BONE DISEASES OF PUPPIES AND GROWING DOGS
I have a young dog with a lameness that has been present for several days. Could this be serious?
There are many causes of lameness. Most of these are relatively minor and are within the body's healing capability. However, there are also causes that are not self-limiting and, if not treated promptly, may result in permanent lameness and/or arthritis. The large breeds of dogs (i.e. those whose adult weight is over 25 kg) have several bone diseases that occur during the period of rapid growth (up to 2 years of age). To minimize the likelihood of permanent lameness, we recommend an accurate diagnosis if a lameness lasts more than 2 weeks. Although in some cases diagnosis is obvious without x-rays, (radiographs) radiography is necessary in order to ascertain the extent of the problem and decide on the best method of repair. It is usual not only to radiograph the affected limb(s) but also the normal leg. This allows the veterinarian to use the normal leg’s appearance for comparative purposes. Several x-rays are usually necessary in order to build up an accurate picture of the problem and heavy sedation or a short-acting anaesthetic will be necessary in order to obtain radiographs of good diagnostic quality.

What diseases are likely?
The following diseases will be considered as we radiograph your dog:

1. Hip Dysplasia: an improper formation of the hip joint(s). This is a ball and socket joint. Hip dysplasia results in the ball not being round, the socket not being deep, and the two not fitting together well. Hip dysplasia has several contributing causes, but a primary cause is genetic. A dog of the high-risk breeds for hip dysplasia should not be bred before radiographs of the hips are taken and a score is obtained under an Accredited Hip Dysplasia scheme. This involves your own veterinary surgeon taking the x-rays which have to have the Kennel Club registration number photographed on to the plates and these are then forwarded, together with the appropriate fee, to the appropriate Veterinary Association and a panel of scrutineers examine the x-rays and score them. The lower the score the better the hips. The worst possible score that could be obtained would be 53 for each hip making a total of 106. Since in some hip dysplasia prone breeds it is difficult to select animals that are free from the disease, the aim is to attempt to always breed with an animal with a lower score. There are several choices of treatment depending on the severity. Some involve medication; some require surgery.

2. Elbow Dysplasia: a lack of fusion of the top of the ulna at the rear point of the elbow. This is more properly termed ununited anconeal process. When this part of the ulna does not fuse, the joint is unstable and is quickly subject to arthritis. Treatment often involves surgery in order to avoid the early onset of arthritic changes within the joint.

3. Fractured Coronoid Process: the fracture of a small process (protrusion) on the radius within the elbow joint. When this process fractures, pain and joint instability result. Unless surgery is done promptly after the fracture occurs, return to normal use of the leg is unlikely.

4. Panosteitis: an inflammation on the surface of the long bones. This is also termed "long bone" or "growing pains". This may occur in more than one bone at a time and may cause lameness in one bone or leg and then another. It is self-limiting but may recur until rapid growth is over. The pain may be relieved with several types of medication.

5. Osteochondritis dissecans (OCD): a defect in the smooth cartilage surface within one or more of several joints. It may affect the shoulder (most commonly), the elbow, the hip, the knee, or the stifle. Some of these defects may heal with confinement of the dog for several weeks. However, most do not and a few may result in a piece of cartilage breaking off and floating freely in the joint. This disease causes pain which varies in its severity. It is best treated with surgery to remove the defective cartilage.

6. Hypertrophic Osteodystrophy (HOD): an inflammation in the growth plates of the long bones. It usually causes swelling and pain of the bones which may lead to fever and loss of appetite. It is self-limiting in most dogs with no permanent damage. However, some dogs may suffer sufficiently severe damage to the growth plates that leg deformities can occur. Treatment is with medication to relieve the pain and suppress the inflammation.

BLADDER STONES (Calculi)
What are bladder stones?
Bladder stones, more correctly called uroliths, or cystic calculi are rock-like collections of minerals that form in the urinary bladder. They may occur as a large, single stone or as collections of stones the size of large grains of sand or gravel.

Are these the same as gall stones or kidney stones?
No. Gall stones are in the gall bladder, and kidney stones are in the kidney. Although the kidneys and urinary bladder are both part of the urinary system, kidney stones are usually unrelated to bladder stones.

What problems do bladder stones cause?
The two most common signs of bladder stones are haematuria (blood in the urine) and dysuria (straining to urinate). Haematuria occurs because the stones mechanically irritate the bladder wall. Dysuria occurs when stones obstruct the passage of urine out of the bladder. Large stones may cause a partial obstruction at the point where the urine leaves the bladder and enters the urethra; small stones may flow with the urine into the urethra and cause an obstruction there.

When an obstruction occurs, the bladder cannot be emptied and this is very painful. Your dog may cry in pain, especially if pressure is applied to the abdominal wall.

Haematuria and dysuria are the most common signs seen in dogs with bladder stones but with obstruction there is usually pain as well. We know this because when bladder stones are removed surgically, many owners tell us how much better and more active their dog feels.

Why do they form?
There are several theories to explain the formation of bladder stones. Each is feasible in some circumstances, but there is probably an interaction of more than one of them in each dog.

The most commonly accepted theory is called the Precipitation-Crystallisation Theory. It states that one or more stone-forming crystalline compounds is present in elevated levels in the urine. This may be due to abnormalities in diet or due to some previous disease in the bladder, especially infection with bacteria.

Sometimes the condition may be due to a fault in body chemistry. When the amount of this compound reaches a threshold level, the urine is said to be supersaturated. This means that the level of the compound is so great that it cannot all be dissolved in the urine, so it precipitates and forms tiny crystals. These crystals stick together, usually due to mucus-like material within the bladder, and stones gradually form. As time passes, the stones enlarge and increase in number.

How fast do they grow?
Growth will depend on the quantity of crystalline material present and the degree of infection present. Although it may take months for a large stone to grow, some sizeable stones have been documented to form in as little as two weeks.

