We are very pleased to announce that we have just published some groundbreaking research into the genetic causes of cardiomyopathy in IWH! We have paid for it to be open access too so that everyone can read the entire article. Naturally we are going to explain the work in future Nottingham days and we have given an update to the health group. Our work suggests that it might be many genes together which increase the chance of cardiomyopathy, so no simple solutions yet but this is outstanding news not only for the canine world but also has implications in human medicine. The Nottingham Canine Health Genomics
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Irish Wolfhound Health Group
Pyometra - An open and shut case? 24 July 2013 at 12:12 Pyometra – an open and shut case? Pyometra is the term given to the accumulation of pus within the uterine cavity. The name literally means “pus in the uterus” –from the Greek pyo – meaning ‘pus’ - and metra referring to the ‘uterus’. From the start of their first season all bitches, regardless of age, are at risk of developing this serious condition. Signs and symptoms do not always follow the text books – as we were reminded last year……………. August 2011 was a month of mixed fortunes and emotions in the Goldswift household. Our Cairnstorm Fable of Goldswift had just become a Champion and celebrated her 5th Birthday. The house was full of cards, balloons and gifts and we were on a real high. Then all five of our girls came into season and soon after, we noticed that our other ‘blonde bombshell’, 9 &-a-half year old Jasmine, seemed to be a bit off colour. We returned to the ‘real world’ with a bump. It’s not unusual for our girls to be a bit under par during and after a season, so at first we weren’t too concerned. Also, with Jazzy’s advanced years, it’s difficult to tell if signs of lethargy are due to illness, or the ageing process. However, by Day 10 of her season, we began to get really worried that something was wrong. We thought there had been an increase in the amount she was drinking and weeing (although most bitches tend to wee more when they are in season) and she had been sick once. Jasmine~ aged 9yrs My first thought was that she might be developing a pyometra. Although the signs were subtle, I was reminded that our firstWolfhound, Willow had developed a pyometra at exactly the same age, also with very subtle signs. Then I thought, Jasmine couldn’t have a pyo, as she was in the middle of a season. Willow had just finished a season – but only by a day or so. She had been a little quieter than usual, but given her age, even though she was exceptionally fit, we would have been expecting her to slow down a bit with age. She hadn’t been off her food, hadn’t been sick and hadn’t been drinking excessively. I just thought that towards the end of her season she was maybe a little off colour. It was nothing specific – just a feeling something wasn’t quite right. I remembered we were sitting on what passes for the lawn, in the back garden and Willow rolled over on her back for a tummy tickle. As I was cuddling her, I said “Willow – if I didn’t know you’d only just finished a season, I’d have thought you were pregnant!” Then I thought(stupidly) maybe our Mercury had got to her (der!!! ………. she’d hardly be showing signs that early!) Then it just hit me that it was a pyometra – even though she’d only just finished a season a few days before and had no discharge. There was just something different about her ‘upside down’ shape,that wasn’t evident when she stood up – and I just had a gut feeling (excuse the pun!) that it was a pyo. I took her straight to our vet, who was sceptical due to the lack of apparent symptoms, the timing, the lack of a discharge,absence of fever and normal white cell count. After some discussion, he agreed to scan her and we were both amazed to see that she did indeed have a very large, closed pyometra. There was no option but to prepare her for surgery. She was put on a drip and I waited with her, while the fluid therapy was administered and the theatre staff assembled. Despite the fluids, she deteriorated rapidly within a couple of hours and by the time she was operated on, her uterus was so full it was on the point of rupture. We were shocked at how quickly the pus had built up, especially as just a couple of days beforehand, she had been in season. We were so lucky that she survived the operation– and as many of you will know, she went on to live until 12 years of age J. Our other experience of pyometra was with 4 year old Grace. She was just recovering from kennel cough and we had put her lethargy and depression down to that. However, another ‘gut feeling’ told me that there could be a more serious reason for her being poorly. She had finished her season about 8 weeks previously. Sure enough – she also had a closed pyometra. Other than being a little reluctant to exercise, she was almost completely asymptomatic. She did however appear to have gained a little weight - again – not unusual in a post season bitch – and she had been mated (unsuccessfully). It was the slight weight gain that made me think ofWillow’s story. Grace’s operation was successful, but sadly we lost her nine weeks later, due to a blood clot in her brain, which may or may not have occurred either as a result of the surgery, or the infection itself. Since both Willow and Grace had experienced the same problem, with unusual and subtle presentations, I had read quite a lot about the signs, symptoms and reasons for developing, pyometra. At no time did I recall reading that it was possible for a bitch to develop pyometra during a season. I looked for information in books and on theInternet – but couldn’t find any references to bitches developing a pyo whilst still in season. I put a post on my Facebook page to ask if anyone had heard if this was possible. Of the many replies I received, only two people had experience of this – one was a vet nurse, who had seen it in the surgery and one was a Wolfhound owner from Spain, whose GSD had developed it.
