Dogs are susceptible to a range of infectious diseases. Fortunately, we are able to immunize against many of these potentially fatal diseases. We can’t make specific recommendations on vaccinations without knowing the lifestyle of your pet. Generally though, many vaccinations will need repeating annually. We send out regular reminders every year through the post or by email. Prior to the vaccination, your pet will be given a full physical examination to check for any health issues. Please note that we will not give live vaccinations if your dog is pregnant in case it harms the unborn puppies.
Puppy Core vaccinations
For the core (general) vaccines, the first injection will normally be given at 8 weeks of age, followed by the first booster 4 weeks later, at 12 weeks of age.
The third and final dose is given at 16 weeks of age or later and is important for improved protection against Leptospirosis.
This initial course is followed by yearly boosters.
Vaccinations available for your dog are:
Canine Parvovirus 2 – core vaccine
Canine Distemper Virus – core vaccine
Canine Adenovirus 2 – core vaccine
Parainfluenza Virus – core vaccine
Bordetella bronchiseptica – This vaccine involves squirting a very small amount of fluid into the nose. Normally this is given as one dose at the same time as the general vaccination. It is then repeated annually (or more often if the animal is in a high risk environment such as boarding kennels).
Leptospirosis – This is given as part of the core vaccine. There are different serovars (strains) of leptospira (e.g. interrogans, canicola, pomona, icterohaemorrhagiae, grippotyphosa). Most general vaccines only cover 2 of these strains. We recommend an additional vaccine (covering 4 strains) for those dogs at a higher risk which include those who frequently go swimming, hiking or who are left in boarding kennels.
Either monthly treatment (tablet such as heartgard or topical drops applied to skin such as Revolution) or a simple injection (Proheart) under the skin given initially at 6 months of age, followed by booster 9 months later and then yearly. If your dog is older than 6 months, a rapid test using a drop of blood should be performed testing for heartworm prior to using heartworm preventative medicine.
By Hong Kong Law, all dogs that are 5 months of age or older, are required to be licensed, microchipped (with AVID microchip) and vaccinated against Rabies. The licence and Rabies vaccination is valid for 3 years and will then need to be repeated for a new licence to be issued. If you are planning to export or travel abroad with your dog, many countries require that the Rabies vaccination is given more than 30 days and less than 12 months before export.
Fleas, ticks and other external parasites
There are a range of products to use for external parasites. External parasites include fleas, ticks, lice and mites (scabies and ear mites). Many of these products are fluid drops which should be applied to the back of your pet’s neck (onto the skin not the hair) and are applied every month. It is important to follow the manufacturer’s guidelines in regard to how soon before or after bathing, the drops can be applied.
Ticks are particularly problematic for dogs in Hong Kong as they spread blood-borne diseases. Sadly, there are no vaccinations for these blood parasites (Babesia species and Ehrlichia canis), which can cause an anaemia in your dog (tick fever) –a condition very similar to malaria in humans. We can however help to stop your dogs getting infected with this terrible disease by killing the ticks. Dependant on your dog’s lifestyle, we will give recommendations on which products (drops and possibly tick collars) to use.
De-sexing your Dog
If you are not planning to breed from your pet, it is responsible to de-sex to benefit your dog’s health, welfare and behaviour. Neutering males helps to reduce behavioural problems such as aggression, frustration and territorial marking. We normally recommend de-sexing at 6 months of age. After de-sexing, it is important for your pet to be fed less than before the operation as their metabolic rate will be lower and therefore, it will be easy for them to gain weight.
Female health benefits
De-sexing (spaying) greatly reduces the risk of mammary tumours/cancer and completely eliminates the risk of ovarian and uterine disease (infection and cancer). In addition to this, de-sexing also prevents unwanted pregnancies and vaginal bleeding during menstruation (and unwanted male attention).
Male health benefits
Desexing (castration) prevents testicular tumours/cancer as well as, prostate problems. Castration also reduces the risk of hernias and tumours/cancers in the perineal region.
We anaesthetize animals every day. Modern day anaesthesia is very safe and in the case of our beloved pets, the risk of dying under general anaesthesia is estimated to be less than 1 in every 1000. The advances in anaesthesia have allowed us to perform successful surgeries and procedures on even the most critically ill patients.
At Acorn Veterinary Hospital, we take general anaesthesia very seriously and are proud of our safety record. Unfortunately, there is no “ideal anaesthetic agent” but we use drugs that we are comfortable and experienced with and that we also feel are most appropriate to your individual pet’s needs.
Before any anaesthetic drug is given, we give your dog a full physical examination and discuss with you about their health. The more information we have, the more we can ensure a safer anaesthetic. Sometimes, pets may have undetected problems, which may be identified by blood and urine tests.
A pre-anaesthetic blood test (and urine test) will enable us to determine both the general health and also the functioning of the internal organs. Many anaesthetic drugs affect the blood flow to the major organs and are also inactivated and removed by the liver and kidneys. This will allow us firstly to decide if your dog is healthy enough to undergo a general anaesthetic and subsequently, which drugs are most suitable for use. We strongly recommend blood and urine tests in all senior animals (over 8 years old) and any we suspect may not be in full health.
Acorn Veterinary Hospital uses advanced monitoring equipment during any anaesthetic to allow us to closely observe vital signs (such as blood pressure, heart rate, oxygen saturation and respiratory rate). Our staff are trained to determine the depth of anaesthesia by evaluating the animal’s reflexes, muscle tone and the response of vital signs to surgical stimulation. Our close monitoring during anaesthesia allows us early recognition and correction of any problems.
Anaesthetized animals are unable to regulate their body temperature. Following the induction of anaesthesia, the core body temperature will rapidly drop risking hypothermia – which is associated with higher mortality rates and surgical complications (such as infection). At Acorn, we use a system of forced-air warming to prevent hypothermia.
General anaesthesia generally will decrease the heart rate, blood pressure and respiratory rate. An endotracheal tube (ET tube) is a soft plastic tube that is placed into your pet’s windpipe to allow us to administer oxygen (and inhalational drugs if necessary) and to assist and control the breathing if necessary. An ET tube also prevents any stomach contents or foreign materials being inhaled into the airways or lungs.
Intravenous (IV) catheters allow us to have immediate access to the blood stream during an anaesthetic. This allows us to administer any fluids or drugs rapidly during and after surgery. IV fluids are an excellent way to make an anaesthetic safer. Firstly, administering fluids helps to maintain a good blood pressure which ensures good blood flow around the body to the vital organs. IV fluids also assist in the rapid clearance of certain drugs and anaesthetic agents from the body. IV fluids also allow us to correct any dehydration before the surgery and replace any fluid loss during the surgery such from bleeding. Ideally, IV fluids should be used for all animals during an anaesthetic and at Acorn, we particularly recommend their use in sick and senior animals.
We understand that anaesthesia on your loved dog is a cause for serious concern to you and we take every anaesthetic extremely seriously.
