CWB Vet

Acupuncture Handout

History

The word acupuncture comes from Latin meaning acus "needle" and punctura "prick"

The technique is most commonly recognized as a part of Traditional Chinese Medicine. The use of acupuncture in China date back at least 3000 years. In China the healing art of acupuncture has been practiced on animals for centuries. The Chinese practiced acupuncture on horses then gradually tried it on other farm animals and finally dogs, cats and birds.

Acupuncture was brought to Europe in the 1600’s but was not widely used in the west until the after 1972 when President Nixon visited China and the “bamboo curtain” was lifted.

The Theory

In Traditional Chinese Medicine the acupuncture healing work is based around “Qi” - the “Life Energy”. “Qi” is said to flow around the body in meridians or channels and acupuncture serves to unblock Qi energy and boost the immune system which aids in self-healing. Acupuncture points lie on the meridians and are areas of the skin at which the flow of Qi can be affected. In China acupuncture developed under influence of different philosophies like Taoism and Naturalism and the concepts of Yin and Yang and “The Five Elements” - Wood, fire, earth, metal and water.

In Western Medicine acupuncture is used as a therapy following orthodox clinical diagnosis and the acupuncture points are chosen based on neurophysiological principles. In Western terms, acupuncture can assist the body in healing itself by affecting certain physiological changes. For example, acupuncture can stimulate nerves, increase blood circulation, and relieve muscle spasms, and cause the release of hormones, such as endorphins (one of the body's pain control chemicals) and cortisol (a natural steroid). Although acupuncture's physiological effects have been studied, much is still unknown.

How does it work?

The effect of acupuncture needling is mediated through stimulation of the peripheral nervous system and the effect can be local, segmental or general. Acupuncture causes release of hormones, endorphins and other “messagers” in the body and stimulates wound healing, antiemesis, immunomodulation and pain modulation. Local needling of trigger points, tender points and acupuncture points is used in treating somatic pathology and segmental needling is used to enhance the effect or to treat visceral conditions

Side effects and safety

Acupuncture is considered one of the safest forms of medical treatment when it is administered by a properly trained person. However, it is possible to physically harm the patient through improper needling of a few points, but this should not happen with an experienced acupuncturist. Side effects of acupuncture are rare, but they do exist. An animal's condition may seem worse for up to 48 hours after a treatment although this is rare. Other animals may become sleepy or lethargic for up to 24 hours after acupuncture. These effects are the indication that some physiological changes are developing, and they are most often followed by improvement in the animal's condition. The worst thing that may happen is nothing. That is, no change in the patient's status as a result of the acupuncture treatment.

Is acupuncture painful?

The needles that are use for acupuncture are very fine needles and for small animals, the insertion of acupuncture needles is virtually painless. Once the needles are in place, there should be no pain. Most animals become very relaxed and may even become sleepy. Nevertheless, acupuncture treatment may cause some sensation, presumed to be those such as tingles, cramps, or numbness which can occur in humans and may be uncomfortable to some animals.

How long do acupuncture treatments last and how often are they given?

The length and frequency of acupuncture treatments depends on the condition of the patient and the method of stimulation that is used by the veterinary acupuncturist. Stimulation of an acupuncture point may take as little as 10 seconds or as much as 30 minutes. A simple acute problem, such as a sprain, may require only one treatment, whereas more severe or chronic problems may need several treatments over a longer periode.

The treatment intervals will vary with different conditions. Routinely treatment will be recommended given once weekly until results are observed (usually 2-6 weeks) then start increasing the time interval until we find how long your pets' condition can go between treatments. The maximum intensity of treatments would be 2-3 times per week in acute severe conditions. On the average you can expect anywhere from 2 months to 4 months between treatments once results have been achieved. The nature and severity of the condition is the determining factors. The number of points or needles used during a treatment will also be determined by the condition and the response to earlier treatments.

For which conditions is acupuncture indicated?

Acupuncture should never be administered without a proper veterinary diagnosis and an on going assessment of the patient’s condition and response to any prior treatment. Acupuncture as a treatment is not an alternative to surgery for such conditions that require surgical treatment, but can be used alone or in addition to medical treatment to treat certain conditions. Following surgery, it can improve the patients’ comfort level and speed up the postoperative recovery period. In some cases, it may reduce or eliminate the need for chronic medication.

In veterinary medicine, there is evidence of the success of acupuncture for treating disorders of the musculoskeletal, neurological, pulmonary, gastrointestinal, reproductive and dermatologic systems.

The most common conditions that are treated;

Musculoskeletal problems, such as arthritis, hip dysplasia, tendonitis or intervertebral disk disease
Chronic pain caused by degenerative joint disease
Traumatic nerve injuries
Skin problems, such as lick granulomas and allergic dermatitis
Respiratory problems, such as asthma, rhinitis, chronic coughing, or pneumonia
Gastrointestinal problems, such as diarrhoea or vomiting
Certain neurological disorders Certain reproductive and endocrine disorders
Some urinary disorders.

Obesity

Obesity occurs when a pet eats more calories than it requires on a daily basis. The excess calories are converted to fat, and the fat is laid down in the body tissues. Just as obesity has become a more important medical condition in people, so also pets are being affected. Pets share our lifestyles. They eat food provided in bowls that they do not need to hunt for. They live in our comfortable, temperature-controlled homes and do not need to look for suitable places to sleep. Most pets are provided with plenty of snacks and they just have to look longingly at us, to be supplied with a treat or more food. Animals are not like us in that they do not care what they look like, so have no desire to sort out the weight problem by dieting and exercise.

