifestyle but, in most cases, if you stopped treatment the fits would come back. However, provided your dog is checked regularly by your vet to make sure that the drugs are not causing any side effects, many epileptic dogs lead a full and happy life.

Anal sac disease

Anal sac problems are very common in pet dogs and something frequently seen by veterinary surgeons. In most cases, the conditions are easily treated, though they can sometimes recur. This factsheet provides information on the location and function of anal sacs as well as discussing common conditions and their treatment.

Anal sacs (sometimes referred to by vets as anal glands) are two small pockets located on either side of the dog’s bottom with openings to the surface at about the 4 and 8 o’clock positions. They produce a strongly scented substance that is deposited on the faeces and contributes to scent and territorial marking in dogs. The passage of faeces usually results in emptying of the glands in healthy dogs. The strong scent, designed to last a long time in the environment, is part of the way dogs communicate with one another.

Anal sacs may also occasionally be emptied in times of distress or panic e.g. a dog fight or a road traffic accident, resulting in a strong smell coming from the injured dog. The secretion usually has an unusual fishy odour, unpleasant to the human nose.

In this very common condition, the anal sacs fail to empty, possibly because the ducts leading to the surface are too narrow, or because the consistency of the dog’s faeces is too loose. Many dogs have anal sacs that do not empty normally. When they get very full, they can cause discomfort, usually showing as:

  • Licking the anal area excessively.
  • Sitting down abruptly and clamping the tail.
  • Dragging the bottom along the ground (‘scooting’) – often misunderstood by owners as a symptom of worms.
  • General irritability and restlessness.

The anal sacs can become infected, possibly as a result of chronic blockage (see above). If an abscess develops, the symptoms can be severe. All the signs of anal sac blockage may be present and the affected dog may be very uncomfortable and even aggressive if the hind quarters are approached or touched. The abscess may burst out to the surface, producing a foul smelling or bloody discharge. Symptoms usually ease off at this point as pressure is released and pain decreases.

In the case of straightforward blockage, periodic emptying by the veterinary surgeon is required. Some dogs need this done every 4-8 weeks; in others it is a much less frequent occurrence. Occasionally, it may be possible for an owner to learn how to perform this task, though many prefer to leave it to their vet.

Sometimes changing the composition of the diet may help. Adding more fibre to promote a bulkier stool is often recommended. It has to be said that this does not always work but is certainly worth trying.

If infection is present, a course of antibiotics may be needed. The anal sacs may also be flushed with saline or dilute antiseptic solutions under sedation or anaesthesia to help eliminate the problem. Abscesses may require surgery to aid drainage and resolution of the infection, together with a course of antibiotics and, often, painkillers.

Persistent anal sac problems may be treated by surgical removal of the anal sacs. This tends to be reserved for dogs experiencing frequent, moderate to severe problems with early recurrence after the above treatments. Removal of the anal sacs carries a small risk of incontinence due to the proximity of important nerves in the area. This may be temporary or permanent.

Much less common are tumours affecting the anal sacs. Symptoms might initially resemble full or infected anal sacs. Tumours are identified by biopsy; treatment by surgery or other means may be possible. Unfortunately, tumours in this area may prove to be malignant and ultimately life-threatening.

Anal sac problems may also be associated with another condition called anal furunculosis. As part of the treatment for that condition, removal of the anal sacs may be recommended.

How often should my dog’s anal glans be emptied?

Some dogs never need them emptied. If your dog exhibits any of the signs described above, then a check up should be arranged, but if no signs are present then the anal sacs should be left alone.

My dog seems to have a bad smell. Is it the anal sacs?

It could be, but other common conditions can also result in a bad smell e.g. ear infections, mouth infections and skin conditions. Your vet will check for these and advise on treatment.

Do anal sac problems cause constipation?

Some dogs may appear to strain, though they may not be constipated as such but just responding to irritation around their bottom area. Note that full anal sacs may occur after a bout of diarrhoea. The very loose faeces means that the sacs are not emptied as usual.

