Have you got PPI…D?

All we hear these days are the immortal words “Do you think you’ve been mis-sold PPI?”. However I think you’d be surprised to find that your horse is affected… well, if not by PPI, then by PPID. Pituitary Pars Intermedia Dysfunction (or Equine Cushing’s disease) has been making the news recently with vets being told they should routinely test for the condition as the initial symptoms are slow developing and so owners may associate them with the ageing process rather than the condition (indeed a study claims, in a sample of horses aged over 15, 1.6% of owners reported PPID but when a vet examined the group, 21% were found to have signs of the disease).

Continue reading “Have you got PPI…D?”

The Problems with Being Premature

Prematurity is common in humans. It is estimated that every year 15 million babies are born before 37 weeks of gestation. Those born between 22-24 weeks have only a 10 per cent chance of survival, making prematurity the most common cause of death in babies. It is, however, apparently less common in other animals – perhaps this is due to us breeding with who we want rather than following our natural instincts of selection…?

Anyway, prematurity is a pretty big problem in humans causing various lifelong conditions such as:

  • Intellectual and developmental disabilities:
    • Learning
    • Communication skills
  • Behavioural problems:
    • attention deficit hyperactivity disorder (ADHD)
    • Anxiety
  • Neurological disorders:
    • cerebral palsy
  • Autism
  • Lung problems:
    • Bronchopulmonary dysplasia (BPD)
    • Asthma
  • Intestinal problems:
    • sometimes caused by necrotizing enterocolitis (NEC)
  • Infections:
    • Pneumonia
    • Meningitis
  • Vision problems (e.g. retinopathy of prematurity (ROP))
  • Hearing loss
  • Dental problems

As you can see from the list, there are many health concerns which can arise from a baby being premature. The current solutions to prematurity are basically put baby in an incubator. However, this leaves them prone to infections and the post-natal ventilation that is too much for their immature lungs can cause lung damage.

This may be about to change with a new development in the US which has just been trialled in sheep: an artificial womb. This sealed water-and-salts-filled bag allows lambs to develop for four weeks after premature birth, without the risk of infection. The clever thing about this is that if uses the foetus’s own heart to pump the oxygen around the body through the umbilical cord. This means blood pressure is kept at a normal level and it should hopefully remove the risk of damage to the lungs.

A premature lamb developing in a plastic bag systemYou can clearly see the continued growth after being ‘bagged’

The natural gestation period of a sheep is roughly 5 months (21 weeks) and the labs used in this trial were born at 15-17 weeks. Once they had matured, most of the lambs were euthanised and examined. All of the lambs showed healthy and normal development, and no abnormalities in the brains and lungs were found. The lambs not euthanised were allowed to be ‘born’ – removed from the make-shift uterus and fed by the bottle.

Research is now being done into the eventual aim: to produce a similar device for premature human babies. This should hopefully get the infants to 28 weeks where the chances of survival and good health are higher than, for example, at 24 weeks of age. The researchers say this technique could be used in human medicine in the next three to five years. It is imperative that thorough testing is put in place to make sure it will have no adverse side effects. This was not the case in the 60’s where the babies were given too much oxygen, disrupting blood vessel formation and sometimes causing the retina to separate from the back of the eye, causing blindness.

Improvements are hoping to be made to the ‘amniotic fluid’ used in the bags to make it more realistic as the real stuff contains nutrients, growth factors and foetal urine. The bag will also look, well, less like a bag. The scientists involved are conscience of the distressing nature of having a premature baby. Therefore the machine should hopefully be parent-orientated , incorporating a camera and microphone for communication as well as making the whole set up look more like an incubator. The technique will only be available to the half of babies that can be delivered by C-Section. Even so, that means preventing potentially 7.5 million children each year having any adverse effects from being born prematurely.

