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What is Addison's disease?
Addison's disease, or 'Hypoadrenocorticism', is a condition in which the adrenal gland, a small gland next to the kidney, does not produce enough hormones. Normally the adrenal gland produces a cortico-steroid hormone called cortisol and a mineralo-steroid hormone called aldosteron (as well as other substances such as adrenaline). In Addison's disease these hormones are deficient.

How is it caused?
Causes for Addison's disease include trauma to the gland, tumours, infections, and auto-immune disease, under stimulation by the pituitary gland or the influence of certain drugs.

What are the signs and symptoms of Addison's disease?
Symptoms are often non-specific, such as vomiting, weight loss, inappetence, diarrhoea, increased thirst and urination, abdominal pain and sometimes shaking. In rare cases the patient may get what is called an 'Addisonian Crisis': this causes weakness and collapse, vomiting and diarrhoea.

How is it diagnosed?
The condition is diagnosed on the basis of the above symptoms together with blood tests.

What is the treatment?
Treatment is in the form of long-term medication and sometimes dietary management. In more serious cases the patient may have to be hospitalised and put on a drip for some time. From time to time your vet may decide that your dog needs further blood tests to monitor the treatment and possibly to alter the medication.

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What is amuputation?
Amputation of body parts is often performed in dogs and cats. In this case we are talking about amputation of body parts for medical reasons, such as severe damage or tumours, rather than fashion reasons, such as in tail docking, ear cropping, declawing in cats or the removal of dew claws in dogs.

Will amputation affect my pet?
Most owners are shocked when amputation is suggested by the vet. This is because the procedure is thought of as having severe psychological consequences, at least in humans. Pets are not affected by this and will often have totally normal and happy lives after amputation of body parts. This includes toes, legs, tails (or part thereof), ears, nails etc. We will describe all of those in turn.

Why is amputation performed?
Toes are sometimes amputated when they are severely damaged, for instance after a road traffic accident, or affected by a persistent infection or tumour. Most dogs and cats will cope perfectly well with one or even several toes less than normal. The procedure is comparatively simple and most patients will walk normally within days.

An entire leg can be amputated as well. This can be a front leg or a hind leg. This is done for the same reasons as those mentioned for toes. Cats especially are very good at coping with three legs. They will often be able to jump and run, even climb trees, within days to weeks. In dogs, the larger breeds have more difficulty with coping on three legs, but it is never impossible. It is a prerequisite though that the disease process does not severely affect any other parts of the body, and that the other legs are strong enough to carry the entire weight of the animal. In nearly all cases, amputation of a single leg is a better option than euthanasia, which is often the only other 'treatment' option open to the patient. Tail amputations are performed for several reasons. Again, severe damage and tumours are common reasons. Paralysis is also a common reason though, especially in cats. Cats can be suffering from paralysed tails after accidents, where damage has been done to the pelvic area, involving the nerve supply to the tail. Some cats will get some feeling back in the tail, but if they do not, the tail can be easily damaged, causing possible further problems for the cat involved. Therefore, it is often suggested to amputate permanently paralysed tails in cats. In cases of damage or tumours, only the affected part of the tail needs to be removed. Most vets will try and save as much of the tail as possible.

Ears are sometimes amputated, or parts of them, especially in cats. Again, damage or tumours are possible reasons, but in cats there is another: cats, especially white ones, can be affected by sunburn, to the extent where the earflap is severely burned and infected. They can also have a certain type of skin cancer, which requires amputation of the ear flap. Apart from a very individual look, these cats are not affected in any way by the amputation. Nails sometimes have to be amputated, for instance in cases of severe bacterial or fungal infections, auto-immune diseases or parasitic conditions. Even if all the nails have to be amputated, pets can still walk perfectly normal. In all cases of amputation your vet will be able to discuss with you the pros and cons of the procedure, as well as the expected quality of life after the procedure. Never make a hasty decision not to have your pet treated in this way, based on ideas from the equivalent in humans.



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What is anaemia?
Anaemia is a shortage of the pigment haemoglobin in the blood. This pigment is what gives blood its red colour. It is caused by either a shortage of red blood cells or by a shortage of the pigment within the red blood cells. Haemoglobin carries oxygen around the body. Anaemia is not a disease itself, but rather a consequence of different diseases or conditions.

What are the causes of anaemia?
There are three possible reasons for anaemia:

(1) Blood loss: This in itself can be caused by for instance external and internal bleedings (often the result of trauma), blood sucking parasites (fleas, ticks etc.), bleeding tumours or conditions which cause ineffective blood clotting (rat poison, liver disease etc.). (2) Destruction of red blood cells: This can be the result of certain parasites, toxins, auto-immune disease or some tumours. (3) Insufficient red blood cell production: This can be caused by severe chronic disease, poor nutrition, auto-immune disease, hypothyroidism (under-active thyroid gland), toxins or certain tumours. Iron deficiency is not a common reason for anaemia in dogs, unlike in humans, but is possible in principle.

How is anaemia diagnosed?
To diagnose anaemia your vet will perform a full clinical examination on your pet. He may find pale mucous membranes, for instance inside the mouth or on the inside of the eyelids. Dogs with anaemia will often appear lethargic and have a decreased exercise tolerance. Some dogs may have a fast and weak pulse and some may have a heart murmur. In most cases it will be necessary to do blood tests as well. Your vet will determine the haematocrit or PCV (packed cell volume), which is the percentage of red blood cells within the blood. If this falls below 35%, your dog is diagnosed as anaemic. Blood smears are often examined for the presence of young, immature red blood cells. This is to check whether the body is actually making new red blood cells in the bone marrow. Parasites are also sometimes found on a blood smear. In some cases it may be necessary to perform other tests as well, such as a biochemistry profile, to check for underlying diseases, faecal examinations, to check for certain parasites, bone marrow biopsies etc.

How is anaemia treated?
Treatment of anaemia is totally dependent on the cause of the anaemia. Only in severe cases (generally if the PCV falls below 10%) is a blood transfusion necessary. Your vet may have set up a blood donor scheme to make this treatment possible. Most dogs do not need a blood group test for their first blood transfusion.




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What is anal furunculosis?
Anal furunculosis, or peri-anal fistulas, is a condition affecting the tissues surrounding the anus of the dog. It is particularly common in German Shepherd Dogs and their crosses.

What are the signs and symptoms of anal furunculosis?
The condition shows as multiple holes in the skin next to the anus, sometimes with fluid seeping from these holes. There can be swelling of the area, as well as redness or a more bruised appearance. Your dog may show pain when sitting, increased licking behaviour, straining when defecating, blood or bloodstained fluid leaking from the holes, as well as an altered position of the tail. In some cases the dog may become aggressive, especially when approached from behind.

What are the causes?
Nobody understands totally how this condition arises, but there are several theories. One says it is caused initially by infection of the anal glands, small scent glands embedded in the sphincter muscle of the anus. Another mentions poor ventilation of the area due to a close implantation of the tail base as a cause. Again another mentions auto-immune disease as a cause, while genetic predisposition can also be found to be a factor. Some people now think that the condition is related to lower bowel disease, such as colitis.

What is the treatment?
Treatment is not always successful, partly because the cause is not fully understood. Different forms of treatment are possible, such as medication (antibiotics, anti-inflammatories, auto-immune disease modifiers), surgery, cryosurgery, dietary management etc. Your veterinary surgeon is the best person to discuss your dog's treatment options.



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What is anal sac disease?
Anal sacs are often wrongly called 'anal glands'. The anal sacs are two small pockets embedded in the sphincter muscle of the anus. They are at the '4 o'clock and 8 o'clock' position and connected to the outside world via small ducts. The wall of these sacs contains glandular tissue, producing a foul-smelling fluid, which is often excreted when the dog passes faeces. Problems can arise in several ways: The sacs can become impacted when the contents are not excreted and solidify. Your vet can empty the sacs by squeezing them. The sacs can also become infected by bacteria. In this case the anal sac will often contain bloody or even purulent fluid and can be painful when emptied. Antibiotics are necessary to treat the infection. Sometimes this infection can become an abscess. In this case there will be a warm, soft and very painful swelling, often with pus draining through a hole in the skin when the abscess has burst. This may require surgical drainage by your vet as well as treatment for infection, with antibiotics.

What are the signs and symptoms of anal sac disease?
Symptoms of anal sac disease include excessive licking of the anal area and dragging the bottom on the floor. Sometimes pain, discharge, a strong smell or a swelling can be noted as well.

What are the treatments?
Some dogs may need repeated emptying of the anal sacs, whereas others may never need it at all. If the problem recurs frequently, the anal sacs may be surgically removed. One possible complication of this technique is a, often temporary, lack of bowel control.



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What is an aural haematoma and how is it caused?
An aural haematoma is a collection of bloody fluid within the earflap (the pinna). Sometimes blood clots are present as well. It shows as a swelling of the earflap or part thereof. This swelling is often warm, but not painful. Most dogs will scratch or shake their head. Some people think it may be caused by the vigorous shaking of the ear, resulting in the rupture of small blood vessels. Others think there may be an auto-immune disease, involving the blood vessels, as a cause for this condition.


What is the treatment?
Treatment can be one or more of the following:


1. A course of tablets, mostly steroids.

2. Draining the fluid through a needle. Some dogs will have to be sedated for this. This procedure may have to be repeated.

3. Surgical drainage of the fluid, under general anaesthetic. This is normally only done if the swelling involves the entire earflap. After draining the fluid, stitches are placed through the entire thickness of the earflap and a bandage may be applied. In some cases there is a concurrent external ear infection present, which will need treatment at the same time.




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What is cauda equina syndrome?
This is a condition which affects the lumbosacral junction. This is the area in the lower back where the lumbar vertebrae of the spine join the sacrum, which is the part of the spine which is connected with the pelvis. The lumbosacral junction is the only connection between the pelvis and hind legs of the dog and the rest of the body. Therefore it has to withstand quite large forces. The term 'cauda equina' comes from the Latin for 'horse's tail', and refers to the appearance of the spinal cord in this area, which is now made up of a large number of individual nerves running together through the spinal canal.

What is the cause?
The cause of the condition is often a protruded inter- vertebral disc. This is a cartilage disc in the space between the last lumbar vertebra and the sacrum. Other possible causes are tumours, infection, trauma or instability between the different parts of the joint.

What are the symptoms?
Pressure on the nerves in the spinal canal causes pain. Dogs may appear hunch backed or have difficulty rising and jumping. Some dogs may have nervous problems such as weakness of the hind legs or tail, or urinary or faecal incontinence. Incoordination, or ataxia, is seen in some cases as well.

How is it diagnosed?
To diagnose the condition, your vet will perform a clinical examination. In addition he will often take x-rays. These may or may not show the extent of the changes in the area. Sometimes it is necessary to use more sophisticated techniques such as a myelogram (an x-ray with contrast material around the spinal cord), or an MRI (Magnetic Resonance Imaging)-scan.