How are they diagnosed?
Most dogs that have bladder infections do not have bladder stones. These dogs will often have blood in the urine and will strain to urinate, the same symptoms as a dog with bladder stones. Therefore, we do not suspect bladder stones just based on these clinical signs.

Some bladder stones can be palpated (felt with the fingers) through the abdominal wall. However, failure to palpate them does not rule them out.

Most bladder stones are visible on radiographs (x-rays) or an ultrasound examination. These procedures are performed if stones are suspected. This includes dogs that show unusual pain when the bladder is palpated, dogs that have recurrent haematuria and dysuria, or dogs that have recurrent bacterial infections in the bladder.

Some bladder stones are not visible on radiographs. They are said to be radiolucent. This means that their mineral composition is such that they do not reflect the x-ray beam. These stones may be found with an ultrasound examination (if available) or with special radiographs that are made after placing a special dye (contrast material) in the bladder.

How are bladder stones treated?
There are two options for treatment. The fastest way is to remove them surgically. This requires major surgery in which the abdomen and bladder are opened. Following two to four days of recovery, the dog is relieved of pain and dysuria. The haematuria will often persist for a few more days, then it stops. Surgery is not the best option for all patients; however, those with urethral obstruction and those with bacterial infections associated with the stones should be operated upon unless there are other health conditions that prohibit surgery.

The second option is to dissolve the stone with a special diet. This avoids surgery and can be a very good choice for some dogs. However, it has three disadvantages.

1. It is not successful for all types of stones. Unless some sand-sized stones can be collected from the urine and analysed, it is not possible to know if the stone is of the composition that is likely to be dissolved.

2. It is slow. It may take several weeks or a few months to dissolve a large stone so the dog may continue to have haematuria and dysuria during that time.

3. Not all dogs will eat the special diet. The diet is not as tasty as the foods that many dogs are fed. If it is not consumed exclusively, it will not work.

Can bladder stones be prevented?
The answer is a qualified "yes." There are at least four types of bladder stones, based on their chemical composition. If stones are removed surgically or if some small ones pass in the urine, they should be analysed for their chemical composition. This will permit us to determine if a special diet will be helpful in preventing recurrence. If a bacterial infection causes stone formation, it is recommended that periodic urinalyses and urine cultures be performed to determine when antibiotics should be given.

BLOAT (Gastric Dilatation/Volvulus)
What is meant by the term "Bloat" in dogs?
This is a term that is synonymous with the more scientific term "Gastric Dilatation/Volvulus." It is often called GDV. That means that a dog's stomach distends with gas to the point that it goes into shock and may die.

Dilatation means that the stomach is distended with air, but it is located in the abdomen in its correct place. Volvulus means that the distension is associated with a twisting of the stomach on its longitudinal axis.

How or why does this occur?
We really do not know the answer to either of those questions. Original theories suggested that it occurred when a dog ate a large meal of dry food and then drank a lot of water. The water caused the dry food to swell. At the same time, the dog was supposed to be engaged in strenuous exercise that included running and jumping. That resulted in the dog's stomach twisting on itself as the heavy organ was jostled about in the abdomen.

Although that is the most common explanation given, there is no scientific evidence to support this theory. In most dogs experiencing GDS, the stomach is not excessively full of dry food and the dog has not recently engaged in strenuous exercise. The most current theory is that the stomach's contractions lose their regular rhythm and trap air in the stomach; this can cause the twisting event. However, the sequence of events for most cases defies a good explanation.

How is it diagnosed?
The first step in diagnosis concerned breed disposition. The condition almost always occurs in deep-chested dogs of giant or large breeds. Some of the more commonly affected breeds include Great Danes, Irish Setters, German Shepherds, Afghan Hounds and Bassett Hounds.

The next step is to establish that the stomach is distended with air. An enlarged stomach will cause the body wall to protrude prominently, especially on the dog's left side. The swelling will be very firm and obvious enough to see across the room. Occasionally, this distension is not very apparent. This occurs in dogs which have a large portion of the stomach up under the rib cage. In most cases, however, the owner is able to detect the distension. A dog which experiences significant pain will be very depressed. It may lie in what is commonly called a "praying position" with the front legs drawn fully forward. This should occur quickly, within two to three hours at the most.

The presence of a rapidly developing distended abdomen in a large breed dog is enough evidence to make a tentative diagnosis of GDV. A radiograph (x-ray) is used to confirm the diagnosis of dilatation. It can also identify the presence of volvulus, in most cases.

What happens when the stomach is distended with air?
The first major life-threatening event that occurs is shock. This occurs because the distended stomach puts pressure on the large veins in the abdomen that carry blood back to the heart. Without proper return of blood, the output of blood from the heart is diminished, and the tissues are deprived of blood and oxygen.

The reduced blood output from the heart and the high pressure within the cavity of the stomach cause the stomach wall to be deprived of adequate circulation. If the blood supply is not restored quickly, the wall of the stomach begins to die; the wall may rupture. If volvulus occurs, the spleen's blood supply will also be impaired. This organ is attached to the stomach wall and shares some large blood vessels. When the stomach twists, the spleen is also rotated to an abnormal position and its vessels are compressed.

When the stomach is distended, digestion stops. This results in the accumulation of toxins that are normally removed from the intestinal tract. These toxins activate several chemicals which cause inflammation, and the toxins are absorbed into circulation. This causes problems with the blood clotting factors so that inappropriate clotting occurs within blood vessels. This is called disseminated intravascular coagulation (DIC) and is usually fatal.

What is done to save the dog's life?
There are several important steps that must be taken quickly.

1. Shock must be treated with administration of large quantities of intravenous fluids. They must be given quickly; some dogs require more than one intravenous line.

