Follow by Email

Friday, 9 December 2011

Heart disease and heart failure in dogs and cats

Welcome to PercyPods Pet Emergency blogs. We hope that you and your pets have been well since our last one. This week we are going to discuss heart disease. Heart disease is relatively common in both dogs and cats. Although many of them are affected for many years without ever having a major crisis, some pets can suffer life-threatening problems and so it is important for pet carers to be well-informed about this condition.

What is the heart and what does it do?

Okay so let’s start by considering what the heart is and what it does. The heart lies in the chest cavity and is divided into four chambers. It is made up mostly of muscle and of a number of little valves. Blood flows through these valves which open and close intermittently, a bit like automatic gates; this flow of blood through the valves can usually only occur in one direction and this makes sure that the blood flows around the heart in the right way. The heart acts as a pump which pushes blood around the body. Blood picks up oxygen in the lungs. It flows through the heart and is pumped out to the rest of the body providing an oxygen- and nutrient-rich blood supply to all the tissues and organs, including very important ones such as the brain, the kidneys and the liver. When the blood reaches these organs the oxygen is removed from the blood, along with other very important things such as sugar, and the blood picks up waste substances such as carbon dioxide. The blood then returns back to the heart and flows back to the lungs where the cycle repeats itself. Now the tissues and organs of the body need to receive a good blood supply that contains enough oxygen and other essential substances in order to work properly and stay healthy. In heart disease the heart can start to fail as a pump which means that the circulation is disrupted resulting in widespread and potentially life-threatening consequences.

How can the heart become diseased?

So now that we have considered why the heart is important, let’s look at how the heart can become diseased. As mentioned before the heart is mostly made up of muscle and valves and most types of heart disease in dogs and cats affect one or both of these structures. Diseases that affect the heart muscle mean that the ability of the heart to pump blood is compromised – the pump becomes weaker. Diseases of the heart muscle are known as cardiomyopathies and they occur in both dogs and cats. Some dogs, especially large dogs such as Great Danes and Dobermans, can be affected by a disease known as dilated cardiomyopathy and Boxers are also affected by so-called Boxer cardiomyopathy. There are a variety of different diseases of the heart muscle seen in cats and this type of heart disease is the most common type in cats; a disease known as hypertrophic cardiomyopathy is especially common and one of the main contributory factors for hypertrophic cardiomyopathy is another common condition called hyperthyroidism. Hyperthyroidism is a hormonal disorder that is common in older cats.

The other main group of heart diseases in dogs and cats are ones that affect the valves, the four little gateways through which blood has to flow. When the valves become abnormal the flow of blood through the heart is disrupted and this has a knock-on effect causing changes in the rest of the heart. The valves can become leaky so that blood can flow backwards – remember how we said before that it is important for blood to only flow one way through the heart. The valves can also become narrowed which makes it harder for blood to flow through them. Valve diseases are especially common in dogs and breeds that are commonly affected include the Cavalier King Charles Spaniel, the Yorkshire terrier and the Boxer.

Other types of heart disease that we see in dogs and cats include ones where the heart rhythm becomes very abnormal due to a problem in the electrical system of the heart. As a result, the normal regular beating of the heart is disrupted; this is called a dysrhythmia. Some dogs in particular can also be affected by a condition where fluid builds up in the sac around the heart and stops the heart from filling properly with blood and therefore from pumping properly; this is called a pericardial effusion.

It is important for you to realise that these types of heart diseases in dogs and cats also occur in some humans but they are not the same thing as a heart attack which is something that is in fact thought to be very rare in dogs and cats.

What will I notice if my pet has heart disease?

The next thing to discuss is what you may notice if your pet has heart disease. The first thing to say is that in many cases heart disease is something that affects older animals. However some animals are born with heart diseases or become affected at a young age so the possibility of heart disease cannot be excluded just because an animal is young.

The second thing to say is that we have to distinguish between heart disease of the sort that we have already described and actual heart failure. Many animals are affected by heart disease but cope just fine, often for long periods of time, until eventually the heart becomes too compromised and stops pumping blood efficiently; this is heart failure – in other words heart failure is a consequence of heart disease. Animals with heart disease may not show any signs if the heart disease is mild enough to allow the heart and the rest of the body to compensate for the disease. However, if the heart disease is severe enough that the heart cannot compensate, heart failure will occur and will lead to signs that we will describe shortly.

Having said that many animals that have heart disease have abnormal heart sounds when listened to by your vet using a stethoscope. These abnormal heart sounds are referred to as heart murmurs and they may be detected by your vet when your pet is seen for an annual health check at the time of vaccination or at other times. Finding a heart murmur may prompt your vet to recommend that your pet is examined further for possible heart disease. In this way you can be alerted to the possibility of heart disease in both dogs and cats before it becomes a significant problem.

There are some notable differences between dogs and cats mostly because dogs are usually taken on walks and other forms of exercise when heart disease symptoms may show themselves. Cats tend to exercise away from their owners and so it is not so obvious. This means that heart failure often becomes apparent in cats in much more advanced stages of disease.

In dogs with heart failure, the most common things that you might see are that your dog will be less keen than normal to go out for a walk, they may also seem to get tired more quickly when out exercising, and they may pant more than normal. Another common sign in dogs is coughing, especially after sleep. In more serious cases, breathing may be obviously laboured. Sleep and eating may be difficult for animals in these advanced stages of disease. Other signs that may be seen are that your dog's abdomen or tummy area looks swollen because of fluid accumulating inside it. In other dogs fainting episodes known as syncope may occur.

Usually the signs of heart failure progress slowly so that there is time to get treatment started before the symptoms get too bad. However, occasionally the first thing you will notice is that your dog will be collapsed, struggling to breathe and pale or cyanotic. Cyanotic means that the gums take on a bluish/purplish appearance and this is a life-threatening emergency.

In cats, the signs of heart failure are usually initially quite subtle as cats are very good at adapting their life-styles to suit how they are feeling. It is not common for cats to cough when in heart failure (unlike dogs). Most commonly cats will present as having progressively more difficulty breathing, they may use their abdominal muscles to help them breathe in. Like dogs, they may have difficulty sleeping and eating in the later stages of the disease.

Another relatively common scenario is for a cat to have been completely normal and then suddenly to be found having trouble walking in their back end or to be completely unable to use their back legs. Some of these cats may also be in severe pain and will be yowling or breathing quickly with their mouth open. This happens because in cats much more than in dogs heart disease can cause a blood clot to form in the heart that then dislodges and comes to lie in a position where it cuts off the blood supply to the back legs. This condition is known as feline aortic thromboembolism or saddle thrombus. The clot most commonly gets lodged where it affects the back legs but it can also affect the front legs or elsewhere in the body although this is less common.

In both dogs and cats, the signs of heart failure, especially in the early stages, may be non-specific such as lethargy, weight loss or loss of appetite.

What treatment will my pet need?

So let’s now talk about what treatment your pet will need if he or she is suffering from heart disease. There are basically three different scenarios that might occur. The first is that you will know that your pet has heart disease for a long time and eventually your vet will recommend that he or she is started on some medications. They will continue to work with you to monitor your pet’s progress and adjust the treatment as necessary. The second scenario is when an animal that is already on long-term treatment has a severe acute flare-up in their condition and your vet will have to try and restabilise them. The third scenario is when your pet has shown no prior signs and is suddenly found one day in a very bad way, struggling to breathe and often collapsed.

We cannot be too specific or go into too much detail here but we would just like to mention some of the tests and treatments your pet may need. In terms of diagnosing heart diseases, as mentioned before, the first signal is often an abnormal heart sound or a heart murmur during a physical examination of your pet; sometimes an abnormal heart rhythm can be detected. The main tests that are then used to diagnose heart disease and to assess its severity are x-rays of the chest to examine the heart and lungs and ultrasound of the heart, which is known as echocardiography. An ECG is performed in some cases to check whether the heart rhythm is normal or not and some animals will also have blood tests. These blood tests may include measuring certain markers of heart disease and also for example to check how your pet’s kidneys are working. Measuring thyroid hormone levels may be appropriate in cats.

In terms of treatment, it is important to realise that we cannot actually cure most types of heart disease and treatment is aimed at managing your pet’s problem, basically trying to improve their heart failure so they can enjoy a good quality of life for as long as possible. There are many different drugs that are used to treat heart disease and heart failure in dogs and cats. The medications chosen will depend on the type of heart disease present, the overall health of your dog or cat, and the severity of the heart disease.

Drugs are used to help reduce the workload on the heart so that it can continue to cope for as long as possible. They are also used to try and deal with the consequences of the fact that the heart is not working very well. In particular most animals with heart disease will receive drugs known as diuretics; the most common example is called furosemide and another drug known as spironolactone is also used quite commonly. When the heart does not work properly fluid can build up in the lungs and elsewhere in the body and diuretics help to get rid of this fluid from the body via the kidneys. Animals on diuretics will therefore urinate frequently and must have access to drinking water at all times.

Other drugs used to treat heart disease include ones that are intended: to try and actually make the heart muscle beat more strongly; to slow the progression of the disease in the heart; or, to make the heart beat with a more normal rhythm. Management of these patients will usually also include some form of exercise control and more recently some diets are also used to try and help support the diseased heart.

Animals that are suffering from a severe flare-up of their heart disease, an acute crisis, will need oxygen therapy and quite intensive care at your veterinary practice and sadly sometimes it is not possible to stabilise them. Cats suffering from blood clot problems can recover to an extent but treatment options are very limited and in the worst cases it is much kinder to put the cat to sleep on welfare grounds. Cats that are less severely affected by a clot will need lifelong treatment for their underlying heart disease and they are usually also started on medication to try and prevent a clot from forming again; aspirin or a drug called clopidogrel are most commonly used for this but you must never administer aspirin or any other drug to your pet without first consulting your vet practice.

Okay so that brings us to the end of this blog on heart disease and heart failure in dogs and cats. There are a number of different types of heart disease and animals can be affected in different ways. The most common scenario is for your pet to be affected long-term, to be on long-term treatment and to slowly get worse, but this is not always the case.  Some animals remain remarkably stable for a very long time while others have a severe crisis from which they do not recover. A number of different treatments may be needed and your vet will talk you through all of this as appropriate.

