Cerenia licensed for cats

Cerenia - a potent anti-sickness drug – was released in 2007, but has only recently become licensed for use in cats. Available as an injection that lasts 24 hours and also tablets (dogs only), it provides a highly effective way of stopping nausea and vomiting from many causes.

At high doses it is effective against motion sickness in dogs, although this should only be used for longer infrequent journeys. It is not recommended to give medication every day for your trip to the local woods to go for a walk.

It should be used with caution in cases where an obstruction to the gastrointestinal tract is suspected, and should be avoided or used at a reduced dose in animals with liver disease.

It is a useful anti-sickness medication for patients undergoing chemotherapy. Whilst animals do nto experience the same degree of side effects as human chemotherapy patients, some do show nausea and stomach upset for a couple of days after administration of the drugs. Sending patients home with two days of cerenia tablets to give after each chemotherapy session has been shown to be effective in reducing nausea and thereby improving both the animal and owner perception of the experience and situation.

Vets have been using it “off license” in cats for years but the license has come as wlecome news. We are allowed to use an unlicensed product through the Cascade System – a prescribing method that ensures drugs are used responsibly and animals are not put in danger. In the absence of any licensed anti-sickness drugs for cats, the next step is to use an anti-sickness medication that is licensed for use in an alternative species. If your vet has been using cerenia for your cat, they have done nothing wrong at all.

Some animals (cats and dogs) show a transient pain response on injection and may yelp. It is not known why it causes discomfort for some animals and not for others.

It is currently only available in the oral (tablet) form for dogs, I do not know if they are planning on bringing out an oral formulation for cats.

Dilated Cardiomyopathy (DCM)

What is dilated cardiomyopathy? (DCM)

 

A condition that causes the heart to become enlarged and with poor contractile strength. The valves and blood vessels are normally relatively normal, but the heart muscle becomes stretched, weak and floppy and fails to pump blood properly.

What kind of dog gets DCM?

 

The incidence of this disease is estimated at 0.5-1.1% of the canine population.

There is thought to be an inherited genetic component with some breeds being more prone to developing the disease. Doberman pinschers, boxers, Giant breeds (Scottish deerhound, Irish wolfhounds, Great Danes, St Bernards, Afghan hounds) and Cocker Spaniels are all over-represented.

Average age of onset is between 4-10 years old.

Males of some breeds are more often affected than the females.

What are the signs of DCM?

 

Some dogs do not show any symptoms at all. Others show respiratory signs of breathing fast or with difficulty, and coughing. Many dogs have weight loss, weakness, lack of appetite and lethargy. Some dogs have a bloated appearacne to their abdomen due to fluid build up, and fainting is not uncommon.

What is found when my vet does a physical examination?

 

Your vet will find physical signs characteristic of the underlying condition. If your dog is mildly affected then there may be little to find without diagnostic tests being used. If there is an associated arrhythmia (abnormal heart beat rhythm), then this can be heard, and there may be a discrepancy between the heard heart beat and the pulses that can be felt elsewhere in the body. Your dog may have crackles in its lungs, an audible heart murmur, be depressed and have weak pulses. They may have pale gums and have a slow refill time after being blanched by gentle pressure. There may be a large liver palpable.

WHen your vet does their physical examination, they will check all these things, even if you think they are “just stroking them” your vets hands will be feeling for and finding things you aren’t aware of.

What are the causes of DCM?

 

In many cases there is no known cause. These cases are called idiopathic.

Nutritional deficiencies of taurine and/or carnitine have been linked to cases in some breeds.

An underactive thyroid may cause reversible heart failure if treated promptly.

What are the diagnostic tests for DCM?

 

Your vet will probably advise taking some blood tests and will want to perform (or refer your dog for) an echocardiogram (ultrasound scan of the heart) and an electrocardiogram (documenting the electrical activity of the heart). The condition is best diagnosed by echocardiography. Xrays of the chest to get an overall picture of the size of the heart and condition of the lungs may also be useful and recommended.

The characteristic changes seen in this condition are an enlargement of all four chambers of the heart, together with thinning of their muscle walls.

What is the treatment for DCM?

 

Most dogs can be managed as outpatients.

