HYPOTHYROIDISM
What is the thyroid gland, and what does it do?
The thyroid gland is one of the most important glands in the body. It is located in the neck near the trachea (windpipe) and is composed of two lobes, one on each side of the trachea. This gland is controlled by the body's master gland, the pituitary gland, located at the base of the brain.

The thyroid gland regulates the rate of metabolism (body chemistry). If it is hyperfunctional, metabolism speeds up. If it is less functional than normal, metabolism slows down. The latter is the basis for the clinical signs of hypothyroidism.

What causes hypothyroidism?
Hypothyroidism is almost always caused by one of two diseases: lymphocytic thyroiditis or idiopathic thyroid gland atrophy. The former disease is the most common cause of hypothyroidism and is thought to be an immune-mediated disease. This means that the immune system decides that the thyroid is abnormal or foreign and attacks it. It is not known why the immune system does this. Idiopathic thyroid gland atrophy is also poorly understood. Normal thyroid tissue is replaced by fat tissue in what is considered a degenerative disease.

These two causes of hypothyroidism account for more than 95% of the cases. The other five percent are due to uncommon diseases, including cancer of the thyroid gland.

What are the clinical signs?
When the rate of metabolism slows down, virtually every organ in the body is affected in some manner. Most affected dogs have one or more of several "typical" physical and/or chemical abnormalities. These include:

(a) Weight gain without an increase in appetite
(b) Lethargy and lack of desire to exercise
(c) Cold intolerance (gets cold easily)
(d) Dry haircoat with excessive shedding
(e) Very thin haircoat to near baldness
(f) Increased pigmentation in the skin
(g) Failure to re-grow hair after clipping or shaving
(h) High blood cholesterol
(i) High blood muscle enzyme levels
(j) Anaemia

Some dogs also have other abnormalities that are not the typical findings. These include:
(a) Thickening of the facial skin so they have a "tragic facial expression"
(b) Abnormal function of nerves causing non-painful lameness, dragging of feet, lack of co-ordination, and a head tilt
(c) Loss of libido and infertility in intact males
(d) Lack of heat periods, infertility, and abortion in females
(e) Fat deposits in the corneas of the eyes
(f) Keratoconjunctivitis sicca or so-called "dry eye" due to lack of proper tear production.

How is it diagnosed?
The most common test is for the T4 level. This is a measurement of the main thyroid hormone in a blood sample. However, testing for the T4 level can be misleading because some dogs that are not hypothyroid may have subnormal levels. This happens when another disease is present or when certain drugs are given. Generally confirmation requires giving a drug that stimulates the gland and measuring the T4 level before and after. A subnormal response confirms hypothyroidism.

If hypothyroidism is suspected but the T4 is normal, other tests can be performed. These are more expensive so they are not used as first line tests.

Can it be treated?
Hypothyroidism is treatable but not curable. It is treated with oral administration of a thyroid replacement hormone. This drug must be given for the rest of the dog's life.

How is the proper dose determined?
There is a standard dose that is used initially; it is based on the dog's weight. However, after about one month of treatment, further testing is done to verify that the thyroid hormone levels are normal. In some dogs, the dose will need to be further adjusted every 6-12 months. Close liaison with your veterinary surgeon is necessary in order to ensure that the dog is neither overdosed nor underdosed.

What happens if the medication is overdosed?
Although overdosing is difficult, excess medication may produce signs of hyperthyroidism. These include hyperactivity, lack of sleep, weight loss, and an increase in water consumption. If any of these occur, please let us know immediately.

INFLAMMATORY BOWEL DISEASE
What is inflammatory bowel disease?
Inflammatory Bowel Disease (IBD) is a chronic disease of the intestinal tract. Occasionally, the stomach may be involved. Most affected dogs have a history of recurrent or chronic vomiting and/or diarrhoea. During periods of vomiting or diarrhoea, the dog may lose weight but is generally normal in other ways. As a rule, most affected dogs eat well (or even have an increased appetite) and appear normal.

What causes this disease?
The cause of IBD is poorly understood. In fact, it appears that there may be several causes. Whatever the cause(s), the end result is that the lining of the intestine is invaded by inflammatory cells. An allergic-type response is then set in place within the bowel lining. This interferes with the ability of the dog to digest and absorb nutrients.

For some dogs, dietary components are speculated to play a role in initiation of the disease. Bacterial proteins may be involved in other cases. In most instances, an underlying cause cannot be identified.

How is IBD diagnosed?
Firstly blood tests are likely to be taken to establish if there is an exocrine pancreatic insufficiency, i.e. if digestion is normal and whether the digested food is being absorbed correctly. Depending on the results, special diets may then be tried depending which part of the bowel appears to be most involved. These diets include hypo-allergogenic foods, low residue diets or high fibre foods. In addition if it appears from the blood tests that bacterial overgrowth is present, drug trials may be instituted involving administration of certain drugs and gauging improvement. Finally it may be necessary to obtain biopsy samples from the bowel, either via the oral route using a flexible endoscope or in some cases following an exploratory laparotomy where the bowel is examined during operation for signs of disease and portions of the diseased tissue are secured for further tests.

Is IBD treatable?
When a diagnosis of IBD is made, the dog is placed on a hypoallergenic, low residue or high fibre diet for eight weeks or more. This helps to identify the contribution of dietary components to the problem. Although this is not a common cause of the disease, it is easy to treat if an acceptable food is found. If the dietary trial does not offer any improvement, medication is used to control (not cure) the problem. Since not all dogs respond to the same medication, a series of drugs may be necessary.

What is the prognosis?
Once the appropriate drugs or diet can be determined, many dogs are maintained on these for life, although dosages of the drugs may eventually be decreased. Occasionally, a dog will be able to stop drug therapy at some point.

Most dogs do well for many years; others require alterations in therapy every few months. Unfortunately, a few dogs will ultimately become totally resistant to treatment.