The next blog will be in approximately 2 to 4 weeks time when we will talk about what can cause a dog or cat to have a red-looking eye. Remember that if you have any comments or questions on this blog, or indeed any suggestions for future blogs, you can contact us in the usual ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. Also don’t forget to subscribe for future episodes via the RSS feed. So thank you for reading and until next time, may you and your pets be safe.

Monday, 7 November 2011

Seizures in dogs and cats

Welcome to PercyPods Pet Emergency blogs. We hope that you and your pets have been well since the last blog. This week we are going to discuss another one of the more serious problems that can affect dogs and cats, namely seizures or what some people also call fits or convulsions. Although a single seizure is often not especially harmful to your pet, seizures can be life-threatening and so it is important for pet carers to be well informed about this problem.

What is a seizure?

Okay so let’s start by discussing what a seizure is. Basically the brain works because there is an electrical circuit flowing around it at all times. The brain controls a very large amount of the body’s actions and functions and all of these essentially rely on this electrical circuit flowing properly. A seizure occurs when there is an uncontrolled burst or sudden increase in this electrical circuit. It is a bit like if there is surge in the current in the electrical circuits in your house that blows a fuse. Depending on exactly where in the brain this burst occurs, how severe it is and how long it goes on for, there can be quite varied consequences. Some seizures are what we call ‘partial’ or ‘focal’ where only one or two parts of the brain and therefore the body tend to be affected and they are usually less severe and less of a concern. The other type of seizure, the type that is more concerning and that we are going to focus on here, is a ‘generalised tonic-clonic seizure’ and this type of seizure is more common in dogs than it is in cats.

What is a generalised tonic-clonic seizure?

So what is a generalised tonic-clonic seizure? As the name suggests, this type of seizure is one where most of the brain and the body is affected. The animal will fall over if standing, may lose consciousness, and their muscles become very tense or rigid which may cause their neck and legs to become extended; this is the ‘tonic’ phase and usually only lasts for a few seconds. This phase is then followed by the ‘clonic’ phase in which many of the muscles contract and relax rapidly. These convulsions may range from exaggerated twitches to violent shaking or vibrating. Paddling of the legs often occurs. The eyes may roll back or close and the tongue may be injured by strong champing of the jaws or from being bitten. Some animals will salivate or froth at the mouth while others may pass urine or faeces during the seizure.

In many cases a generalised seizures lasts for a few seconds up to a couple of minutes. However in more severe cases a condition known as status epilepticus may occur where your pet will continue to seizure for 5 minutes or more or will have repeated seizures one after the other without much time at all in-between to regain consciousness. Status epilepticus is a life-threatening emergency.

Will I notice anything before or after the seizure?

Now, as with humans, before a dog or a cat has a seizure, they may show what we call a ‘pre-ictal’ phase during which their behaviour changes before you notice the other signs described above; the actual seizure itself occurs in the ‘ictal’ phase hence we use the term ‘pre-ictal’ for the period before the full blown seizure starts. Many people who care for pets that suffer seizures come to recognise these signs and can therefore take appropriate measures before the seizure begins. So what are some of the reported pre-ictal signs? Well, animals may appear restless, agitated or nervous. They may hide or they may be more clingy than normal and later some may become unresponsive to you. The pre-ictal phase may last for just a few seconds or may go on for several hours.

You should also be aware that after a generalised seizure your pet may have what we call a ‘post-ictal’ phase. This phase may include a variety of abnormalities such as unusual behaviour, panting, disorientation, staring straight ahead, temporary blindness, inappropriate urination or passing of faeces, and in some cases more obvious neurological signs. The post-ictal phase usually lasts for less than an hour or maybe a few hours but it can go on for much longer even as long as 2 days believe it or not. There is no direct correlation between the severity of the seizure and the duration of the post-ictal phase.

Is there anything that I might confuse with a seizure?

Before we talk about some of the causes of seizures, we would just like to mention some of the things that dogs and cats can do which you might mistake for a seizure. There are quite a few and some are just part of normal animal behaviour while others are abnormal. One of the most common things to be confused with a seizure is what we call syncope. Syncope is basically like a fainting episode and usually occurs because of a problem with the heart or with the breathing. Animals often fall over suddenly but in many cases they recover quite quickly within seconds to a minute. However some animals pant and remain weak after the episode. Some animals get a condition known as vestibular disease which affects one of the nerves in the head. This causes signs such as an abnormal head position and loss of balance which can come on very suddenly and be mistaken for a seizure. Then there are those dogs that twitch or paddle their legs while sleeping. Some will even vocalise. This is especially common in young puppies although many older dogs show similar behavior. This is normal and is usually associated with very deep sleep.

The biggest difference between seizures and non-seizures is the animal’s state of consciousness. If an animal is doing something that resembles a seizure while conscious, is aware of its surroundings, or is easily roused (as in sleep), it is not having a true seizure.

What are some of the causes of seizures?

Okay so before we go on to consider what you should do if your pet has a seizure, let’s first talk about what some of the causes of seizures are. There are many causes of seizures and we tend to divide them into two groups. The first group are causes that originate within the brain itself. These are causes that we refer to as intracranial and they include for example brain tumours, inflammation affecting the brain and bleeding into the brain. One of the most common causes of seizuring originating in the brain is known as epilepsy; this condition, similar to epilepsy in people, affects both dogs and cats although it is more common in dogs. It is seen especially in purebred and large dogs and tends to become apparent for the first time between one to five years of age. At the moment we are not sure why any one dog or cat develops epilepsy – it is a condition of unknown cause or so-called ‘idiopathic’ – but much research work continues in this area. Idiopathic epilepsy is inherited in some breeds of dog at least, for example in German Shepherd dogs. Inflammation affecting the brain, so-called encephalitis, may be due to an infection but it is often not found to be due to an infection rather a sterile non-infectious problem.

The second group of causes of seizures are ones that do not originate in the brain itself but are still able to disrupt the electrical circuit in the brain. We refer to these causes as extracranial and a very common example would be seizuring that occurs after a dog or cat is exposed to a poison that can cause seizures. There are several examples of such poisons, one of the most common affecting dogs being metaldehyde which is found in slug bait. In cats we quite commonly see seizuring when they are overdosed with an anti-flea preparation that contains substances called pyrethrins and pyrethroids. Both of these types of poisoning were discussed in episode 3 of these blogs so please have a read if you haven’t already.

Other extracranial causes of seizures include severely low blood glucose, so-called hypoglycaemia, which can occur for example in puppies and kittens, when a diabetic animal is overdosed with insulin, or in older dogs with tumours that produce insulin, so-called insulinomas. Hypocalcaemia (low blood calcium levels) is another metabolic cause of seizures especially common in lactating bitches after they have given birth. High blood ammonia levels can also lead to seizures. This metabolic disturbance is seen in animals with liver disease, for example so-called portosystemic shunts.

What should I do if my pet has a seizure?

Okay so now that we have considered what a seizure is and what some of the possible causes are, let’s focus on what you should do if your pet has a seizure or indeed if you recognise the signs which suggest that your pet is going to have a seizure soon. If your pet is having a seizure, the first thing to do is to make sure that he or she cannot injure themselves. Rather than trying to move your pet away from danger it is better if possible to move any potential hazards away from them. For example, move any pieces of furniture that they may injure themselves on or any bottles or ornaments that could fall on them. It is best if possible to avoid actually touching your pet, especially around the mouth, during a seizure as they may inadvertently bite you. However if your pet is not on the floor then you do need to take steps to make sure that he or she does not fall off the sofa or the bed or wherever they happen to be.

Try to stay calm and make note of as much information as you can in terms of what your pet is doing and then ring your practice immediately for advice. If your pet has had a seizure previously, your vet may have given you some tubes of a drug called diazepam that we use to stop a seizure. These tubes are designed to be given to your pet through their anus – their bum – into their rectum. If you have these tubes, you should administer the dose suggested by your vet and wait for a few seconds to a minute to see if the seizure stops and then call your practice.

Not all animals that have suffered a seizure need to be examined as an emergency. Your vet practice will want to get some information from you to help them decide on a recommendation. Of course your wishes are also very important in this. The sort of information that your practice will want to know includes:
  • What signs you noticed during the seizure and, assuming that the seizure has finished, how long it went on for; also, did you administer any diazepam rectally and if so, what effect did it have.
  • They will also want to know if your pet has had any more seizures that day and if so, when they occurred
  • You should also tell your practice whether your pet has had any seizures in the past and if so whether he or she is on any treatment for this
  • It is also important to your practice to know if you think your pet may have been exposed to something like a poison or a drug overdose
  • And lastly, they will want to know if your pet has any significant previous medical history
On the basis of this sort of information and your wishes, you can decide with your practice whether your pet should be examined at the practice or stay at home and continue to be monitored. If the decision is made to monitor your pet at home then you should monitor him or her very closely for another seizure and ring your practice immediately if it occurs again. Remember that your pet’s behaviour may be abnormal as we discussed before during this post-ictal period. A single isolated seizure in an otherwise healthy adult animal does not usually require emergency veterinary care, though an appointment should be scheduled promptly for a thorough work-up.

As we mentioned before, a condition known as status epilepticus may occur where your pet will continue to seizure for 5 minutes or more or will have repeated seizures one after the other without much time at all in-between to regain consciousness. Status epilepticus is a life-threatening emergency and your pet must be seen as soon as possible. Another situation in which your pet must be seen as soon as possible is if they have had what we call cluster seizures; this is when your pet has two or more generalised seizures within a 24 hour period.

If you do end up taking your pet to your practice while he or she is still seizuring, be careful not to get bitten when putting him or her into the car. Make sure that they are surrounded by plenty of padding so that they are protected from injury during the journey and if at all possible, take someone else with you in the car – your partner or a neighbour for example. Ideally the person who is calmest and least stressed should drive quickly but legally and carefully to the practice – it is clearly essential that you all reach the practice safely. Animals that are seizuring can become very hot so depending on how far the practice is it may be wise to have the air conditioning on in the car or some of the windows open.

What treatment will my pet need?

