Winter 2020 Newsletter - Holmer Veterinary Surgery

It seems impossible that it time for another winter newsletter. 2020 has been a surreal year with all consept of time blurred as the UK, the world, has been facing the Covid pandemic. We are proud of our veterinary team who have continued to work tirelessly, to continue to provide essential care to our patients. We are ever grateful to all our clients for their ongoing support and patience during these difficult times.

2020 has been a year of great change for our practice we have seen old friends and colleagues move on to new pastures and welcomed new ones. The practice building works continue to progress but there is still much work to do. We look forward to the day when we will be able to invite clients back into the practice and the benefits of the renovations can be appreciated by all.

For this newsletter we take a look at some of the issues we see more commonly over, although not exclusive to, the festive period. Our second article discusses osteoarthritis looking at current understandings and management options for this all too common condition.

Our winter newsletter addition would not be complete if we did not wish everyone a Happy Christmas, as far as is humanly possible in the current circumstances, and Best wishes for the New Year. As always we at Holmer Vets will continue to provide care for your pet/s 24/7 throughout the festive period, please do not hesitate to contact us if your animal is injured or unwell.

Beware the Christmas and New Year pet perils

Food:

o Overfeeding/ feeding table scraps. While it is tempting to indulge our pets as well as ourselves, feeding table scraps, particularly fatty foods, can cause vomiting and/or diarrhoea. Ingestion of high fat foods can also lead to dogs developing pancreatitis with animals typically presenting with vomiting, inappetance and abdominal pain.

o Cooked bones from meat, poultry or fish are brittle and can splinter when chewed, so are a potential foreign body risk that can lead to an intestinal blockage.

o Christmas pudding, mince pies or any foodstuff containing raisins, sultanas or grapes can cause acute kidney injury in dogs which can be fatal.

o Chocolate, especially dark chocolate, is toxic to dogs, it contains the stimulant theobromine which can cause seizures and arrhythmias.

o Sweeteners, used in tea, coffee and also many cakes, biscuits, mints, jam and peanut butter. Most are non-toxic but a very common sweetener Xylitol is toxic to dogs and can cause a life threatening drop in blood sugar, liver failure can also occur.

o Onions and products containing onions, such as gravy and stuffing, can cause vomiting and diarrhoea and lead to anaemia in cats and dogs. Related vegetables leeks, garlic and spring onions can also cause the same problems.

Decorations:

o Tinsel and ribbons, if swallowed can become entangled in the intestines and cause life-threatening blockages. Cats are at particular risk as they enjoy playing with string like objects.

o Baubles, especially those made from fragile materials that can potentially shatter could become a hazard if caught by an adventurous cat/wagging tail. Some dogs have been known to chew baubles/decorations potentially leading to lacerations in the mouth or intestinal obstructions.

o Fairy lights pose the risk of pets getting tangled up in the wires, which could cause the pet to panic and injure itself. If swallowed, bulbs can pose threats to pets.

o Plants, such as holly, ivy and mistletoe can be toxic to pets and lead to vomiting.

Toys/gifts:

o Some pets, especially young dogs, will chew up toys, which may or may not be intended for the pet. If a dog ingests part of the toy, be it a firm material like plastic or soft stuffing, this can potentially cause a blockage and cause the animal to vomit and go off food.

o Batteries if ingested can not only cause an intestinal blockage but if contents leak out this can result in severe necrosis and/or ulceration of the gastrointestinal tract, less commonly neurological and haematological changes can occur due to metal poisoning.

Weather:

o Antifreeze, containing ethylene glycol, is a highly toxic substance that if ingested causes acute kidney failure and sadly is often fatal even with early aggressive treatment. It is toxic to all pets but cats are at most risk.

o Rock salt (grit), used to de-ice roads and pavements can be hazardous to pets. It can cause irritation to the paws. If ingested it can result in a high blood sodium level leading to vomiting, lethargy, convulsions and kidney damage.

o Hypothermia, dogs kept on hard floors overnight, in the kitchen/conservatory, on cold nights can struggle to keep warm and become hypothermic requiring hospitalisation. Older and large breed dogs, such as boxers, are at highest risk. Small furries are even more sensitive to hypothermia, guinea pigs kept outdoors in the summer month should be brought inside over the winter, rabbits should be given extra bedding and cages given extra protection from inclement weather. Research has shown that rabbits have been shown to be better able to regulate their body temperature when kept with a companion.

