Spring 2020 Newsletter - Holmer Veterinary Surgery

Welcome to our first newsletter for 2020. We hope everyone had a lovely Christmas and New Year and has survived all the rain, wind and mud this year has dealt us so far. A reminder to all owners who have dogs who suffer from fear of fireworks that, if you haven't already started, now is the best time to try and implement a noise desensitising program. Please look back at the information in our Autumn 2019 Newsletter, which is still available to view. Please do not hesitate to speak to one of our vets if you feel you need additional support with using the Sounds Scary download, which is freely available from the Dogs Trust website.

In this issue we look at the life threatening disease Leptospirosis, as we have sadly seen several suspect cases over the last few months. We also look at rabbit vaccinations and the diseases which they protect against, reminding owners why now is the best time to vaccinate. Our last article covers a group of all too common conditions generally known as FLUTD (Feline lower urinary tract disease) in cats, giving some recent understandings of what may cause the condition and current best management strategies

Leptospirosis

What is it?

Leptospirosis (lepto) is an infectious disease caused by a type of bacteria called Leptospira. Lepto is a serious, often fatal disease in dogs that can cause acute kidney and liver damage. At the time of writing in the second half of 2019 we treated 7 suspect cases of lepto, sadly only 2 of these survived. Dogs can become infected by coming into contact with urine from an infected animal or a contaminated water source. It is also a zoonotic disease which means that humans can also be infected by the disease. If you have concerns about being infected with lepto please seek advice from your doctor or visit https://www.nhs.uk/conditions/leptospirosis/

Symptoms

The symptoms can vary from mild to very serious, and the progression of the disease can be rapid. Lepto can present a wide range of symptoms and resemble other infectious diseases such as canine infectious hepatitis, however progression of disease is much more rapid. Signs of lepto can include:
• Fever
• Vomiting and/or diarrhoea which can contain blood
• Jaundice – yellowing of the skin, gums and eyes
• Collapse
• Dark/very yellow urine
• Marked dehydration
• Lethargy
• Increased thirst
• Anorexia/off food
• Abdominal pain
• Sudden death

Diagnosis

An initial blood test to assess your dog’s liver, kidney, electrolytes and blood count will be performed, as this will help to rule out other potential diseases and assess the severity of the illness. Specific blood tests to try and confirm the diagnosis of lepto can be performed by external laboratories, not only do these tests take time to run but they are unfortunately do not always detect all infections, in addition given the wide range of Lepto strains that exist investigating for all strains can be costly. Because of this treatment is started on a presumptive basis, as any delay could potentially reduce the chance of survival.

Treatment

Rapid intervention is needed for dogs presenting with suspect Lepto as the disease can progress quickly and can cause permanent organ damage and be fatal. Sadly even for dogs who receive prompt treatment the mortality rate is still very high. Treatment consists of:
• Aggressive fluid therapy to rehydrate and try and support the kidneys and flush out toxins
• Antibiotics that are effective against lepto
• Supportive treatments to help control other symptoms such as vomiting and diarrhoea
• Supportive nursing, with strict hygiene precautions including placing the dog in isolation, to reduce the risk of spreading the disease
• For severe cases the prognosis is very poor, meaning survival is unlikely, euthanasia may be considered to prevent the dog from suffering
Even after recovery, the dog will shed lepto in their urine for some time afterwards and be risk to other pets and people. Therefore if a dog has caught lepto it is advisable that all other in-contact dogs have an up to date appropriate lepto vaccine and that good hygiene is observed at home to reduce the risk of further infections.

Prevention

There are several vaccines available that offer protection against lepto. The most widely used are the L2 and the L4 vaccines. The number refers to the number of strains against which the vaccine is protective. We as a practice recommend that the L4 vaccine should be used as we are situated in a higher risk area for the disease. The immune response generated by the vaccine is short lived so it is necessary for dogs to receive annual boosters to ensure they are protected as well as possible. All the cases of lepto we have seen have been in unvaccinated dogs, dogs who had the primary course but no annual boosters, or have had an unknown vaccination history.