Unless severely affected or advised otherwise by your vet, let your dog choose their own level of activity. Do not try to push them to do more than they want. This could be very dangerous.

Diet should have a mild sodium (salt) restriction. Severe restriction is not necessary due to the mainstays of drug therapies that are used.

Ensuring you, the owner, is fully aware of the potential signs associated with disease progression, and what the adverse effects of medication may be.

Medication

This is the mainstay of treatment options for DCM. Your vet will need to diagnose the problems your dog has associated with his DCM, and then prescribe appropriate treatments to address these problems. There is not a “DCM pill” and your dog will be on multiple drugs.

Your vet will discuss what treatment is right for your dog and monitor their response to treatment.

Examples of drugs that may be recommended include:

  • furosemide
  • aminophylline
  • digoxin
  • dobutamine
  • benazepril
  • spironolactone
  • pimobendan

What monitoring should my dog with DCM receive?

 

Lots is probably the only true answer here. Follow up clinical examinations, xrays and ECGs are often needed.

If your dog is prescribed Digoxin then regular (and initially fairly frequent) blood samples to check the levels of the drug in their blood will be necessary.

What are the possible complications I should be prepared for?

 

Unfortunately sudden death may occur if the heart spontaneously enters an abnormal rhythm that is incompatible with life. There may also be complications associated with the life saving medications.

What is the prognosis associated with DCM?

 

Not good I’m afraid. It is a condition that is always fatal and can never be cured. Most dogs live for 6-24 months after the time of diagnosis, however Dobermans have a worse prognosis and often live less than 6 months after diagnosis. Dogs which are found to have certain abnormal heart rhythms are also found to live less time.

Questions? Email me.

What is Apoquel?

What is Apoquel?

 

Apoquel is the trade name of a new drug called Oclacitinib, that has been found to be safe and effective in controlling acute (short term or sudden onset) and chronic (long term) itching in dogs.

How does Apoquel work?

 

The active ingredient (Oclacitinib) targets molecules called cytokines that are responsible for the inflammation and itching seen with allergic skin disease. By stopping these cytokines from working, the inflammation and itching is also reduced.

Other cytokines in the body essential for blood cell production and immune system function, are spared from the effects of Apoquel.

It is a completely different family of drug from those vets currently have access to for itchy dogs (steroids, antihistamines, immunotherapy, cyclosporines).

How quickly does Apoquel work?

 

The drug is reported as starting to work and give benefit to your dog within 4 hours of the first tablet. Itching is said to be controlled after just 24 hours.

Will Apoquel work against any allergy?

 

Yes. It is non-specific to the allergen, but works to block the allergic response. Therefore it is effective against a wide range of allergens.

Can I use Apoquel long term?

 

Yes. It is designed to have minimal side effects and be safe and effective for long term, ongoing use. There is no evidence to suggest that any tolerance to the drug develops over time.

Can Apoquel be used with any other drugs?

 

Yes. Your vet will be able to advise you on this, but unlike many of the existing treatments of itchy dogs, Apoquel can be used with antibiotics, anti-inflammatory drugs (eg for arthritis), vaccinations, and immunotherapy vaccinations.

Can my vet do diagnostic tests after starting Apoquel treatment?

 

Yes. Testing to find the underlying cause of the allergy is not affected by Apoquel treatment. A major advance! Current treatments have make diagnostic tests give a false negative result, meaning that either a diagnosis can not be found, or treatment is delayed to allow testing to occur.

How do I give Apoquel  to my dog?

 

Apoquel comes in three different strength tablets. Your vet will advise you what dose to give your dog. It is given twice a day for the first 14 days of treatment, and then just once a day. It can be given with or without food.

My dog is only itchy in the summer – can I use Apoquel for his flare ups?

 

Yes. Because it starts to work within 4 hours, you can use the tablets to help with a seasonal problem, as well as a lifetime condition.

Sounds great, but what are the side effects?

 

The most commonly seen side effect of Apoquel was gastrointestinal upset – vomiting and diarrhoea.

Animals that have severe infection or have Demodex mite infestation or concurrent cancer conditions should not be given Apoquel as it can make these conditions worse.

You cannot give Apoquel to animals less than 3kg in weight, or under a year old.