Surgery and your Dog
It is important to withhold food from your dog for 12 hours before the surgery. This is to ensure that there is no food in his stomach which will decrease the likelihood of any food being aspirated into the lungs should they vomit during the induction of general anaesthesia. We may also sometimes make specific recommendations. For example, very young pups or diabetics may need food to be withdrawn for a shorter time period before surgery or adult Bulldogs may need food to be withheld for a longer time period.
There is no need to withdraw water at home. Normally we will stop any water intake for the last few hours before surgery at the hospital.
Normally, your dog should arrive early in the morning and will be admitted by the veterinarian. You will be asked to sign a consent form. This confirms that you are aware of the procedure and agree to it being performed. It also confirms that you are aware of any risks and complications that may develop. It is important that the consent form is signed by an adult and ideally by the registered dog owner.
You will be required to leave a contact phone number for us to use in the event of an emergency. It is essential that you are available throughout the day for us to be able to contact you immediately should the need arise.
We recommend that you call the hospital in the early afternoon on the day of surgery to confirm a suitable time for discharge. In cases of concern we will phone you upon recovery to let you know your loved pet is safe and well, and may advise keeping your dog in overnight for further observation, intravenous fluids and pain relief.
The discharge appointment after surgery will be with either a trained nurse or the veterinarian.
On the first evening, your pet may be a little quiet or sleepy. You should allow them to rest comfortably and the next day, they should be brighter.
We recommend that you offer some food and water when you get home. It is perfectly normal for your dog to have a reduced appetite and he may even vomit that evening as a result of the anaesthetic.
You should restrict the amount of exercise until the sutures are removed. Leash walking is acceptable (unless advised differently by your vet).
You should not bathe your dog until 2 days after the sutures have been removed. Try to keep the wound dry and clean. You can check the wound daily for any excessive signs of bruising, bleeding, discharge, swelling or redness.
It is normal for fur to have been shaved. Commonly clipped areas are the site of the wound, the leg (where an IV catheter may have been placed) and the neck (for blood sampling). Don't worry, the fur will grow back over the next couple of months.
Occasionally, your pet may cough for a few days following the anaesthetic due to any irritation by the endotracheal tube in the airway. This should resolve a few days after the surgery.
It is important that you stop your dog from licking or biting at the wound as they may damage the skin and pull out the sutures. Elizabethan collars will help to prevent this.
The stitches will normally be removed 10 days after surgery free of charge. Sometimes we may have elected to use dissolving sutures but we will keep you informed of this.
Please follow the vet’s instructions regarding any medication (e.g. pain relief) and when to come back to the hospital for a re-visit. At Acorn, we routinely administer pain relief to all animals undergoing surgery.
You should contact us immediately if:
Your dog vomits repeatedly
Becomes excessively lethargic or weak
The gums appear a lot paler than normal
There is excessive bleeding from the wound
Heartworms (HW) are parasites that live in the arteries of the lungs (pulmonary arteries) of dogs and wild canines. They cause an increased pressure in these vessels (pulmonary hypertension) which increases the work-load of the right side of the heart, resulting in damage and eventual failure.
HWs (Dirofilaria immitis) are endemic to Hong Kong and are spread from an infected animal to others by mosquitoes. Adult female HW produce larvae (microfilariae) that migrate through the body and are picked up by mosquitoes when they feed on the dog.
Once a dog is bitten by an infected mosquito, the HW larvae moult and travel to the lungs, where they develop into adults, a process which takes about 6 months.
HWs produce a substance that irritates the arteries causing them to harden, and as worms die they can also lodge in and block smaller lung vessels.
If a dog is bitten by many infected mosquitoes at once, many HWs can become adult simultaneously and if there is no room for them in the pulmonary arteries, they will live in the actual heart chambers and the large vein (posterior vena cava) leading to it. This is called caval syndrome and alters blood flow and damages the red blood cells. This is rapidly fatal!
Most infected dogs have no signs yet, and the disease is detected by routine HW blood tests
The first signs of problems are coughing and dullness. As the disease worsens, breathing rate (more than 50 breaths per minute) and effort increase and some dogs may faint when stressed.
Dogs with advanced disease will show the effects of right-sided heart failure, with fluid build-up in the abdomen and weight loss.
A simple blood test can be performed within 5 minutes at Acorn to check for the presence of antigens given off by the adult female HWs and is the most common test used.
If a dog is positive for heartworm, chest radiographs are advised to look for changes to the heart and lungs and an echocardiogram (heart ultrasound) is indicated to look for presence of worms in the heart and vena cava, and for evidence of right-sided heart failure.
Prior to treatment routine lab tests are advised to check other body organs are functioning normally, as the drug used to kill adult worms can adversely affect the kidneys and liver
If right-sided heart failure, liver disease or kidney disease are present they must be treated before treatment to kill the adult HWs.
No single drug kills all the stages of the parasite.
Adult worms are killed with melarsomine (“Immiticide”) and 2 protocols are used
Killing the worms slowly reduces the risk of parts of parasite breaking up in the lungs causing sudden death.
Circulating microfilariae are usually killed 1 month after adulticide therapy with an injection of Ivermectin or milbemycin.
Once all stages have been treated, oral HW-preventive drugs are started monthly. These include ivermectin (“
Heartguard”), selamectin (“
Revolution”) and milbemycin.
Alternatively a yearly slow-release injection of moxidectin (“
ProHeart 12") can be given and is more convenient for many owners.
Follow-up and Prognosis
When adult HWs die they break up and lodge in the smaller lung vessels (embolism) but this should cause no significant problems in dogs with no or few lung changes.
However it is VITAL all dogs treated are kept quiet for 6 weeks after treatment to reduce the risks of embolism and often anti-inflammatory drugs are prescribed to reduce risks of complications.
Sadly even with the most careful management a dog may die when the adult worms die.
4-6 months after adult HWs are treated a repeat blood test for adults is performed and occasionally an animal may require repeat adulticide treatment for this
Dogs with no clinical signs of HW infection have a very good prognosis although unfortunately there is the occasional fatality after treatment.
Dogs with right heart failure have a more guarded prognosis as their significant lung changes may not reverse, and will require life-long therapy
The most common protocol composes 2 injections intramuscularly 24 hours apart killing worms slowly over 2-3 weeks
In more severely affected animals, one dose is given, followed by a rest of 4 weeks before two more shots 24 hours apart.
Tick Fever Babesia
Babesia is a blood parasite that infects and destroys red blood cells causing life-threatening anaemia. It is spread by ticks and is common in Hong Kong.
Currently Babesia canis and Babesia gibsoni are the only two species known to infect dogs.
Infection occurs when an infected tick bites a dog and releases the infection into the dog's bloodstream. New ticks pick up the infection by biting an infected dog.
Pregnant dogs can spread the infection to unborn pups.
The dog’s immune system recognizes the infected cells and destroys them leading to anaemia.
Severe inflammation may also develop in other body systems such as the liver, kidneys, eyes, brain and lungs.
The infection typically incubates for 2 to 3 weeks before clinical signs show and most dogs will clear the infection and never become ill, but may become carriers. When stressed at a later date they may come down with clinical illness.