What is the treatment?
Treatment is dependent on the cause of the problem. In many cases rest (ideally in a cage) and the use of anti-inflammatory drugs will be sufficient to reduce the clinical symptoms. In some cases, especially if there is incontinence or paralysis, it may be necessary to perform surgery. In this case a 'dorsal laminectomy' is performed, in which part of the bony wall around the spinal nerves is removed to relieve the pressure.



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What is Coccidiosis?
Coccidiosis is infection of the gut by coccidia. Coccidia are protzoan parasites (single cell creatures). They are usually species of Eimeria or Isospora.

How do dogs & cats catch Coccidiosis?
As gut parasites, they are spread by what is known as the faeco-oral route. The infective form is passed in the faeces and must be ingested to cause infection. The does not necessarily mean that faeces must be eaten to catch the parasite (although some dogs will do this). When the faeces decompose and break down, the infective oocysts are left on the ground and can be picked up when sniffing, scavenging or cleaning the feet after walking on them. Infection is very common with most cats and dogs being infected at some stage during their lives.

What problems do Coccidiosis cause?
Coccidiosis can cause enteritis and diarrhoea associated with the growth of the parasite in the gut, sometimes with blood in the faeces. The diarrhoea is usually mild, but in severe infections in very young animals can become life threatening. Disease is most often seen in kittens and puppies under a few months of age, or animals that are stressed or otherwise have a suppressed immune system. In most adult infections, coccidia cause no problem at all, although the parasites may be present and infective oocysts are being passed in the faeces.

How can coccidiosis be diagnosed?
Examination of the faeces under a microscope can identify the oocysts that are passed.

What is the treatment for coccidiosis?
Sulphonamide antibiotics are effective in treating this condition.



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What is a collapsed trachea?
The trachea is the windpipe, the tubular structure between the throat and the lungs. This tube is normally circular, kept in shape by a series of incomplete cartilage rings, with a soft membrane joining the ends of the cartilage rings together on the top surface. When the trachea is no longer circular in diameter, but flattened, it is called collapsed. This is caused by a combination of a weakness of the cartilage and a flaccid and mobile top membrane. It is particularly common in certain breeds, such as Yorkshire Terriers, Toy Poodles, Shih Tzus, Lhasa Apsos, Chihuahuas and Pomeranians, and it is therefore suspected to have a genetic background as well.

What are the symptoms?
Clinical symptoms are as follows: a chronic dry cough is the most common symptom. It happens especially when the dog gets excited, or when there is extra pressure on the neck, for instance from the lead. A decreased exercise tolerance may be present and the dog may make a honking sound.

How is it diagnosed?
Your vet may have a suspicion of a collapsed trachea, based on the symptoms and the breed of dog, but often it is necessary to perform additional tests, such as x-rays. In this case the x-rays are best taken with the dog totally conscious, as the trachea will change its appearance during the phases of the respiration. It is not always possible to get a definite diagnosis on the basis of these x-rays. In some cases it is possible to get a diagnosis by performing an endoscopy. This is looking inside the trachea with a flexible pipe attached to an optical instrument. Ultrasound examination is also a possibility.

How is it treated?
When your dog has been diagnosed with a collapsed trachea, it is important to try and keep the weight of the dog down. Your dog will also have to lead a life without too much excitement, and preferably be walked on a harness rather than a lead on the neck. Further treatment is in the form of medication or surgery. Medication, usually in the form of broncho-dilators, anti-inflammatories or antibiotics, is often successful. In some cases surgery is indicated. In this case the trachea is supported with artificial rings to give the trachea its original tubular shape again. This is only possible if the affected part of the trachea is in the neck rather than in the chest. Surgery can be very successful.



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What is a corneal ulcer?
A corneal ulcer is an erosion of the superficial layer (epithelium) of the cornea, which is the clear membrane at the front of the eye.

How is it caused?
Most corneal ulcers are caused by trauma, such as a cat scratch, a branch in the bushes, or rubbing the eye against something. Another possibility is a chemical burn, for instance by erosive fluids or even irritating shampoo. Some infections and systemic diseases can also cause ulcers. Finally, a lack of tears, such as in the condition called 'dry eye' (or Kerato-Conjunctivitis Sicca) can also lead to ulcers.

How is it diagnosed?
A corneal ulcer is very painful and the dog will scratch or rub the eye, close its eyelids and possibly have a discharge from the eye. It may show as a clouding of the normally clear cornea, sometimes with small blood vessels around the periphery of the cornea. Your vet will often have to perform a special staining test on the eye, sometimes after the application of local anaesthetic drops, to diagnose a corneal ulcer.

What is the treatment?
Treatment of corneal ulcers will vary with the degree or depth of the ulceration. Mostly it will be in the shape of eye drops or ointment. In some cases it may be necessary to perform minor surgery on the affected eye by removing the loose edges of the ulcer. This can be done under local anaesthetic in some, but not all, patients. Others may need a general anaesthetic. In some cases your vet may decide to perform a 'third eyelid flap', whereby the third eyelid, the small membrane in the inside corner of the eye, is stitched over the corneal ulcer to help the healing process. Nowadays, it is also possible to protect the eye, and therefore its cornea, with special veterinary contact lenses. In this way, the patient will still be able to see and the vet can keep an eye on the healing process. At the end of the prescribed treatment period your vet will have to do the staining test again to check whether the entire ulcer has healed.



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What is coronavirus?
Coronavirus disease affects the intestine of your dog. It will lead to diarrhoea and often lethargy and inappetence. The stools may be orange in colour and smelly. Most cases are quite mild but sometimes it can be severe, especially if other viruses are involved as well, such as Parvo virus. In such cases the diarrhoea often contains blood or mucus as well. Many other conditions cause similar symptoms however, and it is often not possible to distinguish between coronavirus or other causes of diarrhoea based on clinical symptoms alone. Your vet may have to do laboratory tests to determine the cause of the diarrhoea.

How is it transmitted?
Corona virus disease is transmitted through direct contact between dogs or through contaminated food bowls, as the dogs shed the virus with their faeces and possibly with their saliva. It takes only a few days to become ill after coming into contact with the virus.

What is the treatment?
Treatment is often symptomatic, which means the dog is treated for its symptoms rather than for the virus itself. There are no drugs which kill the virus, so the dog has to overcome the virus by itself. Antibiotics are sometimes used to prevent secondary bacterial diseases however. Other treatment options are fluid therapy, for instance intravenous drips in severe cases, electrolyte supplementation or dietary management.



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What is a cruciate ligament rupture and how is it caused?
The cruciate ligaments are the two ligaments, which run inside the knee joint of your dog, which is the joint in the hind leg just below the groin. The cruciate ligaments cross over in the middle (hence their name) and give stability to the knee joint. On the inside and outside of the joint are the collateral ligaments, giving further support. When the knee joint is stressed in an abnormal way, one of these cruciate ligaments can tear or rupture (the 'cranial' cruciate ligament or CCL). It is more common in larger breeds of dogs and especially in unfit or overweight dogs.

How is a ruptured cruciate ligament diagnosed?
If your dog has ruptured a CCL, it will not use the affected leg normally. It may hold the leg up, or just touch the ground with its toes, but will often not bear any weight on the leg. There may be a swelling around the joint. Your vet will perform a test on the leg to check for instability of the joint. This may be done in a conscious patient, but in cases where the dog is uncooperative or in severe pain, the dog may have to be sedated for this. In cases where the ligament is ruptured this test will be positive and is called a 'positive drawer sign'. In some cases dogs also damage the meniscus, which is a cartilage disc in the joint. This may cause a clicking sound on examination. Patients suspected of a CCL rupture are often x-rayed to check for additional damage to the joint.

What is the treatment?
Treatment can be in two ways:

1. Conservative treatment, which means rest, exercise control and, if necessary, anti-inflammatories. This type of treatment is usually restricted to small dogs, for instance under 15 kg body weight. Most dogs will be sound after a few months but will certainly develop arthritis in the affected joint.

2. Surgery: this involves stabilisation of the knee joint. There are many different methods available to this purpose and your vet can best advise you on the best method in your dog's case. Even if surgery is performed your dog will still develop arthritis in the knee, but it will be mobile and free of lameness sooner. If your dog is overweight, your vet may advise a weight control diet.



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What is cryosurgery?
Cryosurgery involves the controlled freezing of tissue to establish dying off of this tissue. This happens because the blood supply to the tissue is destroyed. The sensory nerves in the direct area are often destroyed as well, leading to a lack of pain. Cryosurgery has been used for a long time. Several substances can be used to this purpose. Common ones are liquid nitrogen, carbon dioxide or nitrous oxide. These substances are administered to the patient by using a gun-type apparatus with exchangeable tips to freeze only the target tissue.

What is cryosurgery used for?
Lesions which are commonly treated with cryosurgery, or tumours in inaccessible places for conventional surgery, such as for instance in the mouth or around the anus. It may also be used if a general anaesthetic is considered to be too risky, for instance in elderly patients or those with kidney- or liver disease.

Is treatment painful?
The treatment itself can initially be painful. For this reason patients are either anaesthetised, or perhaps sedated and treated with local anaesthetic. After the first treatment follow up treatment is often not painful anymore. Many patients require more than one session of cryosurgery, usually with about one week in between. After the treatment the tissue which has been destroyed will slough off in several days. This may lead to some discharge. The wounds are normally not infected as the cryosurgery also kills any bacteria present. However, your vet may prescribe antibiotics if the treatment leads to large wounds.

Is it effective?
Some cases are totally cured with cryosurgery, such as small warts or skin tumours. Other cases may be alleviated only, for instance by reducing the size of a tumour or relieving pain.



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What is Cushing's Disease?
Cushing's Disease is an overproduction of the hormone Cortisol by the adrenal gland. Cortisol is a hormone that is produced during stress to help the body release energy to respond to whatever caused the stress (part of the Fight & Flight response). When this hormone is elevated for long periods of time, it causes changes in the body.

What are the signs of Cushing's Disease?
A dog with Cushing's disease may drink excessively and have a tendency to put on weight. There are changes in the hair coat, usually becoming thin on the flanks and underneath although some produce a longer and thicker coat. The skin becomes thinner, particularly under the abdomen, and scabs and crusting may be seen. The muscles are weakened by the long term high Cortisol levels, causing the abdomen to sag, the limbs to become weaker and sometimes the back will sag. The immune system is suppressed making infections more likely, particularly of the skin. Female dogs often get bouts of bacterial cystitis (bladder infection).

The signs of Cushing's disease come on very gradually and since the disease most often affects old dogs, the changes are often attributed to the animal's old age. It is usually the excessive thirst that first warns of a real problem, particularly as the increased urine output and weakened muscles can result in urination indoors at night. In younger dogs, they appear to age prematurely, but this is actually a result of the disease. In rare cases neurological signs can occur along with Cushing's disease. This can be a problem with the nerves or relating to the tumour in the brain. What neurological signs are seen is very variable. Diabetes can occur as a secondary consequence of Cushing's disease. The main sign of diabetes is excessive thirst and urination as well, so sometimes it is hard to see what the primary disease is. The secondary effects of Diabetes, such as cataracts, may be seen.