Brain tumour or cancer

Brain tumours in dogs are unfortunately as common as they are in people. Brain tumours can be devastating diseases and sadly cannot be cured in most animals. At present the only options for treatment are to improve the animal’s quality of life and help them to live for as long as possible. Unfortunately all brain tumours are eventually fatal diseases.

A tumour (or cancer) is a growth of abnormal cells within a body tissue. Tumours in the brain can develop from brain cells (primary brain tumour) that have started to grow uncontrollably or the tumour may be the result of spread of a tumour elsewhere in the body.

Common primary brain tumours include tumour arising from cells forming the lining of the surface of the brain (meningioma), the lining of ventricle (ependymoma), the choroid plexus (choroid plexus tumour) or the brain parenchyma itself (glioma). Fragments of tumours elsewhere in the body can break off from their primary source and travel in the blood to the brain where they settle and start to grow.

The signs seen in animals with brain tumours are usually the result of the tumour growing and causing pressure on the surrounding normal brain tissue. This causes brain damage and inflammation.

Brain tumours can cause a wide variety of clinical signs which vary according to the part of the brain that is affected. Often the first sign to develop is seizures (fits). These seizures are often very severe causing the dog to collapse, salivate profusely, thrash around and occasionally void its bowels and bladder. Unfortunately, these seizures are likely to be permanent.

Other signs commonly seen are blindness, changes in the dog’s personality, profound lethargy, circling and disorientation. Some people may notice that their dog appears to have a ‘headache’. As with seizures, some of these signs may be permanent whatever the treatment course that you decide upon.

Your vet may suspect that your pet has a brain tumour because of the signs you describe. The brain cannot be seen on standard X-rays so special diagnostic tests are needed to allow your vet to take pictures of your pets brain.

Diagnosis of brain tumours is based on imaging the brain either with a CT-scan or an MRI-scan. Although these tests are very good for detecting the presence of a mass in the brain, they are not good at identifying the exact nature of this mass (i.e. whether it is a tumour, inflammation or even bleeding within the brain).

A sample of the fluid from around the brain may need to be taken to rule-out an inflammation of the brain and, in rare cases this can reveal the presence of a certain type of tumour called lymphoma. In order to confirm the exact cause of the mass and – if it is a tumour – to find out how malignant it is, a tissue sample must be collected. This sample can be obtained by inserting a biopsy needle through the skull. If surgical removal of the mass is planned a sample may simply be collected at the time of surgery.

Aggressive tumours may spread around the body (metastasise). Brain tumours can spread to the chest, and tumours from other sites (especially lung, liver, prostate, and mammary gland) may spread to the brain. X-Rays of the chest and abdomen as well as abdominal ultrasound may be necessary to confirm that the tumour is not elsewhere in the body.

Advances in veterinary care for pets mean that brain tumours can be treated, although unfortunately there are few tumours which can be cured. Treatment is usually aimed at providing your pet with the best possible quality of life for as long as possible. Whatever treatment course you decide upon, if your dog is having seizures they should be given medication to control these as the seizures are likely to be permanent.

The treatment and prognosis for brain tumours vary with the type of tumour. The most appropriate treatment for an individual depends on a number of factors, including the type of tumour and the general health of the patient. There are 3 basic options for the treatment of tumours:

Medication alone

There are few chemotherapy options for brain tumours because the brain is a very protected site and most drugs cannot penetrate it. However treatment may help to reduce some of the signs seen in a patient with a brain tumour.

A combination of anti-inflammatory medication (corticosteroids) to reduce the swelling and pressure caused by the tumour, and drugs to reduce the severity and frequency of seizures can be prescribed. In some cases this may relieve a lot of the symptoms and make the animal feel a lot better. However, animals on this combination of drugs are often very thirsty and hungry and may need to go to the toilet more often occasionally this can cause problems with wetting in the house.

The drugs used to control seizures may initially make your pet more sleepy but most dogs get used to the drugs after a couple of weeks. This approach does not cost much and there is little risk of making your pet worse, however, in some cases this may only provide relief for a couple of months.

