Starting treatment for epilepsy in dogs is slightly controversial as the adverse effects of medication, and the fact that most dogs will be on treatment for life, puts many owners off.
Many dogs will only seizure once, and never again.
I was taught to advocate treatment after the second seizure episode, once other organic causes have been ruled out.
Experimental evidence and a single study in dogs suggest that early treatment offers better long-term control of the seizures as compared to animals that are allowed to have numerous seizures prior to the onset of treatment.
Resolution of the hypovolaemia is the primary concern. Two large bore catheters are placed in the cephalic veins. If the cephalic veins are not available, the jugular vein is used. Fluid resuscitation through the saphenous veins is unlikely to be successful because of the caudal vena caval obstruction.
Photo of an x-ray showing gastric dilatation and volvulus in a large mixed-breed dog. The large dark area is the gas trapped in the stomach. The pylorus and duodenum are in an abnormal position cranial to the stomach and are separated by a fold in the stomach, creating a “double bubble” appearance.
Image by Joel Mills [CC-BY-SA-3.0], via Wikimedia Commons.Either isotonic crystalloids (90ml/kg in the first hour) or hypertonic saline (7% NaCl in 6% Dextran: 5 ml/kg given over five minutes) followed by crystalloid are administered.
Controversial treatments
The use of corticosteroids remains controversial. They have many theoretical benefits but have not been unequivocally demonstrated to improve survival in cases of gastric dilatation-volvulus (GDV).
Prophylactic antibiotics are also somewhat controversial, but rational arguments are made for their use. GDV dogs do have increased levels of circulating endotoxin, perhaps indicating increased GI mucosal permeability. Poor perfusion to the liver could inhibit reticuloendothelial function.
Improving tissue perfusion by fluid resuscitation and subsequent gastric decompression and de-rotation can potentially result in the production of damaging, highly reactive oxygen free radicals. These radicals can cause significant reperfusion injury that may be as damaging as the initial hypoperfusion episode.
It is possible treatment to prevent free radical generation may be beneficial in dogs with GDV. Of the drugs trialled in experimental models, deferoxamine, an iron chelator, shows the most promise for clinical application.
Gastric decompression
Ideally, a continuous electrocardiogram is connected. Once the animal has been stabilised, gastric decompression is attempted using a silicone or rubber tube. The tube is pre-measured to the level of the stomach and marked. A 2in roll of tape is placed in the dog’s mouth and the tube passed through the tape and slowly into the oesophagus and stomach.
If resistance is encountered at the level of the cranial oesophageal sphincter, the tube must not be forced, as this could cause rupture of the caudal oesophagus.
In some fractious animals, sedation and intubation is necessary for gastric decompression. If orogastric intubation is unsuccessful, the stomach is decompressed by trocarization. The abdomen is carefully palpated, and the enlarged spleen is avoided. A large gauge catheter (10-12F) is placed into the stomach percutaneously to relieve pressure.
Syringomyelia is rare in most dog breeds but has become widespread in cavalier King Charles spaniels.
Syringomyelia is a condition where fluid filled cavities develop within the spinal cord. It is sometimes known as “neck scratcher’s disease” because scratching in the air near the neck is a common sign.
Owners often report their dog is worse at night, when first getting up, during hot or cold temperature extremes, when excited, or related to posture (e.g. preferring to sleep with their head elevated).
Affected animals may seem overly sensitive to touch, or to scratch more on one side of the neck, ear, shoulder or sternum. This is typically one side only, often while the dog is moving and sometimes without making skin contact. Some dogs, especially younger patients, develop a scoliosis.
Some severe cases may have other neurological deficits such as fore and hind limb limb weakness and ataxia.
Facial nerve paralysis, deafness and seizures have also been associated with the condition, but a link has yet to be proven.
Angiostrongylus vasorum is the most common cause of haemorrhagic cerebrovascular accidents in dogs.
Bleeding in the brain or spinal cord can cause neurological symptoms. Craniotentorial bleeding can cause epileptic seizures, paresis and abnormal postural reactions.
In cases of cerebellar bleeding, hypermetria, vestibular symptoms and opisthotonus are observed, and if the brainstem is affected, abnormalities of the cranial nerves can be seen.
Inflammation, hypoxia and parasitic emboli may cause neurological signs too.
It is worth treating any dog with a suspected stroke for A vasorum with Advocate (moxidectin and imidacloprid).
Time for a controversial one, I feel… I have three dogs, and other than those they manage to scavenge in the park, I won’t let them have bones!
For those of you preparing to type away and tell me how wrong I am to advocate such a thing, this tip is based on one of the hardest cases I’ve dealt with in my 25 years as a vet, which involved a lamb bone lodged in the distal oesophagus.
This incident was several years ago and, thankfully, our friend is now doing fine, but it was incredibly traumatic for all concerned at the time.
As I type this I am waiting to see a dog that is straining to pass fragments of bone and is in a lot of discomfort.
So, go on – tell me how wrong I am, and give me all the evidence-based medicine that you should…
Greenish purulent discharge accompanied by crusting, erythema and punctuate ulcerations in a crossbreed affected by Pseudomonas aeruginosa otitis externa, secondary to an adverse drug eruption. Image source: Veterinary Times 45.01 (Jan 6, 2014) – “Otitis: a diagnostic approach” by Filippo De Bellis.