2. Pressure must be removed from within the stomach. This may be done with a tube that is passed from the mouth to the stomach. Another method is to insert a large bore needle through the skin into the stomach. A third method is to make an incision through the skin into the stomach and to temporarily suture the opened stomach to the skin. The last method is usually done when the dog's condition is so grave that anaesthesia and abdominal surgery is not possible.

3. The stomach must be returned to its proper position. This requires abdominal surgery which can be risky because of the dog's condition.

4. The stomach wall must be inspected for areas that may have lost its blood supply. Although this is a very bad prognostic sign, the devitalised area(s) of the stomach should be surgically removed.

5. The stomach must be attached to the abdominal wall (gastropexy) to prevent recurrence of GDV. Although this is not always successful, this procedure greatly reduces the likelihood of recurrence.

6. Abnormalities in the rhythm of the heart (arrhythmias) must be diagnosed and treated. Severe arrhythmias can become life-threatening at the time of surgery and for several days after surgery. An electrocardiogram (ECG) is the best method for monitoring the heart's rhythm.

What is the survival rate?
This will largely be determined by the severity of the distension, the degree of shock, how quickly treatment is begun, and the presence of other diseases, especially those involving the heart. Approximately 60 to 70% of the dogs will survive.

What can be done to prevent it from occurring again?
The most effective means of prevention is gastropexy, the surgical attachment of the stomach to the body wall. This will not prevent dilatation (bloat), but it will prevent volvulus in most cases. Various dietary and exercise restrictions have been used, but none of these have proven value.

BREEDING DOGS AND REARING PUPPIES
Breeding from your bitch and raising her puppies can be an extremely rewarding experience, but can also be a difficult and emotional time. Pet bitches are often torn between their instinctive desire to be with their puppies and the routines they have acquired with their owners. This can lead to problems which should be borne in mind before breeding is contemplated. Raising a litter of puppies is also an extremely time-consuming exercise and one which should not be embarked upon without due consideration. The following information is provided in order to help with breeding and puppy rearing.

How often does a bitch come into heat?
The bitch comes into heat about every 6 months, although very large breeds of dogs may cycle anything up to once in 15 months. In most giant breeds (Great Danes, Irish Wolfhounds, St Bernards etc.) a yearly heat is normal. Most dogs then remain on heat for about 3 weeks.

What are the signs of heat?
The most notable sign of heat is vaginal bleeding. This begins about the end of the first week and lasts for about 9-14 days. Another consistent sign is swelling of the vulva. During this period male dogs will be attracted to the female.

What should I do to be sure that a mating is accomplished successfully?
Male dogs are more successful when the environment is familiar. Therefore, it is preferable to take the female to the male's home for breeding. The timing for mating is critical. The most fertile time is considered the 10th through the 14th days of the heat period. However, some dogs will be fertile as early as the 3rd day and as late as the 18th day.

Are there tests to determine when to mate my bitch?
There are two tests that are used for this purpose:

The first is a microscopic examination of vaginal cells to detect changes in cell appearance and numbers. This has been used for many years and is reasonably reliable. A more recent test determines changes in the progesterone level in the blood. This test is very sensitive and can often be carried out in-house by the veterinary practice. It gives a very good indication of when mating is most likely to be successful. It is used for dogs that have a history of unsuccessful mating or for very valuable bitches.

What should I expect during my dog's pregnancy?
Pregnancy, also called the gestation period, normally ranges from 60 to 67 days, the average being 63 days. Most dogs deliver (whelp) between days 63 and 65. The only way to accurately determine the stage of pregnancy is to count days from the time of mating. With all planned matings the date should be recorded and the bitch then examined approximately 3 weeks from the date of mating to detect the signs of pregnancy. Ultrasound scans can be carried out at around the 28th day and radiographs from around day 38.

Feeding
It is important that a bitch is in good condition before she is mated, neither too fat nor too thin. Her food intake should not be altered during the first two thirds of her pregnancy, and if a complete formula is being fed there is no need to use additional vitamin or mineral supplements. After the 6th week food intake should be gradually increased and high energy, low bulk foods may be useful in ensuring the bitch is adequately nourished. As abdominal pressure increases with the size of the foetuses, smaller meals fed more frequently may be helpful. During the last three weeks food intake will often increase by up to one and a half times the normal level and at the height of lactation, approximately three weeks after whelping, food intake is often two and a half to three times normal, particularly if she is feeding a large litter.

What should I do to prepare for whelping?
From the time of mating, many dogs show behavioral changes. Most develop an unusually sweet and loving disposition and demand more affection and attention. However, some may become uncharacteristically irritable. Some experience a few days of vomiting ("morning sickness"), followed by the development of a ravenous appetite which persists throughout the pregnancy.

During the last week or so of pregnancy, the bitch often starts to look for a secure place for delivery. Pet bitches often become confused, wanting to be with their owners and at the same time wanting to prepare for the forthcoming event. It is therefore a good idea to get the bitch used to the place where you want her to have her puppies well in advance of whelping but even then some bitches insist on having their pups in close proximity to the owner. Under these circumstances it is better to let the bitch have her way and then when she has finished, gently try moving her to the place that she should have already been introduced to some days or weeks previously. However some bitches are very determined and under these circumstances less trauma is caused if, within reason, her demands are met or at least some compromise is achieved, e.g. the bitch that wants to nurse the puppies on your bed is quietly moved to a whelping box in a corner of the bedroom. Ideally you may prefer her to use the whelping box you had prepared for her in a quiet corner of the kitchen. Similarly some bitches need the owner present during the whole time of delivery and if they are left alone they are likely to endeavor to delay delivery of the puppies which can create subsequent problems - compromise is the name of the game!