As usual with anything like this, I think it is a fantastic step in the right direction for science and research and really could make a difference to peoples’ lives. The thing that concerned me slightly about this whole project is that the lambs were removed by C-section, they weren’t ‘naturally premature’ as it were. This throws up a lot of questions in my mind. Firstly, researchers are obviously going to have to look into the use of this in actual premature babies, as there is a possibility that it won’t work. This brings me to a question I have been thinking about recently: are babies born premature because there is something wrong with them that the body can detect (and so it wants to get rid of it) or is it the prematurity that causes the babies to become ill? Obviously, with incorrect ventilation, as discussed above, it would be the prematurity that has caused them to become ill. However, if we look at autism it calls up the question of: does the body know that there is something not ‘normal’ with the baby and so attempts to kill it in a natural defence kind of way? In a previous blog post I talked about the new discovery that ASD is caused by a fault in the mitochondrial DNA of cells – can the body detect this? Surely this inherent genetic mutation cannot simply be caused by being born a few weeks early as the DNA would have been set out at conception? Although it has been suggested that a lack of oxygen at birth, along with many other things, can cause it too. In this case an artificial womb would help to stop this condition from developing, however, I understand that much of the science of brain disorders is unknown currently.

This is great new technique that is desperately needed in human medicine and I hope to hear about it being used for research and use in clinical cases in the future.

 

 

Rabbits and cats

Previously, I have mentioned the plight of Brachycephalic dogs but it has now come to my attention that many other species are suffering the same fate, fuelled by ‘fashion’, social media and celebrities.

Something I had never thought about before was brachycephaly in rabbits and cats which was highlighted to me recently in this article. It said that cats, such as Persians can have the same in-breeding problems as pugs (including breathing and dental issues as well as difficulty giving birth). The major problem in rabbits is that their teeth continuously grow throughout their lives, hence the incessant gnawing. The teeth must therefore be exactly aligned to make sure wear is even on all of them – brachycephaly means they have a major under bite causing pain, lacerations, abscesses and death. The other problem is lop ears which lead to middle ear infections and a lack of communication which in turn can lead to behavioural issues. It all stems from the wishes of humans to have our cats, dogs and rabbits look a certain way, which is detrimental to their health, and is often fuelled by celebrities.

Companies are now banning the use of brachycephalic breeds in advertisement, for example for Red Nose day (which was surrounded by a lot of controversy) and Vet Record, which is banning advertisements which use images of flat-faced dogs. This is all to try and raise awareness that these breeds shouldn’t be seen as attractive and desirable. That is the underlying problem: a lack of education on the matter. I am glad that big names are taking a stand against these preventable conditions.

 

Image result for rabbit brachycephaly
Certain breeds of cats, rabbits and dogs are suffering increased health problems due to shorter snouts, as clearly shown here.

 

If this wasn’t bad enough, another breed issue has been in the news this week: Scottish Fold cats. This week the BVA have gone as far as to say that breeding of these animals should be stopped altogether. There has been a recent spike in popularity due to Ed Sheeran and Taylor Swift publically owning a member of the breed and a Japanese fold called Maru whose YouTube videos have been watched more than 300 million times.

But what is so bad about breeding these cats? The appeal is the cats’ small ‘folded’ ears (hence the name) however this ‘cute’ feature is the result of a genetic condition affecting the animal’s cartilage (as it does not support the ears), causing other problems in the body and meaning that they live in pain. The other problems (for example, a type of arthritis) are often lifelong, incurable and painful.

Advocates for the breed say they never mate two Scottish folds together, instead creating a hybrid with an American or British Shorthair – a method they say reduces the risk of congenital health concerns. I disagree with this theory and so does the science – all cats with folded ears will have the mutation and they will all have some degree of the disease. Defenders also say that all pedigree breeds have health problems and this isn’t as bad as some of the others. The BVA again came back retaliating that 80% of cats have no pedigree in them. This makes me wonder whether we really should have any pedigree breeds at all as they do have such big and costly problems and that they only make up a small percentage of the cat in the UK anyway – if there weren’t any ‘favourites’ as such, there would be no popular breeds and so we wouldn’t get into this mess.

 

Image result for scottish fold
A Scottish Fold cat

What strikes me about this is that the cats weren’t even a registered breed until the 1960’s when a floppy-eared barn cat called Susie was discovered and subsequently bred by a local shepherd, creating the breed. The Governing Council of the Cat Fancy (the slightly oddly named pedigree cat registry in the UK) stopped registering the cats in the early 70’s due to concerns over ear disorders and deafness.