Okay so let’s end this blog by considering what treatment your pet may need, what your vet might need to do. As always, the treatment an animal needs will depend on the individual animal. The most important thing to start with is whether your pet is still seizuring at the time he or she arrives at your practice. If they are then the first priority is for your vet to control the seizures by administering anti-seizure drugs. Depending on how your pet responds, this may involve just one drug – usually diazepam or a similar drug called midazolam – or more and this may include your pet being anaesthetised. One of the other priorities in many cases is for your vet to measure your pet’s blood glucose concentration as this is a relatively common cause of seizures as we discussed before and one that can usually be easily treated at least in the short-term. Your vet may also discuss doing additional blood tests as well as analysing your pet’s urine and this is aimed at trying to look for some of the extracranial causes that we described before – remember those are ones that do not originate in the brain itself.

It is important for you to realise that in many cases the cause of a seizure cannot be determined without your pet being referred to a specialist where they can have advanced tests such as an MRI of the brain and collection of cerebrospinal fluid – this is the fluid that circulates around the brain and spinal cord.

So what about anti-seizure medication for your pet when they return home? Well, if and when this is started again depends on the individual animal and also on your wishes in terms of whether you want your pet to be referred to a specialist or not. Most animals that have only had one seizure are not started on medication with this decision being reviewed if another seizure occurs. Even then the decision to start medication will largely depend on how often the seizures are happening as some animals can go months between seizures without medication and starting long-term medication is not always the most sensible choice. On the other hand an animal that has had status epilepticus or cluster seizures may well be started on medication immediately.

The two most common anti-seizure medications used in dogs and cats are phenobarbital and potassium bromide; there are also a few others that are usually not used unless your pet fails to respond to one of these two drugs. You should note that depending on the cause of your pet’s seizure, despite being on treatment, the seizures may not disappear completely. Some animals will continue to have a seizure from time to time and the goal of therapy is to reduce the frequency and severity of seizures to a level the pet and its family can live comfortably with.

Okay so that brings us to the end of this blog on seizures in dogs and cats. It is quite a common and a serious emergency problem for which there are lots of different causes and the outlook very much depends on the cause. A number of different treatments may be needed and your vet will talk you through all of this as appropriate.

The next blog will be in approximately 2 weeks time when we will talk about heart disease in dogs and cats. Remember that if you have any comments or questions on this blog, or indeed any suggestions for future blogs, you can contact us in the usual ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. Also don’t forget to subscribe for future episodes via the RSS feed. So thank you for reading and until next time, may you and your pets be safe.

Thursday, 20 October 2011

Difficulty breathing in dogs and cats

Welcome to PercyPods Pet Emergency blogs. This week we are going to discuss one of the most serious problems that can affect dogs and cats, namely difficulty breathing. As any of you that has had trouble breathing will know this can be very uncomfortable. It can also be life-threatening and so it is important for pet carers to be well informed about this problem.

The basics of breathing

In order to understand what can cause your pet to have trouble breathing it will be useful to briefly discuss how breathing happens and why it is important. So breathing is triggered by the brain and relies on various muscles of the chest as well as some nerves. Breathing happens in two stages. The first stage is when we breathe in, which is called inspiration. Air is sucked in through the nose but possibly also the mouth and passes the throat and vocal cords (the pharynx and larynx). It then flows down the windpipe (trachea) into the lungs.

The lungs consist of lots and lots of airways (bronchi, bronchioles) and millions of tiny little air sacs (alveoli) – you can think of these air sacs a bit like a sponge. When the air reaches these sacs, oxygen leaves the air and passes into the bloodstream. This is essential because the body needs to get enough oxygen basically to stay alive and difficulty breathing can compromise the amount of oxygen that the body receives with potentially disastrous consequences. As well as oxygen leaving the air sacs, carbon dioxide passes from the bloodstream into the air sacs. The carbon dioxide is then removed from the body as the animal breathes out; breathing out is the second stage and is referred to as expiration. Breathing out carbon dioxide is important as too much carbon dioxide is harmful for the body.

What can cause difficulty breathing?

So just to recap, breathing basically relies on the brain, some muscles and nerves, and the respiratory tract to be working well enough; the respiratory tract consists of the nose, the throat and vocal cord area, the windpipe and the lungs. An animal can therefore have trouble breathing if any one of these parts of the body has a problem. There are therefore lots of different causes of difficulty breathing and we will just mention a few of the most common ones here.

Nose, throat (pharynx) and vocal cord area (larynx)

So let’s start with the nose, throat and vocal cord areas. Problems affecting the nose usually do not cause difficulty breathing but instead may cause sneezing and discharge from the nose. However breathing can become laboured if the nose is severely blocked for example by a tumour of some sort or by severe infection; some cats with cat flu for example can develop breathing difficulty due to severe infections affecting the nose. Dogs with short-noses, such as Pugs and Bulldogs, can be affected by a condition known as Brachycephalic Airway Obstruction Syndrome. This condition includes a number of abnormalities affecting the nose and the throat areas; affected dogs may develop significant breathing problems especially on hot days, during exercise or when very stressed.

Certain dog breeds are prone to a condition known as laryngeal paralysis where the vocal cords fail to move properly which prevents them breathing in air adequately. Laryngeal paralysis typically affects large breed dogs, especially retrievers, and the problem often gets worse on hot days or during exercise. A characteristic noise can be heard when a dog with severe laryngeal paralysis breathes in. Cats can suffer for example from something called a nasopharyngeal polyp, which is basically a benign mass on a stalk that can affect the nose and throat area as well as the ear canals. They may also suffer from tumours or inflammation affecting the vocal cord area and actually tumours and inflammation of these areas are problems that can also affect dogs as well.

The windpipe (trachea)

As mentioned before, once air has passed the throat and vocal cord area it enters the windpipe or trachea. Problems affecting the windpipe are actually pretty rare as a cause of difficulty breathing. However some little dogs, such as Yorkshire terriers or Chihuahuas, can be affected by a condition known as tracheal collapse where the windpipe flattens during breathing hindering the flow of air. These dogs often have a cough that has a very characteristic sound; it is usually described as a ‘goose honk cough’ and often gets worse when the dog gets excited or stressed. Both dogs and cats can also struggle to breathe if a foreign object gets stuck in their windpipe; for example we have seen a cat with a tooth stuck in the windpipe and several dogs with little bones stuck in their windpipes.

The lungs

Finally air that is breathed in reaches the lungs. Dogs and cats can be affected by a variety of diseases and other processes that affect the lungs. Unfortunately it is quite common for cats to be hit by cars and many of these cats develop laboured breathing. In some cases this is because of air leaking from the damaged lung, a condition known as pneumothorax, with the air then collecting around and compressing the lung. This compression is a bit like squeezing a sponge so it collapses. Another common cause of difficulty breathing after a traumatic episode is bruising of the lungs; just like any other part of the body, if the lungs are injured they can become bruised and this will hinder the movement of air and removal of oxygen from the air.

Other common conditions that can affect the lungs and cause difficulty breathing include heart failure, infections in the lung causing pneumonia, and cancer. Cats can also get a condition that is similar to asthma in people and in fact it is often referred to as feline asthma or feline bronchial disease. This condition is thought to be due to an allergic problem in many cases and is especially common in certain breeds such as Siamese and Abyssinian cats. There are various worms that can also cause difficulty breathing by different means; examples are lungworm and heartworm. Some dogs in particular may also get a foreign object of some sort trapped in their lungs. The most common example of this is when dogs such as Springer spaniels who like to run in the long grass inhale a grass awn or other plant material.

And lastly we would also like to mention that there are some diseases that can affect the nerves or muscles which are involved in breathing and these can cause your pet difficulties. For example infections such as tetanus or botulism or tick bite paralysis can do this; you should note that tick bite paralysis is not found in all parts of the world.

How will I know that my pet is having difficulty breathing?

Okay so now that we have discussed some of the causes of difficulty breathing, let’s move on and talk about what signs your dog or cat may show if they are affected by one of these conditions. In many cases it will be obvious to you that your pet is struggling to breathe. You spend a lot of time with your pet and are therefore used to seeing them with normal breathing. If they are struggling to breathe, they will usually have either an increase in the rate of their breathing or an increase in the amount of effort they use to breathe; in many cases there is an increase in both rate and effort. You may notice for example that there is more movement of their chest and tummy area or that there is flaring of the nostrils.

Some of the most severely affected animals show what we call ‘postural adaptations’ – this means that they do things such as sit upright rather than lying down, stand with their elbows out, or breathe with their neck extended to help them move air. In very severe cases, you may notice that your pet’s gums take on a bluish or purplish appearance rather than their normal salmon pink colour. This is referred to as cyanosis and should prompt immediate veterinary attention.

Some animals that are affected by conditions that cause difficulty breathing may show other signs for a period of time before they really start struggling to breathe. Such signs include coughing and not coping as well with exercise, and in other cases the signs may be even more vague such as being lethargic or off their food. It goes without saying that if you are worried about your pet’s breathing you must consult your veterinary practice immediately.

What will my vet do to help my pet?

Before we finish this blog let’s discuss briefly some of the things that your vet may have to do to find out why your pet has difficulty breathing and try and treat the problem. As we have already discussed there are lots of different reasons why a dog or cat may have trouble breathing and we can only really speak in general terms here. The first thing to stress is that dogs and especially cats that are struggling to breathe are in a very vulnerable position and it is very important not to stress these animals as this can cause them to deteriorate further. So you should handle these animals gently when getting them to your vet and your vet may want to approach the management of your pet in a slow and steady fashion, taking their time to do the various necessary tests and treatments rather than risking stressing your pet. More severe cases receive oxygen therapy and sometimes various drugs to try and make them feel better and make them more stable for further tests and treatments. It may also be necessary for example to remove air or fluid from around the lungs using a needle, a procedure known as thoracocentesis.

Tests that are commonly performed in animals with difficulty breathing include ultrasonography and taking x-rays, and an ECG may be done in some cases where heart failure is suspected to see whether the heart is beating with a normal rhythm. In some cases an endoscope, which is basically like a tiny video camera, is passed into the respiratory tract under a general anaesthetic and other tests that may be performed include analysing your pet’s faeces and taking blood tests.

Depending on the diagnosis that is made your pet may need to be on medications, sometimes for the rest of his or her life, or they may need an operation. Their exercise may need to be restricted, sometimes just for a while but sometimes also more long-term. Unfortunately in some cases the cause of the difficulty breathing is one that has a very poor outlook and you and your vet may decide together that putting your pet to sleep is the kindest thing to do.

