Welcome to our Autumn 2020 newsletter. It barely seems possible that we have already reached autumn again. So far 2020 has been somewhat a rollercoaster year in the face of the Covid crisis. Whilst life cannot truely be considered back to normal we are pleased to have everyone back at work after lock down. There is no doubt that these Covid times have been difficult in many ways but we are proud of how the team has pulled together to ensure the continued care and support of our patients and clients. The practice is still working in compliance with social distancing and, at this time, the surgery opening hours are still limited to 9-5 (although as always a vet is available 24/7 to see and treat emergency and critical care of patients). We hope to be able to review this as and when there is clearer picture about how the pandemic is further progressing. Thank you to all our clients for their ongoing understanding and support.
This month (September) we happily see the return of Nafisa who has been on maternity leave. Sadyly we have said goodbye to Alicia who qualified with us as a veterinary nurse, she goes on to new pastures after 15 years of service. We will also be saying goodbye to Emma the vet who is moving away to Pembrokeshire and Gemma the nurse. We wish them all the very best in their future endeavours.
This quarter we thought we would consider two common, non seasonal, conditions seen in dogs: cruciate disease and Brachycephalic obstructive airway syndrome. We routinely see dogs with these issues and felt it would be useful to share some more information about these conditions to help give owners, and potential owners, of affected dogs a better understanding. As always we hope you find this information useful, if you are concerned that your dog may suffer from either of these conditions then one our vets will be happy to discuss the individual needs of your pet.
Cranial Cruciate Disease (CCD)
Cranial Cruciate Disease injuries are a common cause of hindlimb lameness in dogs. In humans these can be called ACL ruptures or knee ligament damage and are a common sporting injury with often a 6 - 12 month rehab period after major surgery.
The normal cranial cruciate ligament tightly binds the far end of the thigh bone (femur) to the near end of the shin bone (tibia). This binding allows the leg to bear weight through a strong knee joint.
Microscopically the ligament looks like a multi-stranded fisherman's rope. Rupture can occur either through a sudden twisting force (such as a dog chasing a stick/ball) or through repeated minor strains which fray and weaken the ligament leading to eventual rupture.
CCD can be seen in any breed of dog but large breeds including Rottweilers, Labradors, Retrievers etc are more often affected. Some studies have suggested that delaying neutering of these larger dogs until after 18 months of age, when they are fully mature, may possibly reduce the risk of them developing CCD, but investigations are ongoing.
When the cruciate is strained it will be uncomfortable for the dog but it will usually get better over a few weeks with anti-inflammatories and rest. However, when a cruciate is ruptured it will never repair itself and, except in a small proportion of cases (usually low activity small breed dogs), without surgery, there will often be a marked persistent lameness.
Over the years, many surgical techniques (at least 6) have been developed to try to successfully return the dog's knee to normal function. No single technique is perfect for all scenarios - here at Holmer Surgery we offer several of these surgical options and so can help with almost all cruciate presentations.
There is one group of patients who sometimes are not operated upon - aged or low energy dogs weighing less than 10kgs. If they are just left to rest, over around 6 months the other tissues of the knee will tighten up to give a weight-bearing, it is not clear but medically managed cruciate disease knees may be more likely to develop osteoarthritis earlier than surgically stabilised knees. This is an option to consider if other illnesses are present, if general anaesthetic risk is considered too high or where there are financial constraints.
Broadly there are two different groups of operations available:
1. The ruptured ligament can be replaced by an 'extra-capsular repair' in which either nylon or a braided cord is placed around/through the knee joint to mimic what the original cruciate ligament was doing. These operations are intricate and an interest in orthopaedics by the vet is needed to do them. We've offered this option for many years and have had good success rates at around 80% good return to function. However, this option can be prone to problems - the implant can stretch, become detached, or even break, at some time after the operation, and this is especially a problem in dogs weighing over 20kg.
2. A part of the shin-bone can be detached and then fixed back in a certain way which changes how weight is transferred through the knee - these changed forces mean that the knee no longer needs a cruciate ligament for stability and to function well. It is these techniques which are used on human ACL injuries.
The shin-reconstruction techniques are considered to be superior, but are more challenging and require training and more advanced surgical kit - both to perform the operation and the various implants which are left in the tibia. Until recently these operations were only available at specialist referral centres, however, we are now proud to offer one of these advanced techniques, the Tibial Tuberosity Advancement (TTA). Holmer Surgery has been doing TTA operations for nearly two years now and we have had very good success rates - typically around 90% regarded as doing very well, and with few complications.
We are able to do these TTA operations, usually for dogs over 10kg (but sometimes also for lighter ones, depending on circumstances). There is an all-in price covering the cost of the operation, post-operative care and any complications.
Recovery is generally quick and good. Cases tend to be using the operated leg reasonably well within just a few days of surgery. Due to the tibia being sectioned and repositioned strict rest for 6 weeks post-op is vital to allow the bone to heal and grow into the implants. If the leg is used too vigorously too quickly before the 6 weeks is up, there is a risk of fracturing the tibia - we haven't had a case do this yet, but it is completely dependent on the owner being careful with their dog, and a tibial fracture can potentially be very serious.
When cases get to their 6 week post-op check and are doing well we can then discuss building up levels of exercise. Complications after this time are rare - we've had one infected metal staple which had to be removed, out of the 40-50 cases we have done so far. This is in contrast to the older extra-capsular replacement-ligament techniques where the implanted synthetic ligament can occasionally fail at any point in the rest of the dog's life.