Jasmine was still eating and pooing normally, she was drinking less, her temperature and respiration were normal, but she had as lightly elevated heart rate. Her season (bleeding) appeared to have stopped and was replaced with a thin, milky (non-offensive) discharge. Although she seemed a little brighter in herself, we still took her to the vet, who gave her a thorough examination. She concluded that there was no evidence that this was a pyometra and said that the change in discharge had likely coincided with the hormone change that takes place around Day 10 of the season. Because Jasmine was so fastidious about keeping clean, there was a noticeable change in the bleeding stopping& lubrication for mating commencing. The vet thought there was an over-production of this, which indicated there could be an infection present,which was more likely to be vaginitis. The vet thought that the colour, texture and lack of odour of the discharge, was not suggestive of pyometra. She was also not at all tender in her abdomen. She was flying her tail bless her – (for the first time ever! Some of you may remember that many moons ago, Jazzy was not too keen on being mated) – so it did seem to be connected to the hormone change. Abroad spectrum antibiotic was prescribed and we left feeling reassured. Over the next couple of days, she showed signs of improvement – all her ‘obs’ were normal, but she still had the milky discharge. Then to our great disappointment, she became worse again over the weekend. Her temperature and resting heart rate went up, she was panting and generally restless. She was still eating and drinking normally, until the Monday morning, when she refused her breakfast. As this had not happened EVER in 9 years (not since she had pneumonia as a 6 month pup) - alarm bells rang. Her resting heart rate had increased to 130 and she was suddenly drinking more again. Her hindquarters looked like she's been smothered in PVA glue. We returned to the vets and by that time, the discharge had changed to a pale tomato-soup colour. We saw a different vet, who thought the discharge to be more indicative of a pyometra. This was confirmed via ultrasound scan. She was admitted immediately for an ovariohysterectomy. Jasmine had been heart tested clear earlier in the year, so we were hopeful that despite her years, she would come through the surgery well. According to the vet, on presentation the previous week, it was too early to detect the pyometra. At first, I have to admit to feeling a little angry that the vet hadn’t taken my ‘gut instinct’ more seriously. However, always keen to see the positive side -the fact that she was on supportive antibiotics over the weekend, meant that at least her immune system had a bit of help prior to the op and the vets had a full team at the surgery on the Monday morning. Happily,Jasmine made a swift and full recovery from her surgery, although she did develop a severe gastric problem, due to an adverse reaction to the medication.This took a further fortnight to resolve. She was very poorly indeed for the best part of a month – but she pulled through and has just celebrated her 10th Birthday.
As a result of these less than typical experiences and the fact that we didn’t find useful information to be easily accessible,I’ve been prompted to write this. I am not medically qualified, but I hope that this article may be helpful from an owner’s point of view. After all, we are the people best placed to notice the subtle changes in our hounds’ behaviour and health. Pyometra is not an easy condition to diagnose on symptoms alone, as there is such a wide variation and almost all could be more readily attributed to other factors. There are many myths and old wives’ tales and even some vets are ‘locked in’ to the idea that pyo’s only occur at a specific time, with a specific set of symptoms.I hope the following may help owners to have a clearer understanding of what may cause pyometra and what signs to look out for. Why should I be concerned about pyometra? All bitch owners should be mindful that signs of a pyometra ‘brewing’, are often subtle. Any un-spayed bitch, of any age, who has had a recent season, or is actually in season and appears unwell,should always be suspected of having a pyometra. Having had three bitches diagnosed with unusual presentations of pyometra, I would advise everyone to monitor their bitch’s behaviour closely, during and for at least12 weeks after her seasons. If in any doubt – please consult your vet. Pyometras can be ‘open’ or ‘closed’ – this refers to whether the cervix (neck of the uterus) is open or not. Neither condition should ever be taken lightly. In ‘open’ cases the pus is able to drain out, but this does not mean that the condition will clear by itself. Some bitches with open pyometra may appear relatively healthy, except for the abnormal vaginal discharge. However, they may actually be very unwell and ‘open’ pyometras can become ‘closed’ at any time. In about 15% of cases, the cervix is closed, which means that the pus remains trapped within the uterus. This can be extremely dangerous to the bitch’s health within a very short time, so early diagnosis is essential. If the bitch is very ill, the toxins may also affect her kidneys & liver. If not treated quickly, this could result in permanent damage to kidney function. A blood test may be taken to estimate the damage to the kidneys before and after surgery.Ideally, IV fluids will be administered before the anaesthetic, to rehydrate and reduce the likelihood of kidney damage. However, with closed pyometras, due to the difficulty of diagnosis, rapid accumulation of toxins and potential for deterioration of the bitch, immediate/emergency surgery is required to save the bitch’s life. The photograph to the left, shows the uterus of a giant breed bitch, filled with pussy infection, at the time of spay for pyometra. A normal uterus should be about the size of the outside diameter of the finger holes in the clamps shown in the picture. What causes a pyometra? Pyometra represents the final stage of a process of uterine disease, which can be insidious in its progression. A pyometra occurs as a result of hormonal changes. Bitches’ ovaries produce progesterone after oestrus, to prepare the uterus for pregnancy. These hormone levels remain elevated for 8-10 weeks. As the lining of the uterus thickens, glands develop in readiness to release nutrients for nourishing the early embryos, until the placentas develop. Normal uterine defence mechanisms are also suppressed, to prevent them from attacking the newly implanted embryos. These changes take place whether the bitch is pregnant or not and whether she has been mated or not. This process progresses with each non-pregnant cycle that the bitch has. Multiple non-pregnant oestrous cycles are associated with the changes that result in pyometra. It is therefore true that bitches who have never had a litter, are more susceptible to developing pyometra. Bitches who have had a litter get a ‘fresh start’, as the uterine lining is completely replenished after giving birth. Some bitches are unusually sensitive to the effects of progesterone. If this is this case, the uterine lining thickens excessively and the glands develop abnormally, sometimes forming cysts. This condition is known as cysticendometrial hyperplasia (CEH). This in turn releases excess secretions and thus fluid may accumulate inside the uterus. This fluid provides a good environment for bacterial growth, especially since uterine defences are inhibited. Progesterone may also inhibit the white blood cell response to bacterial infection. This is why sometimes with pyometras there is no evidence of a rise in the white blood cell count. It is therefore not a reliable indicator for diagnosis of pyometra. Under normal circumstances, a healthy uterus is naturally sterile. However, this can change when the cervix is open during seasons. The most likely sources of uterine contamination are bacteria from the normal vaginal flora, or subclinical urinary tract infections. Contamination may also occur if the bitch has been mated. E-coli is the most common bacterium isolated in cases of pyometra, although other bacteria have been recovered. In mild cases, there may be no clinical signs, thought he bitch may have had a history of infertility. If the infection becomes severe enough, pus forms in the uterus, and the bitch develops pyometra.