Okay so that brings us to the end of this blog on difficulty breathing in dogs and cats. It is quite a common and a serious emergency problem for which there are lots of different causes and the outlook very much depends on the cause. Your priority should be to have your pet examined by a vet and then take it from there.

The next blog will be in approximately 2 weeks time when we will talk about seizures or fits in dogs and cats. Remember that if you have any comments or questions on this blog, or indeed any suggestions for future blogs, you can contact us in the usual ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. Also don’t forget to subscribe for future episodes via the RSS feed. So thank you for reading and until next time, may you and your pets be safe.

Saturday, 8 October 2011

Collapse in dogs and cats

Welcome to PercyPods Pet Emergency blogs; we hope that you and your pets are well. This week we are going to discuss the problem of “collapse”. Not all collapse is the same and we will describe what collapse is, what can cause it in dogs and cats, and what your vet might have to do to discover and correct the problem.

What is collapse?

Okay so let’s start this blog by explaining what collapse is and what can cause it. A dog or cat is usually described as being collapsed if they are unable to get up. To understand the causes better you need to know that in order for your dog or cat to be able to stand up a number of different parts of the body have to be working well enough. These are basically the brain and the nerves, the muscles, bones and joints, the heart and a good blood supply containing enough oxygen, all of which are also tied in with for example factors such as the level of glucose or certain hormones in your pet’s blood. So when your pet collapses it could be because of a number of different reasons.

In some cases the pet will be walking or at least standing up and then fall either into a sitting position if just their back legs give way or into a lying position if complete collapse occurs. He or she will then be unable to get up. There are however some animals that collapse after a period in which they have been sleeping or at least apparently resting normally; in other words an animal does not have to fall over to be described as ‘collapsed’. Some collapsed animals are conscious although they may appear confused or dazed; others can lose consciousness either very briefly or for a more prolonged period. Some animals collapse but then make an apparently complete recovery within seconds to minutes, while others remain collapsed and will not improve without veterinary attention. Animals with more localised problems causing collapse, that is problems that only affect their back or legs, are often quite bright and aware in themselves. They will often respond to and interact with you relatively normally unless they are in a lot of pain.

What causes collapse?

So let’s move on now and consider the causes of collapse. As we mentioned before, in order for your dog or cat to be able to stand up a number of different parts of the body have to be working well enough and it is therefore helpful to separate the causes of collapse along these lines – although the reality is that many causes of collapse affect a number of different parts of the body.

Causes affecting the brain

So a number of the causes of collapse mainly affect the brain. Seizures or ‘fits’ are one potential cause of collapse and it is common for animals to be collapsed for quite some time after a seizure. Animals with other brain problems such as a tumour or a blood clot – like a ‘stroke’ in people – may also collapse as a result.

Spinal cord/peripheral nerve causes

Some causes of collapse mainly affect the nerves supplying the legs either at the spinal cord which is in the neck and back or actually within the legs themselves. For example, just like people with so-called ‘slipped discs’, it is possible for cats and especially dogs to get problems with the discs in their neck or back and this can cause them to be collapsed. This problem is one we see commonly for example in Dachshunds.

Musculoskeletal causes

Another group of causes of collapse are ones that affect the muscles, bones or joints. In such cases symptoms such as limping, difficulty getting up, or inability to sit up or jump are often present and getting worse for days, weeks or months before collapse occurs.

Causes affecting the heart or blood supply

A number of the causes of collapse affect the heart or the blood supply to the body. Lack of a good blood supply can be a localised problem. For example there is a relatively common condition in cats with heart disease where a blood clot blocks off the blood supply to their back legs; they are completely unable to use their legs and this condition is usually very painful. However it is more common for collapse to occur because of lack of a good blood supply to the whole body causing the animal to be very weak or their nerves and muscles to fail.

So what can compromise the blood supply to the whole body? Well, one example would be heart disease where the heart muscle becomes very weak or the heart starts to beat very irregularly. The heart not working properly means that blood does not flow around the body well enough and the animal collapses. We see this type of problem for example in some dogs, such as Boxers and Dobermans, which are predisposed to certain heart diseases.

Another time when the blood supply to your pet’s body would be compromised is if he or she loses a lot of blood. The body needs a good blood supply to be able to stand and move and as an animal loses more and more blood, he or she will become weaker and weaker until they are completely collapsed. We see this type of problem for example in dogs such as German shepherd dogs or Golden Retrievers who quite commonly have tumours in their spleen or liver that rupture and bleed into their tummy area; you should note that this is not bleeding that you could detect just by looking at your dog as it occurs internally.

And yet another cause of poor blood flow around the body would be if your pet goes into ‘shock’. Although people often use the word ‘shock’ to describe how someone feels emotionally when they receive terrible news or lose someone close to them, it is actually a medical term which describes poor blood flow around the body. There are lots of causes of shock in animals, two of the most common examples of which are ‘bloat’ or gastric dilation and volvulus (GDV) syndrome in dogs and blocked bladders in male cats. We have discussed both of these conditions in previous blog so please have a listen if you haven’t already.

Lack of oxygen in the blood

Other causes of collapse that we would like you to be aware of include a lack of enough oxygen in the blood because of a problem with your pet getting oxygen into their lungs or from their lungs into their bloodstream. Oxygen is essential for the body to work properly and reasons why your pet may not have enough oxygen include: severe lung diseases such as pneumonia; heart failure; or obstructions of their airways for example in so-called ‘brachycephalic’ dogs such as Pugs and Bulldogs, or in cats with feline asthma.

Metabolic/hormonal causes

The last group of causes of collapse that we would like to mention includes problems with parts of your pet’s metabolism or with their hormones. For example low blood glucose is one cause that we see relatively commonly. This may occur for example in dogs affected by a certain tumour of the pancreas organ known as ‘insulinoma’, in puppies and kittens, or indeed if you accidentally administer too much insulin to your diabetic pet. Collapse is a relatively common symptom in dogs with a hormonal disease known as “Addison’s disease” or hypoadrenocorticism where they do not produce enough of certain essential hormones in the body, and collapse can also be seen in other hormonal diseases.

What will my vet do and what treatment might be needed?

In general we would recommend that you have your pet examined by a vet if they are collapsed and this is especially urgent if your pet appears to be depressed or non-responsive. This would not be a time to wait and see. So now that we have discussed the causes of collapse, let’s move on and briefly discuss what your vet may need to do and what treatment your pet may need. As you can see there are a lot of different causes of collapse and your vet will need to use whatever information they have available to help them decide what to do. This will include information that you provide, for example about what happened to your pet when he or she collapsed, whether there was a loss of consciousness, and whether there has been any change at all. Your vet will also get very important information from examining your pet about how well their heart is working, their blood is flowing, their nerves and muscles are functioning and so on. Using this information your vet will be able to decide whether your pet needs to be admitted to the practice for immediate stabilisation and monitoring and also what some of the more likely causes are and this will help guide them in terms of what tests they need to perform and how urgently this needs to be done.

Some tests that are commonly performed early on in some collapsed patients include blood tests, for example to check for blood loss or blood glucose concentration, and an ECG test to see how the heart is beating. In some cases x-rays and ultrasound are used and in others your pet may need to be sent to a more specialist centre where more advanced tests such as MRI or CT scans can be performed. The tests that your pet needs will very much depend on his or her particular circumstances and your vet will be able to go through all this with you.

As there are many different reasons why your pet may collapse it will not be surprising that there are also many different possible treatments. These range from supportive measures and time to various medications and in some cases surgery. Unfortunately some animals are diagnosed with a condition that has a very grave outlook and you and your vet may decide that putting your pet to sleep is in his or her best interest. As always, your vet will discuss all this with you as and when information becomes available.

Okay so that brings us to the end of this blog on collapse in dogs and cats. It is quite a common and a serious emergency problem for which there are lots of different causes and the outlook very much depends on the cause. Your priority should be to have your pet examined by a vet and then take it from there.

The next blog will be in approximately 2 weeks time when we will talk about animals with difficulty breathing. Remember that if you have any comments or questions on this blog, or indeed any suggestions for future blogs, you can contact us in the usual ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. Also don’t forget to subscribe for future episodes via the RSS feed or iTunes. So thank you for reading and until next time, may you and your pets be safe.

Saturday, 24 September 2011

Blocked bladder in tomcats (urethral obstruction)

Welcome to PercyPods Pet Emergency blogs. This week we are going to focus on a specific emergency problem that occurs commonly in male cats called urethral obstruction. This condition is one of the true emergencies that can affect cats with the potential to become quickly life-threatening; death can occur for example in 1-2 days. It is therefore very important that all carers of male cats are aware of this condition.

What is urethral obstruction?

So let’s start this blog by explaining in a bit of detail what urethral obstruction is and why it is more common in male cats. Like humans, cats have two kidneys which make urine. Urine is made by filtering the blood and it allows the body to stay well hydrated as well as to get rid of toxins that would otherwise be harmful. The urine that is made by the kidneys flows down to the bladder; remember that this urinary bladder has nothing to do with the other ‘bladder’ in the body which is the gallbladder. The urinary bladder is basically like a balloon which gets bigger or smaller depending on how much urine it contains. Now, urine leaves the bladder by flowing through a tube that is called the ‘urethra’ which transports the urine to the outside world when the cat urinates. Both male and female cats, and for that matter humans and dogs, have a urethra. The term ‘urethral obstruction’ describes a situation in which this tube, the urethra, becomes blocked.

Why is urethral obstruction more common in male cats and which male cats are most often affected?

Okay so the next question is why is it more common for the urethra to get blocked in male rather than female cats? Well, in male cats the urethra runs from the bladder through the penis to the outside world. At a certain point this tube turns a corner and becomes narrower and this is the main reason why male cats are much more commonly affected by a blockage. In female cats the urethral tube is shorter, does not turn a corner and does not become narrower.

As vets we see urethral obstruction most commonly in male cats that are overweight, confined indoors and fed dry food only, although it is essential to realise that the urethra can get blocked in male cats of all kinds. Many of these cats are young or middle-aged and have been castrated although the problem can occur in older cats and uncastrated ones as well.

What does the urethra get blocked with and why is it a problem?