Prior to the time of delivery, a whelping box should be selected and placed in a secluded place, such as a closet or a dark corner. The box should be large enough for the dog to move around freely, but have low enough sides so that she can see out and you can reach inside to give assistance, if needed. The bottom of the box should be lined with several layers of newspapers. These provide disposable, absorbent bedding which the bitch can tear up and reorganise according to her own requirements. At the same time they will absorb the fluids which are always more copious than you would ever expect at the time of whelping. If sufficient thickness of newspaper is laid at the outset, the upper, soiled layers may be removed with minimal interruption to the mother and her newborn puppies.

What happens during parturition?
Most dogs experience delivery without complications; however first-time mothers should be attended by their owners until at least one or two puppies are born. If these are born quickly and without assistance, further attendance may not be necessary. However, with a bitch having puppies for the first time a careful watch should be kept upon her until she has finished, just in case any complications develop. If the owner elects to leave, care should be taken so that the dog does not try to follow and leave the whelping box.

Signs of impending whelping
These generally include nervousness and panting. The bitch will often stop eating during the last 24 hours before labour although with some breeds this does not apply. All the textbooks tell you that rectal temperature will drop below 100°F (37.8°C) but this again may only occur an hour or two before she starts producing.

Delivery times will vary. Dogs having slim heads, such as Shelties, Collies, and Dobermans, may complete delivery in one to two hours. Dogs having large, round heads generally require longer delivery times. English Bulldogs, Boston Terriers, and Pekingese puppies tend to have sizeable heads that make delivery more difficult. It is not unusual for these breeds to rest an hour or more between each puppy. Rarely, a dog may deliver one or two puppies, then have labour stop for as long as twenty-four hours before the remainder of the litter is born. However, if the bitch does not start to strain in two hours and you think there are further puppies veterinary advice should be sought without delay.

The normal birth position
Puppies are usually born head first; with the head and forelegs extended. This is called anterior presentation. Posterior presentation is also normal in the bitch. The puppy is born with tail and hindlegs coming first. Breech presentation in which the hindlegs are forward and the tail and rump is presented is abnormal. However it does occur and can result in a normal birth although breech presentations frequently present problems. If a puppy's rump is presented and the bitch is straining continuously without making any progress, veterinary attention should be sought without delay. Each puppy is enclosed in a sac that is part of the placenta ("afterbirth"). These usually pass after the puppies are born. However, any that do not pass usually disintegrate and are passed within 24-48 hours after delivery. If the bitch develops a blood stained, pussy or smelly discharge consult your veterinary surgeon. Note that it is normal for the mother to eat the placentas.

If the delivery proceeds normally, a few contractions will discharge the puppy; which should exit the birth canal within ten minutes of being visible. Following delivery, the mother should lick the newborn's face. She will then proceed to wash it and toss it about. Her tongue is used to tear the sac and expose the mouth and nose. This vigorous washing stimulates circulation, causing the puppy to cry and begin breathing; it also dries the newborn's haircoat. The mother will sever the umbilical cord by chewing it about to 1 inch (1.9 to 2.5 cm) from the body. Next, she will eat the placenta.

If the puppy or a fluid-filled bubble is partially visible from the vagina, the owner should assist delivery. A piece of dampened gauze or thin face cloth can be used to break the bubble and grasp the head or feet. When a contraction occurs, firm traction should be applied in a downward (i.e. toward her rear feet) direction. If reasonable traction is applied without being able to remove the puppy, or if the mother cries intensely during this process, the puppy is wedged. Veterinary help may be needed.

It is normal for the mother to remove the placental sac and clean the puppies; however, first-time mothers may be bewildered by the experience and hesitate to do so. If the sac is not removed within a few minutes after delivery, the puppy will suffocate, so you should be prepared to intervene. The puppy's face should be wiped with a damp face cloth or gauze to remove the sac and allow breathing. Vigorous rubbing with a warm soft towel will stimulate circulation and dry the hair. If the puppy does not start to take a breath, gentle blowing down the throat after gently opening the mouth with the fingers also helps to assist respiration. The umbilical cord should be tied using sewing thread or dental floss and cut with clean scissors. The cord should be tied snugly and cut about half an inch (1.3 cm) from the body so it is unlikely to be pulled off as the puppy moves around the whelping box.

Newborn puppies may aspirate fluid into the lungs, as evidenced by a raspy noise during respiration. This fluid can be removed by the following procedure. First, the puppy should be held in the palm of your hand. The puppy's face should be cradled between the first two fingers. The head should be held firmly with this hand, and the body should be held firmly with the other. Next, a downward swing motion with the hands should make the puppy gasp. Gravity will help the fluid and mucus to flow out of the lungs. This process may be tried several times until the lungs sound clear. The tongue is a reliable indicator of successful respiration. If the puppy is getting adequate oxygen, it will appear pink to red. A bluish coloured tongue indicates insufficient oxygen to the lungs, signalling that the swinging procedure should be repeated.

It is helpful to have a smaller, clean, dry box lined with a warm towel for the newborn puppies. After the puppy is stable and the cord has been tied, it should be placed in the incubator box while the mother is completing delivery. Warmth is essential so a heating pad or hot water bottle should be placed in the box, or a heat lamp may be placed nearby. If a heating pad is used, it should be placed on the low setting and covered with a towel to prevent overheating. A hot water bottle should be covered with a towel. Remember, the newborn puppies may be unable to move away from the heat source. Likewise, caution should also be exercised when using a heat lamp.

Once delivery is completed, the soiled newspapers should be removed from the whelping box. The box should be lined with soft acrylic type bedding, prior to the puppies' return. The mother should accept the puppies readily and settle down to feed them.

The mother and her litter should be examined by a veterinary surgeon within 24 hours after the delivery is completed. This visit is to check the mother for complete delivery, and to check the new-born puppies. The mother may receive an injection to contract the uterus and stimulate milk production. Sometimes antibiotics may be prescribed if it is thought there is any infection present.

The mother may have a bloody vaginal discharge for 3-7 days following delivery. If it continues for longer than one week, she should be examined by a veterinary surgeon for possible problems.