I find it disgusting that people will pay for an animal just for the way it looks only to find out later it will have crippling illness all of it’s, probably short, life. There are so many animals in rescue homes which will be put down eventually if no one wants them which is such a shame as they are nearly all perfectly healthy animals. I have heard from work experience and the news that black cats are out of fashion. Celebrities have so much power that if they had black cats, the world would fall in love with them. The problem then comes when another colour or breed goes out of fashion as a result but if we stop breeding ridiculous breeds which have no chance of a healthy life then we would be taking steps in the right direction.

Our society as a whole has become selfishly superficial and image obsessed. Too many girls my age and younger are being indoctrinated into thinking that they are fat and ugly which is completely destroying all hope of self confidence and is a breeding ground for the mental health issues that I have seen first hand. The same is happening in the animal sector. This also links to the puppy farming industry, which is (hopefully) now being shut down where we will trust someone to sell us a puppy, possibly for its looks, but when we get it home, it dies. We need to take a long hard look at ourselves as a whole and consider if we really want a ‘perfect’ cat in terms of looks, when, in the end, nothing is perfect.

 

The Perks of having Pets

I have always had cats in my household, although I’ve always wanted a dog, but my parents both work and it wouldn’t be fair to leave it alone all day. I have always loved having pets and animals have always intrigued me – if they didn’t I shouldn’t want to be a vet! A pet can be a companion, a friend and even a comforter. They can read your emotions and look after you if you’ve had a bad day. But now it seems they have another role in our lives – to stop our children becoming obese.

You might think I say that because we all know they will find any possible way to steal food, however, it is slightly more scientific than that. Research from the University of Alberta, Canada, has now shown that children exposed to pets even before they are born and up to 3 months afterwards have doubled levels of Ruminococcus and Oscillospira – gut bacteria. Also, despite various factors which could reduce a child’s gut bacteria level (caesarean, antibiotics during birth and limited breast-feeding), having a pet counteracts the reduce and actually still increases the level of healthy bacteria.

But what do these bacteria do? Ruminococcus has previously been shown to reduce childhood allergies, which is, perhaps, not surprising due to the desensitization that would logically occur if exposed to, for example, cat fur (although there used to be concerns that having pets increased allergies, but now the tables have turned). The remarkable part is that Oscillospira has been linked to a reduced risk of obesity. Could this be part of the answer to the child obesity crisis which is a growing national problem?

Scientists suggest that pets can physically alter a child’s own microbiome through ‘sharing’ the animal’s gut bacteria. This is most likely to be due to direct contact, for example if a dog licks a child’s face or hand, the microbes will inevitably enter the mouth and therefore the digestive system.

I think some parents these days are too protective of their children and don’t let them experience things which they think could cause them harm. I understand that you try and protect your child as best as you can, however, that is how we build up immunity to allergies and exposure to bacteria can even prevent asthma. Without the risk of perhaps putting something in their mouths that they aren’t supposed to, they will be vulnerable later to a simple cough or cold, which for most would be easy to fight off, but for them it could be debilitating. You cannot ‘wrap children in cotton wool’ as the saying goes – especially if you have a pet – and if you do, you may well be doing more harm than good.

 

Economic issues

It’s probably the worst case scenario: you’ve diagnosed the animal, you have the treatment all lined up,  you know exactly what you are going to do and how to do it… but the owner cannot afford it. It is a big problem in our sector that, for whatever reason, owners cannot afford the vet’s bills for the necessary surgery or treatment for their pet – and I’m sure it is heart-breaking for all involved.

I saw a tweet recently on twitter under the hashtag #wewishyouknew which said ‘we and other charities can offer low cost vet treatment’. I had never even thought about this as a possibility until I saw that tweet. It made me proud that we do have mechanisms in place to support those people who are struggling to save the ones they love. At these charities, the client needs to pay nothing or very little, however, there are still cases where the best cannot be done, due to insufficient charity funds or that the owner just can’t manage to find that tiny amount.

