Kingsnorth Vets – 18th December 2013

After cleaning several kennels, I was in consults again today. A poorly rough collie was brought in who had a knee joint disease. After lots of tests being done at Kingsnorth and no results being found, it had been referred. However, this had found that the dog had lung disease. Its legs had become worse and it was struggling to walk despite the medication including steroids it was on. Therefore, the owners had asked for another blood test to be taken to see if anything had changed to trigger this period of worsening. We took the dog out to the kennels where I held it with its held tilted upwards to try and reveal a vein. However, at least ten minutes past and neither the vet nor the nurse could find a vein from which blood could be taken whilst the dog was becoming agitated. Eventually, enough dripped into the syringe to run test for and I took the relieved dog back to his owners. Afterwards, I asked the vet about steroids because I have seen many cases in which they have been used but I was unsure about why they were so effective for such a wide range of problems. The vet told me that they were used for any kind of inflammation. They were extremely effective with very few side effects. Furthermore, unlike many drugs including antibiotics, which many anti inflammatories have an element of, they do not need to be taken in a course. However, they can suppress the immune system so should not be used chronically. ‘Steroids’ actually refers to the class of chemicals corticosteroids. These are completely different from anabolic steroids apart from the fact that they are both based on steroid hormones produced in the adrenal gland. Anabolic steroids are used occasionally in veterinary medicine to boost muscle growth.

Two Staffordshire Bull Terriers were brought in for their booster vaccinations. However, whilst they were in the owner wanted to query one of the dogs scratching. It was likely that it had had an allergic reaction to flea bites, but when combed through, there were no signs of fleas. The vet proceeded to check the other dog for fleas as well because if there are fleas in a two dog household, it is likely that both will have them and the itching dog may have managed to scratch all of his off. However, there were still no signs of fleas so a steroid spray was prescribed to reduce the inflammation of the skin causing the itching. The vet discussed with the owner that they could consider changing the food in the long term and explore factors triggering the dog’s known allergies to red meat and dust mites.

A rabbit was brought in needing approval for travelling into Europe with its owner. Unlike cats and dogs, rabbits do not need passports but do need consensus from a vet to agree that they are in good health and vaccinated so won’t take or bring back any diseases. The owner thought that it had been scratching more than usual so the vet brushed some dandruff out of its fur and placed them on a slide. She then looked at them under the microscope and concluded that there was nothing serious although the scratching was most likely to be caused by Cheyletiella, a mite commonly known as ‘walking dandruff’.

Another rabbit was brought in because one of its eyes had been watering more than usual, making its face wet. The eye did not look inflamed or sore and was tested fluorescein negative. However, the fluorescein ran across the face rather than coming out of the nose as it normally would. This suggested that the rabbit had blocked tear ducts as the tear ducts connect the eyes and the nose. Very little could be done about this but the vet prescribed some eye drops to try and unblock them and told the owners to bring the rabbit back in if its eye became sore.

An 8 week old puppy was brought in to have a health check and immediately it became apparent that something was having an effect on its skin. It was very itchy and the skin was scaly, coming away with large clumps of fur. There were no signs of fleas but after taking a sample on a slide, the vet looked at them under the microscope. The vet let me look through the microscope and I immediately saw mites. These were Cheyletiella, as we had expected to see on the rabbit. However this was a much more severe case with the small amount of skin on the slide crawling with them. Cheyletiella are most commonly found in rabbits and although they affect dogs as well, they are very rarely found on adult dogs because the developed immune system of the dog means they have little effect. Unlike fleas which feed on blood, Cheyletiella burrow into the surface of the skin. Therefore, they are treated using a spray rather than a drop on. A spray is sufficient because they are not deep burrowers. If they were it would be expected to see thick crusty skin. After the owners had left, the vet and I watched the dandruff left on the consulting table to see if we could see any movement for Cheyletiella are often called ‘walking dandruff’. This is because they are visible to the eye only as moving pieces of dandruff.

The third rabbit of the day was brought in for its booster vaccination and also wanted to query mites, but this time it was clear that they were affecting its ears. The vet wanted to prescribe a mite treatment, however, the rabbit had recently been given flea treatment although the owners could not remember the brand they had used. This was a problem because if the mite and flea treatments contained the same substances the rabbit could be given a potentially harmful overdose. The owners would contact the vet when they found out the brand of the flea treatment so a suitable mite treatment could be prescribed.

A young collie with irritable bowel syndrome was brought in. It had always had problems with bowel movement and had been constipated so the owner had fed the dog liver to act a laxative which had resulted in diarrhoea. It had a sensitive anus and was very uncomfortable. The vet prescribed liquid paraffin to soften the stools and aid movement. If this did not solve the problem, it was suggested that the dog was brought back for an enema. It was likely that this had been triggered by two sudden changes in food. The owner also talked to the vet about suitable weights for rough collies, for often they can become too thin without the owner realising because of their thick fur.