Some severe forms of canine inflammatory bowel disease will eventually progress to intestinal cancer. This finding is well documented in human beings and, in recent years, it has become apparent that this occurs in dogs, as well.

INHALANT ALLERGY
What are allergies, and how do they affect dogs?
One of the most common conditions affecting dogs is allergy. In the allergic state, the dog's immune system "overreacts" to foreign substances (allergens or antigens) to which it is exposed. These overreactions are manifested in three ways. The most common is itching of the skin, either localised (one area) or generalised (all over the dog). Another manifestation involves the respiratory system and may result in coughing, sneezing, and/or wheezing. Sometimes, there may be an associated nasal or ocular (eye) discharge. The third manifestation involves the digestive system, resulting in vomiting or diarrhoea.

What is inhalant allergy?
The most common type of allergy is the inhalant type, also known as atopy. Dogs may be allergic to all of the same inhaled allergens that affect humans. These include tree pollens (cedar, ash, oak, etc.), grass and weed pollens, moulds, mildew, and the house dust mite. Many of these allergies occur seasonally, such as the grass pollens. However, others are with us all the time, such as moulds, mildew, and house dust mites.

What happens when a dog inhales something to which it is allergic?
When humans inhale allergens, we express the allergy as respiratory problems. These include coughing, sneezing, a runny nose, and watery eyes. The dog's reaction, however, usually produces severe, generalised itching. It will chew, lick, or scratch almost any area of the body, including the feet. Chewing and scratching produce hair loss and inflamed areas of the skin. Saliva will stain light coloured hair, so dogs that lick excessively will have orange or reddish brown hair. This is often seen on the feet. Although most people think that itching is related to fleas, the most common cause of itching in the dog is inhalant allergy.

What is causing my dog's allergy?
That is not a question that can be answered easily. The itching produced by grass pollen is the same as that produced by oak pollen allergy. In other words, an individual animal can be allergic to many different things with the end result (itching) being the same. In some cases, allergy testing can make specific determinations, and sometimes an educated guess can be accurate if the itching corresponds with the blooming season of certain plants. However, it is not always necessary to know the specific allergen for treatment to be successful.

What is meant by "seasonal allergy" and "year round allergy"?
As the names imply, some dogs only have allergic reactions during specific periods of the year. Others will itch year round. A year round allergy occurs for two reasons. First, the allergen is present year round. This is the case for indoor dogs that are allergic to house dust mites, also known as "house dust". Second, the dog is allergic to so many things that at least one of those allergens is present at all times.

My dog seemed to have a seasonal allergy for several years, and now it seems year round. Is that possible?
Not only is that possible, it is almost expected. As the dog ages, it usually becomes allergic to more and more things. After several years of acquiring new allergies, it reaches the point that it is constantly exposed to something to which it is allergic.

My dog seems to have a grass allergy. Does that mean it should not walk on grass?
No. Dogs that are allergic to "grass", for example, are really allergic to grass pollen. The blades of grass will cause no harm to your dog. Some grasses are more allergenic than others, depending on the amount of pollen they release into the air. Keeping it mowed so it does not pollinate seems logical, but your neighbours must do the same because the pollen is airborne. The same principle applies to trees. Dogs are not allergic to the wood of a certain tree, only to its pollen.

How is inhalant allergy treated?
Treatment depends largely on the length of the dog's allergy season and involves four approaches:

1. Anti-inflammatory drugs.
Anti-inflammatory therapy will dramatically block the allergic reaction in most cases. Corticosteroids may be given orally. If steroids are appropriate for your dog, you will be instructed in their proper use. Antihistamines can be of value in treating the allergic dog when they are combined with steroids. In some dogs, antihistamines can significantly decrease the amount of steroid needed to provide relief. Fatty acid supplementation can also be implemented with steroids and antihistamines. When the three of them are combined, most allergic dogs are significantly improved. This is a non-specific approach which does not treat the allergy, only the result of the allergic state (itching).

2. Shampoo therapy.
Many dogs are helped considerably by frequent bathing with a hypoallergenic shampoo. It has been demonstrated that some allergens may be absorbed through the skin. Frequent bathing is thought to reduce the amount of antigen exposure through this route. In addition to removing surface antigen, bathing alone will provide some temporary relief from itching and may allow the use of a lower dose of steroids. Some of the hypoallergenic shampoos incorporate fatty acids; these may be absorbed through the skin and offer a localised anti-inflammatory action. The role of the fatty acids in allergy treatment is an area of active research interest in veterinary medicine.

3. Hyposensitisation.
The third major form of allergy treatment is hyposensitisation with specific antigen injections . Once testing identifies the specific allergens, very small amounts of the antigen are injected weekly. The purpose of this therapy is to reprogram the body's immune system. It is hoped that as time passes, the immune system will become less reactive to the problem-causing allergens. If hyposensitisation appears to help the dog, injections will continue for several years. For most dogs, a realistic goal is for the itching to be significantly reduced in severity; in some dogs, itching may completely resolve. Generally, steroids are only used on a brief and intermittent basis. This therapeutic approach is recommended for the middle-aged or older dog that has year round itching caused by inhalant allergy.

4. Antibiotics.
Dogs that damage their skin by licking, chewing and scratching are quite susceptible to bacterial infections in the skin. If this occurs, antibiotics should be given until the infection is controlled. The skin infection itself can be quite irritating and cause a dog to itch even more.