If you observe your pet ingesting any of the toxic foods or foreign material please phone the surgery for advice. Please do not hesitate to call the surgery if your pet goes off food, develops vomiting, abdominal pain, neurological signs, weakness, collapse or becomes unwell in any other way.

Osteoarthritis (OA) in dogs and cats.

It is estimated that approximately 20% of all dogs suffer with OA, the incidence being significantly more in older dogs (8yrs +) where approximately 80% of dogs are thought to be affected. Incidence of OA in dogs is higher in medium to large breed dogs. Some dogs are predisposed to developmental issues e.g. Labrador Retrievers with hip or elbow dysplasia which can lead to symptoms at a young age. Although OA in cats is often less well recognised, than in dogs, over 85% of cats of 12years or more suffer from the condition. OA is a degenerative disease of the joints which worsens over time, the animal will suffer increasing pain and debilitation. Whilst the condition cannot be cured early recognition and intervention can result in a significant improvement in quality of lif

Recognition of disease.

Dogs and cats suffering with OA will present in different ways, although some similarities may also be recognised. In general signs in cats are much more subtle and so more readily missed. Signs in individual animals will vary but may include the following:

Dogs

Changes in willingness to exercise
Reduced ability to exercise, including lameness
Change in gait e.g. rolling in the hips, bunny hopping, crabbing.
Joint pain +/- swelling

Changes in behaviour- the dog may seek more or less attention from their owner, some dogs may become aggressive due to the pain, which may also induce fear/anxiety.
Depression
Difficulty getting comfortable
Pacing at night (which may be difficult to differentiate from a sign of cognitive dysfunction/dementia)
Decreased muscle mass, develops as the dog avoids the use of a painful limb.
Change in posture, as the dog tries to shift weight away from a painful area.
Increased sleep.
Weakness in the back legs can lead to difficulty toileting as it is hard for the dog to maintain the position. Dogs will often walk forward as they urinate and/or defecate.
Licking of joints.
It is uncommon for dogs to vocalise.

Cats

Changes in ability/reluctance to jump
Decrease in how high can jump
Decreased playing and/or hunting
Decreased grooming
Decreased activity/increased lethargy
Increased attention seeking with owner
Difficulty negotiating the litter tray may lead to inappropriate elimination outside the box
Difficulty going up and/or down the stairs
Overgrown or ingrowing toe nails
Reluctance to use the cat flap/go outside
Vocalisation is common (can be difficult to differentiate from cognitive dysfunction syndrome/dementia)
Stiff joints
Hunched stance
Some cats may become aggressive

Diagnosis

In both cats and dogs a diagnosis is often made on clinical history and examination. Radiography can be used to help assess the affected joint/s and to help investigate/rule out other potential issues; however, the degree of OA changes do not always correlate with the severity of clinical signs seen in an individual patient. In older dogs and cats a general health screen which may involve bloods, urine samples and, particularly in cats, blood pressure testing to investigate for concurrent diseases, which may co-exist and may have an influence on some of the presenting signs, as well as influence the treatment options, is recommended.

Treatment

Increasing more treatment options are available for the management of OA. In both dogs and cats a multimodal approach is now considered optimal.

Lifestyle management is of utmost importance for both dogs and cats.

o Obesity, not only does obesity result in an increased risk of OA in pets the increased pressure placed on the joints of a pet suffering OA causes significant increase in morbidity. Weight control is a core component of helping manage OA.

o Exercise. For some dogs intense forms of sustained exercise can lead to the development of OA due to wear and tear, just as it does in humans. More importantly maintaining joint mobility is a critical component of managing OA in animals. It is important that owners have realistic expectations in relation to what their pet with OA can do, with the best treatment they will not be the athletic pet they may have been in their youth. Exercise little and often will help try and maintain muscle strength and joint mobility but it is important to remember, unless the animal is only mildly affected, pain is likely to be needed to facilitate this.

o Environmental change is particularly important for cats. Cats need to be able to access all core resources easily, adjustments/adaptions to the environment will enable a cat, or dog, with reduce mobility to perform normal functions and express normal behaviours.

Raised food and water bowls help cats and dogs with OA in their front legs crouching forward to eat and drink.
Soft warm bedding which is easily accessible. If a cat or dog has a preference to sleeping higher up e.g. on a chair or the owners bed, then steps or a ramp can be provided to allow them the easily get on without jumping.