Other causes Other factors proven to be associated with the occurrence of pyometra, include post insemination infections and the administration of long-lasting drugs to delay or suppress seasons. According to the Merck Veterinary Manual, the administration of “mismate shots” also greatly increases the risk of developing pyometra and should be discouraged. Although rare, it is possible for pyometra to develop, if some uterine tissue is left behind after ovariohysterectomy. This is referred to as stump pyometra. Pyometra can also occur secondary to metritis, after giving birth. So when might my bitch be at risk? Having scoured many books and websites, I found that the following examples are the most quoted, useful (or not!) guidance, widely found in veterinary textbooks,specialist dog books and well-respected sites on the Internet:- “Pyometra is seen 4 to 8 weeks after oestrus, sometimes longer” “Pyometra is reported primarily in older bitches (>5 yrs old)” “Pyometra can occur as early as the end of heat or as late as 12 weeks after heat” “The infection will most often develop within weeks of going out of heat, whelping a litter, or after being bred and missing conception” I only found one reference to a pyometra being possible in an in-season bitch and this was when I was researching this article. So, I would say that the following statement is the most accurate and helpful to bitch owners and should be borne in mind for all un-spayed bitches:- · “Pyometra can occur in bitches of any age,anytime during and up to 12 weeks after the bitch has visibly finished her season, whether she has been mated or not. It can also occur secondary to metritis after giving birth” What signs should I look for? Signs can vary and may cause some confusion. In a few cases, many of the clinical signs are absent. However, drinking or urinating excessively, seem to be present in most – but by no means all - cases. Toxins released by the bacteria often affect the kidneys. This is what causes an increase in drinking and urination. The classic signs are: · Increased thirst/urination : Vaginal discharge :Lethargy : Vomiting : Enlarged belly : Fever : Depression : Loss of appetite : Overall weakness. · In some cases the bitch can show signs of back pain and loss of function in the hind legs. · Older bitches may exhibit a poor coat, and possibly a mild discharge after every season, which over time gets progressively worse. Obviously, any of these signs can have a number of other causes. However, a purulent, vaginal discharge – at ANY time – evenDURING a season - is the most obvious indication of infection. If the cervix is open and the uterus is draining (as with "open pyometra") there will be a discharge from the vagina of pus and/or blood. This may, or may not have an odour and can be white and milky, cream and sticky, pale green, brownish-grey, or pale red-orange (tomato-soup) Any unusual discharge should always be taken seriously and the cause investigated by your vet. Closed pyometras are more difficult to detect symptomatically – as are open pyometras that occur during a season. In closed pyometras, the swollen uterus might be evident as abdominal distension. However, this is easier to see in smaller breeds. In giant breeds, with their more capacious bodies and the tendency to change shape and/or gain weight after a season, this distension may be less noticeable – even in severe cases. It is also more difficult to assess, if your bitch has been mated; the increase in girth could be mistaken for pregnancy. It is difficult in Irish Wolfhounds to successfully detect pregnancy by appearance and palpation alone, until the later stages. If you are hoping that your bitch is pregnant, but concerned that she might be ill, then an ultrasound scan is indicated, to differentiate an accumulation of pus, from a litter of puppies! The bacteria and pus in the womb release toxins,which are absorbed into the blood, thus making the bitch ill very rapidly. A seriously ill bitch should show obvious signs of being unwell. I have to say that none of our bitches showed well-defined, typical signs (but isn’t that just typical of Wolfhounds?!!) Or perhaps, I should clarify this and say that in all three cases, there were other factors that caused us to fail to immediately attach significance to some of the signs. Veterinary Diagnosis X-rays are not reliably interpreted. They may reveal the presence of an abnormally enlarged fluid-filled uterus in a bitch that is not pregnant, or who is in early pregnancy. In mid-pregnancy, it is not that easy to distinguish between a uterus filled with pus and a uterus filled with pups! The puppies’ bones become calcified enough to show up on an X-ray, only in late pregnancy. In open cases, the discharge from the vulva is usually diagnostic,but vaginal cytology is helpful in determining the nature of this, as in some cases, the condition has been mis-diagnosed as an aberrant heat. Blood tests will usually, but not always, show an elevated white blood cell count, in response to the infection. A full blood profile and urinalysis, will help exclude any other causes of vomiting, and/or excessive drinking/urination. These also evaluate kidney function and septicaemia. Only 20% of affected bitches present with a fever. The only definitive way to detect a pyometra is via an ultrasound scan of the uterus. This also has the advantage of being done immediately at the surgery and will show if your bitch has a uterus full of pus. How can I avoid my bitch developing pyometra? Bitches who have been successfully spayed, do not get pyometra. If you do not intend to breed from your bitch, the only way to ensure she does not develop pyometra is to have her spayed when she is young and fit,when surgical risks to her are minimal. Treatment The best treatment for this condition is ovario-hysterectomy– (spaying – i.e. the complete removal of the uterus and ovaries). Due to the toxins that can rapidly build up, your bitch may be weak and in need of fluids and antibiotics for a few days. If toxins from the bacteria are causing septicaemia, only surgical removal of the infected uterus can resolve the septic condition. There is a medical treatment for pyometra, although it is not without risk. Prostaglandins are a group of naturally occurring compounds that relax and open the cervix, contracting the uterus to expel bacteria and pus. They also decrease the production of progesterone. However, they are not always successful in completely expelling the