Medication and radiation therapy

While many brain tumours in dogs are relatively benign and amenable to surgery, some are deep seated and therefore pose significant surgical risks. Radiation therapy can result in dramatic and rapid improvement of signs. The benefits of this treatment far outweigh the risks in most pets. Most animals suffer any side-effects from the radiation treatment but these might include; occasional nausea, mouth ulcers, ear infection or, rarely, blindness. Most of the side-effects of radiation can be controlled with additional medication.

The advantage of using radiation treatment in addition to medication is that it can provide a longer period of good quality of life than with medication alone. Unfortunately, radiation rarely completely destroys the tumour and average remission times are 8 to 14 months before the tumour recurs.

Medication, radiation therapy and surgery

The ultimate goal of cancer surgery is to remove the tumour completely. Unfortunately, this is rarely possible with brain tumours and there are nearly always tumour cells left behind which cause the tumour to regrow. However, by removing as much of the tumour as possible at surgery, the remaining cells may become more sensitive to radiation. The polytherapy approach (combination of medication, surgery and radiation) is the mainstay of treatment for most brain tumours in humans. The aim of treatment is to remove the bulk of the tumour by surgery to give other therapies a better chance of success.

Surgery also allows the vet to obtain a sample of the mass and identify its nature, which may make it easier to give a more accurate prediction of how well the patient is likely to do. Not all brain tumors can be removed surgically, practicality depends on their position within the brain. Tumours that are on the brain surface are more likely to be amenable to surgery. To reach a tumour deep within the brain the surgeon would have to cut through a large area of healthy brain tissue and this could have devastating effects for the recovery of the patient.

Surgery is the most invasive and costly option. Although many dogs recover well and without complication brain surgery can (on rare occasions) cause irreversible damage to the brain. Some owners report that their pet’s personality and behaviour has changed after surgery. Brain surgery does carry a risk, particularly if the patient has other health problems as a lengthy anaesthetic is needed. Occasionally the patient may not recover from the surgery. The benefits of this option are that it potentially offers the longest period of quality of life for your pet.

The aim of treatment for a brain tumour in pets is to prolong the period in which they enjoy a good quality of life. Your vet will not want to prolong your pet’s life if your pet is unhappy. Discuss all your concerns with your vet before your pet starts treatment and at every stage of the course. It will always be your decision as to when your pet is no longer happy. At this time the best option for your pet will be to ask your vet to put him or her to sleep.

Predicting how long your animal can live with a brain tumour can be very difficult as this estimation depends on many factors including the type of tumour (which determines how quickly it grows), its size and place within the brain and finally the treatment used. Although many animals survive only a matter of months after diagnosis of a brain tumour, with help they can have a good quality of life.

If you decide to opt for treatment this time may help you to come to terms with what is happening to your pet and to have some happy memories to keep. As a rough guide, average remission time ranges from 1 to 6 months with corticosteroids alone, from 8 to 14 months with radiotherapy alone and 12 to 20 months with surgery followed by radiotherapy.

Anal sac gland carcinoma

Anal sac gland carcinoma (also known as apocrine gland carcinoma of the anal sacs and anal sac adenocarcinoma) is a malignant tumour of the anal sacs of the dog. It is a relatively uncommon tumour but it is seen with increased frequency in English Cocker Spaniels in particular and other spaniels to a lesser degree.

The anal sacs are 2 scent glands located either side of the anus in the dog. They are usually emptied when a motion is passed. In some dogs a tumour develops in the glandular tissue in the sacs. The fact that the disease is more common in some breeds of dogs suggests that genetic factors are involved but no one really knows for sure why some dogs develop the disease. In many cases this is the only site in which the tumour is growing but sometimes the tumour may spread to the lymph nodes or via the bloodstream to places like the lungs, liver and spleen.

A large proportion of these tumours are discovered by chance when a dog is presented for evacuation of the anal sacs. Sometimes the dogs develop irritation of the anal sacs which prompts this check in the first place, though this is unusual. In some cases owners actually see a swelling under the tail and next to the anus but it is rare for the tumour to grow big enough to cause problems at the original site.