What is the cost?

 

In the UK, it looks like you should budget to spend about £1 per tablet. So long term use about £1 a day. This is so much cheaper than some of the current drugs. Steroids will always be the cheapest. But the serious side effects associated with long term steroid use make this a poor decision to make based on economics.

 

Any questions? Email me.

 

 

Cat Blood Donation

Why do cats need blood transfusions?

 

There are many conditions that our feline friends can become ill with that may cause life threatening anaemia. The best solution to this may be for the cat to receive a blood transfusion from a donor cat. Blood transfusions are much less common in cats than they are in dogs, and there are complicating factors in collecting and administering blood. Please read below and speak to your vet before considering volunteering your cat as a donor.

What is different about cat blood donation to dog blood donation?

 

Firstly cat blood cannot be stored in the same way as dog and human blood. Therefore keeping a Pet Blood Bank or supply of blood in case it is needed is not possible. If a need for blood arises then a donor cat has to be found and the blood used directly after collection. This raises problems all of its own. Some large hospitals and university veterinary hospitals may keep some donor cats, but for the average veterinary practice this is not possible. Having a register of cat owners with suitable animals is therefore important. There are a number of things to consider before you rush to sign your cat up though.

Consent for donation

 

If you volunteer your cat to donate, you are giving consent on their behalf. They have no knowledge of what they are doing and there are risks for the donor so whilst benefitting another cat, you are putting yours at risk. All risks must be carefully evaluated and an informed decision made. There is more risk for cat blood donors than for dog or human donors.

What are the risks for cat blood donors?

 

Virtually all cats will be sedated to donate blood, as they have to sit still for a period of time with a large needle in their jugular vein. It is safer and less distressing for the donor to be relaxed, comfortable and not fully aware of what is happening. Often blood is collected with the cat lying on its back with head and neck extended. I haven’t met a cat that will lie like that without sedation! Sedation in itself carries a small risk, and so if there are any reasons not to have your cat sedated then they are not a suitable donor.

Underlying health concerns such as kidney or heart disease will also may your cat an unsuitable donor.

How does my vet minimise the risks of donating blood?

 

There are some health screens and physical examination checks that your vet will make before agreeing to use your cat as a donor. These are some things that will be checked:

Checks before donation

  • Age – between 1-5 years old
  • Weight – more than 4kg but not due to being fat!
  • Temperament – calm and relaxed when being examined, handled and during trips to the vet.
  • Vaccination status – must be fully vaccinated
  • Ideally an indoor only cat as this reduces the risk of carrying infectious diseases
  • Must NOT have donated within the previous 4 weeks
  • Physical examination
  • Blood pressure measurement
  • Basic blood screens to check for the amount of red and white blood cells, kidney and liver function
  • Blood screens to test for Feline Immunodeficiency Virus (FIV), Feline Leukaemia Virus (FeLV), and Haemoplasma infection
  • Possibly a heart ultrasound scan

Risk reduction during and after blood donation

  • Food is withheld for a few hours before sedation. This reduces the risk of vomiting under anaesthetic which can be dangerous.
  • The correct and safe volume of blood is collected. Most cats donate 40-50ml of blood only.
  • Cats are kept warm during and after the procedure and monitored until they are fully awake.
  • An intravenous drip is often used to help maintain blood pressure and aid recovery from sedation.
  • Cats are fed when they are awake enough to eat. This is similar to humans being given a drink and a couple of biscuits after giving blood.

Should I volunteer my cat to be a blood donor?

 

Only you can answer this question. If all the appropriate checks are made, then the risk of donating blood is small, but there is always a risk. If you know your cat hates the vet, then as much as it is lovely to think of saving another cat’s life, it is not the right thing to do. There is no guarantee with any procedure that there won’t be complications. You will be told about all the risks before your cat donates, and will be asked to sign a consent form to say you understand what is happening.

Talk to your vet about it as they will be the one performing both the collection and the transfusion. They will be able to advise you. There is excellent information available for vets by the International Society of Feline Medicine.