bacteria and have some serious limitations. As the uterus contracts, it is possible for it to rupture and spill infection into the abdominal cavity. This is most likely to occur when the cervix is closed and is often fatal.Therefore, this treatment should not be used in a closed pyometra, as it could result in peritonitis and likely - death. For breeding bitches, administration of prostaglandins and antibiotics in an open pyometra may be successful,but this does not prevent this condition from happening again. Bitches who have previously had pyometra, will almost certainly have a recurrence, if not bred from the following season. It should be noted that putting bitches on good antibiotics such as Baytril, prior to mating,can also make them more prone to infectious disease, by killing off normal organisms. Treatment with prostaglandins can be extremely unpleasant for the bitch. The twice-daily injections administered over the course of a week, are intended to cause strong (often painful) uterine contractions to squeeze the pus out of the uterus. The treatment causes vomiting, and it can cause diarrhoea. Antibiotics are used for several weeks as follow up therapy. Prostaglandins can also cause such side effects as restlessness, panting, anxiety, vomiting, diarrhoea, salivation, tachycardia and acute abdominal pain. These can occur within 15 minutes of the injection and last for several hours. No clinical improvement is evident for at least 48hours, so bitches which are very ill at presentation, have a very poor prognosis with this treatment. It should also be borne in mind that the likelihood of a bitch returning to her reproductive capacity after pyometra varies considerably. If she was never successfully bred before, she probably still won't get pregnant. If she has previously whelped a litter and is in good health,there is a 50-75% chance that she will be able to bear another litter. Her fertility may be reduced due to uterine damage caused by the pyometra. If there is uterine scarring, there are fewer locations for the new embryos to implant,and litter size will be smaller. These statistics should also be considered before choosing this treatment:- ▪ The success rate for treating open cervix pyometra is around 75%. ▪ The success rate for treating closed cervix pyometra is less than 25%. ▪ The rate of recurrence of pyometra at the next season, in bitches who do recover, is 75% - and the severity is usually increased. Therefore, the Merck Veterinary Manual recommends that the bitch should be bred on the next and each subsequent cycle, until the desired number of puppies has been produced - and then spayed. For all of the above reasons, the safest course of action for a bitch with pyometra (either open or closed) is ovario-hysterectomy. (Missed full stop here and need them below!) So this goes in the 'lessons I've learned from my wolfhound' book:- · Pyometra can happen:- During a season :Immediately after a season : Up to 12 weeks after a season : After whelping a litter. · A slight raise in temperature and a heart rate just past the top end of normal, can still be indicative of something very wrong. · If it’s going to happen during a season - the hormone level change (pretty much coinciding with bitches feeling 'sexy') is the most likely time for a pyo to develop. In this case, discharge changes from the usual blood - to thin & milky - to glue-like and sticky. · If it's draining freely, the discharge may not befoul smelling. · The absence of a discharge, does not mean an absence of pyometra. · In the early stages, the bitch may not show any obvious signs - may not be off her food - may be only slightly off colour - and may present with no apparent discomfort when fully examined abdominally. · If in doubt – get an ultrasound scan – even if you think it’s only for your peace of mind – it could just save your bitch’s life. · Listen to your 'gut feeling' .………. and most important of all …………. listen to your bitch . What are the odds of three hounds from one household all being unlucky enough to have unusual presentations? I’m guessing that a lack of obvious symptoms is not as unusual as the textbooks would have us believe. I was sceptical about joining ‘Facebook’,but if it hadn’t been for the help we received from our FB friends, our dearJasmine might not still be here. I hope that this article may go some way to thanking everyone for their input and to pool information gathered. Perhaps it may even help save a life ……………. by Caroline
DR JEAN DODD’S PET HEALTH RESOURCE BLOG
For some of us, coconuts conjure up images of palm trees and tropical locales. For others, they take us back to mouth-watering memories of our mother’s home-baked coconut cream pie – or even the sweet, gooey center of our favorite childhood candy bar! But did you know that besides tasting delicious, the oil pressed from the meat of the coconut contains numerous health benefits, for people and companion animals? Let’s take a closer look at coconut oil and why you should consider adding some to your pet’s diet. If it’s saturated, isn’t it bad? Fats are made up of fatty acids that fall into three categories – monounsaturated, polyunsaturated and saturated. Saturated fats, which are predominantly found in animal products such as meat and dairy and are solid at room temperature, have been linked to a host of health issues in people such as obesity, high cholesterol and increased risk of heart disease. As a plant-based saturated fat, coconut oil was once grouped with other unhealthy fats, and people were advised to avoid consuming it. However, even though coconut oil is a saturated fat, it is not unhealthy. In fact, it contains numerous health benefits! The chemical structure in coconut oil is quite different from the fat found in, say, a steak or a slab of butter – and that difference has huge implications for our health and our pets’ health. Whereas most saturated fats are comprised of long chain fatty acids (LCFAs), coconut oil is comprised mainly of medium chain fatty acids (MCFAs), or medium chain triglycerides (MCTs). Our bodies metabolize (break down) and recognize medium chain fatty acids differently than long chain fatty acids, producing a very different effect. Benefits of coconut oil There are many reasons to let your pet indulge in some coconut oil every day. For example, we now know that, unlike animal-based saturated fats that contribute to heart disease, coconut oil is actually heart healthy! Coconut oil also contains lauric acid, a saturated fatty acid that converts in the body to monolaurin, a monoglyceride compound with numerous beneficial properties, including anti-viral, anti-bacterial, anti-microbial, anti-fungal and anti-protozoal. Lauric acid actually destroys lipid-coated bacteria, fungus and viruses such as herpes, the measles, influenza, hepatitis C and HIV, ringworm and athlete’s foot. In addition, studies show that MCTs such as those found in coconut oil provide a wide range of health benefits, including: • Help with weight loss (MCTs increase metabolism, send signals of satiety and cannot be stored as fat) • Improve digestion and absorption of fat-soluble vitamins • Benefit the skin and coat • Provide a rapid form of non-carbohydrate energy