What causes Cushing's Disease?
The problem is an adrenal gland that is overproducing the hormone Cortisol. There are two main reasons that this can occur.

The commonest reason (about 90% of cases) is a small growth in the Pituitary Gland a region of the brain that controls the production of hormones. This tumour produces too much of a hormone messenger that tells the adrenal gland to produce Cortisol. The tumour is usually very small and does not spread or cause any other damage to the brain, although in some cases it can get big enough to press on other areas of the brain.

The less common reason is a tumour of the adrenal gland itself that produces Cortisol in large amounts regardless of the message from the brain ' it is out of control. Many of these adrenal tumours are malignant and can spread to other parts of the body.

How can Cushing's disease be diagnosed?
Although the appearance and thirst of a dog may suggest Cushing's disease, none of the signs definitely distinguish it from other diseases. Blood tests are required to diagnose this disease. A general blood screen will give some indication that Cushing's disease may be indicated, but a specific test must be done to confirm it.

There are two main tests for Cushing's. The most commonly used (and quickest) is the ACTH stimulation test. Two blood samples are taken before and 1 hour after injecting ACTH (the hormone messenger to stimulate the adrenal gland to produce cortisol). The other is the Dexamethasone Supression Test that involves three samples taken over an 8 hour period and a steroid injection. There is also a test that will determine between the two causes of Cushing's disease which is the same as the Dexamethasone Supression Test, but uses higher doses of steroids.

What is the treatment for Cushing's disease?
The only permanent cure for Cushing's disease is to remove the tumour that is causing the problem. This is only a realistic option if there is a tumour of the adrenal gland that affects only one gland and is not malignant. To get at the growth in the pituitary gland requires brain surgery.

The usual treatment used is a drug called mitotane. This is a type of chemotherapy drug that attacks the adrenal glands, and if used in high enough doses can destroy the glands completely. It is usual to carefully work out the dose of the drug to suppress the adrenal gland enough to lower the Cortisol levels to something near normal, preventing signs of Cushing's disease. The drug is given daily for a time to start with, and then at a longer intervals afterwards (often weekly) to keep the adrenals suppressed. This drug can have dramatic side effects in the starting period, mainly associated with excessive destruction of the adrenal glands and requiring replacement of cortisol to correct.

As mentioned above, it is possible to try and destroy the gland completely with these drugs, but if this is done the dog must receive hormone replacement treatment and the chances of dramatic side effects in the starting period are higher. There are a couple of other drugs that can be used in the treatment of Cushing's disease, but neither is as effective, nor do they have any great advantages in cost or safety. Since many dogs that develop Cushing's disease are very old, many owners opt not to treat their animals. The disease is generally debilitating rather than fatal, so some people are prepared to accept an ageing, weakened dog rather than use treatment. It is usually the younger dogs with Cushing's that get treatment.



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What is dehydration?
Dehydration is a reduction in the normal amount of water in the body. Mammals are 60-70% water and this is vital for normal function of the body.

What are the signs of dehydration?
The signs of dehydration will vary with the severity. The main test for dehydration is to pull up the scruff of the animal and let is fall back into place. In a normal animal it should drop immediately back into place, but in dehydration it falls back slowly, known as 'skin tenting'. The skin generally moves about over the body less freely, so feels a bit dry. In severe dehydration, the eyes become sunken and the third eyelids may come across.

It should be noted, however, that Siamese cats often show the 'skin tenting' even when they are normal.

What causes dehydration?
The problem is a greater loss of water than intake. Normally the body responds to loss of water by reducing urine output from the kidneys and increasing thirst. If either is disturbed, dehydration may result.

The main causes of dehydration are vomiting, diarrhoea, failure to eat or drink and kidney disease. These can be a part of many disease processes and almost any disease process that causes an animal to feel ill.

It is possible for an animal to become dehydrated even if it is still drinking, particularly with kidney disease. The drinking is often increased in kidney disease, but it still can't keep up with the loss from the kidneys.

How serious is dehydration?
The significance of dehydration depends on its severity. Mild dehydration can often be ignored if the underlying disease is treated and the animal will get better quickly. Severe dehydration, however, cannot be ignored as the circulation can fail if there is not enough fluid to keep it going properly. It can also damage the kidneys if allowed to go on for too long.

What is the treatment for dehydration?
Dehydration is treated with fluid replacement therapy. If dehydration is mild and drinking is not a problem, oral fluids may be sufficient. Oral re-hydration fluids containing glucose and salt are better than plain water for re-hydration.

Fluids can be given under the skin by injection to re-hydrate an animal. There is a limit to how much fluid can be given by this method and it can be a little painful. It is usually only use in very small animals where the veins are too small to give the fluids as a drip.

If dehydration is severe, fluids may have to be given by an intravenous drip, particularly if the fluid loss is continuing (e.g. severe diarrhoea & vomiting). A catheter is placed in one of the leg veins and bag a sterile fluid is connected. The fluids contain salts and sometimes glucose at the same concentration as in the blood to replace what has been lost. The rate at which the fluid is given can be varied according to how much is needed. Fluids can also be given into the abdomen or even into the bone marrow if necessary, but these methods are usually only used if a vein is not possible ' usually because of small size.



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What is dermatitis?
The term dermatitis is used to refer to any inflammatory condition of the skin. As such it is not a single disease, but can be part of many disease processes.

What are the signs of dermatitis?
The most consistent signs of dermatitis are itchiness and a degree of reddening of the skin. Apart from this the signs will depend somewhat on the severity and cause. There may be scabs, sores, crusting, pustules, flaking, oily discharge, serous discharge, thickening, colour changes (usually darker or redder), hair loss and in extreme cases bleeding.

Very often the signs seen with dermatitis are affected by the reaction of the animal. Scratching and biting at the skin will cause damage to the skin.

What are the causes of dermatitis?
There are a great number of causes of dermatitis in cats & dogs. The general groups of causes and some specific causes are listed below. Parasites ' fleas ' either by number of bites in bad infestation or flea allergy, ' mange mites ' Sarcoptic Mange (also known as 'Fox mange') is very itchy, ' Harvest Mites.

Allergies ' Flea Allergy ' if an animal is allergic to fleas, it only requires very small number to cause a bad reaction, ' Food Allergy ' dogs in particular usually show dermatitis if they are allergic to something they eat rather than any signs affecting the gut, ' Seasonal Allergies ' the animal is sensitive to something that is only around at certain times of year ' usually the summer months. Pollens are often responsible, ' Atopy ' this is a condition is which the animal has an immune system which is prone to developing allergic reactions to all kinds of things,

Infections ' Pyoderma ' bacterial infection of the skin. This is often a secondary part of skin disease rather than a primary cause. Scratching damages the barriers that normally prevent bacteria from invading the skin. ' Juvenille Facial Pyoderma ' a bacterial infection of the follicles of the face and chin in young dogs of certain breed ' particularly Boxers, Bulldogs and Staffordshire Bull Terriers. ' Ringworm ' a fungal skin infection ' Malassezia ' a yeast-like fungus that can infect warm, moist areas of skin. ' Poxvirus ' a viral infection that causes skin lesions in cats. ' Mycobacterial granulomas ' a nodular skin disease in cats that can break out into dermatitis Seborrheoa ' an abnormal condition of the production of oils on the skin that can be very greasy or cause lots of dry flakiness. Either form can cause irritation and a tendency to skin infections.

What is the treatment for dermatitis?
Treatment of dermatitis is a very large area and will vary greatly dependent on the cause of the problem. Typical treatments will include antibiotic and anti-inflammatory drugs in tablets and/or creams and dietary management, accompanied by skin washes and shampoos. Anti-parasitic treatments are used where parasites are involved. There are also treatments that will influence the immune reaction in allergic dogs.



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What is diabetes insipidus?
Diabetes insipidus is a hormonal disease caused either by under-production of a hormone called ADH, or by failure of the kidneys to respond normally to ADH even though it is being produced in normal amounts. ADH, or "anti-diuretic hormone" is a substance normally produced by a part of the brain called the hypothalamus. Its function is to promote water resorption by the kidney, thus conserving body water and making the urine less dilute.

What are the signs of diabetes insipidus?
(1) excessive urination, very dilute urine (2) excessive drinking (more than 100ml per kilogram of body weight per day) (3 )possible dehydration and weight loss

Can diabetes insipidus be treated?
If the diabetes insipidus is caused by inadequate production of ADH then it can be treated by giving the animal synthetic ADH in the form of a nasal spray or eye drops.

If the condition is caused by inadequate response to ADH by the kidneys then there is no specific treatment. A low sodium diet may help, and certain drugs that increase sodium reabsorption by the kidney may help to reduce the volume of urine produced.



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E

What is endocarditis?
Endocarditis is inflammation of one or more of the valves within the heart, due to infection by bacteria. It occurs rarely in dogs and cats. The incidence is believed to be higher in large-breed male dogs; German Shepherds and Boxers are possibly predisposed. If severe, the affected valve ceases to work properly, and so the animal begins to show symptoms of heart failure.

What causes endocarditis?
Endocarditis occurs when bacteria spread from another part of the body to the heart via the blood. Infections of the mouth and pharynx are of particular importance, so good oral hygiene and regular dental checks may help to prevent endocarditis from occurring.

What are the symptoms?
The symptoms are extremely variable depending on the severity. If the animal still has a bacteraemia (bacteria in the bloodstream), then it is likely to have a fever, be inappetant and lethargic, and may show signs of lameness if the joints have become infected. If the infection is very mild then there may be no signs. If a valve is severely affected then the animal will show signs of heart failure: coughing due to fluid on the lungs, breathlessness, excessive tiredness and restlessness during the night.

The bacteria can break off the valve in a particle called a "thrombus" and spread to other sites in the body: this can be fatal since the thrombus can block blood vessels, preventing blood from reaching important organs such as the kidneys.

Can endocarditis be treated successfully?
The infection can be treated using antibiotic injections which must be administered by your vet. Antibiotic tablets will then be required for at least 4 weeks since endocarditis is a particularly difficult infection to clear. If there are already signs of heart failure then the prognosis is poor. Recurrent infections are a problem in spite of intensive antibiotic therapy, and there is always the risk of thrombus formation.



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F

What is Fading Puppy Syndrome?
Fading Puppy Syndrome is the name given to a collection of illnesses in puppies, each of which can lead to death within a few days of birth. Such puppies become progressively weaker until they are unable to suckle; they may have an abnormally low body temperature. Fading Puppy Syndrome may be caused by infection with many agents. The main ones are: (1) Canine Adenovirus (2) Canine Herpes Virus (3) Bordetella bronchiseptica (4) E.coli (5) Salmonella

Canine adenovirus
Canine adenovirus, also known as Canine Infectious Hepatitis Virus, causes sudden death in newborn puppies. They can be infected whilst still in the uterus if the bitch has not been vaccinated and becomes infected, or can be infected after birth by exposure to infected dogs. The virus causes the puppies to have a high temperature, and they are depressed with extreme pallor. They vomit and have diarrhoea, both of which can contain blood. Puppies collapse due to shock and die within 1-3 days.