You may notice changes in your pet that reflect spread of the tumour or are a consequence of substances produced by the tumour. Sometimes these tumours produce a hormone that causes excessive drinking and urination. This may be the only problem evident prior to diagnosis of the tumour.

Your vet may suspect the disease from examination of your pet and may be able to feel a swelling in the gland on rectal examination of your dog. In order to plan the most appropriate treatment, your vet will want to know the extent of the tumour. They will want to take samples if they suspect that the tumour has spread to the lymph nodes or to other organs. In addition they will want to take some blood tests and may need to check blood calcium levels as this is related to the hormone disturbance noted above.

The presence or absence of spread can be determined by X-rays and ultrasound examinations. These can usually be performed under light sedation.

There are a number of treatment options available for the management of anal sac gland carcinoma. Decisions are made on the basis of a number of factors, primarily whether and where the tumour has spread at diagnosis.

For patients with small (less than 3cm diameter) tumours and no evidence of spread of the tumour, surgical removal of the tumour is likely to be the most appropriate therapy. For patients where the tumour cannot be completely removed, radiotherapy can be used post-operatively to improve the tumour control.

For patients with larger primary tumours but still no evidence of spread, chemotherapy can be used to attempt to shrink the tumour, before surgery. This makes the surgery easier and may reduce the risk of post-operative complications. Again, radiotherapy may be appropriate following surgery to improve the duration of the resulting complete remission.

In some patients, where the tumour has spread to the lymph nodes but no further, the treatment plan is determined by whether or not those enlarged lymph nodes can be removed surgically. As always, the aim is to achieve optimal quality of life first and foremost and a good long life second. Therefore, if it is apparent that the enlarged lymph nodes can be removed without causing undue risk, they are removed.

If the lymph nodes look like they cannot be removed in their entirety or without presenting the patient with undue risk, they can be left or managed by either chemotherapy or radiotherapy or sometimes by a combination of these. Subsequent surgery can be performed in these dogs to remove other lymph nodes that become enlarged months or years in the future.

The average life expectancy for a dog with a small tumour that is removed by surgery is three years and three months. Dogs with larger tumours that have chemotherapy before surgery have an average life expectancy of two years.

For patients where the lymph nodes are involved but they can be removed there is an average life expectancy of sixteen months. If the lymph nodes cannot be removed then sadly less than 50% of these patients live more than 12 months from the time of diagnosis but as before, their quality of life is paramount during this time and measures are always being taken to ensure their well-being.

The final group of patients is the group with cancer that has spread throughout their body. Of course this is the worst case scenario but even in this situation patients can enjoy a normal quality of life for long periods of time with appropriate management.

Despite the gravity of a diagnosis of malignant cancer, some patients can enjoy an extremely prolonged period of complete normality and an excellent quality of life with appropriate therapy.

von Willebrand’s disease (vWD)

This is the most common inherited bleeding disorder in dogs. It causes defective blood clotting due to reduced amounts of von Willebrands factor (vWF). This is a protein which helps tiny blood cells called platelets stick to each other and form an effective blood clot in the body.

Many breeds may be genetic carriers of this trait, but problems are most likely to be seen in Doberman Pinschers, German Shepherd dogs and Labrador Retrievers. Both sexes are affected equally.

Affected dogs can have poor blood clotting, making them prone to bruising and bleeding. This can be serious and dangerous if these dogs have to undergo major surgery for any reason, or if they are badly injured. Extensive and continued bleeding can occur from even small blood vessels, complicating anaesthesia and surgery. Protracted bleeding may also occur during normal events such as oestrus and giving birth in female dogs. Seriously affected puppies are likely to die.

As dogs get older, they may be less likely to bleed excessively. However, the presence of another disease (often the case in patients receiving surgery) can make the underlying bleeding tendency worse.

In some dogs the symptoms are so mild that no clinical problems are caused.