Coconut: the new “brain food” But of all these benefits, my favorite is that coconut oil is scientifically proven to improve brain function in older dogs – findings that have important implications for people and animals. In one study, 24 senior Beagles fed a diet supplemented with 5.5% MCTs showed significant improvement in cognitive ability within just one month. The study’s authors concluded that the MCTs (as contained in coconut oil) provided an alternative source of brain energy for the senior dogs. As the body’s “supercomputer”, the brain requires a lot of energy, most of which is satisfied when our bodies metabolize glucose from the foods we eat. However, as we age, we metabolize glucose less efficiently, leaving a “gap” in the brain’s energy requirement. When this occurs, alternative sources of fuel become important to fill this gap and provide much-needed energy to the brain. This is where MCTs such as those contained in coconut oil can help save the day: • Unlike regular fats (which the body metabolizes slowly), MCTs break down and absorb rapidly into the bloodstream, providing a quick source of non-carbohydrate energy.• MCTs readily cross the blood-brain barrier, supplying up to 20% of a normal brain’s energy requirement. • MCTs are important for ketone production, which serve as an additional source of “brain food”. • MCTs help the body use omega-3 fatty acids more efficiently and increase omega-3 fatty acid concentrations in the brain (a good reason to give your dog both omega-3s and coconut oil)
What to look for When purchasing coconut oil, opt for unrefined, cold-pressed varieties. If possible, choose organic brands to avoid potential contamination from pesticides. Coconut oil does not need to be stored in the refrigerator, but since it is light sensitive (like all oils), it’s best to keep it in a dark cupboard. Dark glass containers are excellent storage choices, as they protect the oil from light while also ensuring that no BPAs (harmful chemicals found in many plastic containers), leach into the product. There are many ways to incorporate coconut oil into your pet’s diet. Try mixing a tablespoon into some sheep’s milk yogurt or adding a dollop on top of some fresh organic blueberries. You can even scoop it straight from the container and let him lick the spoon. Pets love the taste! Studies show that coconut oil fed as 10% or less of your dog’s diet poses no digestive or other health issues. However, since too much coconut oil can cause diarrhea, I advise exercising common sense and introducing it to your pet slowly. Resources Aldrich, G, 2009, ‘MCTs an overlooked tool in dog nutrition’. Feedstuffs, 81(35) :10. Laflamme, DP, 2012, ‘Nutritional care for aging cats and dogs’. Vet Clin N Am: Sm An Pract, 42(4): 769-791. Pan, Y, Larson, B, Araujo, JA, Lau, W et al, 2010, ‘Dietary supplementation with medium-chain TAG has long-lasting cognition-enhancing effects in aged dogs’. Brit J Nutr, 103 (12): 1746-1754.
(Also known as dydmitis and linked with Epididymitis: inflammation of the testicular tube where sperm is stored)**
One of my male Wolfhounds (no prizes for guessing which one) was diagnosed with Orchitis at 12 months of age and this article is designed to try and explain what the condition is, how it is caused and how it is treated and to give hope to anyone else unfortunate enough to be in a similar situation. I am not a vet, but this is my own experience as an Irish Wolfhound owner of an issue that can occur in males of any age.
Orchitis /ˌɔrˈkaɪtɪs/ or orchiditis /ˌɔrkɪˈdaɪtɪs/ (from the Ancient Greek ὄρχις meaning "testicle"; same root as orchid) is inflammation of the testes.1 It can also involve swelling, heavy pains and frequent infection, and is more rarely known as didymitis (as in epididymis). [taken from Wikipedia at http://en.wikipedia.org/wiki/Orchitis]
Signs/symptoms We got up one morning to find Presto looking very distressed and seemingly unable to stand up. He was 12 months of age at this point and an ongoing issue with HOD, (which he had been diagnosed with 2 months previously) caused us to think that he had experienced a flare-up of that condition. In addition to the reluctance/inability to stand, he also refused food (again this is unheard of for Presto and we would have to be under nuclear attack for him not to eat his breakfast). Convinced the problem was his affected femurs (long bones in the back legs going from the knee up to the hip) my husband returned home from work and Presto was taken to the veterinary consultant (Graham Oliver of East Midlands Referrals) who had already been treating the HOD. I checked the dog’s temperature and it was high and all discomfort was concentrated around his back legs, but at this point we could not see any other likely causes for his physical state. In other dogs suffering this condition there may also be symptoms such as blood in the urine. However, I should point out that the number 1 symptom is the glaringly obvious one of swelling to the testicles! It took the veterinary consultant and another vet (who happened to be present at the consultation and who was being mentored by the consultant) 30 minutes of examination and prodding and poking before the cause of the problem was discovered. It was actually my husband who pointed out that Presto screamed in pain when his tail was pulled tightly around his bottom and therefore Steve thought the problem must be located in that area and not Presto’s legs or spine (as both vets thought). Sure enough, once Presto had been laid on his back, the right testicle was very swollen and almost glowing red. You can well imagine that the pain associated with Orchitis can be excruciating (for any men reading this article, bet you’re crossing your legs right now and grimacing!).