Babesiosis can be classified as uncomplicated or complicated
Hong Kong laboratories currently offer PCR testing for Babesia, identifying the parasite DNA. A further test can also differentiate between Babesia canis and the more aggressive Babesia gibsoni.
The parasite may also be identified on a blood smear, but a large percentage of infected dogs may not display this, so a negative smear does not rule out infection.
Treatments are aimed at clearing the infection and reversing the anaemia.
No known treatment clears all babesial infections.
Current treatment protocols include
In uncomplicated cases dogs are acutely ill with fever, depression, anorexia, pale gums and dark urine. Some dogs will become jaundiced with yellow gums and eyes, and some may collapse suddenly.
In complicated cases signs may include acute kidney failure, neurological disorders, swelling of the legs or breathing problems. Shock, vomiting and death may also occur.
The current most recommended protocol is atovaquone/ azithromycin. Unfortunately some dogs may vomit these drugs and at Acorn we use a liquid variant of atovaquone which is far less likely to cause nausea.
It is highly important to understand that at present none of these drugs are currently licenced for the treatment of babesiosis in dogs in Hong Kong, but their use is well documented and dose rates well established.
Some dogs may require blood typing and blood transfusion if their anaemia becomes too severe during treatment. At Acorn we have blood typing kits and routinely keep blood available for transfusion.
Follow-up Care and Prognosis
Dogs that clear the initial infection but become carriers may have relapses when subjected to stress and females that test positive should not be used for breeding.
Prognosis is most favourable when the dog is caught before the anemia becomes too severe, and is also determined by the dogs response to drugs used.
Some animals may develop a secondary immune-mediated haemolytic anaemia after the original infection has cleared, where the body’s over-active immune response continues to attack red blood cells after the original cause has been removed.
Effective tick prevention is VITAL in any dog potentially exposed to ticks to reduce the risk of contracting this and other tick-borne diseases. We recommend monthly Frontline and an effective tick collar. Dogs with babesiosis may also have concurrent ehrlichiosis as ticks may carry both!
Atovaquone and azithromycin combination for 2 weeks
Diminazene (“Berenil”) injection
Imidocarb (“Immizol”) injection
Tick Fever Ehrlichia
Ehrlichia canis is a blood-borne disease of dogs spread by ticks. The tick transmits the disease to the dog during feeding and previously clear ticks will pick up Ehrlichia from an infected dog.
Many dogs are bitten by more than one tick, and some ticks may also carry other diseases, mainly Babesia, so it is possible for a dog to have more than one disease at a time!
Dogs may develop acute (recent) infection or chronic disease months or even years later. The parasite infects and destroys platelets, small cells within the blood vital in the process of clotting.
As a result fever and clotting abnormalities are predominant.
Clinical signs vary widely and can include
Comprehensive laboratory tests are required
fever, anorexia and dullness
enlarged spleen (splenomegaly) and lymph nodes (lymphomegaly)
areas of bruising under the skin or in the mouth and spontaneous nosebleeds
inflammation within the eyes
Joint and muscle pain and resultant lameness (rare)
Central nervous signs such as seizures (rare)
Doxycycline is given for a minimum of 4 weeks, usually with food as it can cause stomach upsets in some dogs.
This is usually effective, but if not , a course of imidocarb (“Immizol”) can be given by injection.
In extremely severe cases a blood transfusion may be needed to provide fresh platelets but this is rarely required.
Follow Up and Prognosis
Normally clinical signs improve within several days of starting medication, and follow-up bloods are usually advised to monitor platelet levels.
Tick prevention is VITAL to reduce the risk of infection/ re-infection and we recommend monthly Frontline and an effective tick collar in dogs potentially exposed to ticks.
Prognosis is usually good, but more guarded in seriously ill dogs with central nervous signs
There is some evidence to suggest E canis occurs in people but is not thought to be direct infection from dogs. Tick exposure is thought to be necessary.
A complete blood count (CBC) is required to determine platelet levels and also white and red blood cells
Biochemistry to determine general organ function
Blood testing for antibodies to Ehrlichia. This is easily done on site at Acorn with a simple kit. Because it measures antibodies to the disease, rather than the disease itself, it may not reliably differentiate between active infection and a dog previously exposed. By taking samples 2 weeks apart, a rise in antibodies indicating active infection can be seen but this is often not practical in critically ill patients
A PCR test measuring Ehrlichia DNA (ie the parasite itself) can routinely be performed now.
Adverse reactions to substances within the diet, known as a food allergy, cause year-round itchy (pruritic) skin, with all the resultant signs that may entail.
Protein sources such as beef, lamb, chicken and dairy products are the most common to cause problems, but anything that your dog eats on a regular basis can become an allergen.
Remember that the body develops an allergic response after
repeated exposure to an allergen common in their environment.
It is also worth remembering that most commercial dog foods contain pork and chicken additives, no matter what flavour is stated on the packaging, and so simply changing brands will not help.
Reactions can occur at any age, but when onset is within dogs younger than 6 months, or older than 6 years of age, food allergy is the more likely cause of allergy present.
Itchiness is non-seasonal, as your dog eats the allergen all year round, and the degree of itch can be mild to severe.
Itching generally leads to self-trauma, with scratching and chewing leading to areas of hair loss, scabs and secondary infections with bacteria or yeasts. Recurring ear infections are commonly seen due to irritation leading to increased wax production within the ear canals and resultant infection.
A small percentage of animals may also develop gastrointestinal signs such as vomiting or diarrhoea.
The only accurate way to diagnose a food allergy is by a strictly controlled food trial
Remember that even a single mouthful of an allergen can lead to a marked reaction, just as with a person with a peanut allergy, so strict adherence is VITAL for the trial to be diagnostic.
In dogs with secondary infections and severe pruritis, we will generally treat these concurrently with the trial.
Clinical improvement is suggestive of the diagnosis, but to check, your dog should be challenged with the old diet. An immediate return of itching confirms food allergy.
Food allergy, once diagnosed, is easy to treat, by merely preventing the offending allergen from inclusion in the diet. Relapses in dogs that steal the wrong foods are commonly seen.
At Acorn we stock Wellness diets, composed of novel proteins, which are ideal for long-term maintenance in many of these dogs. These are available over the counter and are more cost effective and palatable than many prescription diets. We still advise prescription or home-cooked protocols for the diagnostic trial however.
Prognosis is excellent, but everyone in contact with your dog must be educated in which foods to avoid. It can also be harder to combat in households with small children who may drop food or sneak it under the table at dinnertime!
A novel protein, or proteins commercially broken down (hydrolysed)to an unrecognizable size are fed exclusively.
This is performed by either preparing a home-cooked diet containing a protein your dog has never eaten before and a specially chosen carbohydrate, such as boiled potatoes, or by feeding a prescription hypoallergenic diet from Acorn.
The food trial is continued for 8-10 weeks, with NO other foods given. No treats, chews, milk or even chewable heartworm prevention medication (discuss alternatives with our vets) should be given during this period.
Atopic dermatitis (inflammation of the skin) is a genetically inherited, recurring itchy skin disease resulting from an allergy to environmental allergens.