Finally, a 13 year old whippet was brought in. Its lower canine was digging into the upper gum causing soreness and inflammation. The only way to treat it would be to operate, however, this dog had a grade 6 heart murmur with a loud ‘whoosh’ being heard down the stethoscope with every heart beat. This ruled out many medications and made anaesthetic an extremely dangerous option. Furthermore, when removing canines a surgical flap would have to be created making the procedure more complicated than other dentals. The owner chose to go ahead with the surgery, knowing that although her dog may not make it through it was the only option to make him better.

Your Inner Fish

by neil shubin

published by Penguin Books in 2009

What is this book about?

‘Your Inner Fish’ by Neil Shubin explores the evolutionary history of the human body. The author begins by considering fossil evidence including Tiktaalik which was discovered in 2004 and demonstrates an intermediate between fish and primitive land-living animals. From this point onwards, he relates humans with fish, amphibians and even microorganisms through hands and fingers, teeth, heads, bodies and the senses including smell, sight and hearing. Throughout the book he uses knowledge of genetic makeup and embryology to support the theories he puts forwards, explaining laboratory experiments which of turned on or off specific genes in embryos to find out what happens. For example, in the early 1990s Walter Geyring identified Pax 6 – the gene responsible for the formation of eyes. He did this through experimenting with the gene in flies. If the gene was made active in the antenna, an eye grew there. If the gene was made active in a body segment, an eye grew there. He then took a Pax 6  gene from a mouse and made it active in a fly. The mouse gene caused an eye of a fly to grow on the fly!

By identifying these genes responsible for major body processes, Shubin explains that our evolution can be traced through hundreds of species because the same genes are responsible for the same body processes in almost all animals.

Finally, Shubin uses our evolutionary history to explain the reason for some medical implications including obesity, sleep apnoea, hiccups and hernias.

Areas of Interest for Further Research

  • Scent genes in mammals

In his book, Shubin revealed that all mammals have the same genes for smelling. However, the reason humans have a poorer sense of smell than many other mammals, for example dogs, is because although we have the genes to smell as efficiently, they are active anywhere in our body. Similarly, dolphins and whales have all of the genes necessary to smell. However, none of them are active and therefore they cannot smell. This is thought to be because they do not need to be able to smell to when a genetic mutation occurs, turning off a scent gene, natural selection does not work against the mutation and it gets passed on to the next generation. This is thought to be the same case in humans and other primates for a correlation has been found between improving sight and regressing scent, indicating that when sight is able to compensate for smell mutations turning off scent genes can be passed on without being halted by natural selection.

  • Hiccups

Shubin explains that hiccups are caused when a spasm in a major nerve results in muscles in our body wall, diaphragm, neck and throat contracting. This causes a sharp inspiration of air followed by the glottis at the back of our throat closing the top of our airway, producing the ‘hic’ sound. He then suggests that the nerve spasm is a product of our fish history because the brain originally controlled breathing in fish. Therefore, the brain stem also controls our breathing. However, the impulses have to travel a long distance from the brain to the diaphragm and can be easily interrupted – resulting in a spasm. However, the spasm is only the first part of the hiccup for the ‘hic’ results from the closing of the glottis. It has been found that this is probably a result of our history from tadpoles because when breathing, they have to close their glottis rapidly after inspiring so water can pass into their mouth and over their gills but not into their lungs.

Ways to stop hiccups include breathing excess carbon dioxide and expanding the walls of the chest. Experiments have shown that doing this to a tadpole stops them gill breathing.

How good was this book?

I enjoyed this book and I thought that it followed a good structure with clear subheadings. This meant that it was good to pick at, opening anywhere, or to read from beginning through to end. I found it interesting that it incorporated so many different ideas beginning with palaeontology and exploring genetics as well as embryology concluding with medicine. It used easy to understand metaphors which were often humorous, adding to the overall appeal of the book.

However, I found that I was not fully captivated during the introduction when the discovery of Tiktaalik was discussed in great lengths. I found that it took a long time to reach the point from which the focus of the book was made clear. But despite this weak beginning, the rest of the book travelled at a good pace exploring complex ideas in enough detail to make them understandable but not overwhelming.

Who would I advise this book to?

I would suggest that anyone interested in palaeontology and its modern day relevance should read this book. Furthermore, anyone interested in human evolution and the fascinating link it has with medicine should definitely  give ‘Your Inner Fish’ by Neil Shubin a go.

Scopes

Just a point of interest.