Yes, if they are tested. Some routine measurements of blood clotting are normal in dogs with vWD, e.g. they have normal numbers of platelets in their blood and normal amounts of the other proteins involved in blood clotting.

A simple screening test known as the Buccal Mucosa Bleeding Time (BMBT) is used to check for effective blood clotting. If this test is prolonged or suspicious (i.e. if a stable blood clot is not forming), a measurement of von Willebrands factor in the plasma is made. Affected dogs will have abnormally low levels of vWF or perhaps abnormalities in the molecular composition of the vWF.

Testing is generally only done where there is suspicion of disease or in dogs facing major surgery. If you have any suspicions that your dog’s bleeding time is abnormal then testing would be sensible. Continued bleeding for hours after minor injuries, eg a torn nail, superficial skin wounds, loss of a tooth, all point towards a possible blood clotting problem. In normal dogs bleeding should stop after 10-20 minutes.

Dogs which are already bleeding can be treated with plasma or blood transfusions from healthy dogs. The healthy plasma contains vWF which the body can then use to assist blood clotting. Cryoprecipitate is a concentrated form of vWF and is ideal but not always available. Drug treatment using a substance known as vasopressin is also possible though this drug may not always be kept in many general practices.

If these treatments are not possible or available, intravenous drips are given to replace fluid losses in blood together with surgical or other measures to stop bleeding.

No, in an attempt to limit occurrence of this disease breeding should not occur. Screening of potential breeding animals should be carried out beforehand, if possible, in an attempt to pick up animals not showing any symptoms, but carrying the disease. This is relevant in Dobermans particularly, since this is the breed most commonly associated with the disease.

Urine samples: how to collect

Tests are used by vets to help them diagnose disease in animals that are ill, which means your vet may ask you to bring in a urine sample (water sample) from your pet to help find out what’s wrong with your dog. Urine samples are usually taken to check for diseases such as diabetes or cystitis. Urine samples are also often used as part of a routine health check to detect hidden disease before the development of obvious symptoms; this allows your pet to be treated earlier and more effectively.

You will need a clean, wide-necked container to collect the sample in, and a clean jar with a tight lid to store it in (your vet will be able to give you one of these if you ask). It is important not to use jars that have previously contained jam or honey as this can affect the results of the test.

In most cases, your vet will ask for a mid-stream sample (a urine sample) collected by placing a suitable container (a small bowl or dish) under the stream of urine whilst your dog wees. Some dogs and bitches will stop weeing every time you approach them with your container. You may be able to catch them out by using a long handled collecting pot. Attach a pot, for example a clean yoghurt carton, to a stick or broom handle using sticky tape. Take your dog out on a lead and once he or she starts to wee, move the carton under the stream of urine to collect the sample.

In most cases your vet will only need a few teaspoons of urine to perform all the tests. If a larger sample is needed your vet will tell you.

Sometimes dogs with incontinence or cystitis will wee on the floor in the house. If you find it absolutely impossible to collect a sample from your pet then a sample collected from the floor may be better than nothing (provided the floor is clean). If you need to collect a sample from the floor you can use a pipette or syringe to suck up the urine and then squirt it into the pot. If you collect the sample in this way then tell your vet as there are some tests that cannot be performed on samples collected from the floor.

If you really cannot get a urine sample your vet will probably suggest that they take your pet into the hospital and collect the sample for you. Samples can be collected directly from the bladder using a catheter passed up the urethra or via a needle placed into the bladder through the tummy wall. Both these procedures are simple and carry few risks for your pet.

Pour the sample into a clean, screw-topped container; write your dogs name, your name and address and the date the sample was taken on the jar. If you cant take the sample to the vets immediately, it is best to store it in the fridge for a maximum of 12 hours.

Urinary incontinence

Urinary incontinence means the loss of ability to control urination and can be caused by a variety of diseases. Incontinence is quite common in dogs but is usually more of a nuisance to the owners than a cause of distress to their pet. Urinary incontinence is more common in females than males because of the anatomical differences in the urinary tract especially the shorter urethra in the female.