Let’s now discuss how the urethra gets blocked, what it gets blocked with. In the types of cats that we are discussing in this blog, the urethra gets blocked most commonly either with plugs of material including protein, cells and little crystals or with stones formed from minerals that are normally present in the urine. In the normal cat these substances are present in small amounts and pass out in the urine without any problem. However in some cats these substances build up in the urine and then cause an obstruction.


X-ray from a tomcat showing "stones" (the bunch of little white objects) in the urinary bladder. 

It is possible that lack of enough water in the cat’s food or the cat not peeing often enough can contribute to making this problem more likely. It is important to know that in the types of cats we are discussing here it is actually quite uncommon for there to be a urinary infection present. You should also realise that there are other causes of a blocked bladder, for example a tumour can do this, but also that sometimes we do not find a specific cause.

As we mentioned before, the body gets rid of substances in the urine that if they stayed in the body would be harmful. These substances include for example an electrolyte called potassium and also acid. When the urethra gets blocked these substances are not removed, they build up in the cat’s body, and then have dangerous consequences making the cat extremely ill. The bladder often becomes hard and very painful for the cat as well.

What symptoms does a cat with a blocked bladder show?

Okay so at this point you may well be thinking that’s all very well and good but how do I know when my cat’s bladder may be blocked? Well the first thing to say is that it is important to realise that different cats with this same problem can shows different symptoms. These cats are often off their food, they may be just a little quiet or actually very severely depressed and collapsed, and some of them vomit. A number of these cats, although definitely not all of them, show some very classic signs that we associate with abnormalities of the bladder or urethra. These signs include making frequent visits to their litter tray, straining to urinate but then only passing a few drops or no urine at all, crying out when trying to urinate, and sometimes obvious blood in the urine. If your cat strains in the litter tray you should try and pay attention to whether they have passed faeces recently or not. Carers sometimes ring worried that their cat is constipated and then it turns out that in fact their bladder is blocked and the straining was because of an inability to pass urine rather than faeces.

Some cats with blocked bladders have no other signs except that they start walking abnormally in their back end. Carers often think that their cat has had some kind of accident maybe fracturing a bone for example. And another thing that some carers say is that their cat seemed fine but would let out a yowl when picked up; this we presume is because being picked us is painful when the bladder is blocked.

You must contact your vet practice immediately if you notice any of the signs we have described here and this cannot be stressed enough.

How is a blocked bladder treated?

Having a blocked bladder is a life-threatening problem that requires immediate treatment and vets and nurses are well aware of this. Emergency treatment usually starts with administering a fluid drip into a vein. If facilities allow, your cat will have blood tests and an ECG may be done to check how the heart is beating. One of the problems that can occur in blocked cats is for potassium to build up in their bloodstream and this can affect the way in which the heart beats and may cause death. The build up of potassium in the blood is called hyperkalaemia and urgent treatment is needed. Some vets choose to take x-rays of the cat’s bladder during this initial period of stabilisation.

Once the cat is more stable, the next stage is to try and unblock the bladder. This is done by feeding a catheter from the outside through the urethra into the bladder. As we said the problem in these cats is that the urethra is blocked and so it can be quite challenging to pass a catheter through the urethra. Nevertheless in most, although not all, of these cats a catheter can eventually be passed. The vet has to be very careful when trying to pass the catheter as it is possible to accidentally cause a rupture of the urethra which is already inflamed and very vulnerable to more injury. If a catheter cannot be passed through the urethra then your vet may have to empty your cat’s bladder by another means which involves placing a needle into the bladder from the outside and draining the urine out with a syringe. This procedure is called ‘cystocentesis’ and it can be a life-saving short-term solution in blocked cats. However if a catheter cannot ultimately be passed to relieve the obstruction your cat may require surgery. Your vet will discuss this with you if it becomes necessary. Also in some cases even if a catheter can be placed, surgery is needed at some point to remove the stones from the bladder to stop the obstruction from happening again.

As we mentioned, in most cases it is possible to pass a catheter into the bladder. This catheter is usually left in place for up to 2 days which allows urine to be drained and your cat to start to feel more normal again. During this time they will be kept on a fluid drip and also be given pain-killers. Repeat blood tests may also be performed. Once the catheter has been in place for 1-2 days, it is removed and your cat will usually be kept in at the practice for let’s say half-a-day afterwards to make sure that he can pass urine freely and comfortably before being sent home on pain-killers and maybe other medications. Your vet will most likely have done some tests on your cat’s urine while they were at the practice and will be able to discuss these results with you especially in terms of how they might affect your cat’s on-going care at home. For example depending on what type of stone or material was blocking your cat’s urethra, a specific type of diet may be recommended.

Can I stop my tomcat from getting a blocked bladder?

Okay so let’s now talk about whether it is possible to stop your male cat from getting a blocked bladder. The honest answer is that you cannot stop your cat from getting a blocked bladder with 100% certainty. However you can do some things to try and make it much less likely. There is a lot of debate about whether cats should or should not be allowed to go outside because of the risks they face from cars, other animals and so on. Without going off on a tangent it is our opinion that cats should if possible be allowed to go outside as this is more natural, more in-keeping with what it is to be a cat. The reason we mention it here is because a larger number of the cats that get blocked bladders are indoor cats. It is definitely still possible for an outdoor cat to get a blocked bladder but it is more common in indoor cats.

There is some suggestion that indoor cats are more prone because for example they are more likely to be overweight. Regardless of whether a cat is indoor or has outdoor access, being overweight is another factor that is thought to make it more likely that a cat will get a blocked bladder. Some people suggest that this is because overweight cats do not urinate as often as they should and this makes it more likely that stones or plugs of material will form. So making sure that your cat does not become overweight is essential and in fact there are other health-related reasons why it is not good for a cat to be overweight.

Another factor that might make it more likely that a cat gets a blocked bladder is a having a lack of water in their diet. As you know cat food comes as dry food or wet foods such as sachets of chunks in gravy or cans of meat. Dry food is often recommended as it is better for your cat’s teeth and also usually contains less fat. We would not discourage you from feeding dry food to your cat but you could consider mixing some water with it. Some cats however will not eat dry food with added water and so other means of encouraging your cat to consume water should be considered. For example some cats will drink from water fountains. You can increase the number of water bowls available and make sure that they are of the type that cats prefer, namely made of glass and filled to the top. You can also try keeping water bowls away from food bowls and some people freeze gravy to make gravy-flavoured ice cubes; you can then put one a day in one of the cat’s water bowls. Ultimately offering a mixed diet of both dry and wet foods may be the only compromise to increase your cat’s water intake.

It is now possible to buy dry food diets that are designed to try and prevent your cat from getting a blocked bladder and in certain cases to try and treat existing problems. However in some cats with on-going problems feeding a wet food diet may be the only option. Your vet will be able to discuss and reassess this with you. All cats should have access to clean water at all times regardless of the type of diet they are on.

You may have come across a condition in cats known as ‘feline lower urinary tract disease’ or ‘FLUTD’. This is a bit of an umbrella term for a variety of problems affecting the bladder and urethra in cats. The problem that we are discussing in this blog, namely urethral obstruction, is one of the problems that come under the heading of FLUTD. Although we are not going to discuss the rest of FLUTD here, we did just want to comment on one aspect, namely that ‘stress’ may be a factor that contributes to your cat getting FLUTD. This is important when it comes to trying to stop your cat from having a recurrent blocked bladder. For example in multicat households some cats are too afraid to use the litter trays provided often enough and as we said before, not urinating often enough may contribute to your cat getting a blocked bladder. Some cats prefer certain types of cat litter and litter tray designs. If your cat is an indoor cat then providing multiple litter trays, including some that are covered and secluded, may help and you can also take steps to encourage nervous outdoor cats to go outside by for example providing a covered retreat immediately outside the cat flap. Unfortunately we cannot go into a full discussion of all this in this blog but there are many other good resources available on this subject and we will return to it in a future blog.

What is the outlook for my cat with a blocked bladder?

Before finishing this blog we wanted to say a few words about the outlook for your cat with a blocked bladder. As mentioned before, having a blocked bladder is a life-threatening problem and requires urgent treatment. However although some cats do not survive this problem, nowadays the majority will recover from the initial episode if they receive the treatment that they need in the right timeframe. Once your cat has recovered from the initial episode, as mentioned above, your vet will discuss with you how to try and stop it from occurring again. Some cats go on without ever having another episode; in other cases a second episode does not occur for years. However there are a small percentage of cats that suffer another episode quite soon, within days, weeks or months. In a small number of cats episodes keep recurring and an option of performing surgery may need to be discussed. This surgery, known as ‘perineal urethrostomy’, involves removing the penis and shortening the urethra to get rid of the narrowest part, and creating a new hole from which urine can be passed. Shortening the urethra gets rid of the problem we mentioned at the start of this podcast where the male urethra goes round a corner and narrows making obstruction more likely. There are pros and cons of doing the surgery and it is not always successful in preventing obstructions in the future. Your vet will go through all this with you in some detail if your cat reaches the point where surgery is considered necessary.

Okay so that brings us to the end of this blog on urethral obstruction in male cats. It is one of the most well-known emergency problems affecting cats and can be life-threatening. However increased awareness amongst pet carers and veterinary staff as well as improvements in emergency veterinary care has meant that many cases go on to recover fine at least from the initial episode. The next blog will be in approximately 2 weeks time when we will talk about collapse. Before we sign off just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. We would really love to hear your comments on this blog as well as suggestions for future topics. Also don’t forget to subscribe for future episodes via the RSS feed. So thank you for reading and until next time, may you and your pets be safe.

Friday, 9 September 2011

"Bloat"

Welcome to PercyPods Pet Emergency blogs. This week we are going to focus on a specific emergency problem that occurs in dogs called “bloat” or more correctly “gastric dilation-volvulus syndrome” or “GDV”. This condition is one of the true emergencies that can affect dogs with the potential to become life-threatening very quickly, in a few hours or less. It is therefore very important that all dog carers, but especially carers of bigger dogs, are aware of this condition.

What is bloat and why is it a problem?