The average age of onset is 1-4 years of age and breeds particularly predisposed include the West Highland White Terrier, Boxer, Chihuahua, miniature schnauzer, and Labrador and Golden retrievers.
Allergens are substances in the environment that cause an allergic reaction and include house dust and house dust mites, mould spores and pollens. These stick to the skin which then reacts.
Mild to severe itching of the ears, face, armpits, feet and tummy occur, with secondary infections of the broken skin with yeasts and bacteria common.
Recurring ear infections are a common presentation, with the irritated skin of the ear canals producing excessive wax. This builds up and will often become infected.
Signs may be seasonal depending on when specific allergens are common.
Diagnosis is made by
Blood testing (RAST) is sometimes used to determine atopic allergens but is generally considered to be less reliable than IDST.
Unfortunately this is not a curable condition and treatment is designed to keep your dog more comfortable.
precise history taking, determining when your dog is most itchy
ruling out of other potential causes of skin itching such as infections, mites, fleas and food allergy
Intradermal Skin Testing (IDST)
Initially a low dose of allergens are given and these are slowly raised to try and desensitize the dog to their allergens. It can take up to a year to see an effect.
Atopic dermatitis is a lifelong disease and can be very frustrating for both owner and vet, as well as for the poor dog!
Remember that dogs can become more allergic to more allergens as they age, and good communication between owner and vet is vital.
Antihistamines can be used long term to try and control the itch. Sadly these are often less effective in dogs than humans
Omega Fatty acids may help reduce inflammation, are very safe long term, and often given together with other medications
Steroids are often used in the short term to help control severe itching
Topical therapy with medicated shampoos. Steroid sprays may also help.
Treatment of secondary bacterial and yeast infections is important
Cyclosporin ("Atopica") may control clinical signs in some dogs
STRICT FLEA CONTROL is very important as flea bites will worsen the problem
Immunotherapy can be formulated on an individual basis, based on the results of an IDST.
Giardia duodenalis is a protozoal parasite (single celled) which can cause acute and chronic gastroenteritis. In both cats and dogs, it is a common cause of both weight loss and diarrhoea in Hong Kong.
Giardia is normally spread by the ingestion of the cysts in contaminated food and water. The cysts are found in infected faeces and are spread by the faecal-oral route. Once inside the body, the cysts will mature into trophozoites (active feeding stage of the parasite) and both cysts and faeces can be passed out in the faeces to infect other animals.
Infected animals can appear to be completely healthy with no symptoms at all. However, infections can lead to intermittent or severe diarrhoea, weight loss, inappetance and occasionally vomiting. Sometime, infection may appear simply as small amounts of blood or mucus in normal stools.
At Acorn, we use a rapid test, which can accurately detect small numbers of Giardia antigens (specific proteins) in the faeces. We also routinely analyse faecal samples visually with a microscope after preparation with zinc sulphate flotation and centrifugation (high speed spinning to separate cysts from faecal matter). This visualization allows us to see any other concurrent infections/parasites such as worms or Coccidial cysts)
Since Giardia can be shed intermittently, we may occasionally ask you to collect faecal samples for 3 days to increase the likelihood of detection of Giardia antigens.
There are many different drugs that we are able to use to treat Giardiasis. Albendazole and fenbendazole are commonly used and very effective against Giardia. Metronidazole is another frequently used medication, especially in humans – however it is less a lot less effective in animals than albendazole. These are just a few of the many drugs available for us to use in Acorn against Giardia.
It is very important to treat all animals in the same household together against Giardia (even if not showing symptoms) to minimize the likelihood of re-infections. It is also necessary to clean the environment thoroughly with an appropriate detergent/bleach to prevent re-exposure to the parasite. Faeces should be removed from the environment as soon as possible after each defaecation.
It is very important to note that Giardia can infect humans so appropriate measures should be adopted to minimize infection such as wearing gloves and washing hands.
Parvovirus (CPV) causes vomiting and diarrhoea in dogs and is unfortunately often fatal in unvaccinated animals.
The severity and survival rate of the disease is variable. The virus attacks fast growing tissues, so pups less than 6 months of age are especially susceptible.
Infection occurs through contact with contaminated faeces, with incubation time (from encountering the virus to developing the disease) usually 3 to 7 days.
Infected dogs excrete the virus in their faeces for approximately 2 weeks post infection but the virus can remain in the environment for years.
Most dogs will present with sudden onset bloody diarrhoea and/or vomiting. They will usually have weakness, fever and decreased appetite, and may collapse suddenly.
Their increased fluid loss from vomit and diarrhoea, combined with minimal or no intake causes dehydration which is often life-threatening. Further deterioration leads to toxic shock and possibly death.
In some dogs, inflammation of the heart muscle (myocarditis) can cause sudden death.
Unfortunately there is no drug available to cure the disease and treatment is supportive, keeping the patient alive and comfortable and able to fight the disease.
In some animals hyper-immunised serum may help fight the disease.
In unvaccinated animals, particularly pups, prognosis is guarded, and hospitalisation for over a week may be needed. In vaccinated animals prognosis is very good, with most animals suffering far more mild symptoms.
By far the best course of action is prevention, with a standard vaccination course as described in our vaccination article. Sadly vaccinations cannot help dogs already suffering from CPV.
Do not allow your pup the risk of exposure to CPV until they are fully vaccinated and maintain regular annual boosters.
At Acorn we would advise you to only obtain dogs from a safe source where previous history and vaccination status are known, such as adoption organisations. Many pups from pet-shops will have contracted CPV, and other diseases prior to purchase, due to incomplete vaccinations and mixing with potentially infected animals.
Intravenous fluids to correct dehydration and electrolyte imbalance
Anti-emetics to reduce or prevent further vomiting
Antibiotics to combat secondary infection via a leaky gut wall
Leptospirosis is a zoonotic (transmissible from animals to humans) multiorgan disease seen increasingly frequently in dogs in Hong Kong.
Various animals serve as reservoirs but rats are the most common.
The disease is shed in the urine of infected animals and transmitted by either direct or indirect contact.
Direct transmission occurs through contact with infected urine, during breeding, from mother to offspring through the placenta, via bite wounds, or by eating infected tissue.
Indirect transmission occurs through exposure to contaminated water, soil, food or bedding. Disease outbreaks are more common after periods of heavy rain.
Leptospires enter the blood and other tissues and reproduce and cause damaging inflammation. Common affected organs include kidneys, liver, spleen, brain and eyes.
These can be variable depending on the organs most affected.
Very acute (sudden) infections may result in shock and sudden death, but more often fever and reduced appetite are the first signs.
Vomiting, dehydration, jaundice (yellowing of the gums and skin) and anaemia may follow.
Various blood tests are advised in suspected cases
Follow Up and Prognosis
Dogs with leptospirosis have a guarded prognosis, and may develop life-long complications to kidney and liver even with appropriate treatment.
Vaccination against Leptospirosis is included in routine vaccination protocols in Hong Kong, but infected dogs are still seen. At Acorn we stock Fort Dodge Leptospirosis vaccines, considered to be amongst the most effective in prevention.
