In our practice, the preferred way to induce vomiting after ingestion of poisons (most commonly raisins, chocolate and rat poison) is subcutaneous apomorphine.
If a strong acid or alkali has been ingested, this is contraindicated. This also seems to occur most commonly out of hours for some strange reason.
We give 30μg/kg SC and wait for the desired effect, which works very well and usually results in a peaceful night’s sleep for all concerned.
They often have a history of recurrent microbial skin infections either in the form of Staphylococcal pyoderma or Malassezia dermatitis, which is treated as and when it occurs.
I’m often surprised to find these individuals are not receiving routine parasite control, even when many of them have been prescribed it (sadly it is not effective while still in the packet), particularly as we do have both lungworm (Angiostrongylus vasorum) and Sarcoptes about in our practice locality.
My tip would be start to look for the underlying cause when these patients keep coming back – starting with Sarcoptes (and I personally prefer the blood test because I rarely find mites on scrapings).
We recently had a case where a freely mobile, soft mass on the ventral abdomen, which had been present for a number of years, had started to get larger.
We carried out a fine-needle aspiration (FNA) biopsy, and I fully expected this to confirm the presence of a lipoma (a benign fatty tumour common in dogs).
However, I was really surprised when the cytology revealed the presence of a mast cell tumour, with a surgical procedure to follow.
My tip would be that it is definitely worthwhile checking out those seemingly innocuous “lipomas” with FNAs.
I now try to avoid running food trials in mid-summer. Certainly on first presentation, with no previous history of allergic dermatitis, I tend to treat accordingly and wait to see what happens later in the year as vegetation dies back.
Food allergic dermatitis does not have a seasonal basis, so if the signs resolve or exacerbate over the course of the year, food allergy is not the primary cause (although some cases can confuse us as they have both an element of food allergy and atopic dermatitis).
I have also seen cases started on food trials in the summer months that appear to get better as the year progresses, only for the owner to become reluctant to challenge as the dog is “better” – whereas, in reality, the improvement is the result of reduced exposure to an environmental allergen.
So I usually wait and see if the signs persist to suggest a non-seasonal allergic dermatitis, and THEN do a food trial.
My colleagues and I use immunotherapy on a fair number of dogs to treat atopic dermatitis. Research tells us it can be a valuable tool in some dogs, but at the same time up to a third of dogs respond poorly.
We are lucky in our practice as anecdotally we find the majority of dogs do well, and we only get 10% to 15% that do not respond. This may be because:
Good luck with those frustrating allergy cases – hopefully there are some tips here to help. And cats also do well on immunotherapy.
This line always makes me think of the James Herriot books – and I recently thought of this when I had a poor cavalier King Charles that presented with a colon impacted with numerous shards of cooked lamb bones.
The poor chap was in quite a bit of discomfort and was straining without any production. It took ages to flush out his colon and, to be honest, more than one attempt.
Eventually some warm soapy water and repeated flushing with a cut dog-urinary catheter did the trick and he’s now feeling much better.
At vet school, you learn some basic clinical skills and are taught how to conduct a general clinical examination to prepare you for EMS placements in veterinary surgeries. What they don’t prepare you for is making a complete idiot out of yourself.
Before my first clinical placement I told the vets I would be working with that I had only just finished second year and had no pharmacological knowledge as of yet, non-existent surgical experience and very little understanding of small animal medicine in general.
Luckily, all the vets in the practice were very good at judging the level of my understanding and seemed to find the right balance between patience and pushing me for answers.
Things seemed to be going OK. I’d successfully taken blood samples and started to make sense of abdominal palpation. However, applying clinical skills taught at vet school isn’t necessarily straightforward – cadavers have a distinct lack of weapons in the form of claws and teeth, but I was coping with that reasonably well and taking note of the vets’ advice on particular techniques.
This was until a few days in, when I found myself working with the head vet…
In the same morning, I managed to spray penicillin all over my face while trying to administer an injection, incorrectly insert an endotracheal tube despite being 99% sure it was OK, and cover myself in guinea-pig blood while clipping nails, leaving me to wear the stained tabard for the rest of the day.
To add insult to injury, I later misread the scales and recited the incorrect weight without thinking (it didn’t occur to me that there’s no way a fully grown border collie could weigh 10kg).