If you have any concerns regarding vaccination and/or lepto please get in touch with one of vets and we will be happy to try and answer or address them with you.
The most common strain of Lepto is usually carried by infected rats that shed the bacteria in the urine, often contaminating water sources such as lakes, ponds etc… The bacteria is rapidly destroyed by light and temperatures above 20◦C, therefore it is advised to keep your dog away from stagnant water in shady areas. Most of the dogs we see with lepto are working dogs, this is down to being out in the countryside where they are more likely to come in to contact with contaminated water. If your dog is kept outside or in a kennelled environment try to ensure that any food or water is inaccessible to rats or frequently changed and cleaned to reduce risk of soiling by rats.

Vaccinating Your Rabbits: The What, Why, When and How

What?

We use vaccinations to protect our pets against highly infectious and potentially deadly diseases. Vaccinations also help to decrease the spread of disease, which helps to lower the number of animals becoming ill. It is highly advised that rabbits are vaccinated against both myxomatosis and rabbit viral haemorrhagic disease (RVHD) types 1 and 2.

Myxomatosis

Myxomatosis is a viral disease in rabbits that is very severe in both the wild and domestic rabbit population in Britain. Mosquitos and fleas that have bitten an infected rabbit go on to bite more rabbits, spreading the virus. Both indoor and outdoor pet rabbits are at risk, however rabbits kept outside in an area, where wild rabbits also enter, have a higher chance of contracting the disease. Direct contact with infected rabbits is also a way that the disease spreads, it is thought that mites and midges could also be passing on the virus. The disease affects the eyes, lungs and genitals with symptoms including:
• swollen eyes, face, ears and genitals
• ulcers and scabs
• low energy
• discharge from the eyes and nose
• a high temperature
• breathing problems

Prognosis is poor in unvaccinated rabbits, with death occurring 10-14 days after symptoms appear.

Rabbit Viral Haemorrhagic Disease

RVHD types 1 and 2 are viral diseases common in Britain’s wild rabbit population, which attack the rabbit’s organs especially the liver. RVHD1 kills almost all rabbits within two days post infection from severe internal bleeding. RVHD2 was detected in the UK in 2013 and has a lower mortality rate but has a longer time period during which the rabbit is infectious. This means that the disease becomes more widespread and is harder to recognise as often there are no signs of bleeding. Whereas with RVHD1 there is sometimes bleeding from the nose and bottom before death. Sadly, it is common that in cases of RVHD type 1 and 2 owners will find their rabbits dead, where there have been no previous signs of illness, due to a rapid onset or no outward signs of disease. Things to look out for include, low energy, decreased appetite, high temperature and blood around the nose, mouth or bottom. RVHD is easily spread via direct or indirect contact with an infected rabbit, it can be transmitted via fomites (bedding, bowls etc), other animals (including humans) and insects. The virus can survive in the environment for months.

Why?

Unfortunately, there are no effective treatments or cures for myxomatosis or RVHD types 1 and 2. If your rabbit contracts RHD2 they have a higher chance of surviving than if they contracted type 1, but how an individual rabbit is affected by the disease cannot be predicted so both strains must be considered potentially life threatening. Vaccinating against myxomatosis and RVHD types 1 and 2 is strongly recommended as the diseases are mostly fatal in unvaccinated rabbits. Vaccinated rabbits that contract the diseases often experience much milder illnesses but have increased survival rates. With both diseases causing so much suffering and often death, it is highly important to get your rabbits vaccinated and keep up with yearly boosters. Vaccinations can have side effects including a small increase in temperature and a temporary swelling at the injection site. These side effects are very mild; therefore, it is still advised to vaccinate because the benefits out-way the side effects. If your rabbit stops eating post vaccination, please contact your vets to reduce the chance of gut stasis developing.

Prevention

Check around your rabbit’s back end and underneath their tail daily, we would recommend checking twice a day throughout summer
Keep your rabbit clean and dry
Clean where your rabbit toilets every day
Clean your rabbits hutch and change their bedding at least once a week
It is important that your rabbit is fed the correct diet and is not overweight. This will help prevent diarrhoea, making it is easier to keep them and their environment clean

When?

Rabbits should be vaccinated from 6 weeks old against myxomatosis and RVHD types 1 and 2. Initially there are 2 vaccinations given at least 2 weeks apart, then yearly boosters are required to maintain protection. It is usually preferred for these vaccinations to be given at the end of winter or early spring in preparation for when the insects will begin spreading the diseases, when warmer weather begins.

How?

Please contact the surgery to book an appointment with one of our vets, who can give your rabbits a health check and vaccinations. The vaccinations are administered via an injection underneath the rabbit’s skin.