Complete blood count (CBC) to evaluate red and white cells and platelets
Blood biochemistry to evaluate liver and kidney function
Urine tests to evaluate liver and kidney function
Polymerase chain testing (PCR) to detect Leptospirosis DNA is diagnostic
Severely affected animals require hospitalization and intensive care
Intravenous fluids are required to correct dehydration
Antibiotics that kill leptospires are started as soon as possible. Penicillin-type antibiotics are the drug of choice for initial treatment and given for 2 weeks. Then another antibiotic, doxycycline may be given for another 2 to 4 weeks afterwards. This is to eradicate shedding in the urine.
During treatment infected animals should be isolated to prevent infection to other animals and humans.
Areas of the dog’s environment should be disinfected with bleach
Heat stroke can occur when body temperature rises to 104-106 degrees F (greater than 40 degrees C) and usually involves exposure to high environmental temperatures.
Exertional heat stroke occurs when internal heat generated by exercise cannot be adequately dissipated, with body temperature rising to a dangerous level.
Causes can be split into two groups. Those that decrease the dog’s ability to lose heat and those that increase heat production.
External factors that decrease heat loss include confinement in a poorly ventilated space (eg locked in car), high environmental temperatures, increased humidity, and limited access to water. Internal factors include obesity, thick coat and jackets, and upper airway and heart disease.
Factors that increase heat production include prolonged seizures, exercise and fever.
Panting and high temperature (hyperthermia) are most common, but can progress to weakness, collapse, coma or convulsions.
Breathing may be very noisy and the gums can become bright red or blue.
Some dogs may have vomiting and diarrhoea.
Delayed signs may develop 3-5 days after apparent recovery due to damage to internal organs and can include reduced volumes of urine (kidney damage), jaundice (liver damage) and sudden death from heart failure.
Diagnosis is based on finding an extremely high body temperature, a history of exposure to heat, and consistent clinical signs.
Often lab tests will aid in assessing damage to internal organs and degree of dehydration and electrolyte imbalance.
This is an emergency! The goals of treatment are to lower body temperature, treat shock and other organ damage and correct any predisposing factors.
As soon as you realize your dog has heat stroke soak him in cool water, wrap in a cool, wet towel and get into air-con and to a vet as soon as possible.
Cooling methods at the vet include immersion in a lukewarm bath, applying ice packs to feet and groin (hairless skin) and using fans. Care must be taken to avoid body temperature dropping too low (hypothermia)
Treatment for shock may involve intravenous fluids, oxygen therapy, and treatment for seizures or brain swelling.
Follow Up and Prognosis
Most animals with heatstroke require intensive monitoring for several days after the incident, and prognosis depends on the severity and duration of the hyperthermia, and how much damage has been done to internal organs.
Sadly comatose dogs have a poor survival rate, and animals that have an episode are prone to recurrences.
Whilst most pet owners in Hong Kong are aware of this condition, many forget high air humidity is a risk factor. Dogs only sweat from their pads and rely on evaporation by panting to lose heat. In high humidity evaporation is of course compromised. At Acorn we would strongly advise caution on too much exercise on very sunny or humid days, or if possible choose the beach over the Twins!
Dermatophytosis is a fungal skin infection of animals that affects the hair and surface of the skin. It is commonly known as ringworm since the lesions often appear ring (round) in shape!
The most common organisms associated with dermatophytosis are
Trichophyton mentagrophytes and
All of these organisms (dermatophytes/fungi) are infectious to humans. Animals with a weakened immune system (due to age e.g. young animals, disease or drugs) are more at risk of developing a ringworm infection.
Some animals can be infected as carriers showing no clinical symptoms. Hair loss is the most common sign, which may be present together with crusty scaling, dandruff, redness, increased pigmentation and itchiness.
A definitive diagnosis can be made by a fungal culture. A culture will provide a medium for the fungus to grow, which normally takes 2 weeks. A culture normally involves either brushing the hair with a sterile toothbrush or plucking a small sample of hair form the edge of the lesion. It is important that no antiseptic/antifungal creams or shampoos have been used prior to taking a culture sample.
Wood’s lamp examination can also aid a ringworm diagnosis. Hairs that exhibit a positive apple-green fluorescence under a blue light is considered a positive result for Microsporum canis. It is worth noting that many false negative and positive results can occur with a Wood’s lamp exam.
If the infection is localized, it is common to use just topical therapy such as a cream or shampoo. If the infection is persistent or generalized (affecting many parts of the body), we commonly use antifungal medicine such as griseofulvin, itraconazole or ketoconazole, in addition to shampoos (which minimize environmental contamination). Treatment normally is continued for 1-2 months.
It is also important to isolate affected animals to reduce spreading the fungal infection. Cleaning infected surfaces/areas with bleach and detergents and using a vacuum cleaner to remove all hair that has been shed will help to prevent re-infection.
It is important to remember that humans can also be infected with ringworm, so good hygienic measures such as washing hands will help minimize you getting the disease yourself!
Sarcoptic mange (“scabies”) is an itchy disease of dogs caused by the mite Sarcoptes scabiei burrowing into the layers of the skin.
Scabies causes intense itchiness in dogs and other clinical signs include hair loss, redness, small red bumps, scabs, and dandruff. Sites most affected are the edges of ears, elbows, hocks, and the underside of the belly.
With long-term infestations, skin changes may become widespread, but the top of the dog is usually unaffected.
Well-groomed animals may have intense itchiness, with minimal to no skin lesions. Enlarged lymph nodes may be present, along with weight loss and lethargy secondary to the chronic itching and discomfort.
Owners in contact with infected dogs may develop and itchy patch of small red bumps but the mite cannot live on humans for more than several days.
Sarcoptic mange is suspected in any dog that is intensely itchy. Finding the mite, mite eggs, or mite faecal material on skin scrapings from affected areas confirms the diagnosis, but this evidence is found only 10-50% of the time. Often dogs suspected of infection will be placed on trial therapy and diagnosis based upon response.
All dogs in contact with the infected dog should be treated to prevent recurring infection cycles, and in severe cases the environment must also be treated with anti-parasite sprays.
Topical therapy involves the application of selamectin (
Revolution). This is licensed for use once monthly, but is more effective against scabies if applied every two weeks for a total of three treatments.
Several products, such as ivermectin injection, are not licensed for use against Sarcoptes but have been shown to be very effective. The decision on whether to use them requires discussion between owner and vet, and their use in some breeds is contra-indicated.
Secondary bacterial infections should be treated with antibiotics.
Environmental treatment is easily accomplished with sprays, often with the same products used for treating flea infestations.
Many dogs with scabies will exhibit increased itching for the first week of treatment as a result of mites dying within the skin layer, but if your pet’s itchiness has not decreased after 21 days of treatment, further diagnostic tests and re-evaluation are needed.
The prognosis is very good with adequate treatment of the mite and control of any secondary bacterial infections.
Demodicosis is the overgrowth of a mite (
Demodex canis) found within the hair follicles. Mites are passed from the mother to the puppy within the first few days of birth and the presence of very low numbers on dogs is normal.