The problems with this lifestyle and the resultant obesity are:

True obesity, where the pet is considered 40% or more over the ideal body weight, is a clinical condition, which requires careful weight reduction under veterinary guidance.
Disinclination to move more than they have to or to do any exercise.
More weight means more pressure on the joints and an increased risk of osteo-arthritis.
Arthritis causes an animal to want to move even less, which results in a further increase in weight.
A shorter lifespan due to the higher risk of medical conditions, such as:
- lower immunity
- hormone imbalances
- mammary tumours
- infertility & dystocia
- skin problems
- urinary problems
- diabetes
- constipation
- liver disease in cats
Increased risks during anaesthesia and surgery. Surgery times are lengthened due to increased adipose tissue at surgery sites.
The cardiovascular and respiratory systems are affected, causing increased risks of high blood pressure, exercise intolerance, breathlessness, collapsing tracheas.
Increased insulation from the fat layer causes increased body temperatures in hot climates.

Some pets are more likely to become obese and need to have their weight closely monitored from a young age. Dogs, such as Labradors, cocker spaniels, Shetland sheep dogs, amongst others, tend to become obese. Pedigree dogs are also more at risk than crossbreeds, while crossbreed cats are more at risk than pedigree cats. Female dogs and male cats that are kept in apartments have an increased risk. Overweight puppies and kittens are more inclined to be obese adults as they are not only used to overeating, but they also have a higher number of fat cells than they were born with – fat hyperplasia. As animals become older and less inclined to play like young animals, tend to become more obese. Some hormonal conditions and medications can also cause obesity.

Prevention of Obesity

Pets that are predisposed to obesity should be weighed on a regular basis from a young age. Owners can weigh their pet at home at least once a month, or take the pet to the vet to be weighed more accurately. An adult animal should not fluctuate more than 5% of their body weight.

Neutered animals have a greater chance of becoming obese, as they require 15% less calories after neutering. Therefore pets that have been neutered should get a slight reduction in the calories. This can be done by changing to a diet that is specifically for neutered animals.

Pets should get some form of exercise every day. Dogs should be walked or played with every day. Cats in apartments or homes with no access to the outdoors should be played with and encouraged to move. It is difficult to take a cat for a walk as they get stressed when removed from their usual territory. Wild cats were used to hunting and running to keep their weight down. Companion cats kept in Hong Kong apartments to not get this opportunity and are much more likely to become obese.

The best prevention of obesity is being aware of your pet’s size and not giving excessive treats or overfeeding.

Treatment of Obesity

There are two main areas of treatment: exercise and diet. There are a couple of ‘diet pills’ available now from vets for animals, but exercise and diet remain the best treatments.

Exercise Obese animals need to start off slowly with exercise. Remember that obese pets have compromised cardiovascular and respiratory systems. They may have more painful joints and their joints have to work harder as they carry more weight.

Obese pets should see a vet before beginning an exercise regime, so that the vet can advise the ideal exercise and the ideal amount of exercise for that particular animal.

Walking, running and playing are the most common forms of exercise. Swimming is excellent for obese pets, as the water keeps the temperature of the animal down and swimming does not cause any pressure on the joints.

Diet Obese pets need very carefully balanced diets. Home made meals or table scraps tend to contain too much fat and salt. Commercials pet foods also contain high levels of fat, as fat makes food more palatable. Prescription Obesity diets will contain a higher percentage of fibre. This means that the animal will not need to drastically reduce the amount of food given. This is a great advantage as it prevents the animal from getting hungry between meals, and starting to beg or scavenge for food. If weight loss is attempted by just reducing the amount of food, the pet will also get a reduced amount of proteins, vitamins and minerals. This can lead to deficiencies and health problems. Reducing the amount of food triggers a slower metabolism, as the body tries to ‘conserve’ fat, so no weight is lost unless the metabolism is boosted by increased exercise.

Obesity diets are especially formulated diets that provide the pet with sufficient proteins, mineral and vitamins. They contain L-carnitine, which is a vitamin-like substance that is beneficial to weight loss. They contain an increased level of high quality protein, which promotes muscle mass maintenance, and added minerals and vitamins to compensate for energy restrictions. The antioxidant complex limits cell degradation caused by free radicals and strengthens the immune system. The increased fibre content does not provide any calories to the body as it remains in the gastro-intestinal system and is not digested and absorbed. Increased fibre does increase the amount of stool produced. Owners need to watch out for diarrhoea developing if the pet is changed onto obesity diet too quickly. The pet’s system will not be used to the higher percentage of fibre, unless the diet is introduced slowly.

Aiding our pet’s weight loss

We suggest you join our Weight Loss Consultation Program. The program itself only costs the initial veterinary consultation, any medications required, a suggested diet and your time.

Initial Vet Consultation

One of our vets will examine your pet, take the temperature, pulse, respiration rate and blood pressure. The vet may advise x-rays, if they feel the pressure of the fat compromises the organs of your pet. The vet may also suggest joint x-rays if your animal is showing any lameness or reluctance to move. This way we can find any health or arthritic changes early. We can supply you with supplements for your pet to help with joint pain and slow the rate of arthritic changes. We can discuss any health problems and the best way to deal with them while your pet is losing weight.

The vet will work out the target weight for your pet, the amount of food to be fed daily, and the amount and type of exercise that will be most beneficial. We will keep all your pet’s information in our computer system, so that we can accurately monitor your pet’s weight loss and health.

