Conditions

What is it?

An allergy is an abnormal immune reaction to an otherwise harmless substance (an "allergen"). Allergies are one of the most common causes of skin disease seen in dogs.

What causes it?

Your dog's immune system is a very powerful, very effective defence mechanism - anything that gets into them that it doesn't recognise is attacked and destroyed. However, sometimes the immune system can make a mistake, and respond to a harmless substance in the environment (such as pollen, or a particular type of food, for example). Of course, this cannot be destroyed but the immune system tries really hard to do so! The most common allergen in dogs is thought to be flea saliva (nasty, but not actually harmful!), but they can respond to a wide range of other substances, such as pollen, certain types of protein found in food, storage mites, cleaning products, fabric softener and many more.

What dogs are at risk?

Any dog may develop an allergy; however, it is most common for dogs to become allergic early in adult life. It's important to remember, too, that a dog cannot become allergic to a substance until they have been exposed to it on at least two occasions.

What are the symptoms?

The exact symptoms will depend on what part of the immune system has been stimulated; in general, however, most allergies in dogs present with skin symptoms (yes, even food allergies). These include itching, reddening of the skin, hair loss, self-trauma (from the scratching) and secondary infections. In many cases, the skin first affected is that lining the outer ear canals, so dogs with allergic skin disease may initially appear to have an ear infection; the softer skin between the pads on their feet is also commonly affected (when this is involved, we call it "pododermatitis"). In other cases, the allergy may cause a runny, itchy nose ("allergic rhinitis", very like hayfever in humans!), itchy, sore eyes (allergic conjunctivitis) and, rarely, stomach upsets (especially diarrhoea).

How is it diagnosed?

There are three approaches to diagnosis. The first is to look at the history - when do the symptoms appear, are they associated with any type of food, or bedding, or environment? Do they only appear after walking under certain trees in the park, or if you've used a particular fabric conditioner? This will often allow us to determine what types of things are causing the allergy, but not always. If not, we can use special tests such as the IgE Blood Test (to look for raised levels of antibody in the bloodstream) or the Intradermal Allergen Test (where we inject certain substances into the skin and then measure the response). These both have strengths and weaknesses, but using a combination of the two we can usually determine the cause of your dog's allergic reactions. The exception is food allergies, as there are no lab tests that can diagnose the condition. In the case of a food allergy, the only way to demonstrate it is to put the dog on an Exclusion Diet, where they eat only either novel foods (that their immune systems have never been exposed to before) or, better, a hydrolysed diet (which is specially formulated so the immune system cannot respond to it). If the symptoms resolve, then we reintroduce one foodstuff at a time until we discover which one is the problem!

How can it be treated or managed?

The ideal treatment for any allergy is simple - avoid the allergen! In some conditions (like Flea Allergic Dermatitis) this is very doable - it isn't easy but it is possible to eradicate fleas in your house. However, this isn't always practical, so there are other options. The first is medication - there are a range of different medications available to reduce itching and damp-down the immune system's abnormal response. Some are rarely successful (such as antihistamines), some have many side effects (like steroids) and some are very expensive (like ciclosporin), but careful and judicious use of medication can make all the difference to a dog's quality of life. Other possibilities include desensitisation, where we "teach" the immune system to ignore harmless allergens.

Can it be prevented?

No - predisposition to developing allergies is partly genetic, but it also depends on the environment. Unfortunately, at this time they cannot be prevented.

What is it?

Anaemia is actually a symptom, not a specific disease. It refers to a situation where there aren't enough red blood cells in the dogs bloodstream to effectively transport oxygen around the body.

What causes it?

There are a wide range of different conditions that can cause anaemia. Broadly speaking, these can be divided up into three areas. Firstly, those conditions characterised by loss of red blood cells. This essentially means blood loss - after a serious injury or wound, the dog will become anaemic because they have lost so many red blood cells. Secondly, diseases that result in the destruction of red blood cells, such as Immune-Mediated Haemolytic Anaemia (IMHA, where the immune system malfunctions and starts destroying red blood cells) and Babesia infection (where a parasite attacked and destroyed the cells). Finally, anaemia can also result if the body isn't making enough - for example, in iron deficiency and malnutrition, chronic, long-term disease, kidney failure, or certain diseases of the bone marrow.

What dogs are at risk?

It depends on the type of anaemia, and the specific underlying disease - for example, tumours are more common in older dogs, whereas immune mediated anaemias are more common in young adults.

What are the symptoms?

It will of course depend on how severe it is, but generally, the symptoms include pale or white gums, poor exercise tolerance, breathlessness and panting (even after little exercise, or at rest), rapid heart rate and, in some cases, collapse.

How is it diagnosed?

Firstly, we'll have to look at your dog's blood. We'll use machines in our lab to count the numbers of red blood cells, but then we'll have to look at the cells under our microscope to try and work out what's going on. It may be necessary to use other, specialist tests (such as the Coomb's Test for immune mediated anaemia), and the blood sample may need to be sent away to an external laboratory. Essentially, we will try and work out what the cause is, so that we can correct it. In a few cases, this can be really complicated, requiring lots of different techniques such as X-rays, ultrasound, additional blood tests, and even bone-marrow biopsies to determine what's going on.

How can it be treated or managed?

In most cases, once we can determine the underlying cause and stop that, the anaemia will resolve on its own. For example, surgery to close a bleeding wound; medication to kill Babesia parasites, suppression of the immune system in IMHA, iron supplementation if the diet is deficient, etc). However, if the anaemia is very severe, it may be necessary to carry out a blood transfusion from a donor dog to supply extra red blood cells, and buy us time to work. Sometimes, the cause isn't something we can fix, sadly, but in the majority of cases, it can be either fixed or managed with medication.

Can it be prevented?

It depends on the cause. Babesia infection, for example, can be prevented by using good tick repellents; immune mediated anaemia, however, cannot be predicted or prevented.

What is it?

Dogs have a pair of anal sacs (often called "anal glands") situated just inside their anus. In a healthy dog, these glands empty every time they go to the toilet - modifying the smell of the dog's faeces so that they can be used to communicate with other dogs (although they all smell equally vile to us!). If these glands become impacted, the secretions inside cannot be squeezed out. As a result, the glands become increasingly full, swollen and uncomfortable.

What causes it?

Any source of a "malfunction" in these glands can lead to problems. Most commonly, the glands fail to empty properly, and so become progressively fuller. The usual causes are an episode of diarrhoea (runny faeces don't squeeze out the glands as effectively as nice solid ones); poor conformation of the glands (which is probably genetic); or an increase in the "thickness" of the fluid (for example, a primary infection, but this is quite rare). Once the gland is impacted and unable to empty itself, secondary infections (which are very common!) occur. This causes the tissue to swell, making the impaction even worse. Eventually, if not expressed, a large and painful abscess will form next to the dog's bottom. When it ruptures, it may ooze pus all over the dog's back end, or burst internally causing severe internal infection.

What dogs are at risk?

Any dog may suffer from anal gland problems; however, toy and miniature breeds seem to be at higher risk of abnormally shaped or positioned anal glands. A dog who has suffered from a recent episode of diarrhoea is also at much higher risk.

What are the symptoms?

The first sign is usually "scooting" - rubbing their bottom along the floor, trying to squeeze out the glands. If this is not successful, they may start licking, scratching or biting at their back end. As the glands become more swollen and painful, they may become constipated - they don't want to go to the toilet because it hurts so much!

How is it diagnosed?

Very simply - one of our vets will put a finger in your dog's bottom and feel the glands. They'll easily be able to tell if they're swollen, blocked - and if they're painful, your dog will make it very clear...!

How can it be treated or managed?

The vast majority of anal gland issues are simple impactions, and our vets can easily "squeeze" them out and empty the overfull gland, solving the problem. Occasionally, if the gland is really swollen and inflamed, we may need to give them a short course of antibiotics and anti-inflammatory medication before we can empty them. If this isn't sufficient, the next option is to admit the dog for surgery and surgically drain the glands.

Can it be prevented?

Some dogs are particularly prone to anal gland disease; for these, we'd recommend a small change in the diet (typically, a slight increase in the fibre content) which will allow the passing faeces to squeeze out the contents more effectively. If that isn't enough, we can always surgically remove the glands - this is a pretty complicated operation, and there are possible side effects, but it definitely removed the problem!

What is it?

Also known as "Atopy", Atopic Dermatitis is the second most common allergic disease in dogs, with as many as 15% of dogs affected. It may best be described as a condition where the dog's immune system is hyperactive, giving them a predisposition to developing allergies to multiple different harmless chemicals (or "allergens") in the environment.

What causes it?

Atopic Dermatitis is a genetic condition, although the exact mechanism isn't well understood. It causes a predisposition to developing allergies, and may also make the skin more susceptible to bacterial infections as well. Affected dogs may become allergic to pretty much anything - typically we'd expect to see allergies to grass, tree and other plant pollens, harmless mites (like dust mites or storage mites), as well as foodstuffs (typically protein sources such as beef or soy) and other ubiquitous substances. Occasionally, however, dogs develop much more unusual allergic reactions, for instance to perfume or even rice.

What dogs are at risk?

Although Atopy is seen in many breeds, the most heavily predisposed is the West Highland White Terriers. Other breeds with a higher than average chance of developing the condition include Staffordshire Bull Terriers, Boxers, Labradors, Golden Retrievers and German Shepherd. The symptoms always appear first in young dogs - although they may be so mild at first that they aren't noticed or diagnosed until the dog is older.