So let’s start this blog by explaining in a bit of detail what bloat is and why it can be such a severe problem. There is a little bit of variation in terms of exactly what happens when bloat occurs but in most cases the first stage is for the stomach to become very enlarged being filled with gas and fluid. The term ‘gastric dilation’ is what we use to describe a stomach that is enlarged in this way. In some but not all dogs, the enlarged stomach then twists on itself and this twisting, also known as ‘volvulus’, makes the situation even more severe as the gas and fluid cannot escape from the stomach now. So bloat is basically a condition in which the dog’s stomach enlarges and then may or may not twist on itself.

Now this enlargement and twisting of the stomach has a number of different consequences within the dog’s body that can happen very quickly and be very severe. Many affected dogs go into shock and collapse and some also develop difficulty breathing. Bloat can be rapidly fatal if urgent treatment is not provided.


This x-ray from a dog shows a stomach that is very large and filled with gas as well as some food and fluid. The stomach in this picture is not twisted.


Which dogs are affected by bloat and why does it occur?

Let’s now consider which dogs are affected by bloat and why it occurs. The vast majority of affected dogs are big or deep-chested, with commonly affected breeds including Great Danes, Bull Mastiffs, German shepherd dogs, Standard Poodles, Airedales and so on. Having said that it is possible although very rare for smaller dogs and even cats to develop a similar problem.

It is important to realise that we are still not clear why dogs develop bloat. Many theories or factors have been suggested and it is probable that the situation varies to some extent from dog-to-dog. Some of these factors relate to the dog’s body itself, or its ‘anatomy’, for example to do with the position of the stomach in bigger dogs. There is some suggestion also that dog’s with more fearful or anxious demeanours may be at greater risk of bloat. However other factors are more to do with how the dog is looked after in terms of his or her diet and feeding and exercise routines. The most common scenario that we as vets see in terms of cases presenting with bloat is for a dog to have had a relatively big meal, either a short while before or a short while after doing a fair amount of exercise, and to then go downhill within a couple of hours and most cases seem to occur in the evening.

One thing that we would like to mention at this point is something that we refer to as ‘food engorgement’. Some dogs, especially it seems Labrador retrievers, are very good at raiding food stores or gaining access to garbage bins and consuming a very large amount of the contents, i.e. gorging themselves. These dogs can develop similar problems to dogs with bloat but there is a distinction between the two conditions because dogs with bloat have not usually overeaten as such. This distinction is important to a degree and it can affect the treatment although it is also important to realise that some dogs with food engorgement can then go on to develop the more serious condition of bloat.

What symptoms does a dog with bloat show?

Okay so at this point you may well be thinking that’s all very well and good but how do I know when my dog might have bloat? Well one of the most consistent signs that dogs with bloat show is that they seem to retch; retching looks a bit like vomiting but these dogs do not actually produce anything out their mouth, or occasionally they may produce a little bit of froth or phlegm. Some dogs drool saliva as well. Dogs with bloat may appear restless and in fact sometimes the first thing you will notice is that your dog just doesn’t seem settled; they may be pacing or whining and unable to get into a comfortable position, and some dogs repeatedly turn and look at their stomach area. Depending on your dog, you may also notice that the tummy area looks bigger or swollen and can feel hard – a bit like a ball or balloon that has been pumped up with too much air. It is important to say though that this swelling of the tummy area is not obvious in every case.

You must contact your vet practice immediately if you notice any of the signs we have described here and this cannot be stressed enough.

How is bloat treated?

Bloat is a potentially life-threatening problem in dogs that requires immediate treatment and vets and nurses are well aware of this. Treatment usually starts with administering a fluid drip into one or two veins. Dogs with bloat are often in shock and this fluid drip is very important for stabilisation. The treatment can vary to some extent between individual dogs but may then include an x-ray being taken to confirm that the stomach is swollen and to try and see whether it is twisted or not. The swollen stomach needs to be made smaller – or what we call ‘decompressed’ – and this may be done in a couple of different ways including by placing a tube through your dog’s mouth and down into the stomach; gas can then escape out this tube.

Your vet will want to discuss performing an operation on your dog. There are a number of good reasons why dog’s with bloat should have surgery including to untwist the stomach, check how healthy it looks, and fix it into position so that it cannot twist again in the future. When the stomach swells and twists this can also have effects on other organs in your dog, such as the spleen, and performing surgery allows all of these to be examined as well. Most dogs recover well from this surgery but if you have reservations you should be sure to discuss these with your vet before consenting to the procedure.

After surgery your dog will need to stay hospitalised for maybe 2 or 3 days depending on how he or she recovers and then will also need to be looked after carefully for a while before they can return to life as normal. Your vet practice will go through the details of the post-operative care with you.

As mentioned before dogs with ‘food engorgement’ may be treated differently to those with bloat. Dogs with food engorgement are often starved and just given time for all the food to pass through their bowel. Sometimes a laxative may be given and some cases are kept in the practice to be monitored for a while. Sometimes rather than starving the dog we decide to make them vomit up the food instead. Remember though as we said before that some dogs with food engorgement can go on to develop bloat.

Can I stop my dog from getting bloat?

Okay so before we finish this blog let’s talk about whether it is possible to stop your doing from getting bloat. The honest answer is that you cannot stop your doing from ever getting bloat with 100% certainty. However you can do some things to try and make it much less likely.


The first thing is to recognise that your dog is one that is at an increased risk.
  • As we said earlier bloat almost always happens in big or deep-chested breeds and it may also be more common in older dogs.
  • There is some evidence that bloat may also be an inherited condition so that if one dog gets it, generations of dogs from within the same breeding line are also more likely to be affected.
The next thing is to manage your dog’s exercise and feeding routine:
  • You should feed your dog two or three smaller meals a day rather than one large meal, and most people recommend a good quality food that is very digestible with normal fibre levels.
  • You should also try to make sure that your dog does not eat straight after doing a lot of exercise and similarly that they do not exercise straight after eating. There are no hard and fast rules but you should try and leave at least one hour, if possible two hours, between exercise and eating.
  • If your dog has a fearful or anxious demeanour, try and feed him or her in a quiet peaceful environment and some dogs prefer to be fed on their own away from other dogs in the house.
  • The other important thing is to not let your dog gulp a large amount of water straight after exercise, before eating or after eating. Again, small amounts of water more frequently are best.

Another thing to mention is that as we said earlier bloat is a condition that most often seems to happen in the evening or late at night. You should therefore bear this in mind because if you fed your dog and then when out for the evening, you may return home to find them very sick. Ideally you should be able to keep an eye on your dog for as long as possible after they have eaten. And of course if your dog starts to show any of the signs that we mentioned earlier on then you must realise that this is not a ‘wait and see’ moment but a time for consulting your vet practice urgently.

Okay so that brings us to the end of this blog on bloat in dogs. It is one of the most well-known emergency problems affecting dogs and can be life-threatening. However increased awareness amongst pet carers and veterinary staff as well as improvements in emergency veterinary care has meant that many cases go on to recover fine. The next blog will be in approximately 2 weeks time when we will talk about a condition in male cats known as urethral obstruction which means that these cats cannot pass urine; they are often referred to as ‘blocked cats’.

Before we sign off just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. We would really love to hear your comments on this podcast as well as suggestions for future topics. Also don’t forget to subscribe for future episodes via the RSS feed or iTunes. So thank you for listening and until next time, may you and your pets be safe.

Friday, 26 August 2011

Diarrhoea in dogs and cats

Welcome to PercyPods Pet Emergency blogs. Hope this blog finds both you and your pets well. Following on from the last blog which was about vomiting, this week we are going to talk about diarrhoea which is a common problem in dogs and to a lesser extent cats. It is a problem for which many pets are taken to the vets including outside of normal working hours as a potential emergency. Before we get started, just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods.

What is diarrhoea?

Okay so let’s get started by explaining what diarrhoea is. In a normal healthy animal, the stools or faeces have a well-formed relatively solid consistency with no liquid, blood or mucus. Normal stools are formed from food that the animal has eaten once it has been processed by the stomach and especially the intestines. Processing of food basically involves absorbing certain nutrients as well as water and also adding waste substances into the intestines. Diarrhoea refers to stools or faeces that are not solid and not properly formed but instead loose or liquid in consistency. Some animals will have a single one-off episode of soft stools before their faeces appear normal again and we would not usually class this as diarrhoea. Diarrhoea tends to imply multiple episodes of abnormal stools.

Types of diarrhoea

There are basically two types of diarrhoea although it is important to realise that some animals can shows signs of both types if the cause of the problem is widespread throughout the intestines. The first type is what we call ‘small intestinal diarrhoea’ because the cause of the problem is mainly in the small intestine. The small intestine is the part of the gut that is connected to the stomach and this is where most of the digestion of food and absorption of nutrients occurs. Small intestinal diarrhoea tends to be large in volume and have a liquid watery consistency. Animals don’t tend to strain or try to pass stools more frequently, but weight loss is common. In some animals the diarrhoea looks black or tarry and this suggests that there has been some bleeding into the intestine; we call this melaena and it is a sign that should prompt consultation with your vet.

The second type of diarrhoea is ‘large intestinal diarrhoea’. The large intestine is the part of the gut that connects the small intestine to the outside world via the anus and it includes the colon and the rectum. The colon is the main part and people often refer to animals with large intestinal diarrhoea as having ‘colitis’. The main function of the large intestine is to absorb water from the faeces as it passes through to the outside. Animals with large intestinal diarrhoea often try and pass faeces many times a day with straining and only a small volume of diarrhoea produced on each occasion. The faeces may be loose or soft rather than liquid in consistency, and there is often some fresh blood and slimy jelly-like mucus. Weight loss is uncommon with these patients.

Why is diarrhoea bad?

Okay so now that we have described the different types of diarrhoea, let’s consider why having diarrhoea is a problem. As a general rule, large intestinal diarrhoea is usually less of a risk to the animal than small intestinal diarrhoea. Animals with small intestinal diarrhoea may become malnourished and start to look thin and in poor condition because they are not absorbing their food properly. In more severe cases, the animal may become dehydrated and in the worst of cases, he or she may become very weak and depressed eventually going into shock. Some animals can also lose enough blood in their diarrhoea for this to become a problem to them as well. Other considerations that we have to bear in mind are that some causes of diarrhoea cause discomfort to your pet; some pets feel distressed or embarrassed about soiling themselves or being unclean; and of course there may be some practical problems for you in terms of clearing up the diarrhoea especially if your pet has an accident in the home. Many of the causes of diarrhoea also cause vomiting which as we discussed in the last blog can also cause worrying problems.

