Welcome to our Spring 2021 newsletter
We are all very much relieved to have left the Covid dominated 2020, although we are not completely out of the woods, or yet able to return to business as usual, it finally feels like there is light at the end of this very long and very dark tunnel. We look back at 2020 with sadness for all those who have suffered and lost, we are ever grateful to all the key workers who have maintained essential services. Thank you to all of the Holmer Vet team who have worked tirelessly throughout, to ensure we can continue to bring essential care to animals in needs and their owners. Thank you to all of our clients for their patience and understanding, as we continue to work as best we can in a way that keeps everyone safe. We very much hope that by the time the summer newsletter goes out we will be welcome you back into the practice. The practice update continues to progress slowly but surely ready for you all.
In this newsletter we have decided to look take a look at cognitive dysfunction syndrome (CDS) sometimes referred to as doggy dementia. Given the increased time spent, by many, with their dogs and cats over lock down and the changes to daily routine, this has been a condition that has become more apparent. So our first article looks at how to recognise and best manage the condition. In our second article we discuss the condition Leishmaniasis which we are seeing with increased frequency as more and more pets are being imported from overseas. As always we hope you find these articles both interesting and informative. If you have any questions about these or any other issues we have covered in previous newsletters please do not hesitate to contact us for further advice and/or information.
Cognitive Dysfunction Syndrome (CDS) in cats and dogs.
CDS is a neurodegenerative disorder commonly seen in ageing dogs and cats, similar in many ways to dementia in humans. The signs of CDS are multiple with affected animals suffering one or more symptoms. The risk of dogs and cats suffering from CDS increases significantly with age. In dogs studies have suggested approximately 28% of 11-12 year old dogs suffer from CDS, prevalence increasing to 68% in 15-16year olds. In cats reports suggest up to 36% of senior cats (11-14 year old) show one behavioural problem associated with CDS, increasing to 60+% in geriatric cats (15 years or older).
As pets age they are likely to suffer from increasingly more symptoms. Early recognition and interventions to slow progression of the disease is key to managing CDS and maintaining the welfare of the affected pet.
In many ways the symptoms of CDS in dogs and cats are very similar but it is the prevalence of these signs which is different. Recognising that a pet is suffering from CDS can be difficult as some of the changes may be interpreted as being due to normal aging change, some symptoms can also be caused by other medical issues.
For dogs the acronym DISHAAL can be used to help recognise the behavioural changes an owner may recognise as signs of CDS in their pet.
- Disorientation (Loss of spatial and temporal awareness) the dog may be unable to find its way home, stare into space, get stuck behind doors or furniture, fail to respond to stimuli.
- Interactions (Changes in social interactions) interacts more or less with known people and animals, may show signs of fear and/or aggression.
- Sleep (altered sleep patterns) walks/paces about in the night or vocalises for no obvious reason.
- House soiling (loss of house training)
- Activity (alterations in activity) less active and playful, may show repetitive behaviours, walks/paces without obvious purpose.
- Anxiety – is more anxious when separated from the owner, less able to cope with change.
- Learning and memory deficits
For cats the acronym VISHDAAL differs slightly as vocalising and changes in interactions are the earliest symptoms usually recognised.
- Vocalisation (especially at night) potential reasons include attention seeking, confusion/disorientation, food seeking, pain or there may be no obvious reason at all!
- Interactions (increased or decreased) often increased attention seeking with the owner, increased or decreased interaction with familiar cats which can lead to inter cat aggression issues.
- Sleep, altered sleep/wake cycles
- House soiling
- Activity levels altered
- Learning/memory deficits.
Once an owner recognises that their dog or cat may be showing signs of CDS a diagnosis can only be made by ruling out and treating other medical issues. As CDS is a disease of aging pets it is not uncommon for the individual to be suffering from concurrent medical issues as well as CDS, some of which can exacerbate the signs.
When you present your pet to the veterinary surgeon for assessment they will need to take a full history and perform a physical examination, including taking blood pressure readings to rule out hypertension which can cause or exacerbate CDS symptoms. Blood and urine samples are taken to investigate for any underlying organ issues, infection or anaemia. A test to check thyroid function should also be performed in cats. If any medical issues are detected they should be treated appropriately and the animal’s behaviour reassessed once these conditions are well managed. Animals in pain can have many of the symptoms seen with CDS, this is not always detectable on physical exam (especially with osteoarthritis in cats) a trial course of analgesia may warranted even if no overt source of pain is identified during examination, if behavioural symptoms still persist then it is likely that the patient is suffering from CDS.