Clinical disease (demodicosis) occurs when the number of mites increases to excessive and harmful levels, due to the dog’s immune system being unable to control the mites allowing overgrowth.
There are two forms of demodicosis:
Mite overgrowth destroys the hair follicles leading to hair loss. Bacteria and yeasts can invade the skin via the holes produced by this hair loss (folliculitis) leading to secondary infections with scabs and spots.
The disease is termed localized when hair loss occurs only in isolated, patchy areas. Localised demodicosis is rarely itchy.
With generalized demodicosis, hair loss and lesions may occur all over the body and be extensive. Blackheads, pimples, red bumps, and bleeding areas may be present. Scabs often indicate secondary infection, which can cause itchiness.
Diagnosis is based on finding Demodex canis mites in samples taken from the skin. Samples are taken by scraping the skin or plucking hairs and examined under the microscope. Other laboratory tests may be indicated in dogs with adult-onset demodicosis in case of underlying disease.
Many cases of localized demodicosis will resolve on their own, once the dog’s immune system becomes competent and require only monitoring. However it is important to watch for new areas of hair loss as it may progress to a generalized form and require treatment.
For dogs with generalized demodicosis of juvenile onset, all secondary bacterial infections are treated, and efforts are made to improve the overall health of the animal. Measures include deworming, vaccinations, nutrition, and desexing.
In cases of adult-onset generalized demodicosis, all secondary bacterial infections are treated. Sometimes infections are so severe that they must be treated first. An underlying cause must also be addressed.
There are medications used in canine demodecosis that are not licensed for use but are well-documented and can be very effective. In more serious cases they may be required for effective resolution and cure. Careful discussion with your vet is required to decide if these may be needed.
Successful management of demodicosis can be difficult. Localised cases are rechecked every few weeks until the dog outgrows the disease. Dogs with juvenile-onset generalized disease are usually rechecked monthly until secondary infections are resolved, then every 4-8 weeks throughout the course of therapy which may last for up to 4 months.
Some animals with generalized disease are not cured and must be treated periodically for life to control the lesions.
Prognosis is very good for puppies with localized demodicosis and 85% of dogs with juvenile-onset generalized demodicosis can be cured.
Resolution of adult-onset cases varies based on the overall health of the animal and the presence of any underlying diseases.
Juvenile-onset demodicosis, where the immune system of growing or young adult dogs seems to be unable to identify the mites as foreign, with a genetic predisposition present.
Adult-onset demodicosis, where the overgrowth is frequently associated with a poor or compromised immune system. This can result from underlying conditions such as Cushing’s disease, hypothyroidism, immunosuppressive drugs, or cancer.
Keratoconjunctivitis Sicca (Dry Eye)
Keratoconjunctivitis sicca (KCS or Dry Eye) results from inadequate production of the water component of tears. There are two main tear glands, beneath the third eyelid and behind the upper eyelid.
There are a number of potential causes in dogs:
Signs are related to the result of a dry and itchy eye, with redness, increased blinking and squinting, and a thick mucoid discharge.
The cornea may become pigmented and scarred, with decreased vision.
The dog may rub the eye and corneal ulceration may occur.
KCS may be tentatively diagnosed based on clinical signs and confirmed by measurement of tear production using the Schirmer tear test. A thorough examination of the eyes is conducted to rule out other causes of pain and redness such as glaucoma or lens luxation.
The main goal is to increase tear production.
Drugs such as cyclosporine and tacrolimus protect any remaining active tear gland tissue from further immune-mediated damage. They are administered up to several times a daily, and treatment is often life long. Tear production may increase within a few weeks, but it can take as long as three months for a response to be seen. Unfortunately not all patients will respond to these drugs as the tear glands may have been irrepairably destroyed prior to treatment.
Artificial tears are used to keep the eye well lubricated. They come in various forms, but at Acorn we advise use of the gels which evaporate at a slower rate from the eye surface, and yet still allow good vision.
Follow up care includes periodic checks, with repeated tear tests, throughout the animal’s life. Medications often require adjustments to maintain good surface health of the eye. The key to managing the condition is continuous and diligent treatment by the owner.
KCS is usually a chronic disease that may be controllable but is not often curable.The prognosis for eyes that respond to tear stimulants is good.
Dry eye often arises from an immune-mediated inflammation of the tear glands and is common in certain breeds including the shih tzu, English bulldog and West Highland White terrier
Canine distemper virus infection can cause KCS.
Congenital underdevelopment of the tear glands can lead to KCS very early in life, most commonly in the Yorkshire terrier.
Trauma, corneal ulceration, and extrusion of the eye as a result of injury may result in KCS, usually on one side.
Damage to the facial nerve, which activates the tear glands, can cause KCS and usually arises from chronic ear disease.
Removal of a loose (prolapsed) third eyelid tear gland may predispose to KCS later in life.
Common pet poisons
Although there are many different drugs, plants, foods and household agents that can be poisonous to our pets, the ones which can commonly affect our animals are listed below:
Onions – (also to some degree garlic and chives) contain sulfur compounds which can irritate the gut and more seriously damage the red blood cells.
Human medications – be very careful with any medication you may use. For example, acetoaminophen (paracetamol) can be fatal , especially in cats.
Chocolate – Theobromine is found in chocolate and pets can be very sensitive to its effects. In addition to gut upsets, it can lead to abnormal heart rhythms, tremors, seizuring and even death!
Xylitol – this is often found in sugar-free chewing gum, sweets and mouthwashes and is toxic to pets, especially dogs, where it can lead to low blood sugar levels.
Grapes and raisins – These can lead to kidney failure and death in animals (more commonly dogs).
Nuts –especially Macadamia nuts can affect different systems in the body causing intestinal upsets, tremors, depression, weakness and stiffness. Toxicity is more common in dogs.
Lillies – all parts of this plant are toxic to cats and can cause irreversible kidney damage.
Caffeine – is often highly toxic to pets. It can cause similar symptoms as chocolate toxicity.
Alcohol – the effects are depending on the quantity of alcohol but in severe cases, it can lead to laboured breathing and death.
Avocado –contains a toxin called persin which can cause gut upsets. It is a lot more toxic when eaten by small pets or birds.
Marijuana – Effects can last for days causing drowsiness, slow breathing and heartbeat, depression and in severe cases, death.
All household detergents/chemicals, human medication, plants, insecticides, herbicides and rodenticides should be kept well away from pets.
This is a condition where the patella (kneecap) dislocates from the groove of the bottom of the femur (thigh bone). The condition is more common in small breed dogs such as Pomeranians and Yorkshire Terriers. Often the patella dislocates to the inside of the knee (medial luxation) but can occasionally displace to the outside of the knee (lateral luxation).
Patellar luxation is caused by many factors. Occasionally, it may be the result of a traumatic incident but often it is caused by a genetic influence. Several abnormalities in the anatomy of the affected leg can lead to development of a luxating patella. Commonly, the muscles and major bones of the leg are deformed and malaligned.