Weekly Weigh-in

We suggest that you bring your animal into the clinic on a weekly basis. We will book a nurse consultation appointment for you. The nurse will weigh your pet and check the temperature, pulse and respiration rate.

If you have any problems or queries, you can raise these with the nurse. If she cannot answer the query herself, she will ask a vet to ensure that you get the right answer.

These nurse consultations do not cost anything, unless there was a medical problem, such as high blood pressure, discovered during the initial vet consultation, which needs further monitoring or care.

Once your pet is responding well to the program, we can reduce the weekly weigh-ins to monthly weigh-ins. When your pet has reached its target weight, we can advise you how to maintain your animal at that weight, so that all your hard work is not for nothing.

Tick-borne diseases in Hong Kong - Babesia

Blood-sucking ticks transmit tick-borne diseases. They are also known as Tick Fevers, as the disease process often causes fevers in dogs. This is a worldwide problem. The two types of tick-borne diseases seen in Hong Kong in dogs are Babesiosis and Ehrlichiosis.

Babesiosis

Babesia is a protozoal microorganism that lives in the red blood cells. Of the 71 species of Babesia, three are known to infect dogs worldwide. These are Babesia canis, Babesia gibsoni and Babesia vogeli. Only B. canis and B. gibsoni are seen in Hong Kong. Babesia is dependant on ticks for transmission to animals. There are four different stages of the tick life cycle, i.e. eggs, larva, nymph and adult. When ticks ingest infected blood, Babesia organisms undergo a cycle involving a series of replications that give rise to numerous infective parasites. These are transmitted through different stages of the tick’s life cycle so that all the stages can infect dogs.

The disease process and clinical signs are similar in all species of Babesia. The incubation period following tick exposure ranges from 10 days to 3 weeks. There is then a rapid deterioration in most dogs with parasite circulating in the blood stream, although the severity of the disease is not always proportional to the number of parasites in the blood. Symptoms are caused by damage to red blood cells in the blood stream, which leads to severe anaemia and other complications. Babesia may also induce a chronic carrier state without apparent clinical signs after recovery from acute infection. During the chronic carrier state, the animal’s immune system plays a very important part in keeping the infection under control. When the animal is under any type of stress, the disease will flare up. Puppies are most susceptible to B. canis infections and frequently acquire a more severe infection than adult dogs. This is because their immune system is not as developed as in adult dogs. Babesia infections in puppies have a high mortality rate.

Clinical signs

Depression, weakness and anorexia are usually the main symptoms. Acute infection causes destruction of the infected red blood cells (RBC) by the body’s immune system, leading to severe anaemia. Shock can develop shortly after an acute infection. Animals infected with Babesia can develop a fever as a result of toxins released when the organism and RBC are destroyed. As the disease process becomes advanced, internal organs such as the spleen, liver and kidneys are affected. In severe cases, failure of these organs can occur. In the chronic carrier state, intermittent fever, loss of appetite and weight loss occur. Dogs infected with Babesia can sometimes develop atypical signs, such as fluid accumulation in body cavities, oral ulcers, gastrointestinal symptoms and signs of central nervous system damage.

Diagnosis:

Blood tests: blood changes seen include decreased red blood cell count (anemia), decreased platelet count and increases in various enzymes concerned with organ function. Kidney function is usually affected, as it is highly sensitive to the drop in blood pressure caused by acute or chronic blood loss.
Peripheral blood smears: The blood smear is made from a drop of blood collected from the peripheral circulation of the dog (e.g. the ear). The smear is stained and examined microscopically. The Babesia parasite can be seen within the RBC in most cases. Typical changes in other cells can also be seen. Inability to find the organisms within the blood smear does not rule out Babesiosis, as the organism can disappear from the peripheral circulation for a period of time, before reappearing. In such cases, clinical signs and blood changes are important when making a diagnosis. Follow up blood smears after treatment are important to make sure that the circulation is clear of the organism.

Treatment involves the use of:

drugs that kill the organism; and
supportive therapy.
Stable uncomplicated cases may require treatment with antibabesial drugs only. Complicated cases may require blood transfusions for animals in shock and with severe anaemia and intensive supportive therapy for animal with organ failure. The prognosis for complicated cases is often poor if there is irreversible organ damage.

Prevention:

The primary means of prevention of Babesiosis is to prevent the ticks attaching themselves to dogs. It is also recommended that all blood donors be screened for Babesia, as it can be transmitted by blood transfusion. There are a variety of products that are commonly used for tick prevention in Hong Kong. These include removing attached ticks, products that repel ticks and products that kill the tick on the dog.

Causeway Bay Animal Hospital recommends the following products:

Frontline: this is a product for flea and tick prevention. It has a repelling effect, which reduces the chance of infection. Monthly application of Frontline is recommended. It is easy to apply and can safely be used on puppies that are 12 weeks of age and older. Ticks are killed, but often only after the disease has been transmitted.
Revolution: this is similar in application and effect to Frontline, but is also effective in preventing heartworm infections and mite infestations.
Tick collars containing Amitraz: these collars kill ticks before they attach, as normally it takes about a week from a tick getting onto the dog and the tick finding a suitable site to bite the dog. It is recommended that a preventative tick collar be used in conjunction with Frontline or Revolution. It is important to differentiate between a collar containing Amitraz and a normal flea collar, as the latter does not affect ticks.