There are no drugs to kill the virus, and only supportive therapy (blood transfusions, drips, etc) can be given. Often the puppies die before or soon after treatment is instigated. Any in-contact unvaccinated puppies should be given antisera (a blood extract which contains antibodies to the virus) to protect them from succumbing to the disease. Healthy puppies should be vaccinated as soon as possible (from about 8-10 weeks of age) but they are not fully protected until the second dose of vaccine is given (at about 12 weeks of age). Annual boosters are required to prevent disease.

Canine Herpes Virus
This virus occasionally causes Fading Puppy Syndrome. Puppies are infected by exposure to nasal or vaginal secretions of adult carriers. The virus spreads rapidly in kennels but only causes disease in very young puppies (under 3 weeks old). In these puppies the virus spreads throughout the body via the bloodstream and it is capable of replicating within many organs including the bra

The signs of Canine Herpes Virus infection include inappetance, diarrhoea, a painful abdomen (tummy) and vomiting. Puppies usually die within 1-2 days of showing signs. No vaccine is available. Since the virus survives best at lower temperatures, keeping young puppies warm will help to prevent infection.

Bordetella
This is a bacterium which contributes to kennel cough in adult dogs. An intranasal vaccine is available which can be given to puppies from 2 weeks of age, but by this time the puppies are more likely to get respiratory disease than fading puppy syndrome if infected. The main means of prevention are adopting good hygiene practices. As with most infections, the bitch is often the source of infection event though she may well not show any signs of disease herself.

E.coli (Escherichia coli)
This bacterium is often found in the blood of fading puppies, but its role in the syndrome is unknown. It is likely that it contributes the syndrome, and control is by adopting good hygiene practices.

Salmonella
This bacterium can be carried without symptoms by the bitch or other adult dogs. Once again it is important to adopt good sanitation practices, and avoid intermingling animals of different ages.

Others
Other causes of neonatal death include Canine Parvovirus and Canine Distemper Virus. Both of these have become less common since the advent of vaccination programmes, but unvaccinated litters are still predisposed. This highlights the importance of vaccinating bitches prior to pregnancy and puppies as soon as they are old enough.



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H

What are Harvest Mites?
Harvest mites are very small members of the arachnid family - having eight legs like spiders. Their proper name is Trombicula autumnalis. The adult mites live and feed on plants, particularly grasses and cause no problems. However, their larvae, which are bright orange in colour, have 6 legs and are about 0.2-0.4mm long, are parasitic, attaching themselves to the skin of animals and sucking out juices from the tissues.

When do Harvest Mite infestations occur?
Infestations only occur when the mites breed and produce their larvae. This is usually in the latter part of summer for a period of about 6 weeks in August and September - about the time when harvests are traditionally gathered (thus the name).

What problems do the harvest mite larvae cause?
The mites attach themselves to the skin to feed and this is quite irritating, causing the dog to scratch. Most infestations are around the head, particularly the ears. Small scabs form and if examined closely, bright orange specks may be seen. The location of the infection is likely to be because dogs often push through grass, but also because they cannot lick the mites of it the get around the head.

What treatment is required for harvest mites?
There are now anti-parasitic medications that have some activity against these mites including Frontline and Stronghold. Such medications are only available from your vet. Some dogs may also require anti-inflammatory drugs to stop the dog damaging themselves with excessive scratching. In the past, sometimes a course of anti-inflammatory steroids was all that was used until the mites went away themselves - they only have a very short season.

How can harvest mites be prevented?
At present, there is no product that claims to completely prevent these infestations, although those that are useful in their treatment might also prevent infestation. This is not yet proven though.



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How does a Hip Dislocation occur?
The hip is a 'ball & socket' joint where the round end of the femur is held into its socket on the pelvis by a ligament in the middle. For the ball to come out of the socket, this ligament must tear, which requires a fair bit of force, usually being hit by a car, but it can occur from a fall.

How might a hip dislocation be repaired?
A hip dislocation is painful and an anaesthetic will be essential. Your vet will also wish to take an x-ray to ensure that there is actually a dislocation and not a fracture of the end of the femur - both can feel similar, but are treated differently.

If the femur is intact, the hip can be manipulated back into its socket. This is easiest in a fresh dislocation, but the longer it is left before attempting replacement, the harder it becomes. In some cases, replacement will not be possible without surgery, and even then there may be too much deterioration to save the hip and the joint may have to be taken out.

What care must be taken with a cat after a hip is replaced?
Once a hip has dislocated, the ligament that normally holds it in place has snapped, so there is a very real possibility that the hip could dislocate again soon afterwards. With time, the ligament, joint capsule and muscles around the hip will strengthen again as it remains in place. It is important, therefore to avoid any activity that might cause the hip to come out again, because if the area repairs with the hip in the wrong place, it will get stuck there.

In many cases a bandage sling will be placed on the cat that goes around the body and holds the leg up, preventing any movement that could dislocate the hip and keeping it in position. This may need to be on for 1-2 weeks. All dogs recovering from a dislocated hip will need to be kept indoors and their activity restricted. A confinement cage may be required, but is usually not essential with a hip dislocation. Full recovery will take 4-6 weeks, but the cat can be allowed a bit more activity after the first couple of weeks, even going outside under supervision.



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What is hip dysplasia?
Hip dysplasia is an abnormal development of the hip joint. It is a condition which is influenced by many factors, such as genetic make-up, feeding regime when young, level of exercise, rate of growth and other factors. Hip dysplasia starts at a very young age and will lead to a poorly fitting joint, which in turn leads to the build up of arthritis or degenerative joint disease.

What is the cause?
Hip dysplasia happens in all breeds of dog, but some are more commonly, or more severely, affected than others. Larger breeds of dog are generally more prone to the condition than smaller breeds.

What are the symptoms?
Symptoms of hip dysplasia include weakness in the hind quarters, lameness, a wobbling gait, pain, inability to rise and muscle wastage. Although many dogs develop hip dysplasia as a young dog, the symptoms may only become evident at later age, usually when the arthritic changes set in.

How is it diagnosed?
The diagnosis of hip dysplasia can only be confirmed by taking radiographs, or x-rays, of the hip joints. This is nearly always done under general anaesthesia. Your vet will be able to assess the hip joints for conformation and secondary changes.

What is the treatment?
Treatment can be conservative, medical or surgical. Conservative treatment consists of exercise control and weight control. Medical treatment includes steroids, non-steroidal anti-inflammatory drugs and chondroprotective or structure modifying drugs. Surgical options include Triple Pelvic Osteotomy, Pectineus Myotomy and Total Hip Replacement. Furthermore there are physiotherapy and homoeopathy.

How can hip dysplasia be prevented?
Prevention of hip dysplasia can be established in the following ways: Take on puppies from parents with low 'hip scores'(see later), do not overfeed or over exercise your puppy, do not use food supplements if your dog is on a complete food.

What is the Hip Scoring Scheme?
The Hip Scoring Scheme: This is a scheme which was set up by the British Veterinary Association and the Kennel Club, about 30 years ago, to try and reduce the incidence of hip dysplasia in dogs. It is intended to help breeders to choose good breeding stock. Dogs can be x-rayed, under general anaesthesia, under strictly controlled circumstances, to get a good view of the hip joints. These radiographs (x-rays) are then sent to a panel of specialists, who interpret the radiographs and give each dog a hip score. This is a number, ranging from 0 to 106, the lower the better. Only dogs with hip scores well below the average for the breed are advised to be used for breeding purposes. Ask your vet for further advice on this hip scoring scheme.



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A thyroidectomy is the surgical removal of the thyroid gland(s). This is often done, especially in cats, for the treatment of hyperthyroidism, an overactive thyroid gland, leading to an excessive production of thyroid hormone or thyroxine. The parathyroid gland is a very small gland directly next to the thyroid gland. There are two separate thyroid glands, each with their associated parathyroid gland. When the thyroid gland is removed, it is not always possible to save the parathyroid gland. If both parathyroid glands are either removed, or damaged, during the thyroidectomy, it will lead to an insufficient level of PTH, the hormone produced in the parathyroid glands. This in turn will lead to very low levels of calcium in the blood, which is called hypocalcemia.

What are the symptoms following surgery?
If hypocalcemia occurs, the symptoms can be seen within the first few days after the surgical thyroidectomy. These include panting, nervousness, muscle trembling, twitching, incoordination, facial rubbing or seizures.

What is the treatment?
In most cases treatment with calcium, and sometimes vitamin D, will resolve the problem. In some cases this supplementation will have to be permanent, in other cases it may only be necessary for a short time after the operation. Blood tests will be necessary to decide this.



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What is hypoparathyroidism?
Hypoparathyroidism is an uncommon disease in dogs. It is characterised by under-activity of the parathyroid glands: these are two pairs of small glands that lie very close to the thyroid gland in the neck. These glands normally produce a hormone called parathyroid hormone (PTH). This hormone is responsible for maintaining the levels of calcium and phosphorus in the blood. Under-activity of the parathyroid glands leads to inadequate levels of PTH in the body, resulting in "hypocalcaemia" (inadequate levels of calcium in the blood) and "hyperphosphataemia" (excessive levels of phosphorus in the blood).

What causes hypoparathyroidism?
Hypoparathyroidism can occur spontaneously in older dogs, particularly bitches of small breeds. Spontaneous hypoparathyroidism is very rare in the cat, and, unlike dogs, prevalence is higher in the male.

What are the signs of hypoparathyroidism?
The signs of the disease all relate to the hypocalcaemia, which are as follows: (1) Muscle tremors, twitching, cramps, spasms, rigidity (2) Stiff-legged movement, weakness, seizures (3) Restlessness, panting, over-excitability, howling (dogs) (4) Cataracts may develop, especially in dogs

Diagnosis can be made by your veterinary surgeon who will perform a blood test.

Can hypoparathyroidism be treated?
Hypoparathyroidism can be treated by life-long administration of Vitamin D tablets.

Calcium supplements may also be useful initially, but are not usually needed long-term. If the animal is suffering from a seizure when the initial diagnosis is made, then emergency calcium injections will be needed because hypocalcaemia of this severity is potentially fatal.

Regular monitoring by your vet is essential to ensure that blood calcium levels are maintained within a normal range.



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I

What is infertility and what causes it?
Infertility is the inability of an individual to reproduce, and it can occur in both males and females. There are a number of causes, which can broadly be grouped into the following categories: (1) Congenital (a physical defect that the animal is born with, that prevents it from breeding) (2) Infectious (an infection that the animal has acquired, that damages the reproductive tract) (3) Hormonal (a disease that interferes with the animal's hormones so that it cannot breed) In addition there may be disorders of behaviour, as well as just improper animal management, in which case there is no true infertility but rather a misunderstanding of animal reproduction. As with humans, animals must have reached a certain body weight before they are able to reproduce. A malnourished animal may be infertile, as may an animal that is excessively physically active, such as a racing greyhound, just as a human athlete may stop her reproductive cycles during heavy training.