Although hyposensitisation is the ideal way to treat inhalant allergy, it does have some drawbacks and may not be the best choice in certain circumstances and for these reasons:

(a) Cost: This is the most expensive form of treatment.
(b) Age of Patient: Because many dogs develop additional allergies as they get older, young dogs may need to be retested 1-3 years later.
(c) Success Rate: About 50% of dogs will have an excellent response, about 25% get partial to good response, and the remaining 25% get little or no response. The same statistics are true for people undergoing hyposensitisation.
(d) Food Allergies: Although tests for food allergy are available, the reliability of these tests is so low that it is not recommended at this time. A food trial remains the best diagnostic test for food allergy.
(e) Time of Response: The time until apparent response may be 2-5 months, or longer.
(f) Interference of steroids: Dogs must not receive oral steroids for 2 weeks prior to testing; these drugs will interfere with the test results.

My dog has fleas. Are these responsible for the itching?
A dog with inhalant allergy will itch even if fleas are not present. However, if your dog has fleas, the itching will increase. Although getting rid of all of your dog's fleas will not stop the itching, it will make it much easier to control the itching successfully.

My dog has a terrible odour. Is that related?
There are two possible causes of odour associated with inhalant allergy. These dogs are very prone to ear infections because the ear canal is an extension of the skin. When it becomes inflamed, it is easily infected and this will smell it is likely to have seborrhoea.

Sebum is the oily material normally produced in the skin. When a dog scratches, sebum production increases dramatically. This produces a musty odour. A bath will remove the odour, but it is gone for only a few hours. The key to controlling seborrhoea is to stop the itching and scratching. In addition the sebum is a good medium in which bacteria can grow. This again results in an unpleasant smell.

Is there another disease that can be part of my dog's problem?
Yes. Skin infections (which themselves may increase itching) are common with atopy and may aggravate allergic conditions.

LICK GRANULOMA
What is a lick granuloma?
A lick granuloma is an open sore on the skin caused and perpetuated by constant licking. The correct medical term for this problem is Acral Lick Dermatitis. It is generally located on one of the legs, usually near the carpus (wrist) joint. Typically, the hair will be licked off and the area will be either raw and weeping or thickened and scarred.

Lick granulomas usually begin with an itching or tingling sensation. The dog responds to this by licking which serves to increase the itching or tingling further. A vicious cycle quickly develops, creating a habit much like a child sucking its thumb. Even if the problem that initiated the itching or tingling sensation is gone, the licking habit continues.

Are there certain breeds that are more likely to do this?
Yes. German Shepherds, Dobermans, Great Danes, Labrador Retrievers, and Irish Setters probably develop lick granulomas more often than other breeds, but any breed is susceptible. In addition, male dogs are twice as likely to develop these lesions than females.

Why does a dog do this?
There is no clear answer to this question but there are three basic views on the subject. Some experts consider it to be a primary skin disorder, while others see it as an allergic problem, or as a neurologic disease involving the nerves in the area of the affected skin. It is likely that most lick granulomas have more than one cause or a single cause with one or more contributing factors. Often aching arthritic joints can be a contributary factor.

How is this condition diagnosed and differentiated from other skin disorders?
In most cases, the diagnosis is made based on the appearance and location of the lesion and the observation that the dog has a compulsion to lick the area. However, certain skin tumours, parasites, embedded foreign bodies, and allergies can create lesions that look very similar. In addition, trauma that causes bone fractures or nerve injury can also lead to constant licking, creating a similar lesion. Therefore, if the diagnosis is in doubt or if the dog does not respond well to initial treatment, fungal cultures, radiographs (x-rays), and biopsies may be recommended.

How is a lick granuloma treated?
Many approaches have been attempted, but none have been successful in all cases. Often, success is only achieved after several "trial-and-error" attempts.

The approach to treatment generally begins by trying to eliminate potential psychological factors. Boredom and stress are important issues that should be addressed. It has even been suggested that another dog be acquired to keep the affected dog company and thus distracted from the licking cycle. Since this approach may not be successful, it should only be considered in situations where you have already thought of acquiring another dog and not as a primary line of treatment.

If no initiating cause can be found and eliminated, various medications are used. These fall into two categories: (1) drugs which reduce sensation or relieve inflammation or (2) drugs which affect the mood of the dog. In many cases, a drug in each category will be used simultaneously as a means of attacking the problem from two angles.

Some dogs respond best to combination drug therapy and the use of restraint collars. These collars (often called Elizabethan collars because of their appearance) are wide enough to stop the reaching the affected area to lick. It may be necessary for the dog to wear the collar for 6-8 weeks because skin conditions take a very long time to heal.
Many dogs develop secondary bacterial infections within the lick granuloma so long-term antibiotic therapy (6-8 weeks) may be helpful in some cases.

Some alternative treatments have been used which include radiation therapy, surgical excision of the lesion, cryotherapy (freezing), or intralesional injection of a long acting corticosteroid. The success rate is very varied and improvement is reported in 20-40% of the cases. These approaches are rather radical and usually employed when other methods fail to be successful.

What is the prognosis?
Lick granuloma is a difficult condition to treat successfully. It is frustrating because the cause is rarely identified and there is a strong psychological component to this condition. Remember that the initial course of treatment may be unsuccessful and that other avenues can be pursued once a lack of response has been observed. The trial and error approach, although tiresome, will usually ultimately result in success.

LUXATING PATELLA
What is a luxating patella?
The patella, or knee cap, should be located in the centre of the knee joint. The term "luxating" means out of place or dislocated. Therefore, a luxating patella is a knee cap that moves out of its normal location.

What causes this to occur?
The muscles of the thigh attach directly or indirectly to the top of the knee cap. There is a ligament, called the patellar ligament, which runs from the bottom of the knee cap to a point on the tibia just below the knee joint. When the thigh muscles contract, the force is transmitted through the patella and through the patellar ligament and results in extension (straightening) of the knee joint. The patella stays in the centre of the leg because the point of attachment of the patellar ligament is on the midline and because the patella slides in a groove on the lower end of the femur (the bone between the knee and the hip).