Other tick prevention products, such as vaccines and chemical dips, are used in other countries. The vaccine is currently marketed in France, but its efficacy has yet to be determined. Various insecticide dips are also effective against ticks but must be used with extreme care, as these chemicals can be toxic to human beings and other animals.

Canine Distemper Virus (CDV)

Distemper Virus is a relatively large, RNA-based virus that mainly infects dogs. This virus is closely related to others of the group ‘Morbillivirus’ which includes the human measles virus. Unlike most viruses, CDV can infect many species. At present there is no evidence of human infection. However all members of the dog family (such as wolves, coyotes, foxes and pet dogs), ferrets, raccoons, hyenas, pandas, bears and some members of the cat family (lions and cheetahs), but not pet cats, are susceptible.

CDV is rapidly fatal in seals and epidemics in seal populations threaten them with extinction. A related virus in seals can also affect dogs.

Different strains of the virus exist, some of which are much more virulent than others. More virulent strains are more likely to cause encephalitis, which is usually fatal. In our experience, the strains present in Hong Kong seldom cause encephalitis and fatalities are usually sue to secondary pneumonias.

Vaccination is very effective in preventing CDV infection. Immunity, however, is not long lasting and annual vaccination is needed to keep up the immunity. Since CDV is very common in Hong Kong, it is essential to maintain vaccination.

The severity of the disease depends on the dog’s immunity and the amount of viruses it is exposed to. The virus is spread in all bodily fluids, but mainly in respiratory secretions by air. The virus survives only short periods outside the body in warm temperatures, probably not more than 3 hours. It can survive for days in colder temperatures. It is easily killed by many common disinfectants, such as quaternary ammonia.

Most susceptible dogs are puppies between 3 to 6 months, as they no longer have the protection from their mother’s antibodies. They have not have time to develop antibodies even if vaccinated. This coincides with puppies being exposed to high levels of virus by crowding together, often in unhygienic conditions, in pet shops or at breeders. Since almost all pet shops do not feed their puppies enough, they have further reduction in immunity and increased potential for complications.

Dogs of all ages, if not vaccinated, are susceptible. In susceptible animals, the virus incubates about 5 days before the initial symptom, usually fever, although more obvious symptoms may not appear before 9-14 days. In dogs with some immunity, low levels of virus, or weak strains of the virus, symptoms may only develop 2-3 weeks after exposure.

Symptoms of CDV infection

Initial symptoms affect the eyes, respiratory system and intestines. Milder cases are exactly the same as ‘Kennel Cough’. More severe cases develop eye discharge, then a cough. Poor appetite and depression follow. Vomiting and diarrhoea may be seen, often with blood and mucous. In these cases symptoms are very similar to Canine Parvovirus.

Secondary bacterial infections occur in almost all cases, and because of increased antibiotic resistance, pneumonia, which is fatal if not treated aggressively.
Encephalitis can occur at any stage. Most cases, however, develop 1-3 weeks AFTER recovery from initial symptoms. In some dogs, especially adults, brain symptoms are the only sign of disease. Some dogs may have periods of neurological signs, followed by apparent recovery and further relapses later. The most common sign is muscle twitching, often a single muscle having a persistent contraction. Usually a facial muscle si involved, but any muscle may be affected. Seizures are also common. Seizures include salivation and chewing movements, but more severe seizures are also seen. Loss of balance, partial paralysis and various other signs of brain damage may also be seen. If brain symptoms occur, most dogs will deteriorate or need to be euthanased. A few dogs with very mild symptoms, such as a single muscle twitch may survive with permanent muscle symptoms.

Other symptoms of less importance are skin infections, teeth abnormalities and joint deformities. Skin infections are interesting, as puppies with pustular eruptions almost never develop brain disease. Dogs developing ‘hard pad’ (thickening of the skin of the feet pads and nose) almost always develop serious brain symptoms and ‘hard pad’ is considered a bad sign.

Blood tests, radiographs and so on, do not help differentiate CDV infection from other similar diseases. Cerebrospinal fluid analysis may shoe high levels of protein and CDV antibodies, but even this does not give an accurate diagnosis.

The Diagnosis is usually made on symptoms, especially typical changes such as persistent muscle cramps or ‘hard pad’. Other cases can only be diagnosed by ruling out other diseases (such as testing for Canine Parvovirus) and response to treatment. Often we can only confirm diagnosis after the dog has recovered by the typical tooth abnormalities.

There is no treatment for CDV. However, fatalities are usually low, as in most cases, the immune system gets rid of the virus. Mild brain symptoms, such as a muscle cramp or occasional seizure, can be left untreated. More serious seizures can be prevented with anti-epileptic drugs. Most dogs that develop serious brain damage need to be euthanased though. Symptomatic treatment of vomiting and diarrhoea is needed. Aggressive antibiotic treatment of pneumonia is often needed – usually a culture is needed to choose an effective antibiotic.

A common practice in Hong Kong is to inject vaccines intravenously as a treatment. There is no evidence that there is any benefit to this treatment and serious side effects are common, including death. There is no reason any ethical veterinarian would use this outdated and harmful practice. Pure CDV vaccines have been given intravenously to healthy, but high risk, puppies WITHOUT symptoms – this shortens the time that the vaccine boosts immunity by several days. Unvaccinated dogs entering high-risk situations such as boarding may benefit from this, or possibly even healthy puppies from pet shops. However multiple virus vaccines such as commonly used should never be given intravenously.