What happens if my dog has trouble delivering her puppies?
Although most dogs deliver without need for assistance, problems do arise which require the attention of a veterinarian. Professional assistance should be sought if any of the following occur:

1. Twenty minutes of intense labour occurs without a puppy being delivered.

2. Ten minutes of intense labour occurs when a puppy or a fluid-filled bubble is visible in the birth canal.

3. The mother experiences sudden depression or marked lethargy.

4. The mother's body temperature exceeds 39.4*C (via a rectal thermometer).

5. Fresh blood discharges from the vagina for more than 10 minutes.

6. If a green discharge is seen without any puppies having been born.

Difficulty delivering (dystocia) may be managed with or without surgery. The condition of the mother, size of the litter, and size of the puppies are factors used in making that decision.

Is premature delivery a likely problem?
Occasionally, a mother will deliver a litter several days premature. The puppies may be small, thin, and have little or no hair. It is possible for them to survive, but they require an enormous amount of care, since they are subject to chilling and are frequently very weak and unable to swallow. Some may be able to nurse but are so weak that they must be held next to the teat. Puppies that do not nurse can be fed with a small syringe, bottle, or via stomach tube. The equipment and instructions for these procedures are available from your veterinary surgeon. Premature puppies must be kept warm. The mother can provide sufficient radiant heat from her body if she will stay close to them. If she refuses, heat can be provided with a heat lamp, heating pad, or hot water bottle. Excessive heat can be just as harmful as chilling, so any form of artificial heat must be controlled. The temperature in the box should be maintained at around 30*C but the box should be large enough so the puppies can move away from the heat if it becomes uncomfortable. In addition the warmth provided by the mother is moist warmth: she is licking and cleaning the puppies and they are suckling; therefore if artificial heat is supplied it is essential to ensure there is sufficient moisture present and a damped towel or wet cotton wool in the whelping box will provide this essential moisture.

Is it likely that one or more puppies will be stillborn?
It is not uncommon for one or two puppies in a litter to be stillborn. Sometimes, a stillborn puppy will disrupt labour, resulting in dystocia. At other times, the dead puppy will be born normally. Although there is always a cause for this occurrence, it is often not easily determined without a full post mortem examination of the puppy including bacteriological examination and submission of tissues to a pathologist. Your veterinary surgeon may in certain circumstances recommend this procedure and it is worthwhile discussing the cost beforehand since sometimes it can be considerable. However it may prevent future problems.

What do I do to care for the newborn puppies?
The mother will spend most of her time with the puppies during the next few days. The puppies need to be kept warm and to nurse frequently; they should be checked every few hours to make certain that they are warm and well fed. The mother should be checked to make certain that she is producing adequate milk.

If the mother does not stay in the box, the puppies' temperatures must be monitored. If the puppies are cold, supplementary heating should be provided. During the first four days of life, the environment for the puppies should be maintained at around 30*C. The temperature may gradually be decreased to 27*C by the seventh to tenth day and to about 22*C by the end of the fourth week. If the litter is large, the temperature need not be as high. As puppies huddle together, their body heat provides additional warmth. Their behaviour will give a guide to whether they are comfortable. If they are warm and content they will be quiet and gaining weight.

If the mother feels the puppies are in danger or if there is too much light she may become anxious. Placing a sheet or cloth over most of the top of the box to obscure much of the light may resolve the problem. An enclosed box is also a solution. Some dogs, especially first-time mothers, are more anxious than others. Such dogs may attempt to hide their young, even from the owner. If the bitch continues to move her puppies from place to place, some attempt at confinement may be worthwhile. However if she is still unsettled, veterinary advice should be sought since the puppies will certainly be endangered if they are placed in a cold or draughty location. If the bitch becomes too distressed she could kill her puppies as a means of "protecting" them from danger.

What are the signs that the puppies are not doing well and what should I do?
Puppies should feed and sleep 90% of the time during the first two weeks. Any "mewing" type noises may indicate lack of nourishment or an infection, i.e. they are not thriving. If in doubt consult your veterinary surgeon.

Another good indication of thriving is weight increase. Any available postal scales will usually suffice for this purpose. Puppies may be identified with fibre tipped pen on the abdomen and careful weight records kept.

When the milk supply is inadequate, supplemental feeding one to three times per day is recommended and should be performed on any litter with more than 5 or 6 puppies. There are several very good commercial formulae available. The directions on the container should be carefully followed before feeding particularly with regard to temperature. One method of testing the temperature of the feed is to drop some of the warm formula on to your forearm. It should be about the same temperature. The commercial products have directions concerning feeding amounts. If the puppies are still nursing from their mother, the amounts recommended will be excessive. Generally, 1/3 to 1/2 of the listed amount should be the daily goal. Supplemental feeding may be continued until the puppies are old enough to eat puppy food.

If the mother does not produce milk or her milk becomes infected, the puppies will also cry. If this occurs, the entire litter could die within 24 to 48 hours. Total replacement feeding, using the mentioned products, or finding a foster mother is usually necessary. The owner of the stud dog, your local veterinary surgeon, or other breeders may be able to help with this. If replacement feeding is chosen, the amounts of listed on the product container should be fed. Puppies less than 2 weeks of age should be fed every 3-4 hours. Puppies 2-4 weeks of age do well with feedings every 6-8 hours. Weaning in these circumstances should begin as early as possible, and certainly no later than about 3 weeks of age.

What should I expect during the puppies' first few weeks of life?
For the first month of life, puppies require very little care from the owner because their mother will feed and care for them. They are born with their eyes closed, but they will open in 7 to 14 days. If swelling or bulging is noted under the eyelids, they should be opened gently. Cotton wool dampened with warm water may be used to assist opening the lids. If the swelling is due to infection, pus will exit the open eyelids and should be treated as prescribed by a veterinary surgeon. If the eyes have not opened at 14 -16 days of age, or if there is any pus or discharge, consult your veterinary surgeon at once.