The patella luxates because the point of attachment of the patellar ligament is not on the midline of the tibia. It is almost always located too far medial (toward the middle of the body). As the thigh muscles contract, force pulls against the groove on the inner side of the femur. After several months or years of this abnormal movement, the inner side of the groove wears down or the ligament stretches and the patella is free to move out of the groove or dislocate. When this occurs, the dog has difficulty bearing weight on the leg. It may learn how to kick the leg and snap the patella back into its normal location. However, because the groove is gone, it dislocates again easily.

Does a luxating patella cause any long-term problems for my dog?
Some dogs can tolerate this problem for many years, some for all of their lives. However, with advancing age, the joint may become arthritic and painful.

Can a luxating patella be corrected?
Surgery should be performed if your dog has a persistent lameness or if other knee injuries occur secondary to the luxation.

Surgical repair is a three step process.
1. The point of attachment of the patellar ligament is moved and transplanted surgically to its proper location to correct the incorrect alignment.
2. The groove in the femur is deepened so the patella will stay in place.
3. The capsule around the joint is tightened. This last step is important because the joint capsule will have stretched during the period of luxation.

If the surgery is performed before arthritis occurs, the prognosis is excellent. Your dog should regain full use of its leg. However, if arthritis has already occurred, the joint will still be somewhat painful, especially in cold weather.

ORPHANED PUPPIES
Raising an orphaned litter is a time consuming although rewarding experience. Neonates are very fragile and despite all the care and attention, losses can be inevitable. It is worth bearing this in mind at the outset so that although strong bonding is likely to occur, you are more prepared for sudden loss should it unfortunately occur. Remember we are more than happy to help, assist and guide as necessary.

What problems am I likely to encounter?
Several critical problems must be addressed in caring for orphaned puppies. Among these are chilling, dehydration, and hypoglycaemia (low blood sugar). These problems are interrelated and may often exist at the same time. Close observation and prompt attention if any of these problems develop are essential to survival. Needless to say proper feeding of the orphaned puppy is extremely important.

Chilling
Chilling in newborn puppies can lead to significant mortality. A puppy will dissipate far more body heat per kilogram of body weight than an adult dog. The normal newborn puppy depends upon radiant heat from its mother to help maintain its body temperature. In the absence of the mother, various methods of providing heat, such as incubators, heat lamps, or hot water bottles can be used.

Rectal temperatures in a normal newborn puppy range from 35-37.2°C for the first week, 36.1-37.7°C for the second and third weeks, and reach the normal temperature of an adult 37.7-38.9°C by the fourth week.

When the rectal temperature drops below 34.4°C, the accompanying metabolic alterations are life-threatening. Therefore, immediate action is necessary to provide the warmth the puppy needs to survive. A healthy newborn can usually survive chilling if warmed slowly.

During the first four days of its life, the orphaned puppy should be maintained in an environmental temperature of 29.4-32.2°C. The temperature may gradually be decreased to 26.7° C by the seventh to tenth day and to 22.2°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.
Caution: Too rapid warming of a chilled puppy may result in its death.

Dehydration
The lack of regular liquid intake or the exposure of the puppy to a low humidity environment can easily result in dehydration. The inefficiency of the digestion and metabolism of a chilled puppy may also lead to dehydration and other changes such as those discussed in this paper.

Experienced breeders can detect dehydration by the sense of touch. Two signs of dehydration are the loss of elasticity in the skin and dry and sticky mucous membranes (gums) in the mouth.

An environmental relative humidity of 55 to 65% is adequate to prevent drying of the skin in a normal newborn puppy. However, a relative humidity of 85 to 90% is more effective in maintaining puppies if they are small and weak. One method of maintaining the humidity is to put a damp towel or dampened cotton wool near to the puppy in its container. Remember the bitch is continuously licking the puppy and herself and creates a fairly humid, immediate environment. Her breast area is also additionally naturally moist while she is suckling her puppies.

Hypoglycaemia (low blood sugar)
Signs of hypoglycaemia (abnormal decrease of sugar in the blood) are severe depression, muscle twitching and sometimes convulsions. If a puppy shows signs of hypoglycaemia, a few drops of sugar solution on the tongue can be life saving. Again if in doubt, please contact us.

What do I feed my orphaned puppy?
Total nutrition for the newborn orphans must be supplied by a milk replacer until the puppies are about three weeks of age. At this age, the puppies are ready to start nibbling moistened solid food.

Preferred diets:
1. A commercial puppy milk replacer, e.g. Animalac Masterpet Puppy Formula.
2. For short-term emergencies Evaporated milk made up double strength

Is the temperature of the food important?
Since the newborn may have trouble generating enough heat to maintain its body temperature, the milk replacer should be warmed to 35-37.8°C for the best results. The milk replacer should be about the same temperature as the skin on your forearm or slightly warmer. As the puppies grow older, the milk replacer can be fed at room temperature.

How do I feed my puppy?
1. Spoon feeding is slow, requires great patience and can be dangerous. It is not to be recommended. Each spoonful must be slowly "poured" into the puppy's mouth to prevent liquids from entering the lungs. The puppy's head must not be elevated, or the lungs may fill with fluids. Newborn puppies usually do not have a well-developed gag reflex to signal this.

2. Dropper feeding is marginally easier than spoon feeding but can result in the puppy ingesting air which can cause colic.

3. Feeding bottles made for puppies can be used quite successfully in most situations. There are two types, the open ended feeder with the flow of milk controlled by the finger over the open opposite end. The size of the hole in the nipple is critical . If it is too large and milk is dripping from it, this could drown the puppy. If it is too small the puppy will be discouraged from suckling. The apertures can be enlarged by using a hot needle and puncturing the nipple several times or alternatively a slit can be made with a razor blade. When the puppy stops suckling the small slit closes and thus drowning is prevented.

The other type of feeder is the closed ended feeder which has a nipple on either end. The larger nipple is squeezed in order to force milk through the teat at the other end which has the appropriate holes made in it. Again the rate at which the food is delivered is critical and should be checked carefully.