Desexing your Dog

Pyometra is a bacterial infection of the uterus in the period after heat when the hormone Progesterone is produced to prepare the uterus for pregnancy. Pyometra can occur in both dogs and cats of any breed. The incidence of pyometra is higher in dogs than in cats because dogs are exposed to natural progesterone (when coming on heat) more often than cats. Pyometra is very common in dogs that are not used for breeding, and can develop at any age.

The Older Dog:

The uterus responds to progesterone abnormally. When progesterone prepares the uterus for pregnancy, it causes the wall of the uterus to thicken and an increase in the number of glands. These glands produce a very nutritious secretion for embryo implantation, but unfortunately this is also an ideal environment for bacterial growth. This is very common and the majority of female dogs not used for reeding will develop pyometra.

The Younger Dog:

It is unlikely that the uterus will respond abnormally to progesterone.
The most common cause of pyometra is oestrogen administration, generally by a veterinarian to prevent pregnancy after mating.
Accidental pregnancy is therefore one of the reasons why female dogs should be desexed if they are not going to be used for breeding.

There are two types of pyometras:

Open Cervix Pyometra
The cervix is a structure, which separates the uterus from the vagina. Dogs with an open cervix pyometra have a discharge from the vagina containing pus and blood. This discharge is usually noticed 4 to 8 weeks after the end of heat. Other common symptoms of pyometra include lethargy, depression, inappetance, excessive drinking and urinating, vomiting and diarrhoea. This type of pyometra may be recognised quickly by the experienced owner due to the discharge from the vagina. If left untreated, this pyometra can caused serious damage due to the detrimental effects of the toxins produced by the bacteria.

Closed Cervix Pyometra
Due to the lack of the easily recognizable symptom of vaginal discharge, this pyometra is difficult to detect. The dog will also show symptoms include lethargy, depression, inappetance, excessive drinking and urinating, vomiting and diarrhoea. As the toxins produced by the bacteria are released into the blood stream, these symptoms will get worse. The dog will progressively deteriorate, with worsening dehydration, shock, coma and, eventually, death.

Diagnosis:
Blood tests: It is common to get an increase in the total white cells (WBC) in the blood, but normal or low WBC counts do not exclude the diagnosis of pyometra completely. An increase in the total WBC indicates that the body’s immune system is combating an infection. The dog may also become anaemic – reduced red blood cells (RBC) in the circulation – because toxins produced by the bacteria can suppress the bone marrow production of RBC. The body often loses its ability to regenerate RBC. Together with the constant blood loss from the infected uterus, the dog will become more anaemic and the pyometra may soon turn into an emergency situation. In severe cases, the dog may need a blood transfusion to compensate for the blood loss.
Vaginal smear: A smear is made of the vaginal discharge and examined under a microscope. It is possible to visualize the causative bacteria and the WBC produced to combat the infection.
Ultrasonography: This is the most accurate and non-invasive way to diagnose pyometra. The size of the uterus, the thickness of the uterine walls and the presence of fluid accumulation within the uterus can all be determined by this method. In a closed cervix pyometra, the uterus is identified as a series of large, circular, thin-walled structures in the abdomen. In the open cervix pyometra, the uterus is not as enlarged and may be mistaken for intestine if due care is not taken. Small constant contractions in the intestine distinguish it from the uterus. Ultrasonography can also be used to diagnose pregnancy from 20 days onwards.
Radiology: This is not a very effective way to diagnose pyometra. The uterus can be seen radiographically, beginning with the third to fourth week post mating and throughout pregnancy. It is abnormal for a non-pregnant dog to have an easily identified uterus. A fluid-dense tube-like structure thicker than the small intestine in the ventral abdomen is typically seen if a pyometra is present.

Without treatment, pyometra is always fatal. Treatment:
Surgery: The most effective way to treat a pyometra is desexing. Desexing involves removing both ovaries and the majority of the uterus. This method directly removes the source of the infection. In healthy dogs with pyometra, full recovery is expected in a few days post surgery. In severely debilitated dogs, complications associated with the toxins in the blood stream can cause organ failure. Using prophalactic antibiotics, checking organ function by blood tests pre-operatively and administering supporting therapy if required, and supplying intravenous fluids to the dog during surgery, can markedly reduce these complications.
Medicines: Prostaglandin is a hormone that can be used to treat pyometra. It stimulates contractions of the uterine muscles and inhibits hormonal changes within the uterus. It can also lead to numerous complications and is not registered for use in dogs, only horses and cattle. It is, however, an established therapy in dogs with pyometra. It is not recommended for use in severely debilitated animals, or in closed cervix pyometras, because of its potentially fatal effect. Prostaglandin can be used together with long courses of antibiotics, chosen on the basis of laboratory culture and sensitivity. This treatment is only suitable for valuable breeding dogs, because of the side effects and high cost of treatment.
Temporary side effects include restlessness, nausea, abdominal pain, fever and a slow heart rate. These side effects last approximately 45 minutes. Permanent side effects include infertility and increased susceptibility to future pyometra.

“Prevention is better than Cure”

We recommend that female dogs that are not going to be used for breeding be desexed at approximately 6 months of age. Old dogs can be desexed with precautions such as intravenous fluids and pre-anaesthetic blood tests to check for any diseases involving the kidney or liver, as they are the main organs to remove the anaesthetic agent from the body after surgery. The risk of surgery in the healthy dog, irrespective of age, is minimal.

Tick-borne diseases in Hong Kong - Ehrlichiosis

Blood-sucking ticks transmit tick-borne diseases. They are also know as Tick Fevers, as the disease process often causes fevers in dogs. This is a worldwide problem. The two types of tick-borne diseases seen in Hong Kong in dogs are Babesiosis and Ehrlichiosis.