Ramps can be used to help cats get to high up hiding places, for dogs for getting in and out of the car.
For cats a shallow or low sided litter tray will help with access and reduce the risk of inappropriate elimination. For severely affected cats, especially those with issues with constipation, using a litter based sand can be more comfortable under their feet than grit or wood based litters, so they may be less likely to defecate outside of the box.
For cats horizontal scratching posts are easier to use than vertical ones, being an important part of environmental enrichment/ability to express normal behaviour.
For cats who like to drink running water but can no longer access the tap a water fountain could help maintain their fluid intake, which is especially imperative in ageing cats.
For cats ensuring that entry and exit points into the house, or their preferred location in the house are easily accessible.
For cats smaller toys which are easier to use should be chosen for playing or expressing hunting behaviour.

Pain relief/control

o Non-Steroidal anti-inflammatory drugs (NSAIDs) have, for some time been the mainstay of OA pain for many years. Over the years drugs with increasingly better safety margins, long term use of these drugs is now considered common place, ideally used at the lowest effective dose, and in some instances on an as needed basis. As with any drugs NSAIDs can cause side effects in individual pets including, most commonly, effects on the guts, kidneys and liver. It is particularly important to consider blood testing, especially older pets, before commencing treatment with NSAIDs to help determine if there are any underlying issues which might mean these drugs are not recommended.

o Additional analgesia that can be used alongside or instead of NSAIDs may include Tramadol, Paracetamol (not to use in cats) Gabapentin, Amantadine, buprenorphine or other opioids can be used in the management of OA pain. Many of these drugs are human preparations used off license. For cats a palatable liquid formulation of gabapentin has become available helping with ease of medicating.

Nutraceuticals

Nutraceuticals is a term used to describe dietary supplements with a clinical benefit. Multiple supplements are available on the market to help manage OA in cats and dogs. Studies have so far indicated that products containing green lip mussel extract or fish oils have the most anti- inflammatory benefit. Diets are also available containing beneficial joint supplements.

Physical therapies

Physical therapies such as hydrotherapy and physiotherapy, including massage, can help maintain joint mobility and reduce muscle loss, reducing muscle spasm and pain.

Surgery

For severely affected individuals hip replacements have been available with excellent post op outcomes for many years. Elbow and stifle replacements procedures are in their relative infancy. Salvage procedures may be considered where the pain of OA is not successfully managed by medical means and where financial constraints prevents referral for joint replacement surgery. Salvage procedures would not generally be carried out in geriatric patients, they include femoral head and neck excision where the head to the femur is removed to stop joint pain, and arthrodesis where a joint is fused.

Additional therapies (*available through referral to a specialist)

o Laser therapy is used to help reduce inflammation, promote tissue repair*.

o Chondroprotectants are products aimed to help supplement the joint, they may be given by injection or orally

o Platelet Rich Plasma (PRP) is produced by processing blood from the affected dog and putting into an affected joint where it works to reduce inflammation, slow down changes to the cartilage and joint capsule and stimulate blood supply providing pain relief from 1 month up to 1 year (an initial increase in discomfort in the first 12-24hrs may be observed)*.

o Stem cell therapy is produced by taking a sample of the affected dogs own bone marrow or fat tissue which is processed and then injected into the affected joint/s. The stem cells are thought to regenerate injured tissue, reduce inflammation, improve joint blood supply, reduce cell damage and break down scar tissue. Time is needed to see the benefits of stem cell therapy, 30-80 days (average 60 days) post treatment but 1-2 years of relief is anticipated*.

o Other adjunctive therapies that may be considered include cryotherapy, electrostimulation, pulse electromagnetic field therapy and acupuncture*.

OA is an extremely common condition in dogs and cats. For dogs parental screening for hip and elbow dysplasia has helped reduce the incidence of these conditions which often lead to OA, so choosing a well-bred dog is advisable. For owners of pets with pets who are showing signs of OA early recognition and diagnosis is important and then multimodal therapy can be initiated based on the individual need but comprising of one or a combination of pain management and monitoring, weight and exercise management, house adaption and complementary therapies. If you are concerned your pet may be suffering from OA www.caninearthritis.co.uk offers a useful resource for additional information. Please do to hesitate to contact us to discuss the individual needs of your pet.

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