When will my dog first be able to reproduce?
Bitches reach puberty at 6-24 months depending on when they reach mature body weight. However, some normal dogs do not reach puberty until they are 2-3 years old, and in some greyhounds it may be 4-5 years. Hence a bitch that is apparently unable to reproduce may be normal rather than infertile.

The testicles of male dogs should have descended by 6-7 weeks of age, but they do not reach puberty until 9-10 months, or later for larger breeds.

Congenital causes of infertility:
Congenital causes of infertility include: (1) ovarian aplasia/ hypoplasia: this is absence or failure of development of the female's ovaries. It is very rare. A blood test performed by your veterinary surgeon will detect ovarian activity, or an operation to look for the presence of ovaries can be performed.

(2) Abnormal sexual differentiation: this is when the animals sex organs fail to develop normally. For example an animal may be born looking like a female but instead of having ovaries, it has small testicles hidden inside its abdomen. Such animals usually have abnormal sex chromosomes: real females have the sex chromosomes "XX", real males have "XY" whereas an abnormally developed animal could be "XXX" or "XXY."

(3) Penis deformity: various deformities of the male's penis can occur leading to infertility. Also abnormal testicular development can occur.

Infectious causes of infertility:
Infectious causes of infertility include: (1) Brucella canis infection: this is a bacterial infection of dogs which can cause infertility (in both males and females) or abortion. It can also cause fever and headaches in humans. Infection can be by ingestion of placental, mammary or vaginal material, or it can be transmitted venereally. Treatment involves antibiotics but is not always successful. Control involves regularly testing breeding animals, and never introducing a dog to a breeding kennel unless it has tested negative for this bacterium.

(2) Herpes virus infection: this has been associated with abortions and stillbirths in bitches. It may also be involved in the inability to conceive, but this is unclear. (3) Bacterial endometritis: this is infection of the womb lining by bacteria. Diagnosis can be made by a veterinary surgeon who will test for presence of bacteria. Treatment involves antibiotics.

(4) Cystic endometrial hyperplasia (CEH): this occurs in older females. It is not solely an infectious disease, but bacterial infection contributes to the condition. There are cysts in the lining of the womb, due to the action of sex hormones acting on the uterus, and there are also usually excessive numbers of bacteria. If untreated pyometra (a potentially fatal womb infection) can develop. Treatment involves antibiotics to kill the bacteria, and drugs to inhibit the sex hormones and delay the onset of the next oestrus until the CEH has gone.

Hormonal causes of infertility:
Hormonal causes of infertility include: (1) Hypothyroidism: this is reduced activity of the thyroid gland, a gland in the neck. This means that there is reduced production of thyroid hormone, and this can influence reproductive cycles causing infertility. The condition is most common in young to middle-aged dogs of larger breeds. Predisposed breeds include Golden Retrievers, Irish Setters, Doberman pinschers, boxers, dachshunds and Wolfhounds.

(2) Hyperadrenocorticism ("Cushing's disease"): this is over-activity of the adrenal glands resulting in excessive production of the naturally occurring steroid cortisol. It occurs in middle-aged to older dogs. (3) Hypoadrenocorticism: this is under-activity of the adrenal glands resulting in insufficient cortisol production. The condition is most common in middle-aged (2-5 years) female large-breed dogs.

(4) Pituitary insufficiency: this is a rare disease, most commonly seen in German Shepherd Dogs with hereditary dwarfism. The pituitary gland is a gland in the brain that normally releases Growth Hormone, but it also produces hormones that control reproduction.



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What is intussusception?
Intussusception is an intestinal disorder in which a portion of the intestine (gut) invaginates in on itself, rather like the way in which the fingers of a rubber glove can turn in as the glove is removed from a hand. The folds of gut can cause a physical obstruction, preventing the gut contents from being able to move along towards the anus in the normal manner. If such an obstruction is not treated then the section of intestine can die, because its blood supply is also likely to be obstructed by the intussusception. If left untreated then the animal itself can die because dead gut will eventually rupture. Intussusception can occur in both dogs and cats; it is more common in puppies and kittens than older animals. It often occurs after a bout of diarrhoea: the vigorous contraction of the intestine during diarrhoea tends to force a segment of intestine into an adjacent segment.

What are they symptoms of intussusception?
(1) Vomiting, with or without diarrhoea (2) Abdominal (tummy) pain (3) Presence of blood in faeces (faeces resemble raspberry jam!)

Can intussusception be treated?
Intussusception can be treated by your veterinary surgeon who will first confirm the diagnosis on an X-ray. The treatment involves an operation in which the abdomen is opened up and the intussusception is located and gently pulled until it is no longer invaginated. If the gut has begun to die then this is not possible, and the dead section of gut has to be removed. If diagnosed early, the prognosis is often good. Recurrence of the condition is common: animals that have had an intussusception once are prone to getting them again.



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K

What is Kidney Disease?
Dogs have two kidneys, each made up of many thousands of tiny functional units called 'nephrons', that filter the blood, remove waste substances and maintain the correct concentrations of fluid and minerals within the body. Proportions of these functional units do disappear with age and are not replaced. Kidney disease includes any disorder, which causes the destruction of further nephrons. Accelerated damage to the kidneys can be caused by a whole range of factors, including injury, infection and cancer, but a healthy animal has a considerable reserve of kidney function and signs of serious illness appear only when three quarters of the nephrons have been lost (renal failure). Kidney disease is common in dogs and with early diagnosis and treatment much can be done to help limit its progression.

What is the cause of kidney disease?
There are many factors, which can influence the likelihood of a dog or cat developing renal failure, including:

Age the chance of renal failure developing increases with age and it doubles between 10 and 15 years of age. Breed renal failure is recognised more frequently in Cocker spaniels, Lhasa apsos, and Samoyeds and Doberman pinschers. Environmental some common chemicals such as phenolic disinfectants, anti-freeze, lead paints, and also some drugs are toxic to the kidneys. Dietary careful control of the intake of phosphorus and protein in the food can slow the progression of kidney disease in dogs that have reduced kidney function.

What are the signs of kidney disease?
Increases in thirst and urine production. Important, the signs of kidney failure vary but an increase in thirst is almost always the first warning sign, and should not be ignored. If your dog seems to be drinking more, consult your vet immediately. Decreased appetite,Weight loss,Halitosis (bad breath),Vomiting and less frequently diarrhoea,Sore mouth,apathy and weakness

How is kidney disease diagnosed?
As well as a through physical examination, your veterinary surgeon will usually carry out urine and blood tests if kidney disease is suspected. Sometimes more advanced procedures, such as x-rays studies, Ultrasonography, biopsy or exploratory surgery are required. In many cases of long standing (Chronic) kidney disease the precise cause of the damage to the kidneys cannot be identified.

What are the stages of kidney disease?
Normal kidney function although nephrons may be lost the animals can adapt and does not show any signs of illness Percentage of functional nephrons remaining 100%

Kidney insufficiency (Early warning sign) the animal is unable to concentrate the urine normally and thirst is increased Percentage of functional nephrons remaining 33%

Kidney failure toxic waste substances accumulate because the kidneys cannot eliminate them efficiently, causing signs of illness Percentage of functional nephrons remaining 25%


Advanced kidney failure marked signs of illness appear leading eventually to collapse and death.Percentage of functional nephrons remaining 10%

How is kidney disease managed and controlled?
Although an animal suffering from kidney disease may need treatment with drugs and possibly fluid therapy to stabilise its condition, a permanent change to a specially formulated food is the most important long-term measure for controlling the condition. Your veterinary surgeon is the best person to find the right product to suit your dog's condition Our thanks and acknowledgement to Hill's* Pet Nutrition Ltd, manufacturers of Hill's* Prescription Diet* g/d*,k/d* and u/d* for their help and support with this article.



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L

What is a luxating patella?
A luxating patella, or 'loose knee cap', is a patella or knee cap that is displaced from its normal location over the centre of the lower part of the thighbone. The patella connects the thigh muscles to the straight patellar ligament which runs to the top part of the tibia, the main bone in the lower leg. The patella normally slides up and down in a groove in the femur, or thigh bone, when the knee bends and extends. If the patella is not positioned correctly, the leg can not function properly and the dog will often show lameness, a hopping gait or even inability to bear weight on the affected leg.

How is it caused?
The problem is usually caused by an abnormal development of the bones and joints when the dog is growing up, especially an abnormal position of the tibia, whereby the bone is rotated inwards. It leads to a more than normal wear and tear in the joint and will always lead to arthritic changes in the long term. It can also predispose to other problems in the knee joint, such as torn cruciate ligaments.

Who can be affected?
The condition is particularly common in the smaller breeds such as Cavalier King Charles Spaniels, Poodles and small terriers. Some dogs have only one affected leg, but in some cases both hind legs are affected. It often shows in young dogs, but in some cases the condition only becomes a problem for the dog in later life. In a few cases the condition can be caused by an accident. This is then called a traumatic patella luxation.

There are four grades of patella luxation. It is important for your vet to establish which grade your dog has, as the treatment is not the same for all grades.

What is the treatment?
Treatment is geared towards correction of the position of the patella. This can be established by doing surgery, which often contains three elements: (1) Part of the tibia, to which the straight patellar ligament is attached, is transplanted from its current position to the normal position, directly in the centre of the bone, and fixed in place with pins or wire.

(2) The groove in the femur, which is often shallower than normal, is deepened to keep the patella in its new position.

(3) The ligaments and joint capsule, which are often stretched, are tightened, again to keep the patella in its new position.

How soon will my dog be back to normal?
Most dogs recover very soon after surgery and will be able to bear weight on the leg within 2 weeks. Exercise is encouraged to prevent stiffening up of the joint. The dog will have to 'learn' to walk again with the new anatomical position of the knee cap. Generally, the prognosis is very good. Arthritis will develop though, whether surgery is performed or not, in the long term.



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M

What is Mastitis?
Mastitis is inflammation of the mammary glands, usually are a result of bacterial infection in the milk glands themselves. This infection usually comes in from the outside and only occurs when the animal is producing milk or, more commonly, when they have just finished producing milk. At other times the opening to the gland ducts are sealed.

What are the signs of mastitis?
One or more of the mammary glands will be swollen, hot and hard. It is a very painful condition and the cat or dog will often be depressed and react when the affected lands are touched. The milk produced by the affected glands will often be changed in thickness and colour ' often watery and brown but can be blood stained, thick, clotted or even pus like. In severe cases the infection may burst out onto the skin like an abscess, discharging pus. A dog or cat with mastitis will often appear depressed and will have a fever.

What is the treatment for mastitis?
Mastitis is treated with antibiotics, often combined with anti-inflammatory painkillers since this is a pretty painful problem. Courses of antibiotics often need to be prolonged, at least 1 week but often more.

Severe mastitis can leave open sores on the mammary glands that may take a few weeks to heal. In rare cases, so much damage is done that one or more of the glands must be surgically removed, but this is a rare complication.