Ehrlichiosis

Ehrlichia is a bacterial infection of the blood and bone marrow, causing anaemia, poor immunity and blood-clotting deficiencies. There are many different species of Ehrlichia worldwide. Ehrlichia are small simple bacteria classed as Ricketsiae. Ehrlichia canis is the species seen in Hong Kong. After the tick transmits the disease, there is an incubation of 8 to 20 days. Three stages of the disease may occur:
Acute phase: lasts from 2 to 4 weeks. Ehrlichia infects white blood cells (WBC) and organs that manufacture and store WBC. These organs include the spleen, liver, lymph nodes and bone marrow. Infection often leads to organ enlargement, inflammation and organ failure in severe cases. It also decreases the blood platelet survival time, which leads to decreased platelet numbers required for blood clotting. This in turn leads to a higher chance of bleeding. The organisms can usually be seen in WBC when examined microscopically, but antibodies to counteract the infection can take some time to develop.
Sub-clinical phase: last from 6 to 9 week. An increased antibody response is seen and similar changes in the blood to the acute phase can be found, but symptoms are minimal or less severe.
Chronic phase: an ineffective immune response develops and the infection increases. WBC and RBC production is further reduced due to impaired bone marrow production. Antibody levels are usually quite high in this phase.

Clinical signs

Acute phase: the most common signs during this phase are depression, lethargy, anorexia, weight loss, fever and difficulty breathing due to bleeding in the lungs. Ticks are found in approximately 40% of dogs during the acute phase. Clinical signs may resolve without treatment but these dogs will remain infected and enter the next phase.
Sub-clinical phase: clinical signs may be absent.
Chronic phase: some dogs may be mildly affected, whereas others show severe complications including depression, weight loss, paleness, bleeding episodes and fluid accumulation in the limbs. Ticks are not usually found during this phase. The animal can be in shock, if there is severe blood loss, and 50% of infected dogs show an increased tendency to haemorrhage. Severe blood losses can also lead to blindness and neurological signs when bleeding occurs into the retina and the brain. It is also associated with arthritis and bleeding into the joints leading to lameness.

Diagnosis:

Since only 50% of infected dogs show increased bleeding tendencies, the absence of haemorrhage does not eliminate the possibility of Ehrlichiosis. Some infected dogs may show atypical signs so clinical findings should be considered along with results of various blood tests.
Blood tests: a reduction in the number of platelets and WBC, and anaemia occur in a high percentage of dogs with Ehrlichiosis and usually persists through all phases of the disease. An increase in liver enzyme activity may occur especially during the acute phase. Kidney function may decrease as a result of dehydration and kidney damage. When kidney damage occurs, proteins start to leak out into the urine causing a decreased blood protein level, which in turn increases weight loss.
Peripheral blood smear: The blood smear is made from a drop of blood collected from the peripheral circulation of the dog (e.g. the ear). The smear is stained and examined microscopically. The Ehrlichia parasite can be seen within the WBC during the acute phase of infection. They can also be found in bone marrow, lung, liver, lymph node and splenic cells.
Antibody test kit: this is probably the most useful and reliable method to detect E. canis in most cases. It is highly sensitive and specific for E.canis and results can be obtained in less than 10 minutes. A false negative result may occur in acute phase cases, as antibodies against Ehrlichia will take a period of time to develop.

Treatment involves the use of:

drugs that kill the organism; and supportive therapy.
Tetracycline is a group of antibiotics, which are commonly used. It is very safe and effective in eradicating Ehrlichia, but because of its potential to cause yellow discolouration of erupting teeth, it is not recommended in animals younger than 5 months of age. Chloramphenicol is another antibiotic that is effective and can be used in puppies younger than 5 months of age. It is also recommended in cases that are resistant to Tetracycline therapy. Some drugs that are used to kill Babesia are also effective against Ehrlichia.

In addition to antibiotics, supportive therapy may be needed, especially in dehydrated animals. Bone marrow stimulation with steroids may be beneficial in dogs with depressed bone marrow production and low WBC. Short-term immunosuppressive medications are sometimes used in cases where there is a severe depletion of platelets and in dogs with multiple joint arthritis.

Prevention:

The primary means of prevention of Ehrlichiosis is to prevent the ticks attaching themselves to dogs. It is also recommended that all blood donors be screened for Ehrlichia, as it can be transmitted by blood transfusion. There are a variety of products that are commonly used for tick prevention in Hong Kong. These include removing attached ticks, products that repel ticks and products that kill the tick on the dog.

Causeway Bay Animal Hospital recommends the following products:

Frontline: this is a product for flea and tick prevention. It has a repelling effect, which reduces the chance of infection. It is easy to apply and can safely be used on puppies that are 12 weeks of age and older.
Revolution: this is similar in application and effect to Frontline, but is also effective in preventing heartworm infections and mite infestations. Both Frontline and Revolution are active only after the tick bites, thus still allowing a chance of infection.
Tick collars containing Amitraz: these collars kill ticks before they attach, as normally it takes about a week from a tick getting onto the dog and the tick biting the dog. It is recommended that a preventative tick collar be used in conjunction with Frontline or Revolution. It is important to differentiate between a collar containing Amitraz and a normal flea collar, as the latter does not affect ticks.