I have also read that these situations can be especially hard on the younger vets, and I can see how these cases can perhaps give any vet a sense of failure. Imagine it, you have just been trained to diagnose conditions most have never heard of, do complicated procedures and administer ground-breaking drugs but then all of the knowledge you have gained is useless because the client simply cannot afford it. Therefore, it is vital to develop skills to make it through these times and to learn to do more with less, obviously with the focus still on the pet and the owner. These more economic solutions can often incur greater risks than the usual treatments – such as death, disease diagnosis being missed or inappropriate prescription which can make the condition worse. Due to these risks, such cases are even more reliant on communication with the client than usual. The owner needs to understand the potential hazards and fully informed consent is required before any action is taken. The measures put in place could be symptomatic relief or diagnosis and cure, depending on what is cost-efficient and sensible for the condition.

We as a society have no right to judge people by their back balance, their postcode or the clothes they wear. The vets which are pillars of that society should be exactly the same. We live in a community with massive divides and prejudices which we have to overcome. Even though the road to treatment or cure may be much harder than usual or the initial diagnosis incorrect, we cannot give up on these people and their pets. Every person and their animal which walk through the surgery door are equal, no matter if they are rich or poor, or your most loved or loathed client. I’m sure most vets wouldn’t give up on any animal but I can see how disheartening these situations could potentially be, especially when a much easier treatment is just out of reach.


Side note:

I have noticed that there is a CPD (continuing professional development) associated with this topic coming up. I have heard of CPDs before and they highlight to me how the profession I am hoping to enter is constantly evolving and the fact that if you don’t keep up then you will be lacking the tools to do your job. These courses and lectures really excite me as I have a thirst for knowledge and I cannot wait to (hopefully!) get into vet school, qualify and continue to learn of the new and amazing discoveries being made all the time.

Microchipping – One year on

Around a year ago, a legislation was put in place for compulsory microchipping of all dogs in the UK. This was a major breakthrough in terms of stray and abandoned dogs as they could now be reunited with their owners a lot more easily.  However, a BVA survey released recently has found that 44% of vets cannot find the owners of missing or stray dogs due to incorrect chip information. Despite this, the microchipping has been a success and at least these dogs can be traced to the area or previous owner. Defra has revealed that 95% of dogs in the UK have been microchipped and Dogs Trust are now appealing to the remaining 5% to get it done.

In 2015-16, 43,000 strays were reunited with their owners and a fifth of this number was as a direct result of a microchip. This just shows how important microchipping is, especially as 12 kennel dogs a day are at risk of being put down because they are not microchipped and so cannot be returned to their owners. The legislation also allowed local councils to issue enforcement notices and fines to owners to get their dogs chipped. The average fine issued was for £340 and the maximum was £500, which is a lot considering a microchip only costs £10-20.

Everything you need to know about microchipping your pet

In my opinion the great thing about this legislation is that owners (should) take their dogs to the vets every year for vaccinations (and more often if they are puppies) and the vets there will always check for a chip or recommended that you should get it done if you haven’t. Therefore, if you look after the health of your dog then, through just being at the vets, you have to get it microchipped. The problem then comes when owners abandon dogs without ever taking them in for vaccinations and so there is no record of the owner or the dog even existing. However, this database and the fact that authorities can now fine owners means that cases of neglect and abuse could potentially be highlighted.

I haven’t even considered not having each of my cats microchipped – it’s just as routine as putting a collar on them, although admittedly it’s not up to me. In a way, I have benefitted first hand from microchipping. In September last year, my cat somehow was run over and a kindly onlooker took him to a vets. There they tried to save him but unfortunately he died there and then. Luckily, he had been microchipped and so the vets rang us . We didn’t believe it was him at first but we had to go and fetch him to bring him home. It was one of the saddest moments of my life so far but if he hadn’t had his microchip then we might still not know what happened, and I’m sure that would have been worse than what happened (https://sophieellisvet.wordpress.com/2016/09/24/toby/). I know we as pet owners don’t really want to think about the possibility of our loyal animals going missing (as happened to my other cat in 2012) or worse, however, microchipping allows us to be reunited with them or properly say goodbye rather than wondering what happened to them for the rest of our lives.