In the normal animal urine is produced in the kidney. It drains through tubes from the kidneys to the bladder (the ureters). Urine is stored in the bladder until a convenient time for voiding. The bladder is an expandable bag that slowly stretches as it fills with urine. Urine leaves the bladder and drains to the outside through another tube (the urethra).

In the normal animal urine is kept in the bladder because the urethra is flattened. The urethral wall is made of elastic tissue and muscles that normally keep it flattened so that urine cannot flow. The muscles in the wall of the urethra are stronger in entire females (because of the hormones in the blood). When they have been spayed female dogs have lower oestrogen levels and because the urethra muscles are weaker they may be more prone to leaking urine.

When the bladder is full the bladder wall is stretched and the animal has a feeling that the bladder needs to be emptied. Contractions of the bladder muscle increase the pressure in the bladder and cause urine to flow out through the urethra. The impulse to void urine can be over-ridden by conscious control for some time (until the animal can reach an appropriate site for urination) but eventually the bladder must be emptied.

Incontinence can occur as a result of breakdown of any of the mechanisms that control normal urinary function. In most cases urine leakage occurs because the pressure in the bladder is higher than that in the urethra. This can be due to increased pressure in the bladder, i.e. bladder over-distension, or reduced pressure in the urethra, i.e. weakness of the urethral muscle.

There are many causes of incontinence. Some animals are born with abnormalities in the urinary tract. Others develop problems later in life – neutered bitches are more at risk of developing urethral problems and, in entire male dogs, incontinence is often related to prostatic disease. Sometimes back problems can cause pressure on the nerves to the bladder resulting in incontinence.

Some breeds and types of dog are more at risk of developing incontinence. The most common cause of urinary incontinence is urethral sphincter mechanism incompetence (USMI). This is most often seen in female, large breed dogs and often those breeds that have docked tails, e.g. Old English Sheepdogs and Rottweilers. In animals with USMI incontinence most often occurs when the dog is lying down.

Some animals have an underlying problem with the urinary tract so that it doesn’t work as well as it should. However, they are able to control urination unless something else happens to make extra work for the urinary system. If these animals drink a lot they develop a very full bladder that puts extra pressure on the urethra.

If your dog is incontinent you may see urine dripping from its vulva or penis or, more likely, you will find wet patches where your dog has been lying. Sometimes there are only tiny wet patches or the bed may be soaked. Often the urine is quite dilute and might not smell very strongly.

The time of urine leakage may vary depending on the cause of the incontinence. If the muscles in the urethra are weak urine is more likely to leak when the dog is lying down (because pressure on the bladder is greater) or when the dog is excited (stress incontinence).

Dribbling of urine after urination is more often seen with infections (like cystitis), cancers and abnormal development of the ureters (ectopic ureters).

The age of your pet when you first noticed the problem often provides a useful clue as to the cause of the incontinence. Young animals are more likely to have congenital problems such as ectopic ureters. It is important for your vet to have an accurate description of what the incontinence is like in your dog – so try to explain clearly what signs you have noticed. If your dog appears to be straining without passing any urine they may have a blockage or irritation in the bladder (cystitis) or urethra (urethritis).

A full physical examination will help to rule out potential causes of incontinence. Your vet will feel your dog’s belly to see how big the bladder is. Your vet will need a urine sample from your dog to send for tests in case there is an infection. Routine blood screens are useful to rule out other diseases, particularly those resulting in excessive drinking which may make the incontinence worse.

If your dog has urinary incontinence your vet will need to perform some tests to try to find out what is causing it. X-rays and ultrasound are the most important tests in investigation of incontinent patients. Special X-rays (where contrast is put into the urinary system) may help your vet to identify anatomical abnormalities in the ureters and bladder and your dog will need a general anaesthetic for these. In many cases of urinary incontinence x-rays are normal (but it is still important that they are done to ensure nothing serious or treatable is missed). Ultrasonography can also be helpful in assessing for ectopic ureters, bladder cancers, anatomical defects and chronic thickening of the bladder wall associated with trauma or infection.