Puppies should be observed for their rate of growth. They should double their birth weight in about one week. Use postal scales as described above. The accuracy of the scales is not important, since it is weight increases that you are looking for.

At two weeks of age, puppies should be alert and trying to stand. At three weeks, they generally try to climb out of their box. At four weeks, all of the puppies should be able to walk, run, and play.

Puppies should begin eating solid food about three and a half to four and a half weeks of age. As soon as their eyes are open, one of the bitch milk replacers should be placed in a flat saucer. The puppies' noses can be dipped into this or their noses and mouths wetted with a finger dipped into the formula. Repeat this 2 or 3 times per day until they begin to lap; this usually takes 1-3 days. Next, raw scraped meat can also be smeared around their mouths or alternatively canned puppy food can be placed in the milk until it is soggy. As the puppies lap the milk, they will also ingest the food. The amount of milk should be decreased daily until they are eating the canned food with little or no moisture added; this should occur by 4 to 6 weeks of age. As soon as they are able to eat it is worthwhile weaning them on to one of the complete puppy foods. Most puppies, particularly those of the toy and smaller breeds prefer the canned varieties. Once the puppy is happy with a complete formula there is no need to add any vitamin or mineral supplements.

I have heard of milk fever. What exactly is it?
Eclampsia, or milk fever, is due to a depletion of calcium in the blood of the mother during heavy milk production. It generally occurs when the puppies are 3-5 weeks old (just before weaning) and most often to mothers with large litters or with an abundance of milk as some bitches naturally have. Good mothers, especially attentive of their puppies, always seem to suffer more severely.

The mother has muscle spasms resulting in rigid legs, spastic movements, and heavy panting. This can be fatal in 30-60 minutes, so a veterinary surgeon should be consulted immediately. This is an emergency situation.

Do puppies need a special diet?
Diet is extremely important for a growing puppy. There are many commercial foods specially formulated for puppies. These foods meet their unique nutritional requirements and should be fed until 12-18 months of age. Puppy foods are available in dry and canned formulations. Dry foods are less expensive in the long run and can be left in the bowl for the puppy to eat at will. Canned foods offer a change and are just as nutritious.

We recommend that you buy food formulated for puppies. Adult formulations are not recommended since they do not provide the nutrition required for a puppy. Advertisements tend to promote taste rather than nutrition, so be careful that their influence on purchasing habits is not detrimental to your dog. Table food is not recommended; although often more appealing than dog food, balanced nutrition is not easily achieved.

When should vaccinations begin?
Puppies are provided some immunity to canine diseases from their mother before and shortly after birth. This is particularly true if the dam's vaccinations are up to date. Some of the mother's antibodies cross the placenta and enter the puppies' circulation, but most antibodies are provided in the mother's milk, particularly the first milk or colostrum. These "maternal antibodies" protect the puppies against the diseases to which the mother is immune. This explains why it is so important to ensure that any booster inoculations are administered prior to mating.

Although very protective, maternal antibodies last for only a few weeks; after this time, the puppy becomes susceptible to disease. The duration of the maternal antibodies is quite variable depending on several factors. In general, vaccinations for the puppy should be started at about 6 weeks of age. Puppies should be vaccinated against distemper, hepatitis, kennel cough and parvovirus. Other vaccines are also available for certain situations, and will be discussed at the time of the first visit for vaccinations.

Maternal antibodies are passed in the mother's milk only during the first 1-3 days after delivery. If, for any reason, the puppies do not nurse during this important period of time, their vaccinations should begin about 2 to 4 weeks earlier depending on likely disease exposure although some maternal antibodies are transferred throughout the whole of the suckling period via the milk. Your veterinary surgeon can make specific recommendations for each particular situation.

Do all puppies have worms?
Intestinal parasites ("worms") are common in puppies. Sometimes no signs are apparent but often poor condition, chronic soft or bloody faeces, loss of appetite, a pot-bellied appearance, loss of lustre of the haircoat, and weight loss are seen. Some parasites are transmitted from the mother to her offspring and others are carried by fleas. Some are transmitted through the faeces of an infected dog. Very seldom are these parasites visible in the faeces. Their detection depends on demonstration of eggs under a microscope. Generally puppies are wormed from about 2 weeks of age and medication is usually supplied by your veterinary surgeon at the time of the post natal examination - it is well worth consulting the veterinary surgeon regarding a deworming programme to suit your litter of puppies.

CAESAREAN SECTION POST-OPERATIVE INSTRUCTIONS
A caesarean section is major surgery to remove puppies from the uterus. Most dogs recover quickly from this procedure. However if your dog was in labour for several hours before surgery was performed, her recovery may be slower, and she may need extra attention and help with her litter.

What should I expect during the mother's recovery period?
The bitch will have been given a special anaesthetic that is eliminated from her body as quickly as possible so that usually she is recovering consciousness as she is removed from the operating table. Complete recovery from the anaesthetic may take several hours depending on her physical condition at the time of surgery and her age. During the recovery period, she must be restrained in such a way that she does not fall and hurt herself or roll over and crush the puppies. The puppies should not be left alone with her until she is completely awake and co-ordinated. Sometimes the veterinary surgeon will keep her and the puppies until she is completely recovered or else give specific instructions regarding keeping the puppies warm and separated until she is able to stand and walk unaided.

The mother should be interested in eating within a few hours after she is completely awake. For the first 48 hours after the operation she should offered small quantities of food and liquids frequently, being careful that she does not overeat which could result in vomiting. Immediately after whelping her food intake should be approximately one and a half-times her normal non-pregnant intake. By the third or fourth week of nursing, her food intake may be two to two and a half times normal. Her greatest food intake will be at the time of greatest milk production which is approximately 3 weeks post whelping.