There is no cure for CDS but a selection of management strategies and treatments are available can help alleviate the symptoms and slow disease progression.
- Environmental management and enrichment. Strategies to allow easy access to resources are of benefit to all elderly pets but especially to those suffering CDS.
- Resting places, providing soft comfortable bedding which is easily accessible and in the pets preferred location, this may be close to the owner or somewhere quiet and isolated. When a cat or dog prefers to sleep on a chair, bed or higher location accessibility can be improved by providing steps or ramps to avoid the need for jumping.
- Food and water bowels should be made easily accessible, this may involve raising the bowl to reduce the need for the pet to bend down or providing ramps to ensure easy access. Use of food toys can help promote physical and mental stimulation. NB food and water bowls should be provided in separate locations for cats.
- Toileting, elderly dogs will often need to be taken out more frequently to allow them to toilet or it may be appropriate to provide indoor toileting area/s. For cats low sided, large, open topped litter trays that are easily accessible can help avoid many issues of inappropriate soiling, sandy type litter may be more comfortable to use but remember cats can have a preference for the type of litter they are happy to use.
- Daily routine, pets with CDS are less able to cope with change which can result in increased anxiety, which in turn can lead onto a disturbed sleep pattern. Finding a daily routine can help manage a pet with CDS, regular times for food, exercise, toileting and human interaction. Easy, guaranteed access to resources as they need especially in multi-pet households, the ability to get away from other animals/find a quiet area when needed, the ability to get outside when needed (elderly cats may not be comfortable using a cat flap). For elderly cats providing a horizontal as opposed to a vertical scratch post, which is easier to use can be an aid to their environmental enrichment.
- Companionship CDS dogs typically crave an increase in human interaction, finding more time in the day to interact with your dog, including exercise which is a particularly important form of positive stimulation, can significantly improve their wellbeing. Cats can have an increased or decreased desire for human and/or animal companionship and identifying the needs of your individual cat is key.
- Calming pheromones such as Dog Appeasing Pheromone (D.A.P.) and Feliway by Ceva can be used to help create a more calming environment reducing anxiety for some individuals.
- Dietary supplementation. There have been a number of studies on the use of supplemented diets and dietary supplements to slow the progression and reduce symptoms of CDS in cats and dogs. Diets with enhanced antioxidants including vitamins C, E and selenium, increased omega 3 fish oils, increased essential amino acids like L carnitine, and for dogs increased medium chain triglycerides (MCTs), to name but a few, have been shown to have beneficial effects in animals suffering from CDS.
- Medical therapies, there have been many different medications used to treat CDS, with no perfect treatment/cure. Any medication prescribed to your pet must be tailored to their individual needs.
- Analgesia, pain cannot only cause symptoms similar to those of CDS but, OA pain in particular, is also commonly seen as a comorbidity in these elderly patients. Managing pain effectively will help reduce and anxiety, with increased comfort not only allowing the dog or cat to sleep more comfortably but also better get around potentially helping reduce risk of house soiling, aggression, improve activity levels, for improved physical and mental stimulation, with overall improvement in wellbeing. There are many forms of pain relief available both licensed and used off license that will be selected based on the individual needs of the patient. One of these drugs gabapentin, a human drug, acts not only as a painkiller but also can have additional anxiolytic properties.
- Selegiline (Selgian, Ceva) works to enhance certain neurological signals in the brain aiming to reduce anxiety and separation related issues, it is also thought to have additional protective effects of the nerves of the brain. Whilst only licensed in dogs off-license use has shown some benefit in some cats.
- Propentofylline (Vivitonin, MSD) works to reduce blood supply to the brain reducing dullness, lethargy and depression in older dogs, this has also been used off license in cat.
- Melatonin (Melacutin, Vetruus) given around 30min before bedtime can help re-establish night time sleeping patterns.
- Other anxiolytics from simple herbal remedies and dietary supplements such as Zylkene (Ceva), to antidepressants like Trazadone (off license use only) can help reduce anxiety and subsequently improve the sleep- wake cycle of CDS patients.