If you require any further advice regarding rabbit diseases and vaccinations please ask one of our vets or qualified nurses.

Feline Lower Urinary Tract Disease (FLUTD)

Feline lower urinary tract disease is a term used to encompass diseases of the urinary system in cats including feline idiopathic cystitis (FIC), bacterial cystitis, urethral obstruction (urolithiasis, urethral plugs, urethral spasm and, rarely, cancer). The symptoms for each of the causes of FLUTD can be very similar, although the clinical severity and progression of each disease process differs greatly.
Cats with FLUTD typically present with difficulty urinating, this may be the passing of small amount of urine little and often, inability to pass urine, passing of bloody urine, inappropriate urination around the home and/or over grooming around their back end.

Radiograph showing stone blocking urethra

Urethral obstruction

Of the causes of FLUTD urethral obstruction should be considered an emergency disease. Urethral obstruction is a potentially life threatening situation, when a cat is unable to pass urine the bladder becomes overfull and back pressure is put onto the kidneys. Cats with urethral obstruction can develop kidney injury, which can progress to kidney failure if the blockage is not resolved. Blocked cats will often have a tense and painful abdomen, they can become withdrawn and go off food, as the kidneys are damaged they may develop vomiting and/or collapse.

Some studies suggest that up to 53% of cats presented with an inability to urinate are due to spasm of the urethra, a cause of which cannot be identified, stress is considered to be a significant contributing factor. For these cats management may be relatively straight forward with relief of the blockage and analgesia, urethral muscle relaxants may also be used to help alleviate the functional blockage.

Cats can also present with a physical urethral blockage, most commonly with urinary stones (uroliths) or urethral plugs (which consist of inflammatory proteins, with or without tiny stones/sand like material). Less commonly urethral obstruction can be due to a stricture i.e. where the urethra has suffered previous damage or, in older cats, bladder or urethral cancer. The vast majority of stones seen with feline urolithiasis are made from crystals called Struvites or Oxalates. Cats presenting with a physical urethral obstruction are typically male. As indicated it is important that the obstruction is relieved promptly. A cat who presents with a blocked urethra will be admitted to the veterinary surgery for treatment, depending on the severity of the cats condition treatment may involve direct drainage of the bladder (Cystocentesis), administration of fluids and/or sedation/anaesthesia to place a urethral catheter.

The urethral catheter is used to clear the blockage and flush the bladder, it may be necessary that the catheter is left in place for a few days whilst the cat recovers, giving time for inflammation and/or spasm (functional blockage) to subside. Cystocentesis carries a low risk of bladder rupture, but this is only likely to occur if the bladder was already at the point of bursting. Passing a urethral catheter is also not without risks and haematoma formation, urine scalding, scrotal swelling, penile deviation, urethral rupture or strictures are, unfortunately, all potential complications. Given the potential effects urethral obstruction can have on the kidneys it is advisable that patients have a blood test to check kidney parameters, although this may not be necessary in cases caught and treated early. Cats who have been treated for stones or plugs will also be given pain relief +/- medication to relieve urethral spasm.

Unfortunately, as for all types of FLUTD cases, urethral blockage is reported to recur in more than 50% of cases, with the first recurrence often seen within 3-6 months. It is important to try and determine the reason for the cat obstructing so as to put into place appropriate treatments and management strategies, in an endeavour to reduce the risk of recurrence. Investigations may include urine culture, urine sediment examination (a sample of urine is examined under the microscope to identify the type of crystals involved, if present), stone analysis, bladder imaging using radiography and/or ultrasound. Stress is considered to be a factor in all of the common types of FLUTD so environmental management/enrichment is an important component of treatment, which will be discussed in more detail for feline idiopathic cystitis. Occurrence of urolithiasis generally reduced as affected cats get older.

Specific management/treatment for cats who suffer from uroliths or plugs can include:
• Encouraging increased water intake to help the cat produce more dilute urine, this may be achieved by feeding more wet food, flavouring water, providing water in a wider dish away from food, providing multiple water bowls, providing running water via a cat water fountain, consider providing rain water or bottled water if the individual cat prefers it.