What are the symptoms?

Atopy results in what we often call "allergic skin disease"; however, it is often more severe and harder to manage than other skin-based allergies. The most characteristic symptom is violent itchiness - often dogs will rub themselves raw trying to scratch - which is usually worst on the face, in the armpits and on the feet. Other symptoms often include repeated "ear-infections" (because the ear canal is lined with skin!), and skin infections ("pyoderma"). The end result is hair loss, reddened, sore or scratched skin, and then infection with pustules forming.

How is it diagnosed?

Unfortunately, it is very hard to diagnose atopy conclusively - we generally work by "ruling out" other options! That said, the most powerful diagnostic technique in our armoury is the 2009 Favrot Criteria, which comprise a list of "check-points" we score the dog against. If 5 are met, there's an 80% chance the dog is atopic; if we can match 6, that goes up to 90%. There are different versions of the test, but the criteria usually include: (1) symptoms appearing before three years old; (2) the dog mainly lives indoors but is still affected; (3) the itching improves if steroid medication is given; (4) the itching occurs before the hair loss or rash; (5) the front feet are affected; (6) the centres of the ears are affected, but (7) the edges are not; and (8) the dog's belly is more severely affected than their back.

How can it be treated or managed?

Sadly, there is no cure for Atopic Dermatitis. However, it can be managed, and there are a wide range of different management options available. The key (if possible!) is allergen avoidance - if your dog isn't exposed to any of the allergens they overreact to, they won't develop symptoms. Allergy Tests (which may use a blood sample or a skin-prick test) can tell you what your dog is reacting to, so you can take steps to minimise their exposure. Skin treatments can be very useful, such as fatty acid sprays and soothing shampoos; but medications are usually essential. The mainstay of management is generally a drug called ciclosporin, which "tunes down" the immune response, but other options include steroids (effective but often with severe side effects if used for too long) and oclacitinib (an anti-itching drug). There's also the possibility in many cases to use immunotherapy with a vaccine that helps to "teach" the immune system that a particular allergen is harmless. In most cases, no one approach will be successful on its own, and managing a dog with Atopy requires experimentation and committment to find the combination of techniques that works for them.

Can it be prevented?

There is no preventative medication or screening test at the moment, unfortunately, for this genetic disease.

What is it?

An aural haematoma (sometimes called a "cauliflower ear"!) is like a bruise inside the ear. However, because of the location, the blood doesn't dissipate, but forms a large swelling between the layers of skin and cartilage inside the ear flap. In this sense, it's more like a blood blister, causing massive swelling and deformity of the affected ear or ears.

What causes it?

The most common cause is the dog shaking their head excessively - so it's worth thinking of the haematoma itself as a symptom rather than a disease in its own right. The most common causes are ear infections; ear mites; and foreign objects (like grass seeds) in the dog's ears. This makes them scratch at their ears and/or shake their heads, resulting in rupture of the fine blood vessels inside the ear flap.

What dogs are at risk?

Any dog may get an aural haematoma, but it is most common (and usually most severe) in dogs with long, floppy ears like Setters or Spaniels. These dogs are more likely to injure their ears when shaking, and are also slightly more likely to suffer from ear problems in the first place.

What are the symptoms?

It depends how severe it is. A mild case may just have a swelling (often reddish or blue-purple) on one part of the ear flap (pinna); whereas a more severe one might result in the whole ear flap blowing up like a balloon. The swelling may be soft or hard to the touch, depending on how recent the bleed is and how much the blood has clotted. Usually, they are uncomfortable initially but soon become painless.

How is it diagnosed?

The symptoms are pretty characteristic, but if in doubt, we can put a needle into the swelling and draw out some of the fluid - if it's blood, then the diagnosis is confirmed.

Can it be prevented?

Rapid and effective treatment of ear infections and other diseases will in most cases prevent an aural haematoma from forming in the first place. If you have a dog with itchy ears, regular cleaning with a suitable ear-cleaner will often help too.

What is it?

Babesiosis is a disease caused by infection with Babesia canis. It is spread by ticks and causes anaemia.

What causes it?

The Babesia organism is a microscopic parasite a bit like an amoeba. It can only survive and breed inside red blood cells - unfortunately, by living inside them it damages the cells. These organisms are spread by tick bites, and until recently, wasn't found in the UK. Unfortunately, in 2016 the first UK-based transmission of the disease occurred, and it is now thought to be present in our native tick population. The good news is that it can only be transmitted by the Meadow Tick (Dermacentor reticulatus) which is relatively uncommon; the common Sheep Tick (Ixodes ricinus) doesn't carry the disease.

What dogs are at risk?

Any dog may be exposed to tick bites if they go outside. The East of England is currently the highest risk area for Babesia, but as the disease will be carried by foxes, it won't remain isolated to this region indefinitely.

What are the symptoms?

The destruction of red blood cells results in anaemia, meaning the dog is unable to transport oxygen around their body successfully. The symptoms do vary a little from dog to dog, but usually involve shortness of breath, lethargy, pale gums, discoloured urine and jaundice.

How is it diagnosed?

The parasites are usually visible if we look at a blood sample using a microscope. However, confirmation of the diagnosis requires special stains and so we'll often send a sample away to an external lab for an expert pathologist to confirm.

How can it be treated or managed?

There are no licensed medications for dogs in the UK to kill the parasites, but we can order them in from other sources if needed. In addition, infected dogs are often very, very sick (some will sadly die even with treatment) so intensive care nursing in the practice is essential if they are going to survive. This may also require a blood transfusion, to replace the infected and damaged red blood cells.

Can it be prevented?

There is no vaccine against Babesia, but the need for a tick is the organism's weak link! Ticks can only transmit the disease after they're firmly secured to your dog (usually 24-48 hours after the initial bite), so an effective tick control product will minimise the risk of infection. If you find a tick on your dog, use a tick hook to remove it (or ask one of our nurses to do it!).

What is it?

Bladder crystals form in urine all the time - there are loads of unwanted salts and waste materials in urine which can react together to produce them. Normally, however, they are so small that they don't cause any problems. Sometimes, however, the stones may get large enough to irritate the bladder lining, or even cause a blocked bladder - which is a medical emergency.

What causes it?

There are a number of different types of stones, each with their own set of causes. The more common ones are: (1) Struvite (also called "Triple Phosphate" or "Magnesium Ammonium Phosphate"), which are usually caused by infections, alkaline urine, or sometimes minor dietary imbalances. (2) Cystine, caused by acidic urine, usually only a problem in dogs with a particular genetic disorder. (3) Calcium Oxalate, which may be caused by a genetic disorder, abnormal calcium levels (typically in dogs with a tumour or a parathyroid disease), or antifreeze poisoning. (4) Urate, usually caused by liver disease but is normal in some breeds of dog!

What dogs are at risk?

Any dog may develop a bladder stone - most commonly struvite, triggered either by a urinary tract infection or a slight dietary imbalance. Cystine crystals are most commonly seen in breeds such as Newfoundlands, Bassets and Chihuahuas; whereas the gene causing Calcium Oxalate production is more common in the Yorkshire Terrier and Lhasa Apso (among others). Urate crystals almost always mean liver disease - except in Dalmatians, where they are a normal finding! If stones do start to form, they are unlikely to cause a blockage in bitches (whose short, wide urethra or "urine tube", is normally able to expel them). They're much more dangerous in male dogs, where they may block the urethra or become lodged in the penis bone, preventing the dog from urinating.

What are the symptoms?

The most common symptom is cystitis (although this may also be the cause, especially with Struvite!). This typically causes blood in the urine, pain and discomfort on urination, and unusually frequent production of small amounts of urine. If the bladder becomes blocked (a "Urinary Obstruction"), however, the dog will be straining to urinate without passing anything except perhaps a small amount of blood-tinged fluid. Once their bladder is full this will result in uraemic poisoning, causing depression, dehydration, vomiting, collapse and, ultimately, death if not rapidly treated.

How is it diagnosed?

We can see the crystals in urine samples when we look at it down the microscope - each type looks different so we can tell which we're dealing with (for example, Urate crystals look like spindles or spiky balls, whereas Struvite forms rectangular crystals sometimes described as being like "coffin lids"). An obstruction, however, we would usually diagnose based on the presenting signs, an overfull bladder, and evidence on blood tests of dangerously high levels of urea in the blood. Sometimes, we can see the stones in the bladder too, with ultrasound or X-rays.

How can it be treated or managed?

Many stones (Struvite, Cystine and Urate) can be dissolved with a proper diet - we recommend a commercially prepared diet that is formulated not just to prevent them from forming, but to dissolve any stones already present. However, if they are too large, or are causing an obstruction, they usually have to be removed surgically. Many stones lodged in the urethra can be flushed back into the bladder, and then we can remove them easily from there in surgery, but if not, we will have to cut into the urethra to remove them.

Can it be prevented?

If you have a dog who is prone to bladder crystals or stones, an appropriate diet is the best way to prevent them.

What is it?

Cancer, or more properly neoplasia, is an abnormal growth of body cells. It occurs due to damage to the DNA (the "blueprints" or "instructions" that tell the cell how to behave), and especially to those genes which tell a cell when to stop multiplying itself. However, it's important to realise that cancer isn't a single disease - there are thousands of different types. Some are benign (grow but don't spread); some are malignant (invade tissues and spread around the body); and some are intermediate, being invasive but not prone to spreading.

What causes it?