It usually necessary to prevent the pups/kittens from suckling when the mother has mastitis. If they drink the infected milk is can make the puppies/kittens ill. If they are not old enough to be weaned, it may be necessary to bottle feed the puppies/kittens. If only one or two glands are affected, it may be possible to supervise feeding so that the affected gland is not used, then supplement any that still seem hungry. Mastitis is painful, so the mother may no feel like feeding anyway.

Can anything be done to prevent mastitis?
Ensuring that the mother is in a clean environment helps, but mastitis will often occur despite the best cleanliness. The most important thing is to monitor the glands to catch the problem early. Early treatment will prevent the problem from becoming severe.



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What is megaoesophagus or oesophageal dilitaion?
Megaoesophagus is a dilation, or widening, of the oesophagus, or gullet. This is the tube which connects the throat with the stomach. Its function is to transport the food to the stomach with the help of peristalsis, a wavelike contraction of the muscles in the wall of the oesophagus. If there is a megaoesophagus, this function is disturbed and food can accumulate in the neck or chest part of the oesophagus.

How is it caused?
Megaoesophagus can be caused by several conditions, such as myasthenia gravis (a neuromuscular disease), nervous system disorders, certain metabolic conditions or as a consequence of damage to the oesophagus itself, for instance after an obstruction or infections. There is also a congenital and hereditary form of the disease.

What are the symptoms?
Dogs, affected by megaoesophagus, will often show regurgitation. This is bringing up of food, which has not been inside the stomach. This is not exactly the same as vomiting, as in this case food has been inside the stomach. Regurgitation can take place directly after eating, but in some cases it takes place some hours later. Often dogs will lose weight. Coughing can sometimes occur, especially in cases of inhalation pneumonia, a serious complication of megaoesophagus. This happens when food is inhaled into the lungs.

How is it diagnosed?
The diagnosis of megaoesophagus is often suspected on the basis of the history and the clinical examination, but often it is necessary to perform additional tests such as blood tests or x-rays. The latter may include contrast studies, for instance a barium swallow study.

What is the treatment?
Treatment of megaoesophagus is geared towards control rather than cure. It is often not possible to correct the problem surgically and therefore medication and dietary management are used. Medication is used to prevent or treat pneumonia, or to try and induce more effective peristalsis. Dietary management can be the feeding of dry food only or in other cases wet food only, depending on the individual case. Most dogs with megaoesophagus are fed from a height, to help the food on its way down to the stomach.



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O

What is OCD?
OCD is a condition which affects mainly young, fast growing dogs of the larger breeds. It is most frequently seen in dogs between the ages of four and ten months. There are several forms of OCD and it can affect the shoulder, elbow, stifle (knee) and hock. It is caused by a defect in the transformation of cartilage to bone in the growing bones of the legs. This results in a thickening of a part of the cartilage, covering the bones at the joints. The thickened cartilage can tear or break off and this causes damage to the joint. The loose fragment can even become mineralised. This is then called a' joint mouse'.

How is it diagnosed?
OCD is usually suspected in persistently lame young, large breed, dogs, but it requires x-rays to diagnose this condition with certainty. Sometimes, the lesion itself can be seen, whereas in other cases the resulting arthritis can be seen.

What is the treatment?
Treatment differs from case to case, depending on which joint is affected, the duration of the problem, the extent of the secondary changes etc. In most cases surgery is beneficial, but in some cases exercise control, weight control and the use of anti-inflammatory drugs is the only possible therapy. OCD always leads to arthritic changes in the affected joint in the long term.



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What is osteomylitis?
Osteomyelitis is an infection of the bone and bone marrow. It can be the result of penetrating trauma, such as an open fracture of a bone, a bite wound, a puncture wound by some foreign body, or even surgery and surgical implants. It can also be the result of other infections in the body spreading through the blood stream from the point of origin to the bone. Finally, it can the result of an infection extending from the surrounding soft tissue into the adjacent bone. In all cases the bone, its surrounding membrane, called the periosteum, and the inside, (the bone marrow), become infected. It leads to a painful swelling, often hot to the touch, lameness if the affected bone is in the legs, fever and often general malaise.

How is it diagnosed?
To diagnose osteomyelitis it is often necessary to x-ray the affected bone. Because the changes, seen in cases of osteomyelitis, can also be seen in certain other conditions, it may be necessary to do further tests, for instance blood tests or biopsies. In some cases two or more bones are affected.

What is the treatment?
The treatment of osteomyelitis is dependent on the cause, but in general it is treated with antibiotics. These may have to be taken for a long time. Pain relief in the form of anti-inflammatory drugs is often necessary as well. If osteomyelitis is caused by implants, these will have to be removed. If it is the result of dental infections, such as tooth root infections, the tooth or teeth involved will have to be extracted as well. Treatment of osteomyelitis is normally successful.



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What is osteoporosis?
This name is often used incorrectly in veterinary medicine. It is a form of osteopenia, which means a reduction in bone mass. Osteopenia can be divided in two categories: the first one is a reduction in bone mass caused by excessive bone resorption, this is then officially called osteolysis. The second category is a reduction in bone mass caused by defective bone formation. The latter can be through insufficient formation of osteoid, which is called osteoporosis, or through defective mineralisation of the osteoid, which is called osteomalacia. The term osteoporosis is often used as a general term for the condition in which there is not enough bone tissue, as many people are familiar with this name from human medicine.

What is the cause of osteoporosis?
There are several causes for 'osteoporosis'. One of the most common causes is hyperparathyroidism. This is an overactive parathyroid gland, a small gland next to the thyroid gland in the neck, leading to excessive production of PTH, the hormone produced in the parathyroid gland. PTH leads to resorption of calcium from the bones. An overactive parathyroid gland can be caused by an insufficient uptake of calcium in the diet, for instance when feeding a meat only diet, or by severe kidney disease. The latter can cause such severe demineralisation of the bones, especially in the jaws, that it can lead to soft, malleable bones. It is often referred to as 'rubber jaw'. There is also a primary hyperparathyroidism, in which there is a tumour of the parathyroid gland, producing high levels of PTH.

Another condition leading to 'osteoporosis' is 'Rickets'. This is caused by a deficiency of vitamin D, nowadays a very rare disease. A more common reason for 'osteoporosis' is disuse of a limb. This can happen if a leg is not used properly for some time. Most cases of chronic lameness can cause this, but it is more often seen when a leg has been in a cast for some time, or when the animal has been treated with internal or external fixation for the repair of a fracture. When the leg is used normally again, most cases of osteoporosis will be resolved quickly. In pets we do not see osteoporosis as a consequence of hormonal changes, like in humans.



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What is osteosarcoma?
Osteosarcoma is the most common bone tumour in dogs. It is much rarer in cats. It is a malignant type of tumour and can therefore infiltrate into the surrounding tissues, recur if removed and spread to distant tissues with the blood stream, for instance to the lungs or to other bones.

What dogs are affected?
This tumour is particularly common in the large and giant breeds of dog and affects dogs of all ages, but those between the age of four and twelve are most commonly affected. There are certain predilection sites, which means that the tumour is most likely to arise in those spots. These are the long bones of the front and hind leg, for instance the lower front leg, just above the carpus, or wrist joint. However, osteosarcomas are also seen in other bones, such as ribs, skull bones, vertebrae or pelvis. Symptoms of osteosarcoma are dependent on the bone or bones involved, but in general it leads to a hard and very painful swelling, lameness and in cases where the tumour is not growing fast, muscle wastage. X-rays will give further information about the changes in the bones, but for a definite diagnosis it is often necessary to do a biopsy. This is the removal of a small part of the swelling, which can then be examined under the microscope in the laboratory to get a definite diagnosis. This histology test, as it is called, may take some time, as the bone has to be demineralised first before it can be cut into the very thin slices necessary for the investigation.

Treatment of osteosarcoma is not always possible. If one of the long bones in the legs is affected, it is often necessary to amputate the entire leg. In rare cases it may be possible to do a salvage procedure, in which other bones are used to replace the tumorous bone, for instance a rib. In all cases it is necessary to establish first, whether there are any metastases. These are distant spreadings of the tumour. To this purpose, your vet will nearly certainly take x-rays of the lungs, as these organs are often the first to be affected. If there are already metastases, it is not generally advised to treat the dog. Chemotherapy is also used in the treatment of osteosarcoma. The drugs used for this are quite expensive and need to be used with extreme care. Dogs undergoing chemotherapy will need to have many blood tests taken during the treatment, but do normally not suffer any of the side effects which are often seen in humans, such as sickness or hair loss. Even though dogs with osteosarcoma can be treated, most dogs will die within six to twelve months due to metastatic disease. This is because the disease has nearly always already spread at the time of diagnosis, even though at this stage this may not be visible on x-rays. Therefore the prognosis for a dog with osteosarcoma is extremely poor.



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P

What is panosteitis?
Panosteitis, or Enostosis, is a condition which can affect young, fast growing dogs of the larger breeds. It usually affects dogs of an age of approximately four to ten months, but it can happen as late in life as 5 years of age in certain breeds, such as the German Shepherd Dog. Panosteitis is an inflammation of the long bones of the dog, for instance the radius and ulna in the fore leg, or the tibia in the hind leg. It causes a weight bearing lameness in one or more legs, sometimes shifting from one leg to the other. Dogs often have a high temperature as well and can be off their food.

How is it diagnosed?
The diagnosis can be suspected on the basis of the clinical symptoms , but x-rays are necessary to diagnose the condition with certainty, and to distinguish the condition from other common conditions which affect young growing dogs. Your vet will normally x-ray both legs, even if only one is clinically affected, as the condition may affect both legs, but not equally severely, and also to compare the x-ray appearance of both legs.

What is the treatment?
Treatment of panosteitis is often in the form of exercise control, together with the use of anti-inflammatory drugs or other pain killers. The condition is self limiting and will cause no permanent damage to the bones or joints.



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What is the prostate gland?
The prostate gland is an organ of the male reproductive system that surrounds the urethra (the tube the carries urine from the bladder to the outside) where the vas deferens (the tube that carries sperm from the testicle to the urethra) joins it. It sits at the abdominal end of the pelvic canal. Its purpose is to produce some of the components of semen during ejaculation.

What problems can the prostate suffer from?
There are a variety of diseases of the prostate, all of which cause an enlargement of the gland. The most common problem is Benign Prostatic Hyperplasia, a relatively harmless enlargement of the prostate in response to hormone levels. Other problems include:

(1) Prostatic Cysts ' relatively harmless cysts full of sterile fluid (2) Prostatitis ' inflammation and infection of the prostate (3) Prostatic Abscess ' a cyst full of infected pus (4) Prostatic Tumours ' growths of the prostate are troublesome due to difficulties with removal, and many are malignant

What signs can prostate disease cause?
When the prostate is significantly enlarged, it may partially block the pelvic canal causing problems with the passage of faeces. Dogs with an enlarged prostate often have to strain for a while to pass faeces.