Christmas Poisons

Obviously these are not only poisonous at Christmas, but it is the time of year when there are more of these things around, and as a vet I definitely see more poisonings around Christmas. Something about having the house full of people, more food, treats left out, excited children, presents all seem to lead to carelessness compared to normal. Common poisons you need to make sure your pet avoids include:

 

Chocolate

 

The most common reason we vets see dogs for poisonings. The problem chemical in chocolate is called theobromine. White chocolate contains virtually no theobromine and will not cause poisoning, however the very high sugar and fat content cause vomiting and hyperactivity and it is definitely not to be recommended. The higher the cocoa content of the chocolate, the less of it the dog has to eat to become intoxicated. Therefore dark chocolate is the most dangerous. Dog specific chocolate drops do not have any cacao beans in them and are therefore safe.

What are the symptoms of chocolate poisoning?

Onset of symptoms is within 24 hours, but often much sooner. Vomiting and diarrhoea, stomach pains, panting, twitching, wobbly walking, rapid breathing and heart rate, agitation, drinking and urinating more, seizures and death.

My dog has eaten chocolate, what should I do?

Ring your vet, even if your dog seems well. If you tell your vet how much of what chocolate your dog has eaten then they will be able to tell you if you need to be concerned, and if any treatment is needed. Your vet will have 24 hour access to the Veterinary Poisons Information Service so if they are not sure, they can get advice from this service. There will be a charge for them to do this.

What treatment is there?

There is no specific treatment or antidote for chocolate poisoning. If your dog has only just eaten the chocolate then your vet may induce vomiting to try and limit the amount of toxin that gets absorbed. This should not be attempted at home. If it is too late to induce vomiting, then symptomatic and supportive treatment as necessary will be provided. This may be anti-sickness drugs if your dog is vomiting, an intravenous drip, sedatives and anti-seizure medication, drugs to control a racing heart rate and maybe some activated charcoal to mop up any toxins left in the gastrointestinal system.

Is chocolate poisoning dangerous?

Yes. It can cause death if severe and untreated. However most dogs only have a mild case and go on to make a full recovery with no lasting effects.

Any other problems with chocolate?

Yes, many have raisins or sultanas in them which are toxic. And wrappers which are also often eaten can cause obstructions.

 

Vine fruits – raisins, sultanas, currants, grapes

 

These may be highly toxic and can cause kidney failure and death in many animals. It is not known what the toxic element is, and some dogs can eat handfuls of raisins with no issues; others can eat a couple and have life threatening symptoms. Therefore as there is no way of predicting which animals will be affected it is recommended that no dog is fed any of these fruits. It is not known if cats are affected.

What are the symptoms of eating vine fruits?

All animals seem to vomit. They may have stomach pains, be lethargic, have diarrhoea and poor appetite.

What is the treatment?

Again there is no specific antidote. Treatment is aimed at protecting and supporting the kidneys. Intravenous fluids are given and blood samples should be taken to assess kidney function. These should be repeated every 48 hours to check for any changes. Activated charcoal will be given orally to mop up any toxin still in the gastrointestinal tract.

What is the prognosis?

If there are no signs of kidney failure then the prognosis is very good. If kidney failure exists, then the extent and path that this takes determines the prognosis. Some dogs will be unlucky and go into irreversible kidney failure, in which case euthansia is the only option.

 

Xylitol

 

This is very dangerous to dogs. Personally I have treated cases where owners have given their puppy a child’s homeopathic teething remedy to try and ease the discomfort of new teeth coming through, only to find that they have poisoned their dog. Another example of why human medicines (even if for babies and herbal/homeopathic/natural/organic) are not for dogs. We have different metabolisms and toxins to us may be fine for dogs, and vice versa.

Xylitol causes the dog’s blood sugar levels to plummet dangerously low. This can cause weakness, lethargy, depression, coma and death. Liver failure may also result from xylitol ingestion and is non-dose dependent i.e. your dog could eat a tiny amount and still get liver failure. Symptoms of this may not show for up to 3 days after ingestion.All animals that have eaten xylitol should be treated aggressively.

Treatment may involve a drip, treatment for liver failure and to protect liver function. Sugars to keep blood glucose level steady will also be given.

With prompt treatment your dog should make a full recovery. However if you have delayed going to the vet and liver failure has become established, then the chances of recovery are much more slim and euthanasia may be required.