4. Tube feeding (gavage) is the easiest, cleanest and most efficient method of hand feeding. However, it requires proper equipment and skilled technique to prevent putting milk replacer into the puppy's lungs. If bottle feeding is not successful, we will supply the equipment and demonstrate the proper technique. This is not a difficult procedure, so do not hesitate to ask about it if you feel it is needed.

When and how much do I feed?
Commercial milk replacers have directions on their labels for proper amounts to feed. It is necessary for the puppy's weight to be obtained properly in ounces or grams. Electronic kitchen scales or postal scales are useful for this purpose. The amounts on the labels are based on the puppy being fed only the milk replacer. The amounts given are also for a 24 hour period. That quantity should be divided by the number of feedings per 24 hours. Four meals, equally spaced during a 24 hour period, are ample for feeding a puppy when adequate nutrients are provided. Six or more feedings may be necessary if the puppy is small or weak. Hand feeding can generally be ended by the third week and certainly by the fourth. By this time the puppy should be able to eat from a dish.

How do I get the puppy to urinate and defaecate?
The puppy's genital area must be stimulated after feeding to cause urination and defaecation. The genital area should be massaged with a moist cloth or cotton wool to stimulate action. This cleaning should continue during the first two weeks. If this procedure is not followed, the puppy may become constipated.

When does the puppy start to eat from a bowl?
As soon as the puppy's eyes have opened at 14-16 days , it is worthwhile starting the weaning process. First place the milk replacer in a flat dish and either dip the puppy's nose into it or smear some round its mouth with your finger. By three weeks the puppy can start to eat food from the dish along with the milk replacer. A gruel can be made by thoroughly mixing a puppy food (canned or dry) with the milk replacer to reach the consistency of a thick milk shake. The mixture should not be too thick at first or the puppy will not consume very much. As the consumption of food increases, the amount of milk replacer can be gradually decreased.

By four to four and a-half weeks, the orphaned puppy can consume enough moistened solid food to meet its needs.

It is better to avoid starting a puppy on a baby food regimen. This creates extra work and can also create a finicky eater. Many such foods will not meet the nutritional needs of a growing puppy.

Should my puppy be treated for worms?
We routinely treat puppies for worms from 2-3 weeks of age. Weekly or fortnightly wormings should be carried out until the first vaccinations at 6-8 weeks. It is then worth consulting the veterinary surgeon regarding future worming programmes.

When is the first vaccination given?
The first vaccination is normally given to puppies at 6-8 weeks of age. However, if your puppy did not nurse from its mother during the first 2-3 days after birth, there may be no protective immunity passed on to it. In that case, the veterinary surgeon may advise earlier or more frequent vaccinations to complete the programme.

PANCREATITIS
What is pancreatitis?
The pancreas is a vital organ which lies on the right side of the abdomen. It has two functions:

1. To produce enzymes which help in digestion of food and,

2. To produce hormones, such as insulin. When the pancreas becomes inflamed, the disorder is called pancreatitis. It is a disease process that is seen commonly in the dog. There is no age, sex, or breed predisposition.

There are two main forms of acute (sudden onset) pancreatitis:

1. The mild, oedematous form and

2. The more severe, haemorrhagic form. A few dogs that recover from an acute episode of pancreatitis may continue to have recurrent bouts of the disease, known as chronic, relapsing pancreatitis. The associated inflammation allows digestive enzymes to spill into the abdominal cavity; this may result in secondary damage to surrounding organs, such as the liver, bile ducts, gall bladder, and intestines.

What causes it?
The cause of pancreatitis is not known; however, there may be several contributory factors. It is often associated with a rich, fatty meal. In some cases, it may be associated with the administration of corticosteroid drugs however, some dogs with pancreatitis do not have exposure to either.

Under normal conditions, digestive enzymes produced by the pancreas are activated when they reach the small intestines. In pancreatitis, these enzymes are activated prematurely in the pancreas instead of in the small intestines. This results in digestion of the pancreas itself. The clinical signs of pancreatitis are often variable, and the intensity of the disease will depend on the quantity of enzymes that are prematurely activated.

What are the clinical signs?
The diagnosis of pancreatitis is based on three criteria: clinical signs, laboratory tests, and radiographs (x-rays) and/or ultrasound examination. The disease is typically manifested by nausea, vomiting, fever, abdominal pain, and diarrhoea. If the attack is severe, acute shock, depression, and death may occur. Laboratory tests usually reveal an elevated white blood cell count; however, an elevated white blood cell count may also be caused by many other things besides pancreatitis. The elevation of pancreatic enzymes in the blood is probably the most helpful criteria in detecting pancreatic disease, but some dogs with pancreatitis will have normal levels. Radiographs and ultrasound studies may show an area of inflammation in the location of the pancreas. Unfortunately, many dogs with pancreatitis will elude detection with any of these tests. Consequently, the diagnosis of pancreatitis may be tentative in some cases.

How is pancreatitis treated?
The successful management of pancreatitis will depend on early diagnosis and prompt medical therapy. The mild form of the disease is best treated by resting the pancreas from its role in digestion. The only way to "turn off" the pancreas is to withhold all oral fluids and food. This approach is accompanied by intravenous fluids to maintain normal fluid and electrolyte balance. In addition, anti-inflammatory drugs are sometimes administered. The presence of shock necessitates the immediate and intense use of intravenous fluids. Antibiotics are also indicated in many cases.

Will my dog recover?
The prognosis depends on the extent of the disease when presented and a favourable response to initial therapy. Dogs that present with shock and depression have a very guarded prognosis. Most of the mild forms of pancreatitis have a good prognosis.