The most common symptoms are [taken from PetMD website at http://www.petmd.com/dog/conditions/reproductive/cmultiepididymitis_orchitis?page=show#.UdFYKzu1F8E]: · Swollen testicles · Licking of the scrotum and scrotal skin irritation (dermatitis) · Non-localized symptoms include pain and fever · Unwillingness to walk and general lethargy · Open wound may be found · Refusal to eat is not uncommon · Infertility is commonly seen in dogs with this condition
Causes There are 2 main causes of Orchitis (and/or Epididymitis) and these are trauma or infection. In Presto’s case we initially thought that there had been some infection trigger to set off the condition, but this would have had to have been a direct source of infection (in other words an infection that entered through his urethra and lodged in one of the testicles) and we had seen no other indications of that. So we eventually concluded that it had been caused by trauma, the other main trigger for Orchitis. Usually direct trauma occurs to the affected testicle in the form of the dog injuring itself through normal daily activities such as playing or possibly from a bite wound. We could not locate any marks/bites on Presto and so came up with the one and only likely scenario for trauma-induced Orchitis, yes, you guessed it – Presto had been humping our St Bernard! We did speak to other Wolfhound owners at the time to see if anyone else had experienced anything like this before and to our relief we discovered that a friend’s dog had also suffered trauma-based Orchitis after having played with some younger Wolfhounds and one of whom had dived on the male whilst he was laying and rolling around on his back. A huge thank you to Caroline Sheppard for her great support, advice and experience on this topic as, without her invaluable insight, we would have been even more distressed than we were and also would have probably put Presto through a castration surgery that would have turned out to have been completely unnecessary.
Diagnosis As mentioned previously, the diagnosis in Presto’s case was by physical examination by 2 vets and we eventually discovered the very swollen testicle. However, as the outward symptoms also mimic testicular torsion or a testicular tumour, further investigations were carried out to rule these other 2 conditions out. Presto was nlikely, but not ruled out completely (it is vital for the testicle to be checked in this manner as a torsion will cause the die-off of the testicle and potentially be fatal to the dog). We then began the ‘waiting game’ to see if the inflammation and swelling would subside. Caroline had advised us that this could take several weeks, but that Presto should feel much more comfortable after a couple of days of pain relief and antibiotic treatment. This turned out to be exactly what happened. After 2 weeks of very little reduction in the swelling, our vet was concerned that there was still the possibility that Presto could have a testicular tumour so we decided to allow him to operate and open up the testicle. The deal was that if the vet found a tumour then he would remove the testicle and so Presto would be ‘half castrated’. The day before the surgery was due to take place we decided to have Presto checked again as we thought the swelling had gone down and sure enough our vet agreed that it was definitely decreasing in size and so the surgery was cancelled (coupled with the advice from Caroline, we were all happy that things were moving in the right direction and we needed to wait longer).
Treatment Presto was initially given antibiotics (Noroclav 1500mg bid, 6ml Noroclav injection and Clindamycin 1900mg bid) as we were unsure of the cause of the Orchitis and also pain relief through analgesics (Tramadol 100mg qid, Pardale 600mg bid). The medication ensured that he became much more comfortable very quickly, although the actuall swelling of the testicle took much longer to go down. As mentioned previously, an ultrasound scan was also performed to check blood flow to the affected area. Caroline had taken her affected dog to a fertility consultant for examination and she was informed that the swelling would subside and that the testicle may well continue to shrink, ending up significantly smaller than the unaffected testicle – probably to about the size of a walnut, but the other testicle would remain fertile. In Presto’s case the damaged testicle has indeed shrunk and we now have a broad bean look going on!
Summary Presto’s right testicle is hardly visible at all now (4 months on from the initial event), but it can still be located, with a bit of fumbling around and is literally about the size of a broad bean.
We were quite lucky that this turned out the way it has, but once again, I would urge anyone in a similar situation to seek urgent veterinary treatment as the cause of the Orchitis could be torsion or tumour and could need immediate attention to not only save the testicle, but even save the dog’s life. In the interim between this happening to Presto and writing this article, I have already been in communication with another Wolfhound owner whose young male IW displayed identical symptoms, but in that case the ultrasound showed no blood supply as a torsion had occurred and so the dog was castrated. Finally, a huge thank you once again to Caroline Sheppard for all her help during a very trying time and another one of Presto’s great adventures!
These days HOD can easily be diagnosed as Panosteitis in Irish Wolfhounds
HOD - HYPERTROPHIC OSTEODYSTROPHY - BARLOW'S DISEASE, IDIOPATHIC OSTEODYSTROPHY, METAPHYSEAL OSTEOPATHY, MOLLER-BARLOW'S DISEASE, OSTEODYSTROPHY II AND SKELETAL SCURVY.
This Great Dane puppy suffering from HOD shows swollen joints on the front legs http://www.vetsurgerycentral.com/hod.htm This Great Dane puppy suffering from HOD shows swollen joints on the front legs http://www.vetsurgerycentral.com/hod.htm
Hypertrophic Osteodystrophy (HOD) is a bone disease that occurs in fast-growing large and giant breed dogs. The disorder is sometimes referred to as metaphyseal osteopathy, and typically first presents between the ages of 2 and 7 months. HOD is characterized by decreased blood flow to the metaphysis (the part of the bone adjacent to the joint) leading to a failure of ossification (bone formation) and necrosis and inflammation of cancellous bone. The disease is usually bilateral in the limb bones, especially the distal radius, ulna, and tibia. [ Wikipedia] Diagnosis
Presto was fine for a couple of days after the initial flare-up and then the following Friday the same thing happened again! Once more we rushed him to the vets and they recommended X-rays (done a few days later) and he received more pain relief and more antibiotics.