What about the causes of diarrhoea?

There are a large number of causes of diarrhoea. Like with vomiting, these range from mild and nothing to worry about to very severe and potentially life-threatening. Although as we said earlier, any animal that has diarrhoea that is severe enough, regardless of the cause, can become very ill. The causes of diarrhoea typically are problems which directly affect the intestines causing a failure in the normal actions of the intestine to absorb food and water and also dump waste substances into the faeces. A number of animals recover from diarrhoea without a specific cause being diagnosed. Also it is worth noting that many animals with diarrhoea will also have some vomiting which often occurs before the diarrhoea starts.
 
  • One of the most common causes of diarrhoea is what we call ‘dietary indiscretion’: this is when your pet either eats something that doesn’t quite agree with him or her, for example because it is too rich or rotten, or they overeat. Foreign body ingestion is also a type of dietary indiscretion that can cause diarrhoea.
  • Another relatively common cause of diarrhoea is as a side-effect of certain medications including for example some common antibiotics and also non-steroidal anti-inflammatories.
  • Food intolerance or food allergy is another common cause of diarrhoea: this is when your pet is allergic to either their main diet or any other treats that are fed. However it is important to realise that some animals will develop diarrhoea if their diet is changed suddenly. This does not mean that they are necessarily allergic to the new diet. It is often possible to stop the new diet and then when the diarrhoea has cleared, try introducing it again but much more slowly over several days.
  • ‘Inflammatory bowel disease’ or ‘IBD’ is another cause of diarrhoea affecting the intestines. This is a bit like irritable bowel syndrome in humans and can be very severe.
  • A variety of infections of the intestines can cause diarrhoea, although you should realise that this is actually quite an uncommon cause. In some cases your pet will remain relatively bright and healthy despite the diarrhoea but in others they can become very ill indeed potentially to the point of being life-threatening. One of the most infamous causes of diarrhoea in dogs is a virus called parvovirus which is more common in animals that have not been vaccinated and especially in younger unvaccinated dogs. Parvovirus can very quickly pose a threat to your dog’s life and it is worth noting that the infection is possible even in dogs that have been fully vaccinated. However vaccination has reduced the number of cases of parvovirus in dogs dramatically and you should make sure that your dogs are vaccinated and that this is kept up-to-date as discussed with your vet. Other infections that can cause diarrhoea in dogs and cats include salmonella, campylobacter, giardia, coronavirus and of course worms in the intestine.
  • And one more cause of diarrhoea that we always have to keep in mind unfortunately is cancer affecting the intestines.
So there are a number of problems affecting the intestines which can make a dog or cat have diarrhoea. Some of these problems are potentially more serious than others and as we mentioned before, regardless of the cause, individual animals may be affected more or less badly. In terms of causes of diarrhoea that do not primarily affect the intestines, these include disease of the pancreas, liver or kidneys as well as some hormonal diseases.

What information will your vet need to know?

If you ring your vet practice because your dog or cat has diarrhoea, some of the information they will find useful to try and assess the severity of the problem includes:
  • When did the diarrhoea start?
  • Approximately how many episodes have occurred and is the volume produced each time large or small?
  • Does your dog or cat strain and look uncomfortable at the time of passing the diarrhoea?
  • What does the diarrhoea look like? Is it liquid, water-like or more solid? Is there any fresh blood or slimy jelly-like mucus? Do the stools have a black tarry appearance?
  • Other questions include…Is your pet still eating? Is he or she still drinking?
  • How does your pet seem in himself or herself at the moment? Is he or she still bright and energetic or lethargic and quiet? Are there any other problems such as vomiting – if so, is it bloody? Is your pet’s breathing ok?
  • Are you aware of anything that your pet may have scavenged or did you feed him or her anything out of the ordinary before the diarrhoea started?
  • Has your pet had any medical problems in the past, especially similar episodes of diarrhoea, and is he or she on any medications at the moment?
This might seem like a lot of information but it is important to us as vets when trying to make decisions about your pet so you should try and provide as much as you can.

How is diarrhoea treated?

Right so now that we have considered some of the causes of diarrhoea, let’s talk about the treatment that may be needed. The main thing to realise is that there are really two aspects to this treatment and our job, working with you, is to figure out to what extent each of these aspects is required for your particular pet. The first aspect is what we call ‘symptomatic and supportive care’. This is basically care that your pet may require depending on how severe the diarrhoea is and for how long the diarrhoea has been going on. You will remember that we mentioned earlier how diarrhoea can cause problems such as dehydration and weakness. In terms of the symptomatic and supportive care that may be needed, this can range from no treatment being required to your pet being sent home with treatment for you to give to your pet being admitted to the practice for a fluid drip into a vein and other treatments and tests. The extent of this type of ‘symptomatic and supportive care’ required is dependent on the individual pet rather than the specific cause of their diarrhoea.

It is worth mentioning at this point that there are very few drugs that have been used in dogs and cats to try and directly stop the diarrhoea and those that have been used are not licensed. These drugs are called anti-diarrhoeals. They can have adverse effects and they are usually only used in exceptional cases. It is important that any animal receiving an anti-diarrhoeal also gets whatever other supportive care they need and that they do not remain on an anti-diarrhoeal without also trying to find the cause. Their use is especially not recommended if the diarrhoea is due to an infection.

Anti-diarrhoeals need to be differentiated from probiotics which are not drugs but actually natural supplements that are quite commonly given to dogs and cats with diarrhoea. Probiotics may help by restoring, maintaining and supporting the growth of those bacteria within the bowel that are beneficial. They may also have a number of other positive effects.

The second aspect to the treatment a pet with diarrhoea requires is more specifically aimed at the cause of their diarrhoea and ultimately this is the best way to stop the problem for good. In animals with mild diarrhoea that are otherwise well, it may be enough just to withhold food for 12-24 hours and then offer a bland diet for a few days and see whether this helps. You can buy a special food designed for animals with bowel problems or alternatively feed low-fat easily digestible foods such as boiled chicken or fish with boiled rice or pasta; feeding plain cottage cheese can also be helpful. Once the diarrhoea has cleared, gradually reintroduce your pet’s normal diet over a few days and continue to monitor.

In a number of cases this sort of treatment at home will either not work, that is the diarrhoea will continue, or your pet will already be too unwell and your vet will recommend a consultation at the practice. Once they have obtained more information from you and had a chance to examine your pet, they can make a recommendation about the next best step both in terms of how much of the ‘symptomatic and supportive care’ we discussed previously is required, and also whether they feel that it is necessary to do some tests to try and diagnose the cause of your pet’s diarrhoea. In some cases it will be necessary to do urgent tests because your vet is very worried about your pet, in other cases these tests can be done more slowly over a period of days or even weeks. It will all depend on your individual pet. Your vet may want to test your pet’s stools for infection, do some blood tests to look for causes and also for example for evidence of dehydration, and in some cases it is appropriate to take x-rays or do an ultrasound. Some animals require endoscopy – this basically involves feeding a video camera through your pet’s mouth or anus into the intestines under a general anaesthetic. It may be necessary to take biopsies, which are little tissue samples, of your pet’s intestines either using an endoscope or even by performing surgery.

Depending on the cause of your pet’s diarrhoea, treatments that may be required include trying different diets under strict management, suitable drugs if an infection is identified, or steroids and other medications if for example inflammatory bowel disease is confirmed. Your vet will be able to talk you through the management needed once the cause is known.

Antibiotics in diarrhoea

Before ending this blog we would just like to say a few words about antibiotics. Antibiotics are used to treat infections caused by bacteria. As we said earlier, diarrhoea is not often due to infection and especially not bacterial infection. We would therefore recommend that antibiotics are only used if a bacterial infection is confirmed by specific tests and you should also bear in mind that antibiotics can in fact cause diarrhoea in dogs and cats. It doesn’t make much sense to give an animal antibiotics without confirming that they definitely need them and then the antibiotics actually make the diarrhoea worse.

Okay so that brings us to the end of this PercyPods Pet Emergency blog on diarrhoea in dogs and cats. As you can see, there are a large number of causes of diarrhoea. It is not uncommon for some animals to have very short bouts of diarrhoea that are basically nothing to get too concerned about, especially if they have a varied diet with treats and scraps or because they scavenge on walks and so on. However at the other end of the spectrum, some patients with diarrhoea have very severe and potentially life-threatening disease. In general it is recommended that you consult your veterinary practice if you are at all worried.

We hope that you have found this episode useful and learned a little about diarrhoea in dogs and cats. The next blog will be in approximately 2 weeks time when we will talk about a condition in dogs known as ‘bloat’ or gastric dilation-volvulus syndrome. Before we sign off just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. We would really love to hear your comments on this podcast as well as suggestions for future topics. Also don’t forget to subscribe for future episodes. So thank you for reading this and until next time, may you and your pets be safe.

Saturday, 13 August 2011

Vomiting in dogs and cats

Welcome to PercyPods Pet Emergency blogs. Hope this blog finds both you and your pets well. This week we are going to talk about vomiting which is a common problem in dogs and to a lesser extent cats. It is one for which many pets are taken to the vets including outside of normal working hours as a potential emergency. Before we get started, just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. Thank you to those people who have been in touch so far.

What is vomiting?

Okay so let’s get started by explaining what vomiting is. Vomiting is the forceful expulsion of the contents of the stomach or small intestine back out through the mouth; this might include undigested food, fluid or other debris. Many of you will no doubt have had first-hand experience of this when you have vomited yourself or watched kids do it. It is quite common for dogs and cats to show certain signs before they are about to vomit. This can range from drooling and licking their lips to barking or meowing and they will sometimes walk around looking for a specific place to vomit. Once you have seen your pet do this, you will very likely recognise this behaviour again in the future.

One of the very important things to note about vomiting in dogs and cats is that it is an active process. By this we mean that the animal puts a lot of effort into the vomiting; they show quite exaggerated movements of the tummy area or indeed even their whole body due to muscle contractions; pet carers often say that the dog or cat almost appeared to be convulsing with waves of movement going across their body! It is important for you to note if this is the case in your pet because your vet will want to know this information. There is another problem called ‘regurgitation’ in which an animal may also bring their stomach contents back up. However, unlike vomiting, regurgitation is a passive process; animals often simply open their mouths and the stuff falls out without any obvious effort. The causes of vomiting versus regurgitation can be quite different and this is why it is important for your vet to know what behaviour your pet showed while they were bringing up their stomach contents.