Ultimately, all cancers are due to a mistake when copying the DNA, and is usually due to a random mistake. However, most mutations do not cause cancer - the damaged cell may repair itself (there are enzymes called dismutases whose only job is to fix errors in DNA!); if not, it will usually self-destruct, and if it doesn't, the immune system is very, very good at finding and destroying any mutated cells. However, with so many billions of cells in the body, every now and again, one slips through the net, and grows into a cancer, or tumour. That said, although there is a constant background level of random mutations occurring, some environmental factors can increase the risk - such as radiation, certain chemicals (carcinogens), or because they've inherited defective genes that mean the body doesn't shut down a cancerous growth so efficiently.

What dogs are at risk?

In general, cancer is a disease of older dogs - because they've had many more cell divisions, and therefore more chance of a mutation occurring somewhere along the way. There are a few tumours that are predominantly seen in younger animals, but they are relatively uncommon. In addition, there are a few breeds that are at increased risk of cancer (such as Flat Coat Retrievers) because of their genetics. Finally, some animals are immune to some types of cancer - for example, a castrated dog cannot develop testicular cancer because he doesn't have testicles to become cancerous!

What are the symptoms?

Ultimately, it depends on what the cancer is, where it is, and how big it is. For example, a brain tumour may cause seizures or wobbliness, whereas a bone tumour in the leg might cause lameness. In general though, in most cancers you would expect to find a lump or swelling somewhere in the body; weight loss; lethargy and perhaps depression; swelling of the dog's lymph nodes (as the immune system tries to fight it); and occasionally vomiting or diarrhoea.

How is it diagnosed?

As usual, it depends on the type of tumour! There are, however, a range of different techniques we can use. In general, blood tests or the symptoms will make us suspicious of a tumour somewhere, and then we go on a "tumour hunt", using our eyes and hands, plus X-rays and ultrasound scans (and sometimes CT or MRI scans) to look for it. Once we've found the lump, we'll often take part of it out and send it to a pathologist to find out exactly what it is (you can't always tell just by looking!) and how best to treat it.

How can it be treated or managed?

There are four major approaches. (1) a benign, slow growing tumour (such as a lipoma), may simply be left and monitored, especially if the dog is very old and sick and treatment might be more dangerous than it's worth. If it changes behaviour or starts causing a problem, we would, however, reassess it. (2) Surgical removal of the tumour tissue - this is usually the mainstay of treatment, and we'd aim, to remove every single tumour cell. Sadly however, this isn't always possible. (3) Chemotherapy is increasingly available, to prevent regrowth, mop up any stray cells, or slow down the growth of inoperable tumours. Unlike in humans, we use lower doses because keeping the dog comfortable and happy is more important than killing every last tumour cell. (4) Radiation therapy is available at some specialist hospitals to kill the tumour tissue.

Can it be prevented?

No, full stop. Cancers will occur - probably the vast majority of dogs will develop one in their lifetime if they live long enough (although in most cases, it'll be so small no-one will ever know).

What is it?

A corneal ulcer is a "scratch" on the front of the eye (the cornea being the transparent window in the front). Although the eye is quite capable of healing itself, damage to the cornea can easily become infected, resulting in scarring and, if not rapidly treated, vision impairment.

What causes it?

The most common cause is running through long grass! As the dog runs, the grass whips back in their face and, while the blink reflex is really fast, it isn't always quite quick enough to avoid a grass cut to the cornea. Other common causes include cat scratches (cats always go for the eyes or the nose) and grass seeds and other debris blown on the wind - when running in grass or if dogs stick their head out of a moving car window (which, by the way, it's a really bad idea to let them do!). However, an ulcer doesn't only happen because of trauma - excessive dryness can cause part of the cornea to die and peel away, giving a similar effect. This is seen in dogs with Dry Eye, and those whose eyelids don't meet in the middle properly.

What dogs are at risk?

Absolutely any dog may get a corneal ulcer due to trauma. However, dogs with protuberant eyeballs (like pugs) are at highest risk of getting an ulcer because their eyelids don't close properly to protect and moisten the corneal surface. In addition, some breeds (such as Boxers) are at an increased risk of developing an indolent, or non-healing, ulcer if they do get an eye injury.

What are the symptoms?

A corneal ulcer, whatever the cause, usually presents with what we sometimes call the "PLB Triad" - Pain (the eye is obviously sore and often they'll rub at it); Lachrymation (running eyes); and Blepharospasm (the eye is held closed). If it's been there a while, it may become less painful and they'll open it again; you may then see a milky scar on the eye, and blood vessels growing in from the edges to help repair the damage.

How is it diagnosed?

We look into their eye with an instrument called an ophthalmoscope, and then put some dye into the front of the eye (usually fluorescein, but occasionally others). These dyes stick only to damaged corneal tissue, and glow when exposed to blue light, so we can see where, and how large, the damaged area is.

How can it be treated or managed?

The majority of corneal ulcers will heal rapidly with conservative treatment - antibiotic eyedrops to prevent and treat infection, and painkillers to reduce the discomfort and swelling. However, if an ulcer doesn't want to heal (these are called "indolent ulcers"), or starts to get bigger (e.g. a "melting ulcer"), there are a wide range of different treatment options we can use. These include plasma drops (where your dog's own blood is collected, processed, and then applied to the eye to prevent melting or widening of the ulcer) and EDTA drops (same reason). At the same time, a temporary soft contact lens may be fitted to protect the area while it heals. Surgical treatment may also be needed; the most common techniques are a Grid Keratectomy (where the eye is scored under anaesthetic to encourage healing) and Pedicle Flaps (where part of the lining of the eyelid is temporarily attached to the eyeball to help it heal).

Can it be prevented?

In most dogs no; however "doggles" (goggles for dogs) may be useful to protect the eyes of pets with especially bulging eyes.

What is it?

A cough is a really common symptom; however, it's a symptom not a disease! Coughing is a protective reflex - if anything irritates the airway, the dog will cough to try and clear mucus or debris from their lungs and windpipe. However, many different disease conditions can trigger a cough, so it's always worth getting it checked out.

What causes it?

Any source of irritation to the airway or throat can potentially cause coughing. The most common causes in dogs include: (1) Kennel Cough - a very common infection of the trachea (windpipe) and larynx (voice box); any dog can be infected (although vaccinated dogs are less likely to be ill) and the condition is very contagious. (2) Chest infections and pneumonia are uncommon but do occur in dogs; typically, the dog will be ill in themselves. (3) Heart failure is the commonest cause of coughing in older dogs - caused by an enlarged heart pressing on the trachea, and also an accumulation of fluid in the lungs (pulmonary oedema). (4) Lung tumours can also cause a cough; in dogs (who rarely smoke tobacco!), lung cancer is usually secondary to another tumour elsewhere. (5) Tracheal Collapse Disorder (commonest in toy breed dogs) also causes a characteristic cough, as the windpipe collapses and the dog coughs to try and inflate it. (6) Lungworm (both Dog and Fox Lungworm) can cause coughing, and are being increasingly diagnosed in the UK - although the distribution is rather patchy. (7) Inhalation of food - most common in dogs with laryngeal paralysis, but it can happen in dogs who are just excessively greedy and gobble their food!

What dogs are at risk?

Any dog can get a cough! However, heart disease and lung tumours are more common in older dogs, whereas kennel cough seems to be a bit more common in young adults. In addition, a dog who is vaccinated against kennel cough is less likely to develop the disease than one who isn't.

What are the symptoms?

The type of cough can sometimes help to diagnose the cause (although beware of relying on this on its own!). Tracheal collapse usually causes a "honking" type cough, as does Kennel Cough (which may also be described as a barking cough). The cough in Kennel Cough can often be induced by gently feeling the larynx and windpipe in the neck. On the other hand, a cough caused by heart failure tends to be soft and almost apologetic. Other symptoms may also be relevant - for example, a dog with pneumonia will be systemically ill in themselves with a fever, lethargy and depression; whereas dogs with heart failure are more likely to have exercise intolerance.

How is it diagnosed?

Physical examination and listening to the chest with a stethoscope will give us a lot of information; however, additional tests are often needed - typically X-rays of the chest and ultrasound scans of the heart. Blood tests for infection, lungworm and heart function are also available.

How can it be treated or managed?

It depends on the exact cause - for example, a chest infection would need antibiotics, whereas heart failure requires heart medications. We rarely look to suppress the cough itself (because in many cases it is doing its job in removing mucus and infectious material from the chest), but if needed, there are drugs we can use. NEVER use human cough syrups in your dog unless your vet has recommended it!

Can it be prevented?

The risk of Kennel Cough can be minimised with vaccination and isolation of infected dogs; and lungworm can be prevented with certain spot-on medications, but otherwise no.

What is it?

The cruciate ligaments are a pair of structures in the stifle (like our knee) joint of the dog. These (especially the cranial cruciate ligament or CCL) may rupture or break, causing severe lameness and instability in the joint.

What causes it?

In the majority of cases, the rupture is due to degeneration of the ligament that occurs over some weeks or months before they fail completely. However, an otherwise healthy ligament can rupture if overloaded (typically if the dog slips when running and changing direction fast). The exact cause of the degeneration isn't clear, but is probably due to very mild overloading over months or years, and to some extent to the dog's genetics.

What dogs are at risk?

The biggest risk factor is obesity - a heavier dog means more load on the ligament and more risk that it will start to degenerate. In addition, certain breeds (such as Labradors) are reported to be at higher risk, and there is a (very slight) increase in risk in neutered dogs compared to entire ones.