• Feeding a prescription urinary diet, where a cat produces uroliths or urethral plugs with a high crystal content, urinary diets can be used to alter the pH of the urine and so reduce the formation of crystals and therefore stones. These diets also have a reduced level of certain minerals which are a component of the more commonly seen crystals, and in addition some diets contain natural anti-inflammatories and stress alleviating supplements.
• Antibiotics -Struvite stones can form secondary to a chronic urinary tract infection, antibiotics, ideally selected based on the results of a urine culture and sensitivity test, may be needed for up to 4-6 weeks.
• Bladder surgery (cystotomy) – rarely large stones are detected in the bladder which may need to be removed via surgery.

Cystitis (Bladder inflammation)

Feline Idiopathic Cystitis (FIC) is the most common form of cystitis seen in cat less than 10yrs, with the highest incidence reported to be in 2-7year old cats. Bacterial cystitis is more commonly seen in cats older than 10 years.

It is not fully understood why some cats are prone to FIC, although it is universally accepted that symptoms are triggered by stress, the exact cause is unknown in up to 64% of patients and often thought to be multifactorial. Overweight and indoor cats appear to be more predisposed to FIC. Research suggests that additional risk factors for cats developing FIC include: the cat having no vantage points high up for observations; living in a multi-cat household; non clumping litter in the tray; living in an apartment is higher risk than living in a house; being a male cat! It has also been suggested that for some cats, particularly those who suffer from the most severe FIC may be suffering from ‘Pandoras syndrome’. It is thought that Pandoras syndrome can occur when a cat experiences a stressful event early in life, this may even be a stress to which the queen (mother) is exposed to whilst the affected cat is in the womb, as a consequence the cats hormonal response to, and ability to cope with, stress is reduced.

The veterinarian may diagnose FIC based on the cat’s history, presentation and normal clinical examination. Clinical signs of FIC will typically resolve within 1-7 days in around 90% of cats regardless of treatment. Up to 58% of cats suffering FIC will have recurrence within 6 months. Sadly, for up to 15% of FIC sufferer’s symptoms can be chronic with frequent recurrence and symptoms that can last weeks to months. Where symptoms are not resolving as anticipated investigations including urine tests, bladder and urethral imaging, prostatic examination and blood tests may be required to rule out other causes for the urinary symptoms.

Over 80 different therapies for treatment of FIC have been tried but few have been studied. Treatment and management strategies for FIC patient’s which have been demonstrated to be beneficial include:
• Pain management
• Encouraging increase water intake
• Feeding multiple small meals
• Appealing litter tray/s- ensure large (ideally 2-2.5x the length of the cat) uncovered litter tray/s are readily available, easily accessible in a safe and quiet place. Litter in the tray/s should be of the cats preferred substrate and deep (3cm recommended, such that the cat cannot feel the bottom of the tray as they scratch). Litter trays should be kept cleaned out. All to encourage frequent urination.

• Offer food and water in separate locations- cat like to drink clean water so naturally prefer to drink away from where they eat, by choice. Multiple resources available to avoid competition in multi-cat households.
• Environmental enrichment – providing places in the home to express normal behaviour, including places to hide, hunt and climb, this is even more essential in house cats. Consider the use of vertical space.
• Human interaction –provision of positive, consistent and predictable human interaction has been shown to benefit the cat’s emotional welfare.
• Bladder supplements – Up to 30% of cats suffering from FIC benefit from the use of supplements which contain glycosaminoglycan, which helps to make up the protective mucous layer in the bladder, although the reason why this is the case is not understood. Some of the supplements available also contain natural stress relieving components. Supplements may be used short term or long term.
• Pheromone therapy – in some cases use of pheromones like Feliway has been shown to help alleviate stress and so may help reduce the frequency of FIC.
• Antidepressants – for some of the most severe cases of FIC judicious use of anti-depressants can be of benefit.

FLUTD is a painful, stressful condition in cats which, in the case of obstruction, can be life threatening. Any cat presenting with symptoms should be taken to the veterinary surgeon as soon as possible to instigate appropriate treatment. A new product is also available called BluCare which consists of colour changing granules that can be sprinkled onto the top of your cats normal litter to detect if blood is in the urine, this may be used to help monitor cats who suffer from FLUTD, helping to detect flair ups early. If you have a cat who suffers from FLUTD and would like further advice with regards to your cat’s individual needs please do not hesitate to contact one of our vets. We also recommend you take a look at the following links to International Society of Feline Medicine (ISFM) articles:

• AAFP (American Association of Feline Practitioners) and ISFM feline environmental needs guidelines.

• ISFM Feline feeding programs: Addressing behavioural needs to improve feline health and wellbeing

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