I suspect we have all come across that tricky Pseudomonas otitis case that just seem to refuse to completely respond to antibiotic therapy in spite of extensive investigation for underlying causes.
I had just one such case recently that, in spite of culture and sensitivity, blood work, skin biopsy, extensive flushing, lack of response to licensed products (and so on), just refused to respond.
A quick look through one of my trusty text books* suggested Ticarcillin.
Ticarcillin potentiated with calvulanic acid (Timentin) is an extended spectrum penicillin that often has good activity against Pseudomonas. The 100mg/ml antibiotic solution can be applied directly to the ear canal as a drop.
The case I’m treating has responded really well.
* Reference: Hill, P.B. (2002) Small Animal Dermatology: a practical guide to the diagnosis and management of skin diseases in dogs and cats. Butterworth-Heinemann. London.
Last Saturday I had a “walk in” – a very cute spaniel that was limping slightly and had a cut pad. The owner thought she might have trodden on something.
A good palpation didn’t seem to suggest the presence of any foreign body and the dog was very stoical. My previous experiences suggest any foreign material produces a lot of pain that is exacerbated by palpation – sometimes with dramatic effect!
However, the insistence of the owner made me look closer and I could just see a glint of a firm object deeply embedded in the pad. A pair of rat toothed forceps later and I extracted a 5mm slither of glass from the pad.
The result was a happy dog and owner, but oh – I could so easily have sent that poor dog away!
The homeless come with a certain stigma – particularly those with pets at their side.
Should we be concerned for the welfare of those animals, whose owners cannot afford to feed themselves so surely cannot adequately care for a companion?
Of course we should.
However, instead of claiming these pets should be removed from their owners, Ruby Shorrock (a fourth year vet student at the University of Glasgow) took a different approach.
Being homeless can be extremely isolating and lonely. For some of these people, their dog is their only companion, and can often be the only thing keeping them going. A dog can also provide a connection to home, and so the reluctance to give them up is understandable.
Despite this, many shelters refuse to accommodate dogs and so the help available can become increasingly restricted for homeless dog owners.
In light of this, Ruby founded Trusty Paws, a non-profit organisation that hosts free clinics and provides preventative care for hounds belonging to the homeless. The clinics involve a free health check (a clinical examination performed by veterinary students, supervised by a qualified vet), microchipping, flea and worming treatment and vaccinations. Dog food packages and other supplies such as leads and dog coats are also given out at the clinics.
Trusty Paws: a vaccination clinic for dogs belonging to the homeless, run by fourth year vet students at the University of Glasgow.
There have been three Trusty Paws clinics in Glasgow so far, with several grateful clients being able to benefit from the supplies donated and the services provided by the students. Everyone involved is delighted with how the clinics have been received.
Plans for 2015 include registering as a formal charity and organising public fundraisers. The Trusty Paws team also intends to tackle the problem of local shelters and hostels not allowing dogs.
Trusty Paws relies entirely on donations and sponsorship and the response to requests for both has been exceptional. The concept has really taken off and looks to gain popularity and success in the future.
The work of Trusty Paws is a fantastic way of not only actively ensuring quality care for homeless pets, but also raising awareness within the community to tackle public perception. If these misconceptions can be eliminated, others will be willing to accept that pets are a huge part of the lives of homeless people too and, perhaps, be encouraged to help the situation instead of avoiding eye contact with that person sitting in a doorway on a rainy evening.
Pyometra in a dog, seen during surgery. The uterus is distended with pus. Image by Joel Mills [GFDL, CC-BY-SA-3.0 or CC-BY-SA-2.5-2.0-1.0], via Wikimedia CommonsLast week I removed one of the largest, most pus-filled uteri from a large breed dog that I have ever seen.
I’m a bit long in the tooth now, but I still found the whole procedure a bit scary given the size and vascularity of the uterus – and this made me reflect on the benefits of early neutering.
We routinely spay bitches in our practice from five months of age with minimal long-term complications, and it’s so much easier.
I am aware that recent research indicates early neutering may have some long-term implications in certain breeds, but the procedure is so much safer in young dogs, and anything that prevents them developing pyometra in later life has got to be an advantage.
I’ve not long come across a case of a middle-aged dog that had suddenly become unaccustomedly grumpy and started snapping at its poor owners.
This was uncharacteristic, as it had no previous history of behavioural problems. There were no other obvious clinical signs – perhaps it had become lazy of late, but there was nothing to put your finger on.
I recalled having attended a CPD event a while before when the speaker mentioned hypothyroidism leading to aggression. I thought this was worth a punt, and low and behold it had a very high thyroid-stimulating hormone level and very low thyroxine result. Our friend is now on thyroid supplementation and is much happier, although at the time of writing some two to three months into therapy, it was not completely better.
So, it may be worthwhile considering a blood profile when presented with signs of aggression in middle-aged dogs.
![Photo of an x-ray showing gastric dilatation and volvulus in a large mixed-breed dog. The large dark area is the gas trapped in the stomach. The pylorus and duodenum are in an abnormal position cranial to the stomach and are separated by a fold in the stomach, creating a "double bubble" appearance. By Joel Mills (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/) or CC-BY-SA-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/2.5-2.0-1.0)], via Wikimedia Commons](http://www.vettimes.co.uk/app/uploads/2013/09/GDV_x-ray.jpg)