The mother's temperature may rise around 1*C above normal for the first 1-3 days after delivery, then it should return to the normal range. The normal range is 38-39.2*C. Your veterinary surgeon will probably have prescribed antibiotics or other medication to be given immediately after the operation. If you are at all worried about the mother's condition, do not hesitate to contact your veterinary surgeon.

When should the puppies begin to nurse?
The puppies should be encouraged to feed her puppies as soon as possible after the operation. Although the mother may not be awake enough to handle the nursing alone, it may be possible for you to assist the process by making her lie still so the puppies can suckle.

If the mother does not have any milk at first, you may have to supplement the puppies for the first day or two. There are several good commercial canine milk substitutes available. Feeding bottles are also available, made in the appropriate size for tiny mouths. In an emergency canned evaporated milk can be used reconstituted at double the normal strength. This should be fed at the rate of 30 mL per 100g of puppy weight per 24 hours, divided into 3-5 feedings. The average newborn, small breed puppy weighs 100gm at birth.

Although it is desirable for puppies to begin nursing immediately, a healthy newborn can survive nicely for up to 12 hours without nursing. However, if the newborn is weak, dehydrated, or chilled, nourishment must be given as soon as possible.

How warm should we keep the room where the puppies are?
A newborn puppy is not able to regulate its body temperature very well. As long as the puppies stay near their mother, the room temperature is not too critical. However, if they are not with their mother, the environmental temperature should be between 29* and 32*C. If a heat lamp or other artificial form of heating is used it is important to ensure that overheating does not occur.

Is a bloody vaginal discharge normal?
A bloody vaginal discharge is normal for 3-7 days following birth. It may be quite heavy for the first 1-3 days, then it should begin to diminish. If it continues for longer than a few days, consult your veterinary surgeon. If she was spayed (neutered) at the time of the surgery vaginal discharge should be minimal.

What does it mean if the puppies are crying frequently?
Puppies should sleep or be nursing 90% of the time. If they are crying or whining, something is likely to be wrong. Uterine infections, inadequate milk, poor-quality milk, and infected milk are the most likely causes contributing to the so-called Fading Puppy Syndrome. The entire litter can die within 24 hours if one of these occurs. If you are at all concerned, contact your veterinary surgeon without delay.

When are her stitches removed?
The stitches may or may not need to be removed, depending on the type of suture material used. As a general rule, if the stitches are visible, they will have to be removed. Removal should occur about 10-14 days after surgery.

When should the puppies be weaned?
The sooner weaning commences, the less the strain on the bitch and if a show animal, the sooner she regains her condition. Weaning can commence very soon after the eyes are opened at 10-14 days. The first step is to offer a milk replacer in a flat saucer, either wetting the puppies' mouths and noses with your finger or actually placing their muzzles in the mixture two or three times a day until they begin to lap. Once lapping begins, a puppy-type canned food should be crumbled in the water/milk mixture. Sometimes using raw scraped meat smeared around their muzzles will encourage them to start to eat.. As they begin to eat the solid food, the water/milk mixture should be reduced until they are eating only the solid food. Once they are eating solid food (about 5-6 weeks of age), they may be placed in their new home.

When are the puppies treated for worms?
Puppies should be treated for worms from approximately 2 weeks of age depending on the breed. It is important that accurate weights are obtained for the puppies so that the proper dose of medication can be used. Consult your veterinary surgeon regarding choice of medication.

When should vaccinations begin?
First vaccinations typically begin at around 6 weeks of age. If your puppies were not able to nurse during the first 3 days of life, they will not have received proper immunity from their mother. In this situation, vaccinations should begin earlier. Many breeders today ensure that a first vaccination has been administered before the puppies go to the new homes. Although vaccinations usually begin at 6 weeks if there have been any problems during whelping or nursing, often these are commenced earlier but for lasting immunity the final vaccination must be administered when the puppy is over 12 weeks of age. Annual booster injections are necessary.

Vaccination programmes vary according to local conditions and also the state of health of the bitch and puppies. Discuss this with your veterinary surgeon either during the post natal examination or subsequently.

CHRONIC KIDNEY FAILURE
What is meant by the term "Chronic Kidney Failure"?
Kidney failure is the inability of the kidneys to remove waste products from the blood. Kidney failure is NOT the inability to make urine. Ironically, most dogs in kidney failure are actually producing large quantities of urine, but the body's wastes are not being effectively eliminated.

When is this likely to happen in my dog?
The typical form of chronic kidney failure is the result of ageing; it is simply a "wearing out" process. The age of onset is related to the size of the dog. For most small dogs, the early signs occur at about 10-14 years of age. However, large dogs have a shorter age span and may go into kidney failure as early as 7 years of age. In some breeds there is a genetic predisposition to kidney failure.

What changes are likely to occur in my dog?
The kidneys are nothing more than filters. When ageing causes the filtration process to become inefficient and ineffective, blood flow to the kidneys is increased in an attempt to increase filtration. This results in the production of more urine. To keep the dog from becoming dehydrated due to increased fluid loss in the urine, thirst is increased; this results in more water consumption. Thus, the early clinical signs of kidney failure are increased water consumption and increased urine production. The clinical signs of more advanced kidney failure include loss of appetite, depression, vomiting, diarrhoea, and very bad breath. Occasionally, ulcers will be found in the mouth. When kidney failure is accompanied by these clinical signs, it is called uraemia.

How is chronic kidney failure diagnosed?
The diagnosis of kidney failure is made by determining the level of either of two waste products in the blood: blood urea and/or blood creatinine and by confirming a concurrent inability to modify urine concentration.

Although urea and creatinine levels reflect kidney failure, they do not predict it. A dog with marginal kidney function may have normal blood levels. If that dog is stressed with major illness or surgery, the kidneys may fail, sending the urea and creatinine values up quickly.