Will there be any long-term problems?
There are three possible long-term complications that may follow severe or repeated pancreatitis. If a significant number of cells that produce digestive enzymes are destroyed, a lack of proper food digestion may follow. This is known as pancreatic insufficiency and can be treated with daily administration of enzyme tablets or powder in the food. If a significant number of cells that produce insulin are destroyed, diabetes mellitus can result and insulin therapy may be needed. In rare cases, adhesions between the abdominal organs may occur as a consequence of pancreatitis. However, most dogs recover with no long-term effects.

PARVOVIRUS INFECTION
What is Canine Parvovirus disease?
Canine parvovirus (CPV) infection is a relatively new disease that first appeared in 1978. Because of the severity of the disease and its rapid spread through the canine population, CPV has aroused a great deal of public interest. The virus that causes it is very similar to feline enteritis, and the two diseases are almost identical. Therefore, it has been speculated that the canine virus is a mutation of the feline virus. However, that has never been proven.

How does a dog become infected with parvovirus?
The causative agent of CPV disease, as the name infers, is a virus. The main source of the virus is the faeces of infected dogs. The faeces of an infected dog can have a high concentration of viral particles. Susceptible animals become infected by ingesting the virus. Subsequently, the virus is carried to the intestine where it invades the intestinal wall and causes inflammation.

Unlike most other viruses, CPV is stable in the environment and is resistant to the effects of heat, detergents, and alcohol. CPV has been recovered from dog faeces even after three months at room temperature. Due to its stability, the virus is easily transmitted via the hair or feet of infected dogs, contaminated shoes, clothes, and other objects. Direct contact between dogs is not required to spread the virus. Dogs that become infected with the virus and show clinical signs will usually become ill within 7-10 days of the initial infection.

How does this disease affect the dog?
The clinical manifestations of CPV disease are somewhat variable, but generally take the form of severe vomiting and diarrhoea. The diarrhoea may or may not contain blood. Additionally, affected dogs often exhibit a lack of appetite, depression, and fever. It is important to note that many dogs may not show every clinical sign, but vomiting and diarrhoea are the most common signs; vomiting usually begins first. Parvo may affect dogs of all ages, but is most common in dogs less than one year of age. Young puppies less than five months of age are often the most severely affected and the most difficult to treat.

How is it diagnosed?
The clinical signs of CPV infection can mimic other diseases causing vomiting and diarrhoea; consequently, the diagnosis of CPV is often a challenge for the veterinary surgeon . The positive confirmation of CPV infection requires the demonstration of the virus in the faeces or the detection of anti-CPV antibodies in the blood serum. Occasionally, a dog will have parvovirus but test negative for virus in the faeces. Fortunately, this is not a common occurrence. A tentative diagnosis is often based on the presence of a reduced white blood cell count (leukopaenia). If further confirmation is needed, faeces or blood can be submitted to a veterinary laboratory for the other tests. The absence of a leukopaenia does not always mean that the dog cannot have CPV infection. Some dogs that become clinically ill may not necessarily be leukopaenic.

Can it be treated successfully?
As with any virus disease there is no treatment to kill the virus once it infects the dog. However, the virus does not directly cause death; rather, it causes loss of the lining of the intestinal tract. This results in severe dehydration, electrolyte (sodium and potassium) imbalances, and infection in the bloodstream (septicaemia). It is when the bacteria that normally live in the intestinal tract are able to get into the blood stream, that it becomes more likely that the animal will die.

The first step in treatment is to correct dehydration and electrolyte imbalances. This requires the administration of intravenous fluids containing electrolytes. Antibiotics and anti-inflammatory drugs are given to prevent or control septicemia. Antispasmodic drugs are used to inhibit the diarrhoea and vomiting that perpetuate the problems.

What is the survival rate?
Most dogs with CPV infection recover if aggressive treatment is used and if therapy is begun before severe septicaemia and dehydration occur. For reasons not fully understood, some breeds, notably the Rottweiler, have a much higher fatality rate than other breeds.

Can it be prevented?
The best method of protecting your dog against CPV infection is proper vaccination. Puppies receive a parvo vaccination as part of the vaccines given at 6, 9, and 12 weeks of age. After the initial series of vaccinations when the dog is a puppy, all dogs should be boosted every 2 years with the vaccine used at Kelburn Vet Centre. Dogs in high exposure situations (i.e. kennels, dog shows, field trials, etc.) may be better protected with a booster more often. Bitches should be boosted before mating or immediately before whelping in order to transfer protective antibodies to the puppies. The final decision about a proper vaccination schedule should be made by your veterinary surgeon.

Is there a way to kill the virus in the environment?
The stability of the CPV in the environment makes it important to properly disinfect contaminated areas. This can be accomplished by cleaning food bowls, water bowls, and other contaminated items with a solution of 250 mL of chlorine bleach in 5 litres of water. It is important that chlorine bleach or glutaraldehyde based disinfectants be used because many other "viricidal" disinfectants will not kill the canine parvovirus.

Does parvovirus pose a health risk for me? How about for my cats?
It is important to note that at the present time, there is no evidence to indicate that CPV is transmissible to cats or humans.

PROSTATIC DISEASE
What is the prostate?
The prostate is a gland located near the neck of the urinary bladder of male dogs. The urethra passes through it shortly after leaving the bladder. The purpose of the prostate is to produce some of the fluids found in normal canine semen.

What are the signs of prostatic disease?
Enlargement of the gland is common with most prostatic diseases. Since the urethra passes through it, enlargement of the prostate compresses the urethra, and urination becomes difficult. Complete urethral obstruction only rarely occurs, but an affected dog will spend quite a bit of time urinating and produces a stream of urine with a small diameter. The colon, located just above the prostate, is sometimes compressed by an enlarged prostate. This makes defecation difficult. In summary, a dog with prostatic enlargement often has a history of straining to urinate and/or defeacate. In addition, some dogs with prostatic disease will have blood in the urine. Bacterial infection of the prostate is sometimes, but not always, involved with production of the bloody urine.