What are the symptoms?

Cruciate ligament injuries almost always present with moderate to severe lameness. This may appear suddenly ("acute lameness") or more gradually ("chronic lameness"), depending on the exact type of damage. In addition, you may notice a swelling on the inside of the leg, over the joint (this is sometimes called a "medial buttress").

How is it diagnosed?

If the ligament has ruptured, it is possible to move the tibia (shinbone) forward relative to the femur (thigh bone) - this is called cranial draw. When we examine your dog, we may find this sign, but more often we will book your dog in for X-rays; when they're sedated for the X-ray, this cranial draw is much more obvious and will confirm the diagnosis.

How can it be treated or managed?

In dogs under 8kg, the ligament my heal on its own, given strict rest and a very gradual reintroduction to exercise, possibly involving hydrotherapy. However, in heavier and larger dogs, this is very unlikely, and surgery is usually required. There are several different surgical procedures available, and which we'll use depends on the dog in question and the configuration of their stifle joint. The most common surgical procedures are ligament replacement (like a fabellar suture, where an artificial fibre is used to replace the damaged ligament); tibial tuberosity advancement (TTA and MMP operations, where the front of the tibia is cut and moved, so the cruciate ligament isn't needed any more); and tibial plateau levelling osteotomy (TPLO, where the bone is cut and rotated to stabilise the joint without needing a cruciate ligament). The great advantage of bone surgeries (TTA/MMP and TPLO) are that the dog will be up and able to walk within 24 hours, whereas the ligament replacement surgeries require longer. In all cases, however, the dog will need a very gradual return to exercise, and often physiotherapy or hydrotherapy. Too early return to exercise will result in the repair breaking down, and may result in breaking of the affected leg.

Can it be prevented?

To some extent yes - don't let your dog get overweight or obese! That's the best way to minimise the risk - dogs of a healthy weight are at significantly lower risk.

What is it?

Cryptorchidism, or retained testicles, is one of the most common developmental disorders in male puppies. It is important because once puberty has started, testicles are supposed to be outside the body where they can be kept cool. An overheated testicle inside the body will be infertile (sperm cannot be made at body temperature) and is nearly ten times more likely to become cancerous with a nasty disease called a Sertoli Cell Tumour.

What causes it?

When the puppy is in his mother's womb, his testicles develop next to the kidneys (just like in all mammals, including humans). Once his body decides it is male, a ligament called the gubernaculum pulls the testicles down through the body, through the inguinal canal and into the scrotum - they are supposed to have arrived by a couple of weeks after birth. If this system fails for any reason (usually due to a failure of the gubernaculum to contract fully), the dog will be cryptorchid. It is not uncommon for testicles to be "hidden away" in the inguinal canal before puberty; however, when they grow to adult size at about 6-9 months old, they should drop to and stay in the scrotum - if they're inside the abdomen at this point, they will be too big to fit through the canal.

What dogs are at risk?

This is a genetic condition, so a dog whose father had the condition will probably be cryptorchid, too.

What are the symptoms?

Simple - affected dogs will usually only have one testicle visible! Occasionally, both testicles are retained, but this is uncommon. If your dog does seem to have only one testicle, it is very unlikely that they genuinely don't have a second one (monorchidism), it's far more probable that the second is hidden away internally.

How is it diagnosed?

Physical examination makes it very clear that the scrotum isn't fully occupied! If the second one cannot be located during surgery, it is possible to remove the present testicle and then do hormone tests to see if there is another one hidden away somewhere.

How can it be treated or managed?

Because of the cancer risk, the retained testicle MUST be removed, and because the condition is genetic, so must the "normal" one. In humans, a procedure called an orchiopexy is used to fix a retained testicle into the proper place in the scrotum; however, because of the heritability of the condition, it is considered unethical to do this in dogs.

Can it be prevented?

Only by not breeding from existing cryptorchid dogs, and preventing them from breeding by castration.

What is it?

Cushing's Disease, or Hyperadrenocorticism, is a disorder of the endocrine system, where the adrenal glands release too much cortisol (a natural steroid).

What causes it?

Cortisol is sometimes called "the stress hormone", because it is released in the body in times of stress (physical or mental/emotional). It is produced in the adrenal glands, but these are themselves controlled by the pituitary gland, which releases a hormone called ACTH (adrenocorticotropic hormone) telling the adrenals to make more cortisol. If an adrenal gland malfunctions and starts making excessive amounts of cortisol, or if the pituitary malfunctions and releases excessive amounts of ACTH, the result is the same. In most cases, these are due to secreting tumours (about 85% are in the pituitary, so-called Pituitary Cushing's). There is another form of the disease too, called Iatrogenic Cushing's, which is due to excessively high doses of artificial steroids.

What dogs are at risk?

The diseases usually affects adult to elderly dogs.

What are the symptoms?

The symptoms of any kind of Cushing's are the same; as steroids affect a wide range of different systems, Cushing's can have a wide range of different effects. Common symptoms, however, include: (1) Increased thirst and increased urination. (2) Increased hunger. (3) Hair loss, usually causing bald patches on both flanks. (4) Muscle loss and fat redistribution, resulting in a "pot-bellied" appearance. (5) Increased susceptibility to infection (especially urinary tract and skin). (6) Increased susceptibility to diabetes mellitus. (7) Lethargy. (8) Dislike of heat or hot weather. (9) Increased breathing rate, and often increased panting.

How is it diagnosed?

Although the symptoms are quite characteristic, unfortunately there is no test that is 100% accurate in diagnosing Cushing's Disease. The most commonly used tests are: (1) The Urine Cortisol to Creatinine Ratio (UCCR) Test. This is very good as a screening test, but gives lots of false positive results (in other words, you may get a positive result even if the dog doesn't have Cushing's, but it's very unlikely you'll get a negative test if it does). (2) The ACTH Stimulation Test, which works by measuring the response of the adrenal glands to the ACTH hormone. (3) The Dexamethasone Suppression Test (in High and Low Dose forms), which looks to see whether adrenal function is reduced when additional steroids are introduced to the body, which it should be but isn't in Cushing's. The High Dose test can also distinguish between Pituitary and Adrenal Cushing's.

How can it be treated or managed?

The standard treatment is with medications that temporarily suppress the adrenal gland's ability to make cortisol; with the proper dose, cortisol levels can be managed and kept within the proper range. The active ingredient in these tablets is trilostane, and they are licensed for use in dogs. There is another, related, drug, that permanently destroys the adrenal tissue (mitotane), but this is not licensed and is rarely used, because even a very slight overdose could lead to Addison's Disease.

Can it be prevented?

No, there is no preventative treatment known.

What is it?

Cystitis just means "inflammation of the bladder". In dogs, we usually mean a urinary tract infection (bacteria growing in the bladder), but cystitis can also be caused by bladder stones (urolithiasis) or, rarely, a bladder tumour.

What causes it?

By far the most common cause of cystitis in dogs is ascending infection - bacteria that crawl their way up the urethra (the "urine tube") from the outside world. This is much more likely in dogs where the bladder is a less hostile place - for example, diabetic dogs (where the urine contains lots of sugar for the bugs to feed on), those with Cushing's disease (where the immune system is impaired), and those with unusually dilute urine (e.g. Cushing's, Psychogenic Polydipsia, or Diabetes Insipidus). The bacterial infection damages the bladder wall, resulting in symptoms. It is now thought that in some cases, the bacteria may in fact penetrate further, causing a kidney infection. If bladder stones form, there are a number of different types; the most common, struvite, forms because of an infection, whereas other types may reflect an imbalanced diet, or a metabolic defect (e.g. liver disorders leading to urate stones). These stones then rub against the wall of the bladder, causing irritation (just like an infection would). Occasionally, in older dogs, a tumour (or cancer) of the bladder wall may form, also causing the clinical signs.

What dogs are at risk?

Female dogs are at a much higher risk of infection, because their urethra is shorter and wider, so bacteria can more easily enter along it. Bladder stones are most often secondary to an infection, but some dogs (such as Dalmatians) are at an increased risk due to certain metabolic differences, and any dog with liver disease is also at increased risk. Bladder tumours, meanwhile, are most common in older dogs.

What are the symptoms?

The symptoms may be subtle or very obvious, depending on the severity and the specific dog! However, they most commonly include: (1) Blood in the urine. (2) Urinating often, but only producing a small amount each time. (3) Pain on urination. (4) Sometimes, incontinence may seem to occur. It is unusual for cystitis to cause a fever or other signs of systemic infection (such as lethargy or loss of appetite); if this occurs, its suggests a more serious condition such as a kidney infection. If your dog is trying to pass urine and isn't able to, they may have a stone blocking their bladder - this is an emergency and needs IMMEDIATE veterinary attention.

How is it diagnosed?

Most commonly, cystitis will be diagnosed with a urine sample. The presence of blood suggests significant irritation to the bladder wall, and often we can see (or grow) bacteria from in the urine. A urine sample mustn't be collected from the floor or ground, because we won't be able to check for infection - instead, it should be collected in mid flow (the use of a shallow dish or saucepan may help!). Other tests on the urine may demonstrate crystals (suggestive of stones forming) or abnormal cells (suggestive of a bladder tumour). If stones or a tumour are suspected, X-rays or ultrasound scans may be required to find and localise them.

How can it be treated or managed?