At Acorn, the most commonly reported sign by owners is an intermittent lameness. The animal may cry in discomfort, hop or limp for several steps (then stretch the leg and appear normal again) or walk abnormally. If the condition persists for a long time, the stifle (knee) joint will often develop osteoarthritis (degenerative joint disease) from the abnormal motion of the patella, which will cause pain and lameness.
Patellar luxation is most commonly diagnosed by an examination of the leg during a consultation. Often veterinarians may detect a luxating patella during a routine check-up (e.g. vaccination) before any clinical signs have been noted. We normally grade the severity of the luxation on a scale of 1 to 4.
At Acorn, we often recommend x-rays of the leg to assess the anatomical abnormalities and to aid us to decide the best measures to take to correct the condition.
In animals, with no clinical signs, we may recommend a conservative approach where we monitor movement or any discomfort that may develop in the leg. There are several surgical techniques we may use to stabilize the position of the kneecap to allow proper alignment. The most common techniques include one or a combination of:
Grade 1 – patella can be manually displaced but when released, it returns to its normal position.
Grade 2 – The patella may manually or spontaneously luxate but normally needs to be replaced to the normal position by either manual manipulation or by extending the leg.
Grade 3 – The patella is constantly dislocated but can be manually returned into the normal position but re-luxates once the pressure is released.
Grade 4 – This is the most severe form when the patella is permanently luxated and cannot be returned to the normal position.
After surgery, in most cases, the prognosis is good and the leg can return to a good function.
Deepening of the trochlear groove of the femur where the patella sits by a recession trochleaoplasty.
Re-locating the tibial crest (shin bone which is attached to the patellar tendon) to release the abnormal pull on the kneecap.
Sutures that imbricate (strengthen) the supporting soft tissues and joint capsule that pull the patella to the normal position.
A releasing incision on the side which the patella is luxated to release the pulling tension.
In severe cases, we may perform a corrective osteotomy to realign the patella by straightening the femur (and possibly the tibia).
When faced with a fracture there are many different factors to consider when it comes to which method of repair to use.
The goal of repair is to stabilize the broken bone for long enough to allow healing to occur. With every fracture there is a race between bone healing and implant failure!
Things to consider in fracture management include
With many road traffic accidents or falls, more immediate life-threatening injuries such as blood or air in the chest need to be addressed first. Once the patient is stabilized (which may take days) fractures can be fixed.
With open infected fractures implants ideally need to be kept away from the site of injury as bacteria will grow on them protected from antibiotics.
Commonly used methods of repair are:
the age of patient (and thereby the rate of healing to be expected)
the patient’s activity levels (and thereby chance of implant loosening or breaking)
degree of displacement of the bone fragments
any concurrent diseases (complicating anaesthesia and recovery)
possible infection in an open fracture where bone has pierced through the skin
other injuries caused by the traumatic incident
Sometimes more than one method will be used in conjunction for extra stability, such as an intramedullary pin and external fixator pins, or an intramedullary pin and plate.
It is normal procedure to recommend cage rest for up to 2 months after surgery, depending on the fracture and mode of fixation.
Generally we will recommend follow-up visits to check on progress 3 days and 2 weeks post surgery, and will usually re X-ray the injury at 6 to 8 weeks to check the bones are healing and the implants are in place.
Some implants will always need removal after the bones have healed, whilst others (such as plates) may be left in, and only removed if causing a problem later in life.
Splinting and bandaging. This is commonly used in young dogs with non-displaced fractures that should heal quickly, and is the least invasive method.
Intramedullary pins placed down the centre of the bone. These are also common and best used in fractures in the middle of the long bones such as the femur, where the pin can take good hold in the bottom section.
External fixators, with pins drilled at right angles through the bone and held in position with one or more bars outside the skin. Despite looking scary, these are actually quite non-invasive and have the advantage of staying away from the actual site of fracture. As a result they are often used in injuries that may have been infected.
Plates and screws. These provide maximum security but require the most surgical exposure to place. They are frequently used in older animals that have slower healing rates, often in conjunction with bone grafts to stimulate healing, and in very unstable injuries. They are also often used in very active or big dogs that may place a lot of strain on the implants.
The hip joint (coxofemoral joint) is made up the top (head which is ball shaped) of the thigh bone (femur), which normally sits snugly within the socket on one side of the pelvis (hip bone). The structure is held together by a strong ligament between the bones and a capsule that surrounds the joint. Hip dysplasia is a condition where the hip joint does not develop properly leading to a loose ligament and capsule causing the thigh bone not to sit securely within the pelvic bone.
The laxity of the hip joint gradually leads to inflammation of the joint, causing erosion of the smooth cartilage within the joint and within time, scar tissue and osteoarthritis (degenerative joint disease) will develop. In most cases of the hip dysplasia, eventually, the animal will experience pain and discomfort in the hip joint. Hip dysplasia is a condition that is caused by multiple factors which include genetics, exercise and nutrition.
Not all cases of hip dysplasia immediately result in pain or lameness of the leg. In severe cases, signs may begin to present from a young age e.g. 3-4 months. Signs can frequently improve as scar tissue develops and stabilizes the joint but eventually, as the osteoarthritis develops – animals will become progressively lame as the cartilage is destroyed.
Typically, affected animals may show a decreased range of motion in the hip joint (stiff gait – narrow stance), difficulty rising, jumping, climbing stairs and running, decreased activity, trembling or limping/lameness in hindlimbs. Often as the condition progresses, there is wasting of the backleg muscles. Pain is often worse after rest or strenuous activity.
A thorough physical examination by the veterinarian will often reveal pain and less mobility in the affected hip, especially when the hip is extended. Sometimes, sedation is needed examine looseness (laxity) in the joint by a test called an “Ortolani manoeuvre”.
Hip dysplasia is normally confirmed by x-rays of the hip joint under anaesthesia. Since this condition has a genetic component, it is often recommended not to breed from an affected animal.
Medical options of pain relief in the form of pain killers is a reasonable choice in older dogs, ones that are mildly affected or when there are financial limitations.
Conservative treatment may also involve the use of injections of polysulfated glycosaminoglycans (such as cartrophen – pentosan polysulfate), oral supplements such as green-lipped mussel extract and essential omega fatty acids (e.g. EPA and DHA) and strict weight management to minimize un-necessary load and stress on the joints. Acupuncture can also be used as an alternative means of improving the blood flow, decreasing the pain and inflammation of the affected joints.
Swimming is an excellent way of maintaining joint mobility and improving muscle tone while minimizing pressure on the joints. Hill walking can also help to build the muscles of the hindlimbs to give additional support to the joints.
In severe cases, surgery is often recommended. In Acorn hospital, for young animals that are still growing (less than 12 months of age), we may perform a surgical procedure called a
TRIPLE PELVIC OSTEOTOMY, which involves rotating the acetabulum (socket) so the joint develops normally. We may also occasionally perform a surgery in immature animals called a
JUVENILE PUBIC SYMPHYSIODESIS, which involves fusing part of the pelvic bone earlier than it occurs naturally to improve the joint shape and stability.
In adult animals, we perform one of two surgical procedures. The first is called a
FEMORAL HEAD AND NECK OSTECTOMY, which is a straightforward surgery that eliminates the pain by removing the top part of the thigh bone and allowing scar (fibrous) tissue to fill in the void.