The X-rays came back completely normal for his spine, legs, hips and tail. I should mention at this point that a friend’s Wolfhound puppy had just been diagnosed with meningitis on the spine after showing similar symptoms to Presto and so we were all very worried about a long term prognosis for Presto. Again, Presto had a relapse a few days after finishing the medication and so we were referred to a local veterinary orthopaedic consultant (Graham Oliver at East Midlands Referrals in Hucknall, Nottingham) for an emergency MRI scan. The MRI finally found the cause of the problem in the top of Presto’s femurs (the long bones in the back legs that go from the knee up to the hip) where a cloudy area in the bone identified an area of infection actually inside the bone itself (see image below): Image shows Presto laid on his back with his left hind leg visible on the right hand side of the X-ray. The red arrows point to the outline of a circle of ‘clouded’ bone which is where the infection is located. A subsequent bone tap and sample taken from inside the femur confirmed that infection was present. The sample was grown on in the lab, but the results were inconclusive (not unusual with samples taken from joints or bone), other than it was definitely some kind of infection.
Taking X-rays to determine a diagnosis is the usual first step with suspected HOD and will certainly rule out several other possible conditions at least. In our case the X-rays were not that helpful and so the MRI scanner was used to go right inside the bones and identify the problem areas. As you can probably imagine though, MRI Scans are not cheap (neither are a set of X-rays) and so the cost of such investigations may be prohibitive if the dog is not covered by pet insurance, so do not be surprised if a ‘tentative’ rather than definite diagnosis is made. In Presto’s case the symptoms were not the usual ones seen with HOD and so other possible conditions were also indentified including Osteomyelitis. Wherever possible, a definitive diagnosis is essential as it will also determine the effectiveness of the treatment given and possibly affect how well the dog responds. * Treatment* Treatment methods for HOD have been somewhat controversial and are also dependent upon the severity and symptoms displayed and also whether the condition is caught at an early or advanced stage. Dogs with severe and late stage HOD may require hospitalization, IV fluids, nutritional support, round the clock nursing as well as a host of medications. Most sufferers are given pain relief in the form of NSAID’s and antibiotics, but some dogs may also be administered immunosuppressants and steroids (the latter 2 treatments may not be applicable for young puppies due to the possible effects on the growth plates). In Presto’s treatment plan daily doses of antibiotics (Ceporex) and anti-inflammatories (Previcox) were used over a period of 3 months to halt and clear up the infection and prevent the bone disintegrating (which would have been disastrous and resulted in euthanasia), alongside pain relief when required (Tramadol). The treatment was very successful and we were thankful that we had caught the condition very early and also had excellent veterinary care from both of our vets.
You may be wondering why I have put this section at the end of the article, when it is more usual to include it at the beginning? The main reason is that most research is inconclusive and so the cause or causes of the condition are NOT known and therefore less emphasis needs to be placed on what causes HOD. Also, the temptation for many owners is to try and identify ‘what went wrong’ and often this results in them blaming themselves. Please try and avoid doing this if you find yourself in the same situation, concentrate instead on getting a quick diagnosis and treatment for your dog. Some research studies into the condition have suggested possible triggers for HOD including:
Lack of vitamin C Overdose of vitamin C Diet too high in calories Bacterial infection Viral infection Excessive calcium supplementation Reaction to vaccination In Presto’s case we believe that it was a viral infection that set off the HOD as we found the infection present in the femurs on examination.
In conclusion, be reassured that HOD is not that common, particularly in Wolfhounds and if diagnosed and treated, the condition can be dealt with very successfully (Presto made a full recovery over several months). Also, it is one of those conditions that look like several other things and prompt veterinary attention is essential. The cost of treatment can run into several thousands of pounds however, so it is another great reason to ensure that your dog has adequate insurance cover. In very severe cases HOD can be fatal, but generally the prognosis is good.
© Ali Irvine 2013
Sadly there has been a couple of incidents recently of Irish Wolfhounds contacting Pneumonia, and one of the hounds did not pull through. Our heart felt condolences go out to the owners at such a sad time.
It is the view of many who have experienced pneumonia in their hounds that the use of Excenel really works, but must be kept going long enough to prevent it’s return. Excenel is not actually licensed for use in dogs, but hopefully your vet will allow you to sign a disclaimer.
In America the drug of choice for wolfhounds is Rocephin (ceftriaxone), a 3rd generation cephalosporin, which is not licensed in the UK. Excenel is the drug recommended by wolfhound people in the UK who have had experience of pneumonia. Excenel is also a 3rd generation cephalosporin, available in the UK licensed for pigs, but not licensed for dogs. To obtain it, a waiver needs to be signed by you. Wolfhounds are unique in their presentation of pneumonia.
They may have a normal temperature and their lungs may appear clear on x-rays.
There have been a number of cases of Vets misdiagnosing pneumonia as heart failure. If your wolfhound has clear lungs, does not have a raised temperature, but does have atrial fibrillation, some Vets will put the difficulty in breath ing down to heart failure, and treat that, not the pneumonia.
The Irish Wolfhound Health Group has put together this Guide to Pneumonia in the Irish Wolfhound:
In America the drug of choice for wolfhounds is Rocephin (ceftriaxone), a 3rd generation cephalosporin, which is not licensed in the UK. Excenel is the drug recommended by wolfhound people in the UK, who have had experience of pneumonia. Excenel is also a 3rd generation cephalosporin, available in the UK, licensed for pigs, but not licensed for dogs. To obtain it, a waiver needs to be signed by you and this can be requested from your Vet.