Dogs with prostate disease will often pass blood from the penis. This is usually seen as drips of blood soon after passing urine or at other times, although there can also be some blood in the urine itself.

If the prostate is infected, there will often be a temperature and the dog will appear depressed and unwell, and there is pain in the hind part of the abdomen. Sometimes only a temperature is present with no other external clues as to what is going on, making it hard to determine what part of the dog is affected.

What can be done to find out what is wrong?
The simplest procedure is a rectal examination. Wearing a glove, a vet can feel the prostate through the rectum to determine if it is enlarged and pushing on it may show pain if there is a problem.

Other tests can involve x-rays, ultrasound, blood tests and a prostatic wash. A prostatic wash involves passing a catheter into the penis and collecting a sample of cells from the prostate. A laboratory may then be able to give some idea as to what is present.

What is the treatment for prostate disease?
The treatment will depend largely on what the problem is with the prostate. In many cases castration will be part of the treatment. The prostate is under the influence of the male hormone testosterone, which is produced by the testicles, and when a dog is castrated the prostate will usually shrink down to a very small size and very rarely gets any further problems. There is also an injection, called Tardak, that can stop testosterone production for 4-6 weeks, so this is sometimes used to check that castration will help, or can be used instead if a dog is too old/ill for surgery (although the cost actually ends up higher than surgery with repeated injections).

(1) For Bengin Prostatic Hyperplasia, castration is the only treatment required. (2) For Prostatitis antibiotics, sometimes with anti-inflammatory pain killers, are required. These infections can be difficult to clear so long courses of strong antibiotics are often required. Castration can help recovery and helps to prevent recurrence.

(3) For a Prostatic Abscess or Cyst, surgery is required to drain the fluid and to prevent fluid forming again. (4) For Prostatic Tumours treatment may not be possible. In some cases a small tumour may be removed from the prostate, but if the tumour is too large this may not be possible without removing the whole gland. Removal of the prostate is not a realistic prospect as the gland surrounds the urethra and cannot be removed without affecting the function of the bladder.

Can anything be done to prevent prostate disease?
Castration will prevent most forms of prostate disease, especially if performed when young.



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Q

R

What is radiography?
Radiography is the taking of x-rays and the different techniques involved. Most vets are able to take x-rays of your pet, when this is necessary. Unlike in people, where radiographers can ask their patients to lie still, or hold their breath for instance, veterinary radiographers will almost always have their patient, (your pet), under sedation or even general anaesthesia for the purpose of x-raying. Furthermore, there are very strict Health and Safety Regulations which state that animals should NOT be restrained manually for x-rays. This is because of the potential health risks for the people involved in radiography.

What happens when my pet has to have an x-ray?
When your pet has to go to the vets for x-rays, he will therefore nearly certainly be anaesthetised. Under anaesthetic, multiple views are taken of the body part under examination. These radiographs, or x-rays, are then interpreted by your vet, or, in some cases, sent away for a second opinion. The costs for radiography are likely to be quite high for these reasons. In some cases it may be necessary to perform any further special techniques, such as contrast techniques. This may be necessary to visualise certain structures, otherwise not seen, for instance the bladder contents, the spinal cord, or the lining of the gut. These contrast techniques require specialist knowledge and equipment and you may have to be referred for this.

Can x-rays show up everything inside my pet?
Some structures may not be readily visualised, even with contrast techniques. In these cases the pet may have to be examined by other 'imaging' techniques, such as MRI or Ultrasound. If you have questions about the precise procedure to be performed on your pet, please ask your vet for advice.



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What is Rhinitis?
Rhinitis is an inflammation of the lining of the nose that results in sneezing and nasal discharge. This causes snuffling and is usually referred to as cold or flu-like symptoms. The discharge is usually clear in the early stages of disease and becomes thicker and cloudy as disease progresses. In some cases, blood may come out of the nostrils.

What can cause Rhinitis?
There are several viruses that can cause a rhinitis in dogs, but they are not very common and usually produce mild symptoms. It is possible for an allergy to cause rhinitis, like hay fever in humans, but this is an unusual consequence of allergy in dogs. Foreign material up the nose will cause a rhinitis, either from sniffing up dust or larger objects. The commonest foreign body in a dog's nose is a grass seed, but others seen include slivers of wood, needles, pins, nails, beads, food ' anything that gets sucked in while the dog is sniffing about. A foreign body rhinitis will affect only on nostril and will often progress to producing blood.

There is a fungus called Aspergillus that can cause a particularly nasty rhinitis. This fungus grows on mouldy bread or hay and can infect the nose. It grows in the back of the nose and the sinuses and will eventually eat into the bones of the skull. Although initially indistinguishable from any other rhinitis, it becomes bloody and very painful as the disease progresses. A tumour in the nose may cause a rhinitis ' it blocks the nasal passage and a bacterial infection will often form at the blockage

What is the treatment for rhinitis?
The viral rhinitis that dogs get is usually very mild and requires no treatment. Antibiotics do not help with viral diseases and secondary bacterial infection is not common in these case, but antibiotics may be used to prevent this.

If there is a foreign body up the nose, then this must be removed before signs will resolve. Antibiotics will often produce a temporary improvement as infection forms around the foreign body, but the problem will return as soon as the antibiotics finish. Removal will require a general anaesthetic and some means to visualise inside the nose. An endoscope is best, but x-rays can also be used.

Aspergillus rhinitis is problematic to treat. Anti-fungal drugs can be given as tablets, such as ketaconazole or griseofulvin, but in many cases this is not effective. The most effective treatment is to implant rubber tubes through holes drilled into the skull so that the nose can be flushed daily with an anti-fugal solution called Imaverol. This procedure may require referral to specialist surgical facilities.



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What is ringworm?
The name of this disease is misleading. Ringworm is not caused by a worm, nor does it often form a ring, except sometimes in humans. It is a skin disease cause by a fungus that grows in the hair follicles. There are a variety of species of fungus involved in causing ringworm, but the main variety in dogs and cats is Microsporum canis. Tricophyton metagrophytes is another seen in disease, but more often in farm animals than pets.

What animals can be infected with ringworm?
The ringworm fungus seems to be able to infect the skin of any mammalian species, including humans. Cats are affected more frequently than dogs. It is likely that rodents act as a source of the disease, and cats have greater contact with these.

What disease does ringworm cause?
The fungus of ringworm infects the hair follicles, causing the hair to fall out and irritation of the skin resulting in scaling, sores and/or scabbing. This fungus affects small areas, usually about the size of a 10p piece or so, most frequently around the head and neck. Although the disease is unsightly and irritating, it is not serious.

The disease is frequently self limiting, eventually going away by itself over a course of a few weeks in many cases. In cats, however, the fungus M. canis is able to form a carrier state ' although the skin sores disappear with time, some cats still carry the fungus and are still infectious.

What can be done to diagnose ringworm?
At least half of the type of fungus that causes the problem in dogs and cats will fluoresce under an ultraviolet lamp, which makes a very quick test for the disease.

However, not all cases will show up this way so other methods can have to be used. Examination of hairs plucked from the affected areas under a microscope may see the fungus growing there. The only certain method is to try to grow the fungus in a culture dish from plucked hair or hair brushings, but it can take up to 2 weeks for the fungus to grow to know the results.

What is the treatment for ringworm?
Treatment can be given in the form of tablets or by using anti-fungal preparations on the skin. The most effective treatment is to use both methods at the same time.

The tablets contain a drug called griseofulvin. This drug can cause deformities in an unborn foetus, so should not be given to pregnant animals and precautions should be taken by women of child-bearing age when handling this drug. It is otherwise quite safe. It usually need to be given for at least 3 weeks to cure ringworm.

The washes available for the skin include Imaverol wash and more recently Malaseb shampoo ' the latter is probably the more pleasant to use. Bathing is usually required weekly while treatment if going on. For single ringworm lesions, it is possible to use human athelete's foot remedies such as Daktarin cream. These are what humans should use who become infected from their pets.



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S

There are two likely instances where you may find yourself seeking a second opinion on a problem with you pet. Either your vet may suggest it or you may want it, but your vet has not suggested it.

If your vet suggests it
This first is what is often called a 'referral'. In this instance your own vet will suggest that your pet should see another vet. The reasons for this will vary: (1) Your vet may know exactly what is wrong with your pet, but they do not have either the facilities or experience to deal with a specialised procedure that your animal requires. (2) Your vet may have some idea of what is wrong with your pet, but would like a vet with more experience in the particular area involved (a specialist) to determine exactly what is wrong to be able to give the best treatment possible.

(3) The problem your pet has may be beyond the facilities of your local veterinary practice to diagnose, and they may require the facilities of a more specialised centre to diagnose. (4) It is possible that the problem your pet has is beyond your vet's experience or knowledge. No vet knows everything about every animal species or disease, but a good vet will realise this and know when to call on someone with more experience in the particular field.


A referral may occur within the practice. Some practices have vets who are specialised in particular areas of work. This is the most convenient, but in many cases is not available.

Most referrals will require you to travel to another veterinary practice, or even a specialist referral centre. The Universities that teach veterinary medicine all contain such centres of excellence, but even then facilities and personnel will vary. The referral is usually arranged by your vet, who will need to write a letter of referral requesting their patient be seen and passing on what information they have gained about the case.

If you are being referred to a specialist, you must expect fees to be higher. This is to pay for both the higher expertise and more expensive facilities such specialists must maintain. You will certainly appreciate the advantages of pet insurance.

If you want it, but your vet hasn't suggested it
This form of second opinion can be a less pleasant subject, but it should not be if all involved are civilised. This is when you feel you wish a second opinion on what is wrong with your pet. There are times when this is understandable, particularly when a pet your care deeply about is not getting better.

The best way to tackle this is to approach your usual vet and discuss the situation fully. It may be your vet has further plans that they have not yet had the opportunity to discuss with you, which may allay your concerns. If you still feel you want a second opinion, request a second opinion. If you have a particular specialist you have heard of, you might even suggest where. Most vets will not be offended, particularly if your concerns are valid. It may well be that he or she was considering this option. Sometimes a fresh perspective on a difficult problem is appreciated. Your vet will need to pass on what he or she has learned and details of what treatment has been given, so that the vet giving the second opinion will have all the information necessary - although they will undoubtedly need to make their own examinations to give an opinion. There is a Code of Practice for vets seeing second opinions, and contacting the first practice about the case is part of that code. This code exists for the protection of your pet. If the second opinion vet treats an animal without knowing what treatment it has had previously, they may unwittingly do your animal harm.

It is not a good idea to go to another practice without informing your own vet. This action is likely to offend them, plus it places the practice you go to in an awkward position as they will need to contact your first practice (who do not know you have gone) for details of what treatment they have previously given your pet. You could end up offending the second practice as well. Asking them not to contact your previous vet could even get them in trouble.