 

Scope – instrument for viewing and observing

Endoscopes: illuminated tubular instrument for visualising hollow organs, often with a channel to pass instruments through.

  • Encephaloscope – cavities in the brain
  • Laryngoscope – the larynx
  • Esophagoscope – the inside of the oesophagus
  • Angioscope – the blood vessels
  • Nephroscope – the kidneys
  • Arthroscope – the interior of a joint
  • Rhinoscope – for nasal examinations
  • Bronchoscope – the interior of the bronchi
  • Gastroscope – the interior of the stomach
  • Laparoscope – the peritoneal cavity (the abdomen)
  • Amnioscope – the foetus through the cervical canal before the membrane is broken
  • Cystoscope – the urinary tract
  • Hysteroscope – the canal of the uterine cervix and the uterine cavity

Anoscope – anal canal

Colposcope – magnifies vagina and cervix

Otoscope – auditory canal and ear drum

Ophthalmoscope – interior of the eye

Microscope – making enlarged images of minute objects

Stethoscope – listening to sounds made in the body

 

To name just but a few!

Kingsnorth Vets – 4th December 2013

Today in the kennels were a couple of dogs being sick. The first was guessed to be just because of an upset stomach as no other cause could be found. However, they could not tell if it was improving because it would not eat in the kennels. Eating is one of the best health indicators, therefore they were going to send it home for the night to see if it would eat at home. If it would not then it would have to brought in again for more investigation to be done. The other dog being sick was only two years old but had already had three operations to remove stones it had eaten. This was the most probable cause of it being sick, however, the x-rays which had been taken had not shown any stones. Therefore, the vets were exploring the possibility of other foreign bodies obstructing the digestive tract. To find out if there were obstructions caused by objects, such as socks, which would not show up on an x-ray they were taking multiple x-ray images over a period of time on which they could observe the movement of gas through the intestine. If gas in the digestive tract was to seen move throughout the intestine and out of the body then it would show that there was probably not an obstruction. However, if the gas did not pass a certain point it would indicate that there was a foreign body obstructing its path. Barium sulfate, used in a barium meal can confirm this movement. Barium sulfate is insoluble, therefore it is safe to use as it will not be absorbed through the intestine wall whilst it is dense enough to block x-rays and therefore show up on a radiograph. The vet showed me several pictures in a textbook, giving examples of barium meal used to highlight the intestine as well as x-rays of foreign bodies in dogs’ stomachs including a corn cob and some buttons.

During the consultations today, a dog was brought in with red and inflamed eyes. The vet looked at them using an ophthalmoscope and could immediately see that the cornea of the eye was smooth meaning that it could be concluded that this was a case of conjunctivitis and there was no need to use fluorescein although I had initially thought this would be necessary. They were prescribed antibiotic eye drops and if no improvement was seen they should bring the dog back in.

A cat which had been in a car accident was brought in for a check up. After the accident, it had been brought in with extremely shallow breathing and in a lot of pain. X-rays revealed that it had a ripped diaphragm. The liver had moved into the thorax and was obstructing the ability for ventilation to take place. The cat had to be operated on immediately to move the liver back into place and stitch the diaphragm back together. The cat was recovering well and rapidly improving.

A dog I saw in the kennels two weeks ago who had his toe removed due to a cancerous lump was brought in for a check up. The bandaging was removed and I could now see that the entire digit had been cleanly removed. It had healed well and although it would take the dog a little while to get used to walking on, it would be much better than the malignant, uncomfortable tumour.

I have previously noticed that when doing a general check up, many vets tap the chest around the stethoscope whilst some do not. Therefore, I asked the vet why this was done. She told me that when tapping you could hear the sound resonating around the chest. If it was a clear hollow sound, this indicated that the chest was clear from obstructions including a build up of mucus or fluids. She used the example of the cat who had ripped its diaphragm. Tapping around the stethoscope here would produce a dull, muted sound because of the liver in the cat’s chest. She told me that some vets only do it when necessary whilst others, like herself, did it in most check ups in order to create a habit of it.

Kingsnorth Vets – 20th November 2013

In the kennels today was a hedgehog which had been found by an owner when their dog attacked it. Luckily, it was not injured and was eating well. Apart from removing a couple of ticks and giving it a quick check over, nothing else had needed to be done so the case was going to be handed over to the RSPCA.

Today was the day of kidney failure; also in the kennels was a very skinny, old cat with weepy eyes being given pain relief on a drip because it had kidney failure, a dog was put down because of a number of issues including appalling teeth and kidney failure, a dog with kidney disease (they hadn’t failed yet) was on a drip, constantly whining and in discomfort. It had instructions to be fed only white fish or its own food, this is because, in order to stabilise kidney disease, one of the most important measure to take is diet management to relieve the kidneys of as much work as possible, reducing the build up of waste material.