Note on Dosage: Anecdotal evidence suggests Excenel is given as a 4.5ml subcutaneous injection every 24 hours – and is often combined with Antirobe. This dosage is based on experience and a history of success using the drug for pneumonia in the Wolfhound. It has been observed that treatment length can vary from five days to six weeks, depending on the severity of the infection. It is strongly recommended that you discuss your dog’s requirements with your veterinary surgeon, ideally before the need for it arises, as not all veterinary surgeries will keep Excenel in stock.
Note to Veterinary Surgeon: Excenel is marketed as Naxcel in the US. Naxcel is licensed for UTI’s in dogs, information regarding Naxcel can be found on the Pfizer website.
Wolfhounds are unique in their presentation of pneumonia. They may have a normal temperature and their lungs may appear clear on x-ray for several days after the dog first shows signs of illness
There have been a number of cases of Vets misdiagnosing pneumonia as heart failure. If your wolfhound has clear lungs, does not have a raised temperature, but does have atrial fibrillation, some Vets will put the difficulty in breathing down to heart failure, and treat that, not the pneumonia.
Difficulties in breathing.
Head lowered and stretched forward level with the back, neck extended to expand the airway as much as possible.
Dog reluctant/unable to lie on its side.
Dog may or may not be coughing
Temperature may be very high – but a normal temperature does not necessarily preclude a diagnosis of pneumonia.
Their lungs may appear clear on x-ray.
There have been cases of pneumonia in wolfhounds following a lungworm infection. (Lung worm is no longer restricted to the south of England, and is present in most areas)
URGENTLY- if there is any doubt, treat with the antibiotics first, and argue later – do not take a wait and see attitude.
Most Vets will want to administer an antibiotic intravenously, as it is important to hit it hard and fast.
Fluids intravenously should be considered – but care should be taken if your wolfhound has a heartcondition.
Excenel is the drug recommended by wolfhound people who have had experience of pneumonia in the UK.
Other antibiotics have been used – Ceporex, Baytril and Antirobe, Cefuroxime, Zithromax, Marbofloxacin and Trimethoprim sulfa, but there is a better chance of preventing a recurrence with Excenel.
Drug treatment needs to continue for at least 4 weeks.
Steam and coupage can assist in moving the congestion from the lungs
If your wolfhound has had pneumonia, it is more likely to have it again.
Convincing/ alerting Vets
BEFORE THIS HAPPENS – Please have a conversation with your veterinary surgeon to ascertain their views on using Excenel should the situation arise. When a dog is already sick, it is not a good time to find out that your Veterinary Surgeon will not consider alternative treatments from the mainstream
The IWHG comprises members of each of the breed bodies. None is a qualified veterinarian: any suggestions made are based purely on the personal experience of those wolfhound owners who have had to use the drugs mentioned and are a guide only for you to discuss with your own vet. It is the responsibility of the owner to make a decision on any course of action they take with their hound and we strongly recommend that this is done in conjunction with your vet.
For more information and information sheet, please click on the link below
We always shunt test our puppies, and it is a day we like to get behind us. With some of our litters our vet and veterinary nurse came to us, but for our last litters we started to visit our the surgery. We find that we work as a team: our vet, two if not three nurses and two of us. We pull up outside the back door and the smooth system commences, with love cuddles and hugs all the way.
Time is of the essence from being fed to having the blood drawn. Each puppy has blood taken for the bile acid test, and for AHT. From experience the samples are best taken from the lower front leg. Some puppies are very brave and some not so, but there are plenty of us available for the traumatised! After blood has been taken, each puppy is vet checked, mouth, eyes, ears, heart listened to, joints, stomach and of course the boy bits.
For ease and expediency I microchip at home, and have the forms ready with the chip identity stickers on. I also take the rest of the microchip stickers and these are used on vaccine cards and sample bottles. My biggest fear has always been mistaken identity, and chipping is I feel the only assured way to be certain. In addition it serves another purpose for new owners as they are assured they get the puppy they have chosen. This is something that I feel very strongly about. The first bonding moment is very important, and sometimes it’s the puppy who chooses their new owners and home.
So far I have never had a puppy fail a test, but no doubt that day will come, and I will have to remain strong for that moment. Hence I hate liver shunt test day and waiting for the results. Although we say we can spot a shunty puppy and so does the vet, but the element of surprise is always there.
What is a Liver Shunt?
Liver shunts cause serious and sometimes fatal outcomes in dogs. A liver shunt, or a portosystemic shunt, is a normal fetal blood vessel that in the womb bypasses liver tissue, allowing the mother’s system to filter out toxins for the developing puppy. In some animals, however, the shunt remains open after the animal is born, compromising its liver function, slowing growth, and eventually resulting in death of many affected animals.
What are bile acids?
Bile acids are produced in the liver and stored in the gallbladder between meals. They are released into the intestines to help break down and absorb fats, and are reabsorbed and stored again until they are needed. Dogs with liver shunts have increased blood bile acid concentrations because the liver does not get a chance to remove and store these chemicals after they are reabsorbed.
So please when buying your puppy ask to see his or her liver shunt certificate, and enquire if that certificate is included in your puppy pack, because it should be. At no extra cost to the breeder either. Check the microchip number against your puppy’s number. This can be found in the centre column underneath the Idexx name. See Test Report for one of my puppies. It still happens that breeders don’t test, or say they have tested, and haven’t, for whatever reason. One such incident has happened recently, two puppies were sold and the new owners had to cope with very sick puppies and £4,000 in vets fees each. Please check and ask for your shunt test report.
More very useful information can be found here:
In Accordance with the Irish Wolfhound Club Code of Conduct point
19) Are strongly recommended to screen all puppies for Portosystemic Shunt and only stock clear of the condition should be sold. Affected hounds should never be used for breeding.
In Accordance with the Kennel Club Assured Breeder Requirements it states:
Liver shunt testing of all puppies prior to being sold