The vast majority of dogs with cystitis will respond really well to simple treatment with a course of antibiotics. The use of a urine sample to grow the specific bacteria (culture and sensitivity testing) will allow us to choose the most appropriate and effective antibiotic. If there are bladder stones, it may be possible to dissolve them with a special diet; however, some stones are too large, the wrong type, or in the wrong place (for example, blocking the bladder) for this to work, and in these cases they must be surgically removed. Bladder tumours are, sadly, usually inoperable, but there are some medical treatments that can reduce the severity of the symptoms, making the dog more comfortable.

Can it be prevented?

If a dog has a tendency to develop crystals or stones, the use of a special Urinary diet will reduce the chance of any forming. In any dog, making sure that they have free and unrestricted access to water will reduce the risk of cystitis developing, but cannot entirely prevent it.

What is it?

DCM stands for Dilated Cardiomyopathy, a form of heart disease characterised by an enlarged but weakened heart muscle. It is most commonly seen in certain breeds, but may also be due to dietary deficiencies. In many cases, DCM leads to abnormal heart rhythms (arrhythmias).

What causes it?

In most cases, it is due to genetic disease, but a taurine-deficient diet can also be a cause. In either case, the heart muscle becomes weaker, resulting in decreased pumping effectiveness. As the muscle becomes weaker, the heart swells up like a balloon, resulting in an enlarged heart with very thin walls (which of course reduces the pumping power even further). The enlargement of the chambers of the heart and thinning of the muscular walls increases the risk of arrhythmias as the "communications system" inside the heart becomes less effective. Eventually, it will inevitably lead to heart failure.

What dogs are at risk?

Any dog with a taurine-poor diet (nowadays, this is usually confined to dogs fed a poorly designed home-cooked diet). The more common genetic form is seen primarily in Dobermans, Boxers, Deerhounds, Irish Wolfhounds, Great Danes and other giant breeds, although it is also recognised occasionally in Cocker Spaniels and Portuguese Water Dogs.

What are the symptoms?

Most dogs in the early stages of the disease (the "preclinical phase") show no symptoms. However, this will progress over time to include reduced exercise tolerance, weakness, depression, weak pulses and sometimes a highly irregular or chaotic heart rhythm (atrial fibrillation). Eventually, congestive heart failure will develop with breathlessness, coughing, blue gums, swelling of the abdomen and (sometimes) extremities, collapse and ultimately death. In some dogs (especially Boxers), sudden death may occur without warning. Unfortunately, the disease is always progressive and always fatal - without treatment, death usually occurs in 6-24 months after diagnosis.

How is it diagnosed?

Initially, signs of heart disease in a dog of a susceptible breed are highly suspicious; X-rays can identify an enlarged heart but not the exact cause. A confirmed diagnosis therefore relies on echocardiography - an heart scan using ultrasound. With this technique, the swollen, weak heart is clearly visible. In some cases, an ECG may also be useful to categorise the arrhythmia, allowing our vets to determine the best treatment.

How can it be treated or managed?

The mainstay of treatment is to increase the pumping strength of the heart; and to manage the abnormal heartbeat. The most commonly used drug is pimobendan, which makes the heart muscle work harder, increasing the heart's efficiency. If atrial fibrillation is occurring, the drug digoxin may be used instead, or beta-blockers to slow down the abnormal heart rate. If the dog has gone into congestive heart failure, diuretics ("water tablets") such as frusemide, and ACE inhibitors such as benazepril will help to mitigate the symptoms. Dietary management may also be useful - particularly a low-sodium high taurine and high carnitine diet (as in most commercial cardiac foods). Good medical management will not stop the progression of the disease, but it will slow it down, and make the dog more comfortable.

Can it be prevented?

The dietary form can (by feeding a proper, healthy diet with added taurine), but the genetic form cannot, sadly, be prevented.

What is it?

Dental disease is a catch-all term relating to disease of the teeth and gums. It is very common in dogs, and ranges from mild scale on the teeth to severe periodontal disease that may contribute to kidney or heart disease.

What dogs are at risk?

All dogs are at risk from dental disease, but it is often most dramatic in older dogs where the plaque has had years to build up. In addition, miniature and toy breeds are slightly more likely to develop early onset dental disease because they often have abnormalities of the mouth, meaning the teeth are at odd angles and therefore are more likely to build up plaque and tartar.

What are the symptoms?

Initially, the main symptom is halitosis (bad breath!). Over time, this may progress to red, swollen and inflamed gums, loose teeth and pain when eating. In severe cases, dogs may stop eating entirely. In addition, heart disease and kidney failure have both been linked to untreated dental disease.

How is it diagnosed?

Simple physical examination is often sufficient, however, dental X-rays are also invaluable. In most dogs, a full examination of the mouth and teeth requires a general anaesthetic so that the gum-lines can be probed (something that isn't possible in very many conscious ones!).

How can it be treated or managed?

Once dental disease (even severe plaque) has developed, it requires surgical treatment - we call this "a dental", and it's exactly the same treatment as you get when you go to the dentist. The only difference is that we have to use a general anaesthetic. We will carefully examine every tooth, and remove any that are too diseased to survive. Then we'll clean the remaining teeth with an ultrasonic scaler and then polish them to make them smooth. Afterwards, preventative care is all that is usually needed!

Can it be prevented?

Yes, very easily. Although there are a range of "dental chews" available, these are of limited use in most dogs (although they're often better than nothing). The same goes for specialist dental diets; chewing on bones is not reliable and may introduce health problems of its own, so isn't something we'd usually recommend. The most important and effective preventative treatment is tooth brushing - something you should be doing every day. Use a normal tooth brush, and special dog-toothpaste (don't use human toothpaste - the mint burns their gums), and gently brush the teeth at least daily. Mouthwash additives in their water or food will also help slow down the growth of plaque. Regular brushing sounds difficult, but it is the only way to prevent the formation of plaque and subsequent dental disease.

What is it?

Like humans, dogs can get diabetes mellitus (sugar diabetes). And like us, it is more likely to occur in the obese than in those of a healthy weight. While the early symptoms may be subtle, it is a potentially fatal condition and can result in severe and life-threatening complications.

What causes it?

Insulin is needed in the body to tell cells to take glucose (sugar) out of the bloodstream and into the cells, where it can be used as fuel. In diabetic dogs, there is insufficient production (often coupled with peripheral insulin resistance), so the blood glucose levels rise uncontrolled. However, the body is unable to use this sugar, and instead turns to burning fats and proteins for fuel. In the short term, this is fine, but if it goes on too long, the dog is at risk of diabetic ketoacidosis, where the blood become acidic and organ systems start to shut down. This is rapidly fatal without immediate emergency treatment.

What dogs are at risk?

Any dog may develop diabetes, but it is most common in mid-adult life. Specific risk factors include pancreatitis (because of damage to the pancreas, where insulin is made), pregnancy, some infectious viral diseases, the use of high doses of steroids, Cushing's Disease, and (most importantly) obesity. Certain breeds may be at higher risk, even when all these factors have been accounted for - there is evidence that the Miniature Pinscher, Cairn Terrier and possibly Dachshund and Poodle are at slightly increased risk.

What are the symptoms?

In the early stages, the most common symptoms are increased thirst and increased drinking (this may lead to mild urinary incontinence, especially overnight); increased hunger and weight loss (because they cannot use the sugars in their blood). Affected dogs are also prone to repeated urinary tract infections. Later, if diabetic ketoacidosis occurs, loss of appetite, lethargy, depression, dehydration, vomiting, collapse and ultimately coma and death. All dogs with diabetes, even if it is well controlled, are likely to develop cataracts as well, so it's always worth monitoring their eyesight, or getting the vet to check it over when you come in.

How is it diagnosed?

An increased blood glucose level is highly suspicious, as is a high sugar reading in the urine. However, there are other possible causes of these signs (including stress and certain kidney diseases), so the most usual way to confirm the diagnosis of simple or early diabetes is to send away blood for a fructosamine test - this measures the AVERAGE blood glucose level over the previous 2-3 weeks. Another method is to do repeated blood sugar levels over several hours to a day - this is called a blood glucose curve, and will clearly demonstrate persistent high blood glucose levels. In Diabetic Ketoacidosis, the presence of ketones in the blood over a certain level is diagnostic - we often measure this by ketones in the urine (which is equally useful).

How can it be treated or managed?

Most diabetic dogs can be managed and stabilised effectively, but it is very unusual for it to be possible to manage them without the use of regular daily (or twice daily) injections of insulin. By giving extra insulin at exactly the correct dose, we can "top up" what they're making, and keep their levels in the "normal" range. However, as insulin levels vary over the course of the day, and high levels can be dangerous (leading to a "hypoglycaemic episode" where the dog behaves abnormally, and may become unconscious, have fits, or even die) it is important to match the insulin dose to their feeding times. As a result, a regular, stable routine is VITAL, as is regular monitoring - with a blood glucose meter at home or blood glucose curves. Special diabetic diets also help, by smoothing out the peaks and troughs in blood sugar levels.

Can it be prevented?

The risk can be reduced by keeping your dog a healthy weight, but even healthy dogs develop diabetes, and there is no certain way to prevent it.

What is it?

Distemper is an infectious disease of dogs, also known as "hardpad". It is a very serious condition, and has a mortality rate of approximately 50%; in addition, even dogs who survive and appear to recover may develop symptoms later in life due to the original infection.

What causes it?