If your vet has ruled out medical and structural problems they may want to try some treatment to see if the incontinence can be controlled.

The treatment for urinary incontinence depends on the cause. A specific treatment plan should be worked out for individual cases. If an underlying condition is identified then this should be managed appropriately. If your dog has a number of problems that increase its chance of being incontinent, then removal of just one of them may be sufficient to resolve the problem. Urinary tract infections must be treated and anatomical abnormalities, e.g. ectopic ureters, can be corrected by an operation.

The most common cause of incontinence in bitches is a weakness in the outflow from the bladder (called USMI). There are some drugs that can help to tone up the muscle in the urethra and make the seal better. Phenylpropanolamine and diethylstilboestrol can improve contraction of the urethra. These medications may need to be continued permanently but if this is the case the minimum effective dose must be found.

If your dog has USMI and starts on medical treatment that controls the signs it is likely that they will need to continue to receive this treatment for the rest of their life. Your vet will want to monitor your pets progress and will adjust the dose of treatment as needed.

Separation anxiety

We ask a lot from our dogs when we expect them to fit into our hectic modern lives. Happily most dogs adapt to our lifestyle with ease but there are a few dogs out there for whom the modern way of life can get a bit too stressful at times. Some of these dogs turn to destruction as a way of releasing their feelings. Living with these dogs can be very stressful for owners.

As its name suggests, this disorder in dogs is caused by distress at being parted from their owner. It seems to be more common in some breeds than others and may partly be the result of poor socialisation in puppyhood.

Dogs like to be part of a pack and (in most cases) see their owner as head of the pack. It is not natural for them to be left alone while the rest of the pack goes off without them. The condition is more common in dogs that have been repeatedly re-homed or moved to new owners when they were less than 1 year old, probably because these animals feel very insecure. The problem becomes worse because when someone re-homes a dog from a kennel and finds out it is destructive, the poor dog is often returned to the kennel for re-homing again.

The problem can start after a period of separation where the dog has been in kennels and then returns to the house. Dogs are also more likely to show separation anxiety when their owner returns to work after a long period at home, e.g. after maternity leave or the school summer holidays. The poor dog has been used to plenty of attention and company and is suddenly is alone in a quiet, empty house.

This is usually a problem of young adult dogs. Most dogs with this problem start to become agitated when they sense that their owner is about to leave. They often follow their owner from room to room and show excessive attachment.

Once the owner has left the trail of destruction begins… wetting and messing in the house is not uncommon, alongside barking and the destruction of household possessions. Some dogs vomit or have diarrhoea when left alone and others may harm themselves. When their owner returns many dogs are submissive and cringe amid the debris because they have previously been punished by a furious owner coming home to the mess.

There is help at hand but you must be prepared to put a lot of time and effort into helping your dog overcome his fears.

Never, never punish your dog if you come home to a mess – this will only make the problem worse. Your dog is destructive because he is so anxious about being left alone. If you punish him he learns to associate the combination of you and the mess with punishment. When you are gone he is left in the house alone and becomes destructive. Now he is alone with the mess and becomes more anxious because when you appear and there is mess he is punished.

Treatment is aimed at gradually getting your dog used to longer and longer periods alone. Your vet will be able to give you advice about managing the problem and, in particularly tricky cases, may recommend that you and your dog visit a specialist in dog behavioural problems. With personal advice and some effort most dogs improve over about 4 weeks and will be much better after a few months.

There are drugs that your vet can prescribe (which work a bit like prozac in people) to help your dog overcome his anxiety. Unfortunately these drugs are not a miracle cure, but they can make treatment with behavioural management work more quickly.

Remember that the problem only arises when your dog is left alone. If you can avoid leaving them for long periods while you are in the early stages of treatment life will be much easier for everyone. If you have to go away think about getting a house sitter to look after your dog rather than using boarding kennels. If you can, try to arrange to take them to work with you for a while. These things will help to reduce your stress levels as well as your dog’s!