 

Onions/garlic/shallots/chives/leeks

All members of the Allium family are toxic to dogs, regardless of how many times you will read and hear people advising the use of garlic to repel fleas. Do not do this. It doesn’t work and you are poisoning your dog. These foods cause vomiting and diarrhoea, and with high level or chronic exposure damage red blood cells leading to anaemia. I have worked with a nurse who used to religiously crumble an OXO cube onto her dog’s dinner every night to make it more palatable. Apart from a high salt and MSG content, she was also giving her dog a dose of powdered onion every day. The result? A blood transfusion to save her severely anaemic dog’s life. Watch out for stuffing and human gravies which often contain onion powder.

 

Macadamia nuts

 

May cause gastrointestinal upset, as well as affect the nervous system and muscles. Nuts are also often covered in chocolate – a lethal combination.

 

Mouldy food

 

I have seen the effects of this as well. Mouldy bread and other foods contain toxins that affect the nervous system and can cause seizures and death. The case I saw was utterly confusing as the owner did not give any history of exposure to toxins or substances likely to cause seizures. Eventually after much questioning it was revealed the dog had eaten a loaf of mouldy bread form under the teenage son’s bed! Problem solved.

 

Pine needles

 

If eaten these can cause damage to or obstruction of the intestinal tract. They are also damaging to paws if they are trodden on.

 

There are obviously far more substances your pet can have a problem with at any time of year, so be careful. If in doubt, ask your vet.

Flooding and your pets

When you are worried about your home flooding, planning what to do with your pets may seem like the last thing you want to think about. Sand bags and trying to prevent flooding from occurring may take priority. However, by thinking and planning ahead of a disaster happening, you will minimise risk and stress to yourself and your pets, and save valuable time in the event of an evacuation. Below are some steps and advice relating to flooding.

  1. Harsh as it sounds, the first rule of floodwater and pets is that you must never ever put yourself at risk to try and save an animal. How many news stories have there been in recent years of people getting into rivers to rescue their dog, only to drown themselves and the dog get out relatively unscathed? This is easy to say but I imagine virtually impossible to do. I imagine few situations more horrendous than watching your dog or cat struggle and drown and feeling you should jump in and help, but not letting yourself.
  2. Be prepared. If you are risking having to deal with the heartache of flooding, the last thing you want to deal with is loss of a pet.
  3. Keep cats indoors so they cannot fall into or get swept away by flood water.
  4. Do not let dogs off lead next to floodwater or to run through floodwater. Who knows what is under the water or if a man hole has come away leaving a deep hole your dog could fall down? Even if your dog normally swims in the river or lake every single day, if conditions are different then your dog may not be able to find his normal way out, or cope with faster moving water. Be sensible! Your dog cannot assess conditions and will not know if it is dangerous. Think for them.
  5. All pets should have permanent identification anyway, but this is especially important during flooding. A microchip and a collar with a tag and your details on it are essentials.
  6. Make sure you have enough food, any medications and supplies so that you do not have to go out in a risk period.
  7. If your pet is going to be housed in a kennels or cattery at any point, check if they are liable to flooding, and if so don’t leave them there! The Environment Agency has easy to find information about flood risk and areas that have flooded previously. Check it out before it’s too late.
  8. Stay up to date with information. Just because it has stopped raining doesn’t mean it’s not going to flood. The horrendous floods in Boscastle, Cornwall in 2004 show what can happen and how fast it can happen. Amazingly no-one lost their lives there, but a lack of information can prove fatal. Conditions change incredibly fast. Be informed.
  9. If flooding is imminent, try to take your pets to a friend or family member who live outside the flood area.
  10. Have all their documents together in one easy to access place. Maybe with your own important documents?
  11. Keep a secure cat carrier in an easy to get to place. There is no good having to go into the roof/shed/garage or try to improvise with a washing basket (I have seen all sorts as a vet) in a flood situation.
  12. Make sure your dog’s collar is not too loose, and ideally have a harness easily to hand with a thick secure lead. You don’t want your dog to slip their collar and be lost should they panic.
  13. If you flood and have to be evacuated, try not to leave animals behind as you may not be able to return to them for days. If you do have to leave them, shut them in a secure room as high as possible, with more food and water than you think they can possibly need. Put a sign on the outside of the closed door to tell anyone who may enter the flooded property that there are animals (how many, what etc) inside.
  14. Get all animals into secure carriers or onto secure leads and take them with you as long as you are not putting yourself at risk to do so. Some flood shelters do not take animals, so check this before you are in position of needing to use one. Do not put water into carriers whilst transporting animals – it spills and makes your pet wet, cold and cross.