Why is vomiting bad?

Okay so before we discuss some of the causes of vomiting, it is important to understand why vomiting is bad. Clearly vomiting is an unpleasant experience for your pet. They may well have been feeling nauseous for a while beforehand and afterwards and the act of vomiting is unpleasant as you may know yourself. However this is not the only reason vomiting is bad. When an animal vomits, they obviously lose the contents of their stomach which includes any food they have recently eaten or any water they have recently drunk. This may not be a problem if it only occurs once but especially with multiple episodes of vomiting, your pet will start to become dehydrated and weak and they will also lose important electrolytes such as potassium. If this situation becomes very severe, your pet may become very sick and go into shock. This applies to any animal, or human, regardless of the cause of the vomiting. An animal may be vomiting because of something that is relatively non-serious in itself but become quite sick as a result of on-going vomiting. Another possible consequence of vomiting is that your pet may inhale some of the vomit and develop pneumonia in the lungs leading to breathing difficulties. This is especially a worry in short-nosed or so-called ‘brachycephalic’ breeds of dogs and cats.

What information does your vet need to know?

If you ring your vet practice because your dog or cat is vomiting, some of the information they will find useful to try and assess the severity of the problem includes:
  • When did the vomiting start?
  • Approximately how many episodes have occurred?
  • Can you estimate approximately how much each episode of vomiting contains – for example, in terms of dessert spoons or coffee cups
  • What does the vomit look like? Common descriptions include frothy, greeny/yellowy suggesting bile, or containing food material. One important factor to mention is whether you have seen any suggestion of blood in the vomit. Sometimes you can see obvious fresh red blood, other times the vomit may have an appearance of containing ground coffee which represents partly digested blood.
  • Other questions include…Is your pet still eating? Is he or she still drinking? Do they tend to vomit straight after eating or drinking or is there a time delay or indeed does the vomiting occur randomly and is not obviously associated with eating or drinking?
  • How does your pet seem in himself or herself at the moment? Is he or she still bright and energetic or lethargic and quiet? Are there any other problems such as diarrhoea – if so, is it bloody? Is your pet’s breathing ok?
  • Are you aware of anything that your pet may have scavenged or did you feed him or her anything out of the ordinary before the vomiting started?
  • Has your pet had any medical problems in the past, especially similar episodes of vomiting, and is he or she on any medications at the moment?
This might seem like a lot of information but it is important to us as vets when trying to make decisions about your pet so you should try and provide as much as you can.

What are the causes of vomiting?

Okay so let’s spend a bit of time talking about the causes of vomiting in dogs and cats and then we will finish the blog by explaining some of the treatment that may be needed. There are a large number of causes of vomiting that vary in terms of how serious they are. Although as we said earlier, any animal that vomits enough, regardless of the cause, can become very ill.

So the actual act of vomiting is triggered by the brain. However the signals that tell the brain to trigger vomiting can come from a wide variety of places in the body. One useful way of dividing up the causes of vomiting is by separating them into ones that primarily affect the stomach or the intestines, versus causes that occur elsewhere in the body, for example in the pancreas, the liver or even the brain itself. Many, but not all, of the causes of vomiting also tend to cause diarrhoea and we will discuss diarrhoea in the next blog in 2 weeks time.

In dogs and cats vomiting is most often because of a problem in the stomach or intestines. These problems include for example:
  • What we call ‘dietary indiscretion’: this is when your pet either eats something that doesn’t quite agree with him or her, for example because it is too rich or rotten, or they overeat.
  • Foreign body ingestion is also a type of dietary indiscretion. It is very common for dogs, especially certain dogs like young Labradors, to eat foreign bodies such as balls, corn cobs, toy items, socks, bones and so on. Sometimes this goes entirely unnoticed by you but in other cases vomiting may occur. Cats may also eat foreign bodies, although it is less common. Fur balls are one common cause of vomiting in cats. Poisoning is another type of dietary indiscretion that can often result in vomiting in both dogs and cats.
  • Another relatively common cause of vomiting is as a side-effect of certain medications and especially of so-called ‘non-steroidal anti-inflammatories’ such as carprofen, meloxicam or firocoxib. We discussed these drugs in the context of poisoning in episode 3 of these blogs so please make sure you have a read if you haven’t already.
  • Another cause of vomiting is food intolerance or food allergy: this is when your pet is allergic to either their main diet or any other treats that are fed. These pets will usually have diarrhoea too.
  • ‘Inflammatory bowel disease’ or ‘IBD’ is another cause of vomiting affecting the stomach and intestines. This is a bit like irritable bowel syndrome in humans and can be very severe.
  • Infections of the stomach or intestines can cause vomiting, although you should realise that this is actually quite an uncommon cause. The more severe infections are usually accompanied at some point by diarrhoea, which can be very severe, and examples include parvovirus infection and salmonella. Worms in the intestines can also cause vomiting.
  • And one more cause of vomiting is cancer affecting the stomach or the intestines.
So there are a number of problems affecting the stomach or intestines which can make a dog or cat vomit. Some of these problems are potentially more serious than others and as we mentioned before, regardless of the cause, individual animals may be affected more or less badly.

In terms of causes of vomiting that do not primarily affect the stomach or intestines, they often involve inflammation for example in the pancreas (so-called pancreatitis), the liver, the bladder and so on.  Other causes of vomiting include kidney failure, liver failure and hormonal diseases, and there are a number of other potential causes too. Animals suffering from one of these problems may show other symptoms in addition to the vomiting that relate to the particular problem; so for example if the primary problem affects the liver they may be jaundiced, that is having a yellow discolouration of the gums, skin or whites of the eyes, or if the primary problem affects the bladder, they may strain to urinate.

How is vomiting treated?

Right so now that we have considered some of the causes of vomiting, let’s talk about the treatment that may be needed. The main thing to realise is that there are really two aspects to this treatment and our job, working with you, is to figure out to what extent each of these aspects is required for your particular pet. The first aspect is what we call ‘symptomatic and supportive care’. This is basically care that your pet may require depending on how severely he or is she vomiting and for how long the vomiting has been going on. You will remember that we mentioned earlier how vomiting can cause problems such as dehydration and weakness. In terms of the symptomatic and supportive care that may be needed, this can range from no treatment being required to your pet being sent home with treatment for you to give to your pet being admitted to the practice for a fluid drip into a vein and other treatments and tests. The extent of this type of ‘symptomatic and supportive care’ required is dependent on the individual pet rather than the specific cause of their vomiting.

It is worth mentioning at this point that there are a small number of drugs that have been used in dogs and cats to try and directly stop the vomiting. These drugs are called ‘anti-emetics’. For the most part they are not actually licensed for use in dogs and cats but have been used safely on many occasions. They often make the animal feel better and appear brighter in part because they may also treat any nausea present. However it is crucial to realise that there are some occasions in which the use of such drugs is not considered safe or the best course of action and therefore your vet may decide not to administer one of these drugs. Other drugs that are sometimes used with or without an anti-emetic include stomach protectants and antacids.

The second aspect to the treatment your pet requires is more specifically aimed at the cause of their vomiting and ultimately this is the best way to stop the vomiting for good. In some cases it may be enough just to withhold food from your pet for example for 12 to 24 hours after consulting your vet practice for advice. Water however must be readily available throughout although it can help sometimes to manage your pet’s drinking by offering a small amount of water frequently rather than one big bowl that they may gulp in one go and worsen their vomiting. It is essential not to withhold water and if your pet vomits after drinking water then we would very much recommend that your consult your vet practice. In general we would only recommend withholding food for a short period for those animals that have vomited a small number of times, that remain relatively bright and that can keep water down. These animals should still be monitored carefully at home and should improve quite quickly. For more severely affected animals or those showing signs of weakness, depression or changes in breathing, it is better to be seen as soon as possible.

If withholding food is recommended, after the 12 to 24 hour period you can then start to feed your pet little and often for a couple of days or so to make sure the vomiting has resolved; bland low-fat foods such as boiled chicken or fish with boiled rice or pasta work well and feeding plain cottage cheese for example can also be helpful.

In a number of cases this sort of treatment at home will either not work, that is the vomiting will continue, or your pet will already be too unwell and your vet will recommend a consultation at the practice. Once they have obtained more information from you and had a chance to examine your pet, they can make a recommendation about the next best step both in terms of how much of the ‘symptomatic and supportive care’ we discussed previously is required, and also whether they feel that it is necessary to do some tests to try and diagnose the cause of your pet’s vomiting. In some cases it will be necessary to do urgent tests because your vet is very worried about your pet, in other cases these tests can be done more slowly over a period of days or even weeks. It will all depend on your individual pet. The most important decision that your vet will want to make initially is whether they think your pet is vomiting because of a cause that needs surgery to be performed urgently; such causes include obstruction or rupture of the intestines due to a foreign body. Your vet may want to take x-rays or do an ultrasound in order to help them make the decision whether your pet needs surgery or not. Sometimes endoscopy is also used; this basically involves feeding a video camera through your pet’s mouth down into the stomach and intestines under a general anaesthetic.

Okay so that brings us to the end of this PercyPods Pet Emergency blog on vomiting in dogs and cats. As you can see, there are a large number of causes of vomiting. It is not uncommon for some animals to have very short bouts of vomiting that are basically nothing to get too concerned about; for example, my last cat was long-haired and used to vomit fur balls from time to time, which we both just got used to! Some animals vomit for example once a month for their entire lifetime! However at the other end of the spectrum, some vomiting patients have very severe and potentially life-threatening disease. In general it is recommended that you consult your veterinary practice if you are at all worried about your pet vomiting.

We hope that you have found this episode useful and learned a little about vomiting in dogs and cats. The next blog will be in approximately 2 weeks time when we will talk about diarrhoea and as mentioned many of the causes of vomiting also often cause diarrhoea. Before we sign off just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. We would really love to hear your comments on this blog as well as suggestions for future topics. Also don’t forget to subscribe for future episodes via the RSS feed and that these blogs are also available as audio podcasts. So thank you for reading and until next time, may you and your pets be safe.