Distemper is caused by Canine Distemper Virus - a viral infection closely related to measles. Dogs can contract it by accidentally inhaling or swallowing fluid droplets from an infected dog (produced by the infected dog sneezing them out, but also in the vomit, diarrhoea and urine). Foxes and other wildlife may act as a reservoir for the virus, accounting for sporadic outbreaks in unprotected dogs.

What dogs are at risk?

Any unvaccinated dog is at risk from Distemper; however, if the percentage of dogs in the area that are vaccinated is high enough, the risk is relatively low as the virus will not be able to become established in the population. The more people who choose not to vaccinate however, the higher the risk is for everyone's pets.

What are the symptoms?

Initially, there is a fever, which peaks within a week and may not be noticed. However, a few days later it returns, also causing a runny nose and runny eyes; this is rapidly followed by vomiting and diarrhoea, and a thickening of the skin on the footpads (hence "hardpad"). Some dogs will develop infection of the brain and spinal cord, causing wobbliness, paralysis, seizures or a coma, About half of all infected dogs will die or need to be put to sleep, but this may take weeks or even months. In recovered dogs, some will have damage to their eyesight or persistent neurological problems and a certain percentage seem to be fine but will go on to develop "Old Dog Encephalitis", a degenerative brain disease in later life. This usually causes seizures or a "dementia-like" syndrome.

How is it diagnosed?

Clinical disease is relatively rare nowadays; however, compatible symptoms in an unvaccinated dog are highly suggestive. Confirmation of the diagnosis usually requires virus isolation in a specialist lab from blood, fluid or tissue samples.

How can it be treated or managed?

There is no specific treatment available; the standard treatment is supportive (with fluids and symptomatic relief - e.g. antiemetic drugs for vomiting, or anticonvulsants for seizures). Antibiotics are often used to help prevent secondary infections which may in themselves prove fatal. At all times, however, the infected dog must be kept in quarantine, away from other dogs, to minimise the risk of transmission of the infection.

Can it be prevented?

Yes - the modern Distemper vaccine is very effective, and once the primary course (2 injections 2-4 weeks apart, then a booster at 12 months) is completed, only needs topping-up every 3 years.

What is it?

Although in popular use a "fracture" means an incompletely broken bone, technically it means ANY break in a bone. These may be complete or incomplete (like a Greenstick fracture), compound (penetrating the skin), comminuted (multiple overlapping fractures, also known as "splintering"), multiple (several non-overlapping fractures) or simple (one clean break that doesn't interfere with any other structures).

What causes it?

90+% of fractures are caused by trauma - being hit by a car, falling from a height, or tripping while running fast are all common causes. More rarely, a fracture may result from an underlying disease process, such as a dietary deficiency (like rickets) or bone cancer.

What dogs are at risk?

Any dog can break a bone! Dogs that exercise a lot, or throw themselves around are probably at slightly higher risk, as are very unfit dogs whose musculoskeletal structure is less robust, but the most broken bones are RTAs - road traffic accidents.

What are the symptoms?

The key signs of a fracture are focal pain, swelling, loss of function, and abnormal movement. The majority of fractures are in the legs, where this is often obvious as non-weight bearing lameness (the dog cannot use the limb or put any weight on it). Fractures to other areas may be harder to diagnose, but usually at least three signs will be present. The exception is in incomplete or partial fractures, especially of bones that are naturally splinted (e.g. the toes). These are still very painful, but the dog may be able to use the affected limb to some extent.

How is it diagnosed?

The presence of a fracture may be easily obvious (especially if the bone is bending in the wrong place, or a paw is facing the wrong way round!) but to determine exactly what is broken, how and where, we need to X-ray the dog.

How can it be treated or managed?

It depends what, and where, the fracture is. Some fractures (like incomplete toe fractures, for example) will heal with just a support dressing. Others require surgical fixation, with pins, screws, or even an External Skeletal Fixator (a kind of scaffolding surgically attached to the bone(s) to hold them in place while they heal). It is unusual to be able to effectively cast a fractured limb in a dog, but it is sometimes appropriate, especially in puppies. If a cast is used, it is VITAL to keep it clean and dry, and have it checked regularly for rubbing or sores.

Can it be prevented?

The best way to prevent a fracture from occurring is to keep your dog under control so they can't run out into roads!

What is it?

Better known as "bloat" or a "torsion", a Gastric Dilation and Volvulus (GDV) is a rapidly progressing condition that is almost invariably fatal without treatment.

What causes it?

A GDV occurs when the dog's stomach fills with gas (the "dilation" or "bloat") and then twists (the "volvulus" or "torsion"). This cuts off the blood supply to the stomach and spleen, so these organs start to die; however, it also prevents bloodflow back to the heart, so affected dogs rapidly go into shock. To make matters worse, multi-organ failure then develops, which releases toxic amounts of potassium into the blood, causing the heart to fail. No-one knows exactly why a GDV occurs, but there are certain risk factors we are aware of.

What dogs are at risk?

Certain breeds are particularly prone to developing a GDV, usually large and giant breed dogs with a deep-chested conformation (such as Great Danes, German Shepherds, Setters). However, it can occur in any breed. There does appear to be a genetic component, as close relatives of dogs that have had a GDV are at higher risk themselves. Finally, feeding strategies - exercising vigorously immediately after eating or drinking is a known trigger factor.

What are the symptoms?

Typically, the dog first appears restless or uncomfortable; then they start retching. This is usually unproductive, with nothing coming up, but sometimes white froth is seen. They are obviously painful, and the left side of their abdomen (or, later, both sides) may be visibly distended. They will then start showing signs of shock, with pale gums, fast heart rate and panting or laboured breathing. This is followed by collapse and ultimately death.

How is it diagnosed?

In many cases, the diagnosis is clear from a simple examination of the dog; however, if there is a question mark over the cause of the symptoms, an X-ray will show the gas-filled, distended stomach occupying the majority of the front half of the abdomen.

How can it be treated or managed?

THIS IS AN EMERGENCY THAT REQUIRES IMMEDIATE VETERINARY ATTENTION. For first aid, it is sometimes possible for the vet to pass a stomach tube to deflate the stomach; if not, they will often use a wide-gauge needle to let the gas out and buy time. These dogs are highly unstable and require intensive care fluid and electrolyte therapy before they are fit for surgery. Sometimes, heart medications are needed to stabilise the heartbeat as well. Definitive repair requires a surgical procedure called a "gastropexy", where the stomach is returned to its normal position and then fixed to the abdominal wall so it cannot twist again.

Can it be prevented?

Careful management of feeding and exercise will reduce the risk; however, in high-risk breeds that have a close relative who has suffered a GDV, it is possible to carry out a "prophylactic gastropexy", where we go in and fix the stomach in place to prevent a GDV from ever occurring.

What is it?

Hip dysplasia is a condition characterised by malformation of the hip joints, which leads to rapid degenerative changes (typically early-onset arthritis). It is a genetic condition that used to be present in many breeds; due to the BVA/KC Hip Scoring Scheme it is gradually becoming less common, but it is still one of the commonest causes of hindlimb lameness in dogs.

What causes it?

It is a genetic disorder caused by the interaction of many different genes. In addition, the severity of symptoms will often depend on the environment the dog lives in, and even how they grew up. In most cases, it causes the "socket" (acetabulum) of the hip joint to be too shallow, so the "ball" (the femoral head) keeps popping out. This causes stress on the joint, resulting in further deformity and, ultimately, early onset osteoarthritis in the hips.

What dogs are at risk?

It is typically seen in large-breed dogs, but other breeds may also be affected. The highest risk breeds include St Bernards, German Shepherds, Labradors and other Retrievers. The incidence in Setters used to be very high, but a strict breeding programme appears to have reduced it substantially.

What are the symptoms?

Although the condition begins in the immature dog, in many cases symptoms will not be apparent until later (although very severe cases may show as early as 4 months). Classical symptoms include decreased willingness to run, climb stairs and slopes, or jump; difficulty getting up after lying down; and intermittent hindlimb lameness. The condition usually affects both hips (although one may be worse), so it is not uncommon for the dog to be lame on different sides on different occasions, depending on which one hurts more that day. In addition, dogs often adopt a "Marilyn Monroe" type gait, with a narrow-based stance as they try to keep their legs tightly together to reduce the chance of their hip popping out of joint. Other dogs may adopt a "bunny-hopping" or swaying way to get around, because this puts less pressure on the painful joints.

How is it diagnosed?

Clinical examination is highly suspicious, but X-rays of the hips are diagnostic.

Can it be prevented?

Only by attempting to breed the relevant genetic traits out of breeds - the Hip Scoring scheme is designed to identify those dogs with "bad genes" which should not be bred from, and those with "good genes" that should be prioritised.

What is it?

Kennel Cough is a highly contagious condition that easily spreads from dog to dog. As the name suggests, it causes a cough, but in severe cases may also lead to pneumonia.

What causes it?

There are a number of different viruses and bacteria that can cause kennel cough. These include Parainfluenza Virus, Canine Adenovirus 2 and the bacterium Bordetella bronchiseptica (first cousin to the human disease, Whooping Cough, which it closely resembles). Whatever the cause, however, the condition is very similar, with inflammation of the larynx (voicebox) and trachea (windpipe) and sometimes the lung tissue (bronchi) as well - as a result it is also sometimes called Infectious Tracheobronchitis.

What dogs are at risk?

All dogs are at risk from this highly infectious disease, although vaccinated dogs are less likely to contract it. The infectious agents are carried by dogs, foxes, and even cats and may be transmitted indirectly (e.g. on grass or even clothing that has been exposed).