What are the diseases that cause the prostate to enlarge?
There are at least seven diseases affecting the prostate.

1. Benign prostatic hyperplasia. This is a non-cancerous enlargement of the gland. It is associated with the hormone testosterone and is the most common disease of the prostate.

2. Squamous metaplasia. This is a non-cancerous enlargement of the gland caused by excess amounts of oestrogen. An oestrogen-producing tumour called a Sertoli cell tumour is usually responsible.

3. Cystic hyperplasia. This condition is usually secondary to benign prostatic hyperplasia or squamous metaplasia. It is caused by obstruction of the ducts that carry prostatic secretions to the urethra. Multiple, fluid-filled cavities result.

4. Paraprostatic cysts. These are fluid-filled cysts that develop adjacent to the prostate when abnormal tissue remains from embryonic development before the puppy was born. The cysts begin to develop shortly after birth but may not cause problems or be detected until the dog is several years old.

5. Bacterial infection. Bacteria may enter and infect the prostate by going up the urethra or by coming down the urethra from an infection in the urinary bladder. It is usually associated with a pre-existing abnormality of the prostate, such as benign prostatic hyperplasia.

6. Prostatic abscess. This is a progressive form of a bacterial infection. If the ducts that drain the prostate become obstructed, bacteria are trapped in the prostate and form an abscess which is really a 'walled-off' site of infection.

7. Prostatic cancer. This form is much less common than all of the others. It may be associated with hormones from the testicles, adrenal glands, or pituitary glands or it may occur without any association with hormones.

How are these diagnosed?
The first step in diagnosis is to determine if the prostate is enlarged. This is done by feeling its size either through the abdominal wall or through the rectal wall. It may be confirmed by radiographs (x-rays) or an ultrasound examination.

Because there are so many diseases of the prostate, it is necessary to perform several tests to tell them apart. These tests include cultures of the dog's urine, a microscopic examination of the cells in the urine, and a microscopic examination of the cells in prostatic fluid or in the prostate itself. Samples of prostatic fluid are recovered by passing a urethral catheter to the level of the prostate and massaging the prostate to "milk" fluid out of it. Samples of prostatic cells are obtained by aspiration or biopsy via a needle that is either passed through the body wall or passed through the rectal wall. If the prostate is greatly enlarged, it can be aspirated or biopsied through the body wall; otherwise, an approach through the rectal wall is necessary. An aspiration sample is taken through a very small bore needle and only recovers a few cells. Sometimes this is adequate for analysis; other times it is not. A needle biopsy sample is obtained through a large bore needle that is passed into the prostate using radiography or ultrasound. A biopsy involves an operation which recovers a piece of tissue that permits a pathologist to make a more accurate diagnosis.

How are they treated?
1. Diseases involving primary or secondary bacterial infections are treated with aggressive antibiotic therapy. Because it is difficult to get many antibiotics into the prostate, treatment for several weeks will probably be necessary. Since most of the infections are secondary to another disease, treating the infection is only part of the overall treatment.

2. Diseases associated with excessive hormone levels include benign prostatic hyperplasia, cystic metaplasia, and cystic hyperplasia. Since testosterone and oestrogen are both formed in the testicles, castration is generally very effective for all of these. The prostate will generally be normal or smaller than normal in size within one month after castration.

3. Paraprostatic cysts and prostatic abscesses require major abdominal surgery to drain and remove.

4. Prostatic cancer does not respond well to any currently used form of treatment. If it is associated with an excess of a hormone, castration may be beneficial; however, most are not and metastasise rather easily to other parts of the body. The prognosis for these is usually poor.

PYOMETRA
What is pyometra?
In its simplest terms, pyometra is an infection in the uterus. However, most cases of pyometra are much more difficult to manage than a routine infection.

Infection in the lining of the uterus is established as a result of hormonal changes. Following oestrus ("heat"), progesterone levels remain elevated for 8-10 weeks and thicken the lining of the uterus in preparation for pregnancy. If pregnancy does not occur for several oestrus cycles, the lining continues to increase in thickness until cysts form within it. The thickened, cystic lining secretes fluids that create an ideal environment in which bacteria can grow. Additionally, high progesterone levels inhibit the ability of the muscles in the wall of the uterus to contract.

Are there other situations that cause the changes in the uterus?
Yes. The use of progesterone-based drugs can do this. In addition, oestrogen will increase the effects of progesterone on the uterus. Drugs containing both hormones are used to treat certain conditions of the reproductive system.

How do bacteria get into the uterus?
The cervix is the gateway to the uterus. It remains tightly closed except during oestrus. When it is open, bacteria that are normally found in the vagina can enter the uterus rather easily. If the uterus is normal, the environment is adverse to bacterial survival; however, when the uterine wall is thickened and cystic, perfect conditions exist for bacterial growth. In addition, when these abnormal conditions exist, the muscles of the uterus cannot contract properly. This means that bacteria that enter the uterus cannot be expelled.

When does it occur?
Pyometra may occur in young to middle-aged dogs; however, it is most common in older dogs. After many years of oestrus cycles without pregnancy, the uterine wall undergoes the changes that promote this disease.

The typical time for pyometra to occur is about 1-2 months following oestrus.

What are the clinical signs of a dog with pyometra?
The clinical signs depend on whether or not the cervix is open. If it is open, pus will drain from the uterus through the vagina to the outside. It is often noted on the skin or hair under the tail or on bedding and furniture where the dog has laid. Fever, lethargy, anorexia, and depression may or may not be present.

If the cervix is closed, pus that forms is not able to drain to the outside. It collects in the uterus causing distension of the abdomen. The bacteria release toxins which are absorbed into the circulation These dogs often become severely ill very rapidly. They are anorectic, very listless, and very depressed. Vomiting or diarrhoea may be present. Toxins from the bacteria affect the kidney's ability to retain fluid. Increased urine production occurs, and the dog drinks an excess of water. This occurs in both open- and closed-cervix pyometra.