Please talk to your vet about the individual needs of you pet.
CDS is a common disease of our aging cats and dogs, for many mild cases providing appropriate environmental support, +/- analgesia as appropriate, is enough to ensure these pets continue to have a good quality of life. Unfortunately for some animals, particularly in advanced stages of disease, their symptoms adversely impact not only the pet but also the owner/s. With a break down in the human-pet bond being irrevocably damaged, increasing tension between the pet and the owner/s leading to increased pet anxiety and worsening signs, a decision may be taken that euthanasia is the only option. If we as owners and vets are better able to recognise the signs of dementia in our beloved pets then some simple changes in the environment, daily routines and interactions, with or without the help of medication can benefit us all. Working together we can help ensure our CDS dogs and cats enjoy a long and happy life in their senior years.
What is Leishmania/Leishmaniasis?
Leishmania is a protozoan parasite transmitted to dogs via sandfly found in many countries in Southern and Eastern Europe, the sandfly is not currently present in the UK. Whilst the vast majority of cases seen in the UK occur in dogs with a history of travel abroad there have been some cases diagnosed in non-travelled dogs. Fleas and ticks do not appear to be able to transmit the disease.
Infection with Leishmania causes Leishmaniasis a serious disease that affects dogs and other mammals including humans. Infected dogs are not able to pass the disease on directly to humans, it is only spread by bites from an infected sandfly.
What are the symptoms of Leishmaniasis?
- Leishmaniasis can have a slow onset with no symptoms appearing for months to years after infection
- Skin lesions particularly on the head and pressure points (eg. Elbows), with scaling, hair loss and ulcerations
- Conjunctivitis – red, sore looking eyes
- Weight loss and anorexia
- Kidney failure – increased thirst and urination
- Abnormal nail growth
How is Leishmaniasis diagnosed?
Diagnosis of leishmania infection is not straight forward, being complicated by the fact that there are asymptomatic carriers. Blood tests to check serology (antibodies levels) can indicate whether a dog has been exposed to the parasite, but does not necessarily mean leishmaniasis is the reason for the dog being unwell. Serology is a useful tool for monitoring known carriers of Leishmania with increases in antibody levels potentially indicating a disease flair up, for which the dog is likely to require adjustments to their treatment. Additional blood tests to check for Leishmania proteins (antigens) and samples taken from skin, lymph nodes or bone marrow, to identify the presence of the parasite in cells, may be needed to make definitive diagnosis. Assessment of kidney function is made using routine blood and urine tests.
How is Leishmaniasis treated?
It is a disease which can never be cured and will require lifelong monitoring and for some cases lifelong treatment. Depending on the dogs clinical signs treatment will vary. Some dogs who are asymptomatic and have tests to show that the infection is stable may not require medication but will need regular lifelong monitoring. It is recommended asymptomatic dogs whose tests show an increase in antibody levels receive treatment to try and prevent systemic (symptomatic) disease from occurring. These dogs are often treated with allopurinol and meglumine antimonite or miltefosine. Currently only allopurinol drug which is readily available in the UK with a special import license required to obtain the other drugs from the EU. Dogs with symptomatic disease will require supportive treatments which will vary depending upon the symptoms experienced.
The prognosis for dogs with well managed asymptomatic infections is good, however dogs who experience more severe disease have guarded to poor prognosis.
How can Leishmaniasis be prevented?
Avoiding taking your dog abroad to areas where the sandfly is endemic is the most effective way to prevent infection. A map showing the distribution of Leishmania is available to view at the ESCAPP (European Scientific Counsel Companion Animal Parasites) website. If you plan on adopting a dog from abroad it is advisable to ensure they have had an appropriate test for leishmaniasis prior to coming into the UK.
If it is not possible to avoid taking your dog to an area where sandflies are present sandfly repellents such as the Scalibor Collar (MSD) or Advantix spot on (Bayer) are recommended. However these do not guarantee 100% protection and there is still a risk, although much reduced, of your dog being bitten. Sand flies are most active at dusk so avoiding taking your dog out at this time will reduce risk of being bitten.
A vaccine against Leishmania licensed for use in the UK, however whilst it reduces the likelihood of symptoms developing, if your dog becomes infected, it does not prevent infection itself.