Isolated, these incidents might not seem like the end of the world, but when they all happen in the same day in front of the head vet and when one of the clients involved is your neighbour, you do feel like shouting “I am a vet student – honest”, despite feeling like a complete moron.
This was, however, followed by days of mini-triumph, such as inserting an IV catheter correctly for the first time or scaling and polishing a dog’s teeth myself.
The important thing to remember is that you are inexperienced, and you just have to accept there will be days when nothing seems to go your way, get past them and carry on with your head held high – even if it is covered in yellow spots of penicillin.
Have you ever had an atopic dog that’s really well managed but suddenly flares, becomes very pruritic and seems to stop responding to therapy? I had one such case just a couple of months ago.
Skin scrapes did not reveal the presence of any ectoparasites and cytology was pretty unexciting (a bit of bacterial colonisation but otherwise unremarkable).
However, noticing the pruritus to be primarily around the head, ears and ventral abdomen tipped me off to think about Sarcoptes scabei – particularly as we have a very prolific and confident urban fox population in our practice area.
A serum sample was duly sent off and – lo and behold – proved positive for Sarcoptes antibodies.
The client then confessed to missing “a dose” of Advocate but, upon reapplication, management was readily restored.
I have seen two cases of late with elevated cholesterol, but no hair loss, unexplained weight gain, heat seeking and mucinous skin thickness.
Both cases had blood submitted for total thyroxine (TT4) and thyroid-stimulating hormone (TSH), and both had very low TT4 levels and markedly increased TSH.
Both cases are also improving nicely on thyroxine supplementation.
In my interview for Glasgow vet school, I was asked the question “how far is too far?”, and recent episodes of The Supervet on TV had me musing on the topic again, particularly as I had used The Bionic Vet as an example in my answer.
At the time I discussed kidney transplants in cats in the US and, in the UK, the inspiring work and pioneering techniques being carried out at Fitzpatrick Referrals.
Arguably the most famous patient of Noel Fitzpatrick’s is Oscar the cat who, after having both back paws cut off by a combine harvester, had prosthetic legs specially engineered and fitted (see video below). Oscar’s surgery was the first of its kind, and a huge step for orthopaedic veterinary medicine worldwide.
While this type of surgery was a world first in cats, prosthetic limbs are not an alien concept in human medicine – and, at a time when the emphasis on “One Health” becomes stronger every day, why shouldn’t routine or even rare human procedures extend their applications to our domestic species too?
But at what point do we say that medical advances are not ethically suitable for animals? A person may have a reasonable quality of life in a wheelchair, but that doesn’t mean a dog with wheels for back legs would. Such a “cart” would dramatically effect the quality of life of cats like Oscar, but his new legs have given him the freedom to continue to “be a cat”.
Each individual case is different, and the benefits and risks of undertaking a new, advanced technique would have to be weighed up accordingly. I don’t believe the point at which we draw the line on “going too far” is set in stone – every case is unique.
Kidney transplants in humans are life saving, and yet not seen in the UK in cats. A cat with kidney failure would gain a lot from a transplant, providing the risk of rejection was reduced to minimal. The ethical issue here lies with the health and welfare of the donor cat and the fact the donor can’t consent to its healthy organ being taken.
In the US, donors are often cats from rescue shelters and the recipient cat not only gains a new organ, but also an adopted friend who will come to live with them after the surgery. I think this is an excellent compromise on the consent dilemma – both cats get a second chance at life.
But it is not just the ethical question of whether we should perform such surgeries on our pets, we also have to consider the practical aspects of these procedures (i.e whether we could carry them out if we decided it was ethically acceptable).
There will be a limited number of vets with sufficient surgical experience to attempt such innovations, especially if a certain type of procedure has never been attempted in a particular species yet (such as Oscar’s legs). Financial constraints are also extremely relevant – owners that would love to give their animals the chance to receive such surgery if needed may be limited by the cost that comes with them.
Personally, I think the work of the surgeons at Fitzpatrick Referrals is exceptional and a real inspiration to vets across the country. I would love to see the day that treatment options for our animals routinely match those available in human medicine, and really hope the work of Noel and his team encourages those interested in such developments to continue and further research in order to make it a possibility – within ethical limits, of course.