Furthermore, during one of the consults I observed, a 12 year old collie was brought it by the kennels it was staying at as its owners were on holiday. It was receiving its normal medication for bladder incontinence but had begun having severe diarrhoea whilst at the kennels. It was not eating and smelt awful. After being taken out to the back, bloods were taken and analysed in the onsite lab. The results showed ion imbalance in the dog’s blood. The low iron levels indicated that it was currently anaemic whilst the overview suggested probable kidney failure. It was put on a drip and given pain relief and anti inflammatory drugs for there was very little else that could be done.

Kidney disease can be caused by a number of problems including infection, diabetes, long-term high blood pressure or kidney stones. Kidney disease often does very little harm, but sometimes it can escalate into kidney failure. This is defined as occurring when the kidneys function at less than 30% of their normal level. When the kidneys are functioning so poorly, the concentration of urea in the body and the levels of water and ions become imbalanced. The build up of toxins in the blood can cause coma or heart attack and will almost always be fatal. In humans, kidney failure can be treated using haemodialysis where the ion concentrations are restored outside of the body in a dialyser. However, when appropriate to do so for a better long-term treatment, the patient will undergo a kidney transplant. At the moment, neither of these methods are available for veterinary use in the UK.

A rabbit was brought in to have its claws clipped. I was staggered at the length of them, especially because the owner said that she frequently let the rabbit run on her patio. However, this made no difference to their length as would be expected because the claws were growing in the wrong direction. This meant that the owner would need to ensure that they were clipped as often as necessary to prevent them becoming uncomfortable.

A cat was brought in for its vaccination. Its brother has a heart murmur so the vet also took this opportunity to listen very carefully to this cat’s heart for any signs of heart problems. A heart murmur occurs when a valve in the heart is damaged so when the muscles contract, there is some backflow of blood. The place in which the murmur occurs is dependent on the valve which is damaged. This can become a problem if there is not a great enough volume of blood being pumped under high enough pressure out of the body for cells will not receive sufficient oxygen to aerobically respire. Luckily, this cat only had slight signs of heart murmur so it was rated grade one. The vet explained to me afterwards how murmurs are placed in categories and graded based on their intensity. This ranges from grade 1 – ‘A quiet murmur that can be heard only after careful auscultation over a localised area’ – to grade 6 – ‘A murmur sufficiently loud that it can be heard with the stethoscope raised just off the chest surface.’

An overweight dog was brought in needing nutritional advice for, despite the vet suggesting dietary plans, the dog had lost no weight. The vet suggested a number of options including specially designed ‘obese’ diets, however, the only fool proof way to improve the dog’s weight loss would be to reduce the amount of food that it was being given and encourage more exercise. Portions of food can be reduced slowly so that the dog doesn’t notice and when done gradually, the dog should not become hungry quickly.

A dog was brought in with diarrhoea. The vet asked very carefully about the appearance of the faeces. The owner reported that there was blood and mucus, however the blood was only in streaks. This suggested that it was not a big problem and probably just an upset stomach from something that had been eaten. The vet prescribed anti inflammatories to help settle the swollen stomach and bowels and instructed that the dog should only be fed bland food such as white fish and rice. The vet explained to me that if there had been lots of blood in the diarrhoea, this would present a different, much more serious problem, probably caused by infection. Therefore, antibiotics would be given. There was a chance that this case was the beginning of an infection and could escalate but the vet hoped that it was not. If the diarrhoea did not cease and the blood became more severe, the owner would have to visit again for the situation to be reassessed.

The final appointment of today was a border terrier with an ulcer on its eye. Previously, the ulcer had covered almost the whole eye but after applying fluorescein,  the green dye highlighted a much smaller area, showing that the eye was healing quickly as expected. When the dog had been brought in initially, the eye had to be locally anaesthetised because of the extremely sensitive cornea and very strong muscles in the eyelid which could not be opened. However, after being prescribed eye drops, the dog looked much happier and in very little pain with no anaesthetic required. The vet explained that the dog would have to continue to be brought in to be checked until the eye had fully healed. This is because the ulcer could develop rough edges. This would be a problem because healing happens from the outside inwards, with cells building up and over the wound, burying the damaged cells. Therefore, rough edges on the ulcer would halt the progress of the cells for they would be unable to climb across the ulcer. If this was shown by the fluorescein the vet would smooth the edges of the ulcer with a cotton bud. After the consult, the vet told me more about fluorescein and how if there was a darker patch in the centre of the green highlighted ulcer, this would suggest that the damage penetrated deeper into the eye. This would be a serious problem and would be referred to a specialist.