How is it diagnosed?
A very ill female dog that is drinking an increased amount of water and has not been spayed is always suspected of having pyometra. This is especially true if there is a vaginal discharge or an enlarged abdomen. Dogs with pyometra have a marked elevation of the white blood cell count and often have an elevation of globulins (a type of protein produced by the immune system) in the blood. The specific gravity of the urine is very low due to the toxic effects of the bacteria on the kidneys. However, all of these abnormalities may be present in any dog with a major bacterial infection.

If the cervix is closed, radiographs (x-rays) of the abdomen will often identify the enlarged uterus. If the cervix is open, there will often be such minimal uterine enlargement that the radiograph will not be conclusive. An ultrasound examination can also be helpful in identifying an enlarged uterus and differentiating that from a normal pregnancy.

How is it treated?
The preferred treatment is to surgically remove the uterus and ovaries. This is called an ovariohysterectomy ("spay"). However, these dogs are quite ill so the surgery is not as routine as the same surgery in a healthy dog. Intravenous fluids are often needed before and after surgery. Antibiotics are given for 1-2 weeks.

My dog is a valuable breeding bitch. Can anything else be done other than surgery?
There is a medical approach to treating pyometra. Prostaglandins are a group of hormones that reduce the blood level of progesterone, relax and open the cervix, and contract the uterus to expel bacteria and pus. They can be used successfully to treat this disease, but they are not always successful and they have some important limitations.

1. They cause side-effects of restlessness, panting, vomiting, defecation, salivation, and abdominal pain. The side-effects occur within about 15 minutes of an injection and last for a few hours. They become progressively milder with each successive treatment and may be lessened by walking the dog for about 30 minutes following an injection.

2. There is no clinical improvement for about 48 hours so dogs that are severely ill are poor candidates.

3. Because they contract the uterus, it is possible for the uterus to rupture and spill infection into the abdominal cavity. This is most likely to happen when the cervix is closed.

There are some important statistics that you should know about this form of treatment:

1. The success rate for treating open-cervix pyometra is 75-90%.

2. The success rate for treating closed-cervix pyometra is 25-40%.

3. The rate of recurrence of the disease is 50-75%.

4. The chances of subsequent successful breeding is 50-75%.

What happens if neither of the above treatments are given?

The chance of successful treatment without surgery or prostaglandin treatment is extremely low. If treatment is not performed quickly, the toxic effects from the bacteria will be fatal. If the cervix is closed, it is also possible for the uterus to rupture, spilling the infection into the abdominal cavity. This will also be fatal.

SEIZURES
What is a seizure?
Seizures are one of the most frequently seen neurological problems in dogs. A seizure is also known as a convulsion or fit. It may have all or any combination of the following:

1. Loss or derangement of consciousness

2. Contractions of all the muscles in the body

3. Changes in mental awareness from non-responsiveness to hallucinations

4. Involuntary urination, defecation, or salivation

5. Behavioural changes, including non-recognition of owner, viciousness, pacing, and running in circles

What are the three phases of a seizure?
Seizures consist of three components:

1. The pre-ictal phase, or aura, is a period of altered behaviour in which the dog may hide, appear nervous, or seek out the owner. It may be restless, nervous, whining, shaking, or salivating. This may last a few seconds to a few hours.

2. The ictal phase is the fit or seizure itself and lasts from a few seconds to about 5 minutes. During this period, all of the muscles of the body contract strongly. The dog usually falls on its side and seems paralysed while shaking. The head may be drawn backward. Urination, defecation, and salivation often occur. If it is not over within 5 minutes, the dog may be in status epilepticus or going from one seizure into another without respite.

3. During the post-ictal phase, there is confusion, disorientation, salivation, pacing, restlessness, and/or temporary blindness. There is no direct correlation between the severity of the seizure and the duration of the post-ictal phase.

Is the dog in trouble during a seizure?
Despite the dramatic signs of a seizure, the dog feels no pain, only bewilderment. Dogs do not swallow their tongues. If you put your fingers into its mouth, you will do no benefit to your pet and will run a high risk of being bitten very badly. The important thing is to keep the dog from falling and hurting itself. As long as it is on the floor or ground, there is little chance of harm occurring. If seizures continue for longer than a few minutes, the body temperature begins to rise. If hyperthermia develops secondary to a seizure, another set of problems may have to be addressed.

What causes seizures?
There are many of seizures. Epilepsy is the most common and of least consequence to the dog. The other extreme includes severe diseases such as brain tumours.

Now that the seizure is over, can anything be done to understand why it happened?
When a seizure occurs, we begin by taking a thorough history concentrating on possible exposure to poisonous or hallucinogenic substances or history of head trauma. We will also carry out a full physical examination and detailed neurological examination along with various other tests. These tests rule out possible metabolic causes for brain dysfunction, heart, electrolytes, and blood sugar level.

If these tests are normal and there is no exposure to poison or recent trauma, further tests including a cerebrospinal fluid examination, MRI or CAT scans may be considered.

What can be done to prevent future seizures?
We generally prescribe 1-2 weeks of anticonvulsant therapy. If there are no more seizures during that time, the anticonvulsants are then gradually discontinued. The next treatment is determined by how long it takes for another seizure to occur. That may be days, months, or years. At some point, many dogs have seizures frequently enough to justify continuous anticonvulsant therapy. Since that means that medication must be given every 12 to 24 hours for the rest of the dog's life, we do not recommend that until seizures occur about every 30 days or unless they last more than 5 minutes.

It is important to avoid sudden discontinuation of any anticonvulsant medication. Even normal dogs may be induced to seizure if placed on anticonvulsant