Seizures

Seizures are generally seen as repeated contractions or spasms of the muscles. These are the outward signs of abnormal brain activity, when nerves in the brain send uncontrolled messages around the body. Nerves function by electrical impulses, which are passed by the electrically charged atoms, such as sodium, potassium, chloride and calcium, inside the nerve fibres. Any abnormal electrical impulse in the brain may affect surrounding nerves, like waves in a pool, until a large area of the brain is firing abnormal impulses, which can be transmitted around the body.

The brain, however, has in-born control mechanisms to prevent seizures happening. It is probable that abnormal impulses occur frequently, but are quickly controlled by these mechanisms, so that brain function continues normally. If either the abnormal nerve impulses are too severe to be controlled, or the control mechanism is defective, the result will be a seizure.

There are different grades of seizures:

Minor seizures, which may cause loss of concentration or altered behaviour, but are localized to the brain. If severity increases there may be muscle twitching, often localized to a single muscle or muscle group. Severe seizures will affect several or all muscle groups, the bladder and intestines. They will also radically change behaviour, or cause unconsciousness or coma.

Most seizures seen in animals are severe, although minor seizures may be missed, as symptoms are not obvious. Usually, if seizures occur, the natural control mechanisms will stop the seizures within 30 seconds to a minute. If not, and seizures continue, they will eventually lead to brain damage and death. This is partly because, during a seizure: body temperature rises because of muscle activity; the blood glucose drops, as all sugar is the blood is used up; the oxygen to the brain and tissues decreases because breathing and heart function is impaired; and several other factors.

However, even if these factors are treated or controlled, for instance by anaesthetics to stop contractions, fluid and oxygen therapy, if the brain impulses continue for longer than 20 minutes permanent brain damage is still likely because nerves eventually start to die in the brain.

Why do animals get seizures? Well, there are thousands of causes, but they can be divided into a few main groups:

Damage inside the brain: any abnormal tissue inside the brain can send electrical impulses, which overwhelm the control mechanisms and cause seizures. Infections, abscesses, tumours and even old scar tissue from previous wounds such as blood clots and strokes can be the cause.
Loss of control mechanisms: most cases of true epilepsy are caused, not by increased electrical impulses, but poorly developed mechanisms in the brain to prevent seizures. For this reason, true epilepsy is usually something animals are born with, although they can develop this problem with age, too.
Damage outside of the brain: since nerve function needs a carefully controlled environment of electrolytes and hormones to function correctly, disease affecting the blood levels of these electrolyte and hormones can lead to seizures. Normal blood sugar is needed for healthy nerve function and insufficient sugar available will cause nerves to fail. Any severe imbalance, either too high or too low, of any electrolytes can cause seizures. Many diseases will cause these imbalances. For instances, liver failure may cause high ammonia; kidney failure, high nitrogen and phosphate but low calcium; and tumours may causes various severe imbalances.
Poisons: many insecticides and rodenticides kill their target creatures by affecting nerve function. Organophosphates used for insect control, strychnine for rat control, and even metaldehydes for slug control, can all lead to severe seizures and rapid death.

Although most seizures are not fatal, the cause of seizures should always be investigated, as the underlying disease needs to be treated. Where no obvious underlying disease is present, anti-epileptic drugs can prevent seizures. These do however have side effects, and blood levels of the drugs and potential side effects, should be constantly monitored. Too low levels of the drugs are potentially as dangerous as too high levels and can actually increase the chances of life-threatening seizures. If correctly used, though, these animals should be able to lead completely normal lives.

Skin Problems in Dogs

Summer is a time when we see many dogs with skin problems. A common cause is skin allergies. An allergy develops when the body reacts abnormally against something it is exposed to.

There are many types of allergies. Some only affect the skin, while others may also affect other parts of the body, such as the intestines, throat or lungs. Skin allergies typically start with itching. Certain parts of the body have more nerves which detect itching, so symptoms start there – the paws, ears, face, throat and in-between the legs.

Usually the skin is initially normal but later changes occur – thickening and discolouration of affected areas, increased oil secretions and hair loss. The skin is also less resistant to secondary infections – spots, crusts and raised inflammed areas develop. Hot and humid conditions allow these infections to worsen quickly.

The typical skin allergy is caused by four main things:

Fleas: When fleas bite, they inject a small amount of saliva into the skin. Dogs can develop an allergic reaction to this saliva, which is much more severe and long lasting than a normal fleabite. Even one fleabite is enough to cause allergic dogs to be very itchy all over their bodies for days. The hot and humid environment and small flats are ideal for rapid breeding of fleas, and dogs with allergies need constant treatment of both themselves and their environment to prevent any fleabites.

Contact allergies: This is rare, but direct contact of certain materials with the skin may cause reactions – natural cloth, certain floor types, and even floor wax can be the cause. Usually symptoms will develop in exposed areas with little hair, the feet, the belly and the chin are most commonly affected. Symptoms are usually severe, and diagnosis can only be confirmed by trial exposure if one is suspicious - for instance, a small piece of the suspected cloth can be taped to bare skin and the skin assessed for reaction.

Food allergies: This is also less common than many people think, and in animals it is usually the protein source, although carbohydrates or additives may occasionally cause problems. Normally the problem develops in young dogs, which are fed the same diet for a long period. Remember changing brands of food may not solve the problem, as most commercial dog foods will use similar mixes of protein sources, e.g. chicken or lamb. In the short term symptoms can be relieved with drugs, but in the long term changing to a diet without the cause of the allergy is essential. Prescription diets are usually effective, but no commercial diets are suitable at present. Sometimes people become confused as their dog improves on a diet over time and think this proves the dog is allergic to the old diet. However, all allergies tend to increase and decrease slowly all the time, so often the improvement is coincidental. Also, many diets help alter the skin’s immune system, which is beneficial whatever the cause of the allergy. Food allergy can only be confirmed if the dog improves over a 6-week period, on an exclusion diet, and then worsens immediately when fed the original diet.