Since this is basically just a wearing out process, can it be treated with anything other than a kidney transplant?
In some cases, the kidneys are worn out so that they cannot be revived. However, with appropriate treatment some dogs will live for several more months or years.

Treatment occurs in two phases. The first phase is to "restart" the kidneys. Large quantities of intravenous fluids are given to "flush out" the kidneys. This flushing process, called diuresis, helps to stimulate the kidney cells to function again. If enough functional kidney cells remain, they may be able to adequately meet the body's needs for waste removal. Fluid therapy includes replacement of various electrolytes, especially potassium. Other important aspects of initial treatment include proper nutrition and drugs to control vomiting and diarrhoea.

What can I expect from this phase of treatment?
There are three possible outcomes from the first phase of treatment:

1. The kidneys will resume functioning and continue to function for a few weeks to a few years.

2. The kidneys will resume functioning during treatment but fail again as soon as treatment stops.

3. Kidney function will not return. Unfortunately, there are no reliable tests that will predict the outcome.

If the first phase of treatment is successful, what happens next?
The second phase of treatment is to keep the kidneys functioning as long as possible.

This is accomplished with one or more of the following, depending on the situation:

1. A low protein diet. This helps to keep the blood tests as close to normal as possible, which usually makes your dog feel better. Also, once kidney disease is advanced, a decreased protein diet may decrease the workload on the kidneys. There are a variety of commercially prepared foods that have the quantity and quality of protein needed by your dog.

2. A phosphate binder. Phosphorous is removed from the body by filtering through the kidneys. Once the filtration process is impaired, phosphorous begins to accumulate in the blood. This also contributes to lethargy and poor appetite. Certain drugs will bind excess phosphates in the intestinal tract so they are not absorbed, resulting in lower blood levels of phosphorus.

3. A drug to regulate the parathyroid gland and calcium levels. Calcium and phosphorus must remain at about a 2:1 ratio in the blood. The increase in blood phosphorus level, as mentioned above, stimulates the parathyroid gland to increase the blood calcium level by removing it from bones. This can be helpful for the sake of the normalising calcium:phosphorus ratio, but it can make the bones brittle and easily broken. Calcitriol can be used to reduce the function of the parathyroid gland and to increase calcium absorption from the intestinal tract. This is recommended if there is evidence of abnormal function of the parathyroid gland.

A drug to stimulate the bone marrow to produce new red blood cells. The kidneys produce erythropoietin, a hormone that stimulates the bone marrow to make red blood cells. Therefore, many dogs in kidney failure have a low red blood cell count, or anaemia.

How long can I expect my dog to live?
The prognosis is quite variable depending on response to the initial stage of treatment, your ability to perform the follow-up care and your dog's willingness to eat the special diet. Treatment can be effective. Many dogs will have a good quality of life for months or even years.

CORNEAL ULCERS
What is a corneal ulcer?
The cornea is the transparent, shiny membrane which makes up the front of the eyeball. Think of it as a clear window. To understand a corneal ulcer, you must first understand how the cornea is constructed.

The cornea is comprised of three layers. The most superficial layer is the epithelium. This layer is comprised of many very thin layers of cells. Below the epithelium is the stroma, and the deepest layer is Descemetís membrane. Because all of these layers of the cornea are clear, it is not possible to see them without special stains which colour particular cells and highlight them when looked at with a microscope.

An erosion of few layers of the epithelium is called a corneal erosion or a corneal abrasion. A corneal ulcer is an erosion through the entire epithelium and into the stroma. If the erosion goes through the epithelium and stroma to the level of Descemet's membrane, a descemetocele exists. If Descemet's membrane ruptures, the liquid inside the eyeball leaks out, the eye collapses and irreparable damage can occur.

How does a corneal ulcer occur?
There are several causes for corneal ulcers in dogs. The most common is trauma. An ulcer may result from blunt trauma, such as a dog rubbing its eye on the carpet, or due to a laceration, such as a cat scratch. The second most common cause is chemical burn of the cornea. This may happen when irritating shampoo gets in the eye.

Less common causes of corneal ulcers include bacterial infections, viral infections, and other diseases. These may originate in the eye or develop secondary to disease elsewhere in the body. Examples of other diseases include Epithelial Dystrophy (a weakening of the cornea which can be inherited in breeds such as the Boxer), Keratoconjunctivitis Sicca (drying of the cornea due to abnormal tear formation), which occurs in breeds such as the West Highland White Terrier and diseases of the endocrine system (diabetes mellitus, hyperadrenocorticism, and hypothyroidism).

How does a corneal ulcer affect my dog?
A corneal ulcer is very painful. In response to pain, most dogs rub the affected eye with a foot or on the carpet. To protect the eye, they keep the lids tightly closed. Occasionally, there will be a discharge that collects in the corner of the eye or runs down the face.

How is a corneal ulcer diagnosed?
Superficial corneal abrasions are usually not visible. They can be visualised with the use of special stains such as fluorescein. A drop of this stain is placed on the cornea. The dye will adhere to an area of ulceration and is easily visualised especially with special lights such as Wood's light. This is the most basic test performed and may be the only test needed if the ulcer is acute and very superficial. If the ulcerated area is chronic or very deep, samples are taken for culture and cell study prior to applying the stain or any other medication.

How is a corneal ulcer treated?
Treatment depends on whether there is a corneal abrasion, corneal ulcer, or descemetocele present.

Corneal abrasions generally heal within 3-5 days. Medication is used to prevent bacterial infections (antibiotic ophthalmic drops or ointment) and to relieve spasm and pain (atropine ophthalmic drops or ointment). Antibiotic drops are only effective for a few minutes so they must be applied frequently; ointments last a bit longer but still require application every few hours. It is suggested that an antibiotic preparation be instilled in the eye 4 to 6 times per day. On the other hand, the effects of atropine last many hours so this drug is only instilled about twice daily.

If a corneal