Hopefully you will never have to use these tips, but being prepared is definitely better than finding yourself in a panic.

Insurance

Pet insurance is highly recommended. Not only does it cover you for unexpected vet bills (which can be expensive), but it also provides you with vital 3rd party cover.

If your dog should cause a car accident, it is your responsibility to pay for the damage to the cars, NOT their responsibility to pay to fix your dog.

Most vets will recommend Petplan. This is for a couple of reasons – firstly it is the easiest to deal with, and seems to pay out the most rapidly and with the least amount of hassle. Exactly what you want when you are worried and your pet is sick. It is also the insurer which your vet is most likely to be happy to deal with directly, meaning you pay your excess only, and all other fees are claimed directly from the insurer by the vet practice. This policy is entirely up to the practice – some won’t do any direct claims, and some will claim from any insurer. Ask.

The second reason why most vets recommend Petplan is that they are not allowed to recommend anyone else! The pet insurance industry used to be regulated by the FSA, it is now regulated by the FCA and some things behind the scenes have therefore changed.

Whoever you choose, make sure you look for these key points in your policy:

1: A good level of cover. £1500 per condition is not enough. This will not cover many fairly common surgeries – for example cruciate surgery. If you can, aim for as much cover as you can afford, but at least £4000 per year.

2: cover for life. Some of the cheaper insurers only cover a condition for one year. This is pretty much pointless, and causes an awful lot of heartache when owners realise they cannot claim for ongoing medications, or conditions that recur. Arthritis, heart disease, skin disease, cancers etc will all fall outside the cover of these policies, and can be some of the most expensive conditions to treat.

Insurance is not for everyone. If you have enough money set aside to cover an unexpected £2500 bill should you need to, and you won’t mind spending it when required, then insurance is probably not for you. If you struggle to find £80 then please take it out. Fixable animals have to be euthanased through owner’s lack of financial provision for their care. And that is heartbreaking.

If you choose not to insure against illness, please take out 3rd party insurance. For dogs, signing up to membership of the Dogs Trust is the most economical way of doing this. For £25 a year, all your dogs are covered for 3rd party, and they are also covered if someone else is looking after or walking them. Plus you are supporting a charity doing amazing work for dog welfare.

Dog blood donation

Dog blood donation is a fantastic, life-saving resource available to all vets across the UK. The UK Pet Blood Bank was set up in 2007 and provides organised donation sessions and a central source of blood that vets can access. Where I work I am lucky enough to have a Pet Blood Bank a few miles away, and if I have an emergency case where I need blood, can just go and collect the product I need.

The collected blood is processed into plasma which is frozen and can be kept for up to 5 years, and into Packed Red Blood Cells which can only be kept for 6 weeks. These have different uses and your vet will choose which is needed.

Dogs are registered as donors if their owners volunteer them. Collection sessions are held at veterinary practices across the UK. If you would like your dog to be a life-saver, then check the following critera:

Canine blood donors must:

  • be between 1 and 8 years old
  • weigh more than 25kg
  • have a nice calm temperament and not mind having veterinary procedures or being handled.
  • never have travelled abroad
  • have up to date vaccinations
  • be fit and healthy
  • not be taking any medication

Blood is taken from the jugular vein in the dog’s neck. This is normally done without any sedation, but the donor does need to sit or lie still for a few minutes. About 450ml of blood is collected, either by a phlebotomist or a vet.

Once taken the blood is typed (dogs have blood types like people!) and then put into storage until needed.

If you would like your dog to be a donor visit the Pet Blood Bank. If your dog does not meet the donor criteria then there are other ways you can help.

Some veterinary practices keep their own register of dogs who can be called on to donate at short notice. The same criteria apply, and in addition you have to be prepared to be called on at any time – most emergencies seem to happen over night!