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What is spondylitis?
Spondylitis is an inflammatory condition, affecting the vertebrae and the inter vertebral discs (see also 'spondylosis'). In most cases there is an infection in the cartilage disc which joins the individual vertebrae. This infection also extends into the bone of the vertebrae on either side of the disc. It is a very painful condition, which leads to lameness and often inappetence, a high temperature and general malaise. It is more common in young dogs, especially after other infectious conditions.

How is it diagnosed?
To diagnose spondylitis it is often necessary to take x-rays of the affected part of the spine.

What is the treatment?
Treatment is usually in the form of a long course of antibiotics, together with the use of anti-inflammatory drugs and rest. In rare cases surgery may be necessary. Most cases of spondylitis respond very well to treatment, although many leave some permanent damage to the affected vertebrae.



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What is spondylosis?
Spondylosis is a condition affecting the vertebrae. These are the building blocks of the spine which run from the head to the tail. There are cervical vertebrae in the neck area, thoracic vertebrae in the chest area and lumbar vertebrae in the abdominal area. These are connected to the sacrum, which is made up of three sacral vertebrae, which in its turn is connected to the coggygeal vertebrae, which make up the bony centre of the tail. The individual vertebrae are joined by inter vertebral discs and synovial joints.

How is it diagnosed?
Like any other joint, the connection between vertebrae can be affected by arthritic changes. When the vertebral joints are affected in this way, it leads to pain and sometimes inflexibility of the spine. However, we often see changes affecting the lower part of the vertebrae. In this area we can see bony outgrowths from two adjoining vertebrae, eventually leading to a total bridge formation between them. This will lead to an inflexibility of this part of the spine, but usually no pain at all. In fact, in nearly all older dogs, the presence of spondylosis is an incidental finding when the dog is x-rayed for other reasons. Only in severe cases, where multiple vertebrae are affected, or where the spondylosis puts pressure on the spinal cord, which runs through the spinal canal, do we see any clinical symptoms.

What dogs are affected?
Spondylosis is more common in larger breeds of dog, in overweight dogs and in dogs which lead a very active lifestyle. Boxers are particularly prone to spondylosis. Treatment is not normally necessary.



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T

What is canine tonsillitis?
The tonsils are a pair of lymphoid structures, one on each side at the back of the mouth. Lymphoid tissue plays a role in body defence against bacteria and viruses. Canine tonsillitis is inflammation of the tonsils of the dog; smaller breeds are more predisposed than larger breeds, and the condition is rare in dogs older than one year.

What causes tonsillitis?
Tonsillitis can be caused directly by the following: (1) bacteria (2) viruses (3) foreign bodies (i.e. objects that the animal has tried to swallow but have become stuck in the tonsil)

Tonsillitis can occur indirectly due to the following: (1) irritation of the pharynx by excessive vomiting. This can be caused by a stomach tumour or ulcer, dietary intolerance, other stomach disorders (2) Chronic coughing (3) Tooth disease Enlargement of the tonsil can be caused by tonsil tumours rather than tonsillitis.

What are the signs of tonsillitis?
Some animals show no signs at all. Others may show any number of the following: (1) enlarged tonsils (2) raised temperature (3) difficulty eating (4) excessive salivation (5) inappetance (6) listlessness (7) pawing at the face

Can tonsillitis be treated?
Tonsillitis can often be treated successfully with a course of antibiotics and painkillers, since it is often caused by a bacterial infection. If this treatment is unsuccessful then tonsillectomy (an operation to remove the tonsils) may be required.



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U

What is ultrasound?
Ultrasound, or echosonography, is a technique through which structures are visualised by taking advantage of the different way in which they return sound waves directed into these tissues by a probe. The returning sound waves are picked up by the same probe and transferred, via a computer, into an image on a screen. This technique is best known for its use in the examination of pregnant women.

Why is ultrasound used?
Ultrasound is particularly useful for the visualisation of structures containing fluids, such as the heart, the bladder and other abdominal organs. In most cases there is no need for sedation or anaesthetics, and there is absolutely no risk at all for the patient or the examiner. Only the most nervous animals will need sedation. The area under investigation will always be clipped and cleaned, after which a gel is used between the skin and the probe to improve the images. Drawbacks of the technique are that the examiner needs specialist knowledge to be able to interpret the images, and structures containing air, such as the lungs, can not be visualised.

There are several forms of Ultrasound. These include B-mode, M-mode and Doppler ultrasound. They all have their own specific uses, advantages and disadvantages.Not all vets will have access to Ultrasound but it is becoming more and more commonplace nowadays. The equipment used is very expensive, as is the training required to interpret the resulting images. Therefore, Ultrasound examinations are not cheap. However, it is often worth the costs, as invaluable information can be gained.



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What is an undescended testicle?
When the testicles form in the embryo, they develop from the same tissue as ovaries ' which gonads develop depends on the sex of the embryo. This tissue is located just behind the kidneys. In the female, the ovaries remain in the same position, but in the male the testicles must descend to the scrotum from this position, leaving the abdomen through a hole in the muscles of the groin called the inguinal ring. This journey occurs gradually with growth, finishing some time after birth. The testicles should be in place by 4-6 months of age. In some animals, one or both of the testicles does not reach its proper location. The reasons for this relate to the differing rates of growth of different organs and tissues so that mechanisms to pull the testicle down do not work properly. Undescended testicles are often poorly developed. It is possible for the inguinal ring to become too small for the testicle to come out.

Where might an undescended testicle be?
Potentially, the testicle could at any point along the path from its starting location by the kidney to the scrotum. Many are located under the skin in the side of the groin, but others do not get past the inguinal ring and are still within the abdomen. Most of those in the abdomen are just inside the inguinal ring. An animal with a testicle within the abdomen is referred to as 'Cryptorchid'.

What should be done about an undescended testicle?
It is advisable to have a dog with an undescended testicle castrated, (see castration) removing both testicles wherever they may be located. There are several good reasons for this:

(1) An undesceded testicle is significantly more likely to develop a cancerous growth than one in the scrotum. (2) The tendency to have undescended testicles can be inherited, so it is best to avoid breeding from such animals. (3) In only one testicle is removed, there is potential for confusion over the animals status with regard neutering. If only an undescended testicle is left in, the dog will appear neutered, but could still be fertile (although fertility would usually be reduced). If only the undescended testicle is removed, it could confuse someone at a later date as to whether the other is still present, particularly if the dog is re-homed.

The surgery to remove an undescended testicle requires a separate incision from a normal castration site. If the wayward testicle cannot be felt, it may be necessary to make two incisions to explore all the possibilities before the testicle is found.



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What is Urticaria?
Urticaria is an allergic skin reaction associated with the release of histamine (a chemical involved in producing inflammation). It consists of multiple raised, flat patches of skin over the whole body. In a short-coated dog, this will make the hair appear to stand on end on the raised areas. It appears very rapidly and the dog is itchy or uncomfortable. The face and lips may swell in association with the skin lumps. In some cases it can be associated with collapse and shock ' a condition known as anaphylaxis.

What causes Urticaria?
Urticaria is usually a rapid allergic response to something, usually within a few minutes of exposure. The commonest cause of such a reaction is a sting from a bee or wasp. Another cause seen not uncommonly is a reaction to an injection, most often penicillin, but also vaccines and other drugs. Potentially almost anything could cause the reaction including insect bites, foods, inhaled allergens (often in dust or powders), contact allergens, contact irritants, infections, excessive heat or cold and even strong sunlight.

What is the treatment for urticaria?
In many cases, urticaria will disappear almost as rapidly as it appears, usually being gone within 24 hours of flaring up. However, since there is a potential to develop into analphylaxis, which can be serious, treatment is recommended.

Since the main problem is a histamine release, anti-histamines will produce a very rapid response. The most rapid response is achieved with an injection into the muscle by a vet, but most human anti-histamine tablets can be used in dogs. Contact your vet to find out what dose is suitable for your dog. Anti-inflammatory steroid drugs are also effective, but usually not as rapidly.

It urticaria occurs repeatedly, then the dog is coming into contact with the inciting cause repeatedly. The best means of control is to avoid the thing that sets the problem off, but finding out what it is can take time. It involves changing what the dog is exposed to on a regular basis one thing at a time and seeing what occurs. Skin allergy testing (by injecting allergens and looking for a reaction) can be dangerous in these cases as it can induce anaphyaxis if a positive result is obtained.



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V

What is Vestibular Syndrome?
Vestibular Syndrome is dizziness caused by a failure of the vestibular system ' the organs involved with the sense of balance. The vestibular system consists of part of the inner ear called the semi-circular canals and regions of the brain that process the sense of balance. Usually only one side stops working, so the dog loses its sense of which way up it should be.

What are the signs of Vestibular Syndrome?
The dog will appear dizzy or drunk if it can stand and will tend to walk in circles and fall to one side. Many are unable to stand and will lie on one side only. The eyes flicker from side to side, moving slowly in one direction and flicking quickly back. They will often pant and may vomit. If able to stand, the head will often be tilted to one side.

The severity of signs vary from a slight unsteadiness to complete collapse and severe vomiting. It can come on very suddenly, from a completely normal dog within a matter of minutes.

What causes Vestibular Syndrome?
Vestibular syndrome can be caused by middle ear infection that spreads to affect the inner ear. In these cases, there is often pain in one of the ears and head shaking may have been present for some time previously.

In most cases of vestibular syndrome, however, the cause is unknown. This is known as Idiopathic Vestibular Syndrome. This occurs in older dogs and is often referred to as a 'stroke' to help people understand what has happened to their dog, although the cause is not the same as a stroke in humans ' there is no blood clot or bleed to cause it. Factors that seem to be related to incidence of this problem include general anaesthetics, heart disease, poor circulation and very hot weather. These are all factors that can affect the blood flow in the brain and all indications are that the cause is a disruption of the blood flow to part of the brain. There are similarities with Meniere's Disease in humans. It is possible for a blow to the head to cause vestibular syndrome, but this is rare.

How serious is Vestibular Syndrome?
Provided that only the vestibular system is affected, the prognosis is usually very good for a full recovery. However, in some cases, other parts of the brain can be affected at the same time. Generally, if the dog is able to recognise its owner and is at least partly aware of what is going on, it will recover eventually.

What treatment is there for vestibular disease?
If an underlying cause is suspected, then treatment must be given for that. A middle ear infection will require antibiotics and anti-inflammatory drugs. No drugs have definitely been proven to help dogs recover from Idiopathic Vestibular Syndrome. An injection of steroid soon after it occurs has been proven to help many brain injuries, so it is possible this will speed recovery. Otherwise drugs that help to improve the blood flow to the brain are often given, such as Vivitonin or Fitergol, particularly if the dog has other evidence of poor circulation.

Otherwise treatment is aimed at making the dog more comfortable and nursing care. Drugs may be given to prevent vomiting and if the dog is unable to settle, tranquillisers will help. In the early stages it is best for the dog to rest quietly lying down. They may require help taking food and drink until they regain some stability. Once they start to feel better in themselves, particularly after the eyes have stopped flickering, it is useful for them to try and get around. When they first start moving around again, they will be unstable and fall often. To help them through this phase it is best to protect them from falling on hard f