What are the symptoms?

The classic symptom is a "honking" cough, that is triggered or worsened when the throat is rubbed or stroked. There may also be a mild fever, loss of appetite and lethargy, specially in the early stages; and occasionally a runny or snotty nose. Untreated, the condition will usually self-resolve in 2-3 weeks, but occasionally it can cause more serious effects, such as pneumonia. In this case, the fever will rise, and the dog will become increasingly lethargic. The cough will become moister, and they may struggle to breathe.

How is it diagnosed?

Clinical examination is usually sufficient - a cough that can be induced by gently feeling the larynx is pretty much diagnostic! There are also ways to test for the individual agents, typically by taking a swab from the back of the throat and sending it off to a specialist laboratory.

How can it be treated or managed?

As it is usually self limiting, treatment usually involves rest, quarantine from other dogs (to minimise the risk of spreading it!) and anti-inflammatory medicines to reduce the fever and make them more comfortable. If there is a risk of more severe infection, or an unusually high risk of spreading the infection, antibiotics may be used to kill bacteria and especially the Bordetella. Dogs with pneumonia, however, require intensive care nursing and antibiotics; and may need to be hospitalised and put on a drip of intravenous fluids and medication.

What is it?

Lungworm is a really nasty parasite, that can prove fatal to infected dogs. It is now being increasingly diagnosed, due to the roll-out of a new blood test for the parasites.

What causes it?

The Dog Lungworm, Angiostrongylus vasorum, is a type of roundworm that (as and adult) lives in the blood vessels around your dog's heart. From here, they lay eggs which travel to the lungs, where they hatch. The baby larvae are then coughed up by the dog, swallowed, and pass out in their faeces. Once out of the dog, they infect passing slugs and snails. These molluscs then spread the infective (L3) larvae in their slime trails wherever they go. When a dog licks a slime trail - or eats a snail or slug - the larvae burrow through their gut wall and travel back to the lungs, ready to start the cycle again.

What dogs are at risk?

Lungworm is present throughout the UK; however, its distribution is quite patchy. Some areas see a lot of cases, while others just a mile or two over may see them only very rarely. However, in principle, any dog, anywhere in the UK who ever has access to the outdoors (and therefore to slugs and snails) is potentially at risk.

What are the symptoms?

The most common early sign is a soft, moist cough (as the dog is coughing up the larvae). However, this may progress to heart failure (pale gums, reduced exercise tolerance, even collapse) as the worms build up in the blood vessels. In addition, more worms means more lung damage, so difficulty breathing may also occur. To be able to live in the bloodstream, the worms produce blood-thinners, so abnormal bleeding may also be seen, typically bruising, a rash (on the skin or gums), or bleeding from nose, mouth or bowels. If this stage is reached, affected dogs will usually die if untreated.

How is it diagnosed?

The "Gold Standard" test has always been considered finding the worm larvae in the dogs faeces; however, there is now a simple blood test that can be carried out in the practice lab to see if a dog is carrying the worms and therefore may need treatment - whether or not they are showing symptoms yet.

How can it be treated or managed?

The worms can easily be killed with certain prescription spot-on medications. If there is a severe infection, it may be necessary to give anti-inflammatory drugs as well, to prevent pneumonia happening as the worms die in the lungs. Dogs with heart failure will usually make a complete, or nearly so, recovery once the worms are dead, although they may require oxygen and supportive care in the meantime. Dogs with clotting disorders may require a blood transfusion as well, to replace the clotting factors and the blood that they are losing.

Can it be prevented?

Yes - regular treatment with an appropriate spot-on medication will kill the larvae before they are absorbed. In addition, making sure that your dog doesn't play with slugs or snails; or have any toys or bowls that they might crawl over, will minimise the risk.

What is it?

Mange is a serious skin condition, caused by a burrowing mite. It is one of the itchiest skin diseases known, and dogs will often injure themselves trying to scratch it; in addition, the mites are very contagious!

What causes it?

A variety of burrowing mite called Sarcoptes scabiei. This digs into the skin and munches its way through the top layers, causing severe itching. It can easily be transmitted between dogs, cats, foxes and many other animals - and can also infect humans (we call it Scabies if it infects us!). It's called Fox Mange because most cases are associated with dogs rolling in places foxes have been - the fox having left a few mites behind it.

What dogs are at risk?

Any dog who comes into contact (directly or indirectly) with an infected animal.

What are the symptoms?

Severe itching, followed by a "bumpy" rash. It usually affects the margins of the ears first, but can be anywhere on the dog's body. The itching is so severe, dogs will often injure themselves trying to scratch, and lose their hair, so it isn't uncommon to see a dog who is largely bald in patches, with an inflamed rash and cuts or scrapes from itching.

How is it diagnosed?

Skin scrapes let us collect part of the upper layers of the skin and look at them through the microscope; hopefully, we'll see some mites there! However, because it's so itchy, sometimes there are very few mites to find, so we will often treat a suspicious case even if we can't confirm the diagnosis.

How can it be treated or managed?

There are a range of prescription spot-on medications and medicated washes (again, prescription only) that rapidly kill the mites. They do not, however, kill the eggs, so usually have to be repeated in 3-4 weeks to break the life-cycle.

Can it be prevented?

Not entirely - however, regular treatment with a suitable anti-mite product (which will also do fleas and often worms too!) will prevent an infection becoming severe.

What is it?

Valve Disease, also known as Endocardiosis or Valve Incompetence, is the most common heart disease in dogs - over 30% of dogs will develop some degree of valve disease by 12 years of age. As a result, it is the most likely diagnosis (although not the only one) in an older dog with a heart murmur.

What causes it?

Inside the heart there are four valves, which work to make sure that blood only flows one-way through the chambers. These are the left atrioventricular (the Mitral or Bicuspid Valve); the right atrioventricular (the Tricuspid Valve); the Aortic Valve and the Pulmonic Valve. Over time, in some dogs, these will start to degenerate, with nodules or bits of scar tissue forming on the edges. This prevents the valve from closing properly, leading to "regurgitation", or leakage of blood. Over time, this reduces the heart's efficiency, leading to heart failure. Although any valve can be affected, the Mitral Valve is the most commonly involved, in roughly 95% of cases.

What dogs are at risk?

Any older dog may develop valve disease; however, some breeds of dog are at increased risk. The highest risk is seen in Cavalier King Charles Spaniels, closely followed by Chihuahuas, Cocker Spaniels and a number of other small and toy breeds. Male dogs are at slightly higher risk than females; and the commonest age of onset of heart failure is 10-12 years (although the heart murmur is often detected 2-3 years before that). Cavalier King Charles Spaniels are unusual in that not only is the condition very common, but it develops rapidly, with most affected dogs developing signs of heart failure by 8 years old.

What are the symptoms?

Initially, the only symptom is a heart murmur - an abnormal noise caused by the blood rushing in an unusual direction which the vet will hear when they listen to the dog's chest. As the disease progresses, signs of heart failure will, sooner or later, develop, with reduced exercise tolerance, coughing, panting or difficulty catching breath. Eventually, the heart will fail, leading to profound weakness, pale gums, difficulty breathing, swelling of the abdomen, collapse and (eventually) internal drowning from fluid in the lungs.

How is it diagnosed?

In a high risk breed, hearing a murmur is highly suspicious, and may be sufficient to start treatment. However, to confirm the diagnosis, chest X-rays (to demonstrate an enlarged heart) and ultrasound (echocardiography) are required.

How can it be treated or managed?

The condition cannot yet be cured (although there is experimental heart surgery being tested at the RVC in London). However, there are a wide range of medications available to manage the condition. The most commonly used are diuretics ("water tablets" like frusemide or spironolactone, which prevent fluid build up), ACE Inhibitors (such as benazepril, which improve the dog's quality of life and how well they feel), and drugs to increase the strength of each heartbeat (Pimobendan, which increases lifespan).

Can it be prevented?

No - however, recent research (the EPIC trial) suggests that starting a dog on Pimobendan before they develop symptoms significantly delays the onset of heart failure.

What is it?

Osteoarthritis, also called "Degenerative Joint Disease", is the type of arthritis that older dogs (and people!) get from a lifetime of wear-and-tear. It's probably the commonest single disorder of the older dog, and the commonest threat to their welfare and wellbeing.

What causes it?

As a rule of thumb, there are three causes of osteoarthritis - normal weight bearing on an abnormal joint (e.g. in Hip Dysplasia); abnormal weight bearing on a normal joint (e.g. obese or overweight dogs); and normal weight bearing on a normal joint for an abnormal length of time (e.g. old dogs). Whatever the cause, however, the process is the same - the joint cartilage becomes damaged, leading to inflammation, pain and further damage. At the same time, extra bone forms around the joints to try and stabilise them, but this restricts the range of motion.

What dogs are at risk?

Any older dog, especially if they are overweight, have orthopaedic problems (e.g. hip dysplasia, elbow dysplasia, or a poorly healed injury), or are "high mileage", e.g. working or highly active dogs.

What are the symptoms?

The most common early symptom is "stiffness" and a reduced desire for exercise or activity. This may initially be misdiagnosed as simply "getting older" or "slowing down", but it is in fact due to joint pain. It typically progresses to difficulty rising or ascending stairs or slopes, and then definite and obvious lameness (although this is usually present in more than one leg). A characteristic feature is that the lameness or stiffness is usually worst immediately after getting up, and it then decreases or "works off". It is also often worse the day after strenuous exercise.