Regardless of method of surgery, any dog that has suffered a cruciate ligament rupture is likely to go on to develop some degree of osteoarthritis in that knee joint. This can be ameliorated by good weight control, joint supplements, hydrotherapy, and anti-inflammatory medicines. It should also be noted that around a third of dogs who rupture one cruciate ligament will then go on to rupture the cruciate of the other leg at a later stage.
If your dog is limping on a back leg, or you have any questions regarding cruciate ligament injuries, please make an appointment for a consultation with one of our vets.
Brachycephalic Obstructive Airway Syndrome (BOAS)
Brachycephalic breeds of dog, those with short noses/flat faces, including Bulldogs, French Bulldogs and Pugs are becoming increasingly popular. Whilst these breeds of dogs tend to have a good temperament, their conformation, whilst considered by many to be appealing, very sadly is often detrimental to their health. Not only does the head and body shape of these breeds mean that they more commonly have to be delivered by caesarean section, than other breeds, but their head and face shape mean that their everyday health and welfare can be significantly compromised
Studies done at Cambridge University estimate that 60% of pugs, 46% of French Bulldogs and 40% of Bulldogs suffer from BOAS. From our experience in first opinion practice the numbers of brachycephalic dogs we see would suggest that the incidence is actually much higher.
BOAS is the term used to describe a combination of factors which contribute to affected brachycephalics having issues breathing. Severity of cases vary and whilst some well-bred dogs may not have symptoms, affected animals can be mildly to severely affected. BOAS affected dogs can have noisy breathing, poor exercise tolerance, heat intolerance, suffer from sleep apnoea or develop issues with swallowing, vomiting and/or regurgitation as the result of the abnormal pressures exerted at the dog tries to breath. Dogs who have these gastrointestinal issues can also suffer from aspiration pneumonia which in turn will adversely affect the animals breathing.
The conformational abnormalities that contribute to BOAS include a combination of: an overlong +/- thickened soft palate, narrowed nostrils, abnormal nasal turbinate bones compacted and/or deviated so as to limited the airflow through the nose, enlarged tonsils, secondary changes to the larynx causing it to become inflamed and collapsed, and some more severely affected individuals have also been found to suffer from a narrowed trachea/windpipe.
For some BOAS patients who are only mildly affected management of weight, which studies suggest is particularly important in pugs, and exercise may be adequate to ensure a good quality of life. However surgery is needed to improve the health and welfare of moderately to severely affected dogs. At Holmer Vets we are able to perform nasal resections, usually done at the time of neutering, which can in some cases help slow or occasionally avoid the progression of changes in the larynx and palate. The Cambridge study indicated that in 67% of French Bulldogs the narrowed nostrils were the most significant factor in their BOAS condition, 58% for pugs. It must however be remembered that the nasal changes are often only a part of the more generalised issue, these patients need to be referred for full assessment and appropriate surgical intervention.
For some BOAS patients who are only mildly affected management of weight, which studies suggest is particularly important in pugs, and exercise may be adequate to ensure a good quality of life. However surgery is needed to improve the health and welfare of moderately to severely affected dogs. At Holmer Vets we are able to perform nasal resections, usually done at the time of neutering, which can in some cases help slow or occasionally avoid the progression of changes in the larynx and palate. The Cambridge study indicated that in 67% of French Bulldogs the narrowed nostrils were the most significant factor in their BOAS condition, 58% for pugs. It must however be remembered that the nasal changes are often only a part of the more generalised issue, these patients need to be referred for full assessment and appropriate surgical intervention. BOAS surgery by specialists will vary based on individual need, but in general will involve nostril widening (if not already performed), shortening and thinning of the soft palate, removal of the inflamed section of the tonsils +/- removal of the inflamed and thickened sections of the larynx, if present, severe collapse of the larynx may also require a procedure called a tie back. 30% of cases will not respond adequately to this standard surgical intervention and so may need to go on to have laser treatment to remove excess turbinates from within the nostrils. For the majority of dogs, 80%, which suffer gastrointestinal signs due to their BOAS, the vomiting/regurgitation issues resolve with the upper airway surgery, for those individuals where these symptoms persist medical or further surgical intervention will be needed.
The prognosis for dogs with BOAS is variable, young age at presentation and dogs who are unable to put on a healthy weight tend to have more severe disease. Dogs presenting with laryngeal collapse and/or a narrowed trachea often will sadly have a poorer outcome.
It is clear that BOAS can be a devastating disease. In some countries it has been made illegal to breed certain brachycephalics, in an endeavour to relieve the suffering of these dogs. In the UK no such restriction exists but it is imperative that as a dog loving nation we think carefully about the health and welfare of the dogs we are producing. Not all brachycephalics suffer from BOAS, potential brachycephalic dog owners should try to ensure, to the best of their abilities, they are seeking well bred dogs, whose parents have been seen not to suffer from breathing issues, who are happy and active, an ideally have been assessed. A grading system has been devised at the University of Cambridge which, although a relatively new program, aims to help select brachycephalic dogs for the best conformation for health. There are a limited number of specialists who are eligible to make the assessments for the scheme but a list can be found on the Kennel Club website. With the ever increasing possibilities for treatments of our pets, pet insurance is becoming an ever important consideration for pet owners, never more so for owners, and potential owners, of brachycephalic dogs. If your beloved dog develops signs of BOAS having a good insurance in place (£10,000+ cover recommended) will at least enable you to seek out the treatment required, to try and ensure they do not have to continue to suffer from this debilitating and potentially life threatening condition.