Atopy (Inhalation allergies): This is the most common cause of skin allergies. In Hong Kong, many breeds of dogs, including ShihTzus, Schnauzers and Golden Retrievers, are predisposed to develop Atopy. Dust particles are the cause, and the same dust types as cause asthma in people are usually involved. Since most dogs in Hong Kong are kept indoor most of the time, indoor dusts, especially the remains of dead House Dust mites, are usually involved. Pollens, fungal spores and other animals’ hair are other common causes. To develop an allergy the dog needs to be exposed in two ways – Firstly, the dog must breathe in the dust containing the offending particle. Then these same particles need to be present on the skin surface. This triggers the immune system and chemicals released into the skin cause itching, and eventually other changes, which predispose to secondary infections and other complications. Most dogs that develop allergies are most likely, in time, to develop allergies to many different particles, and possibly food sources and fleas as well.

Allergies cannot be cured only controlled. Where possible, the cause of the allergy should be removed. While this is possible for flea and food allergies, it is much more difficult in dust allergies.

To find the cause is difficult. At present only one method is possible, which is intradermal testing. An area of skin is clipped and the skin injected with a tiny amount of the possible dust dissolved in liquid. This area is then assessed for reaction. At present we test for about 30 different dust types, but cannot obviously test for all possible causes, only the most common.

Blood tests have also been advertised or used by vets to try to find the cause of allergies. It is important not to be mislead by these tests – blood tests cannot diagnose allergies or their source. The blood tests can only give an indication of what the dog is exposed to, so a dog living in an old flat with old carpets is likely to test positive for house dust mites, whether allergic or not. A dog on a lamb diet will probably test positive for lamb, but negative for beef or other proteins.

If the source of the allergy is found, we can attempt to desensitize the dog. This involves injecting the dog with a vaccine made of the cause of the allergy. This ‘overstimulates’ the immune system, so that it starts to ignore the cause. This is only successful in 60-70% of cases. If the injections are stopped, the allergy will almost always come back again, so treatment is usually permanent.

Special diets, especially when combined with oils high in certain Omega-3 oils (such as Evening Primrose oil), are also effective in altering the skin’s immune system and reducing and controlling the allergy. This is our main recommended course of action for long-term treatment.

Frequent washing with soap-free shampoos will remove dust particles from the skin, reducing the allergy. All dogs with skin allergies should be on flea prevention treatments.

For dogs that need immediate relief or have secondary infections, drugs are necessary. Cortisone is the most common, and most effective treatment, but the side-effects of high doses or long courses mean that we usually use lower doses in combination with anti-histamines or other drugs which can reduce over-activity of the immune system. New drugs have recently become available which are safer and very effective. However, as they are still very expensive, they probably only need to be used on dogs where other treatments have been ineffective.

In summary, for all allergies there is no permanent treatment. Since most cases will resolve quickly with drug treatment, this is useful, but long-term control is very important. All allergies will periodically worsen and improve, and drugs should only be necessary during the worst periods, to prevent drug-induced side-effects

Blood Pressure Problems

Has your pet ever had its blood pressure checked?

Most people will answer ‘No’, as very few vets offer this service. However, when a person goes to a doctor, measuring blood pressure is as routine as taking a temperature.

So why don’t most vets check your pet’s blood pressure?

The reason is simple – it is difficult! Because of the size and anatomy differences, until recently taking these measurements accurately was only possible with expensive equipment, and often involved placing catheters into veins. More recently, though, easier and accurate systems similar to those used in humans have been developed, although the equipment is still relatively expensive. With this new equipment, the blood pressure can be measured on the tail or the legs of animals.

Is blood pressure as important in pets as in people?

The answer is ‘Yes’. High blood pressure is common, especially in older animals, and is often an early indicator of disease. High blood pressure also causes the pet to suffer discomfort, lethargy, weakness, poor concentration (which may cause loss of housetraining, a change in personality or aggression) and headaches (these are difficult for the owner to assess).

High blood pressure can eventually lead to retinal damage, heart enlargement and failure, kidney damage, and other organ damage. There is an increased chance of blood clots, causing heart attacks and strokes.

What causes high blood pressure?

Certain breeds, male dogs and overweight dogs are more susceptible. Older cats are especially susceptible. Blood pressure is determined by heart output, amount of fluids in the blood vessels and blood vessel abnormalities. Many cases are due to obvious diseases, though some cases cannot be determined. 20% of cats with kidney disease have very high blood pressure. Most cases of heart disease and many hormonal problems (especially excessive thyroid hormone or cortisone production) also have a very high blood pressure. Treatment usually involves curing or controlling the underlying disease, if possible.

If no underlying disease is diagnosed, tablets to reduce blood pressure are effective. These tablets work usually by relaxing or dilating blood vessels and decreasing the force of heart contractions. Special diets are useful in mild cases too. Reduced salt diets, with reduced protein and phosphorus can help.

The animal’s symptoms should stop, making the pet more active and happier. More importantly, however, reduction of high blood pressure will protect against further organ damage, which can lead to blindness, brain damage and eventually death.