How is it diagnosed?

In many cases, osteoarthritis can be diagnosed simply from the history and a good description of the symptoms. The most useful additional test is often a "Range of movement examination" where the vet will see how far in each direction a joint can be moved without pain - this is usually reduced in patients with advanced arthritis. To fully assess the joint(s), it is necessary to carry out X-rays and look at the bone ends and joint spaces; however, this isn't always appropriate in an old or ill dog.

How can it be treated or managed?

Strictly speaking, there is no cure for osteoarthritis; however, it is possible to replace some joints - hip and elbow replacements are now fairly common. That said, arthritis is rarely so severe that this is required, at least initially, and it can usually be managed with a combination of techniques. At home, the owners can make the dog's life a lot easier with some simple modification - ramps instead of steps, a comfortable bed to lie on, and keeping their sleeping areas warm. In addition, weight loss can be a very powerful tool in the overweight dog - it is estimated that a reduction of one body condition score point is as effective as a dose of a painkiller! Physiotherapy and hydrotherapy can also be very helpful; however, the mainstay of managing arthritis patients is with medication - usually anti-inflammatory and painkilling drugs. Remember, there are no over-the-counter painkillers for dogs, and human products are often lethally poisonous to dogs. Nutritional supplements (such as glucosamine or chondroitin) are also widely used - the evidence for their effectiveness is weak, but they do seem to help some dogs, especially if given with a large meal (to reduce their breakdown by the stomach acids).

Can it be prevented?

Osteoarthritis will probably develop eventually in most dogs; however, it can be delayed and slowed down with proper care throughout life. This would include weight control, regular exercise, and getting and lameness or other orthopaedic disorders diagnosed and treated as early as possible.

What is it?

Parvo (or, more properly, Canine Parvovirus) is a severe, often fatal viral infection. Although nowadays it is most commonly seen in puppies, Parvo can affect adults as well if they are unvaccinated.

What causes it?

The Canine Parvovirus is transmitted in the faeces of infected dogs. The incubation period of the virus is 7-14 days; once the virus infects a new dog, it attacks both their immune system and their intestines, causing massive breakdown of the gut wall. This allows bacteria from the gut to invade the body, leading to septicaemia ("blood poisoning"). In rare cases, there may also be damage to the heart.

What dogs are at risk?

Any unvaccinated dog is potentially at risk. Disease is most commonly seen in puppies between 6 weeks and 6 months of age; up until 6 weeks, they are protected by their mother's immunity ("Maternally Derived Antibodies"). However, in some breeds (such as Rottweilers, Dobermans and possibly German shepherds) this maternal immunity lasts longer - this (counterintuitively) means that the puppies are at HIGHER risk of Parvo, as the maternal immunity may prevent them from responding properly to their puppy vaccines.

What are the symptoms?

The initial symptoms are lethargy and loss of appetite; this is followed by severe vomiting and diarrhoea. The diarrhoea is initially watery but rapidly becomes bloody and develops a foul smell, caused essentially by dead, decaying gut lining. In some cases, chunks of gut lining are passed in the diarrhoea. The dog will now become severely ill, collapse, and will rapidly go into septic shock and die without treatment.

How is it diagnosed?

There are rapid diagnostic tests available which we can carry out in minutes using a sample of faeces, or even a swab from the rectum, which will diagnose the presence of the Parvovirus.

How can it be treated or managed?

These dogs are incredibly ill and need full intensive care nursing - as well as isolation from all other dogs. High dose intravenous fluids via a drip will help combat the septic shock, and antibiotics will help prevent bacterial septicaemia. Anti-vomiting medications are also invaluable. Immune stimulating drugs (such as interferon), although expensive, can also be very useful in rallying the immune system; however, we would expect at least one in three affected puppies to die despite all treatment efforts.

Can it be prevented?

Yes - there is a highly effective vaccine available (although in certain breeds it may need to be given later than in most dogs). Once the dog has had their puppy course and an annual booster, the vaccine lasts for approximately three years before needing a booster.

What is it?

Pyometra, or "a Pyo", is an infection of a dog's uterus (womb). It is a severe and potentially fatal condition, and preventing it is one of the main reasons for spaying bitches.

What causes it?

In a normal, healthy bitch, after every season her uterus prepares to receive puppies (this is driven by the hormone progesterone), and whether or not she becomes pregnant, the uterine wall will thicken and secrete fluid. As she gets older, this becomes more and more pronounced - we call this Cystic Endometrial Hyperplasia. Once she's decided she isn't actually pregnant (about 2 months after her season), the lining thins down and the fluid is reabsorbed. However, if during this time bacteria can enter the uterus, this fluid is a perfect foodstuff for them, and they rapidly grow and multiply, causing disease. There are two types of Pyo - an Open Pyo (where the cervix remains open, so the pus can drain out of her vagina and vulva), and a Closed Pyo (where the cervix is closed so all the bacteria, pus and toxins are trapped inside). Although both are dangerous, a Closed Pyo is more likely to be fatal, and is harder to diagnose.

What dogs are at risk?

Any unspayed bitch - although it may be slightly more common in those who haven't had a litter (although it can happen to any bitch). It usually develops within 3 months of a season, and is more likely in older dogs. Overall, 23% of unspayed bitches can be expected to develop a Pyo by 10 years of age.

What are the symptoms?

A dog with an Open Pyo may just appear a little off colour, with a thick cream, yellow or greenish vaginal discharge. However, more often she will be displaying signs of systemic illness, typically increased thirst and urination, lethargy, and loss of appetite. A Closed Pyo is more dangerous, as there is no discharge to warn you of a problem. She will start out with these non-specific signs, but then rapidly deteriorate and start vomiting, her gums may change colour (to red or possibly pale grey), and her abdomen may seem to swell. Ultimately, she will collapse, go into shock and die.

How is it diagnosed?

Usually with an ultrasound scan to look at the uterus - a pus-filled, inflamed uterus is very obvious on ultrasound. Other possible tests include blood tests and a vaginal exam.

How can it be treated or managed?

The treatment of choice is ALWAYS surgical removal of the infected uterus, and this is the only effective treatment for Closed Pyos. In an Open Pyo, it may be possible to use hormones (to make the uterus shrink down and expel the infection) and antibiotics (to treat the bacteria) - however, although many dogs will apparently respond to this treatment, the Pyo will recur after the next season in over 80% of cases.

Can it be prevented?

Yes - by spaying. In most cases, a neutered bitch cannot develop a pyo.

What is it?

Vomiting may best be described as the active expulsion of the dog's stomach contents. It's actually a normal function - dogs often eat nasty things, and by vomiting them up they can minimise the risk of serious poisoning. However, it is a very non-specific sign, and can be caused by a huge range of different conditions.

What causes it?

In dogs, the most common cause is "Dietary Indiscretion", also known as "Garbage Gut" - essentially, they ate something rotten and nasty! However, there are a huge range of other causes, depending on whether it is Acute Vomiting (sudden onset) or Chronic Vomiting (it's been going on for a while). The common causes of Acute Vomiting include infections (e.g. gut infections, such as Salmonella or Parvovirus; a response to a high fever; or Pyometra); high worm burdens; reactions to certain drugs (such as NSAID painkillers); poisons (e.g. chocolate); intestinal obstructions; metabolic disorders (e.g. liver disease); pancreatitis; or neurological problems (such as Vestibular Syndrome or travel sickness). Chronic Vomiting, on the other hand, is more likely to be due to more ongoing disease processes, such as kidney failure; SIBO (Small Intestinal Bacterial Overgrowth); IBD (inflammatory Bowel Disease); or tumours in the abdomen or intestinal wall.

What dogs are at risk?

Any dog can begin vomiting - it depends what the cause is! In general, in a young dog or one with a habit of eating stupid things (typically but definitely not exclusively Labradors), we'd be leaning towards Garbage Gut or a blockage; whereas in an older dog, kidney disease or tumours are a little more likely.

What are the symptoms?

True vomiting can be difficult to distinguish from regurgitation (where the contents of the oesophagus or gullet simply "flop" out) or even from coughing up a big lump of phlegm. However, vomit when produced has a characteristic acidic smell, and is usually stained yellow or greenish.

How is it diagnosed?

Determining the exact cause is really important - while Garbage Gut, for example, can be treated symptomatically, an intestinal obstruction needs urgent surgery. To determine the likely cause, the vets will carefully examine the dog's abdomen, and check their heart and circulatory function. Blood tests can be used to determine how dehydrated (and therefore in danger of complications such as shock) the dogs is, and whether their kidneys or liver are working properly; whereas X-rays and ultrasound scans are used to examine the intestines and internal organs for signs of blockage or malfunction. In some cases, an "exploratory laparotomy" or Ex-Lap is needed - surgery to open the abdomen and actually look to see what's going on.

How can it be treated or managed?

It depends, of course, on the cause. Simple "Dietary Indiscretion" can usually be managed by starving the dog for 24 hours, providing water little and often, and then reintroducing a bland diet (e.g. boiled chicken and rice, or a commercial intestinal diet). Sometimes, antivomiting drugs may also be appropriate. In other cases (such as Pyometra or kidney failure), the underlying disease must be treated; and in some conditions (like an intestinal obstruction), urgent surgery to remove the blockage is required.

Can it be prevented?

The simplest way to prevent vomiting is to prevent your dog from eating nasty rotten things they find in the garden, the dustbin, or out on a walk!