The other surgery performed in adult animals is a
TOTAL HIP REPLACEMENT. This involves replacing the joint with a metal implant (similar to humans). This is an expensive surgery that can yield good results but complications such as infections, implants loosening/breaking are common.
A new option available to veterinarians is stem cell therapy. This involves using the fat of the affected animal to harvest stem cells, which are then injected into affected joint to help repair the damage joints (such as the cartilage). In the cases that have had stem cell treatment in Acorn hospital, we have so far been very impressed with the results leaving the animals pain-free with good mobility and needing no medication. This is a treatment option that so far is showing great promise for the future!
The cranial cruciate ligament (CCL) is the main ligament that stabilizes the stifle joint (knee). Its function is to minimize internal rotation and hyperextension of the knee, in addition to preventing forward displacement of the tibia (shinbone) in relation to the femur (thigh bone) Although CCL disease in humans is often the result of a traumatic injury such as a skiing or football injury, CCL disease in animals is normally a chronic process. This disease leads to a degeneration in the CCL which can lead to instability in the knee joint resulting in pain and osteoarthritis.
Eventually, the CCL ruptures which can lead to complete instability of the stifle joint and severe pain. This often manifests itself as a lameness of the affected leg. Initially, the disease may be apparent in one leg, but more often than not, rupture of the CCL in the other leg will occur within 6-12 months of the first ligament tear.
It is said that in 50% of cases with a CCL rupture, there are concurrent injuries to the menisci. Each stifle has 2 C-shaped cartilage pads called menisci that act as shock absorbers in the knee.
Like many diseases, CCL disease is multi-factorial and has a genetic component. It is more common in older animals where degeneration of the ligament has occurred for some time leading to eventual rupture. In younger animals, it tends to occur more frequently in large-breed dogs. Abnormal anatomy of the hindleg e.g. a sloping plateau of the tibia can predispose to CCL rupture.
The main clinical sign is lameness (limping) of the affected leg. The degree of lameness can vary depending on a complete or partial rupture of the ligament, the mode of rupture (acute or chronic), the degree of arthritis and if there is any meniscal damage.
The main method of diagnosis is a thorough examination of the leg. Often, this may be necessary after sedating your animal (allowing the muscles to relax) and minimizing any discomfort/pain to your pet. Examination of the joint may reveal swelling/inflammation and excessive instability (especially movement of the tibia in relation to the femur).
Two commonly performed manoeuvres are called the cranial drawer motion and the tibial compression test.
In Acorn, we recommend x-raying the affected stifle to assess if any osteoarthritis (degeneration of the joint) is visible.
Commonly, surgery is performed to aid a faster recovery and improve the function of the leg. In small patients such as small breed dogs and cats, conservative treatment of restricted rest and pain relief may be sufficient. In larger animals, surgery is normally recommended.
There are many different surgical techniques for repairing a CCL rupture. The fact that there are so many techniques indicates that not one single surgery has be conclusively proven to be better than another! The main techniques include:
If meniscal damage is found during inspection of the joint during surgeon, many veterinarians elect to remove the damaged portion to minimize pain in the joint.
Following surgery, animals may need a period of restricted activity combines with physical rehabilitation and/or exercises.
Many animals can return to normal function following treatment although osteoarthritis may still be present/develop. In severe cases of osteoarthritis, medical therapy (pain relief and supplements) may be needed.
Stem cell therapy is a new treatment option, which may become more frequently used in the future to aid recovery and healing of the damaged stifle joint associated with CCL disease.
Intra-articular techniques that create a new ligament by using the animal’s own tissue e.g. patellar tendon or alternatively, synthetic materials.
Extracapsular techniques that stabilize the joint by surgery outside the stifle, e.g. lateral suture placement.
Biomechanical techniques that attempt to change the angles and forces within the stifle joint such as tibial plateau leveling osteotomy (TPLO), tibial tuberosity advancement (TTA) and triple tibial osteotomy (TTO).
Intervertebral Disc Disease
Intervertebral disc disease (IVDD) or “a slipped disc” is one of the most common spinal cord conditions in the dog. Between the bones of the spine (vertebrae) are discs (intervertebral discs) composed of a fibrous capsule and a gel-like centre.
These discs act as cushions and shock absorbers.
IVDD is a general term describing where the disc protrudes into the spine from it’s normal position into the spinal canal, compressing the spinal cord.
Three types of IVDD occur in the dog
Type I is mainly seen in 3-6 year old dogs with short legs and long backs, such as the dachshund, shih tzu, beagle and cocker spaniel. Onset of signs is typically sudden
Type II is mainly seen in older, larger breeds of dog such as German shepherds and Labradors. Onset of clinical signs is often slow and progressive over weeks to months.
Type III have sudden onset of signs.
Neurological signs depend on the site of disc herniation and degree of cord injury
Signs often occur in progressive stages
Type I arises with hardened or calcified disc gel squirting out of a burst capsule to compress the cord
Type II arises with degeneration of the entire disc causing it to bulge into the canal to compress the cord
Type III is a non-compressive herniation where a small amount of disc material shoots out at high velocity to hit and damage the cord.
Some dogs may progress through these stages rapidly but the degree of cord compression does not always correlate with the severity of the signs
Compression of the neck causes signs in all four legs, whilst compression in the chest or back region (more common) causes signs in the back legs only.
A thorough clinical and neurological evaluation is vital
X-rays may be used to rule out other possible causes such as vertebral fractures, but will not normally show up herniated disc material. They can appear normal in even a dog with severe IVDD and cannot aid in planning surgery
Myelography involves injecting a contrast fluid into the spine to aid in locating a compression but is not 100% accurate
Magnetic resonance imaging (MRI) is by far the best method to both diagnose IVDD and locate the site of injury prior to any planned surgery
Treatment options consist of conservative and surgical therapies
The degree and duration of neurological signs are important in deciding the best course of action
Conservative treatment can be tried in dogs that have mild pain or inco-ordination that can walk but unsteadily (ataxia). Dogs with type III compressions are also treated conservatively as there is no compression of the spinal cord to relieve
Conservative therapy consists of
Mild compression or injury may cause only pain
More severe compression or injury causes an unsteady gait and weakness (paresis)
As the spinal cord injury worsens, the dog may lose the ability to move his legs (paralysis) and may be unable to urinate voluntarily
With the most severe injuries, dogs are unable to feel any pain to their toes. This is called loss of deep pain sensation and is important in determining prognosis
Surgical treatment is usually chosen for dogs with more severe, or worsening, neurological problems. It is also considered in dogs with pain that will not resolve.
Surgery involves removing a portion of bone to allow access to the cord at the site of compression. The offending disc material is gently removed, thereby relieving spinal cord compression
Good nursing care is required after surgery to allow proper recovery
Follow up and prognosis
Recovery time depends on severity and duration of clinical signs.
Most dogs with only mild or moderate pain will recover without surgery, but prognosis for more severely affected dogs treated with conservative therapy is poor.
Typically dogs treated with surgery recover after 1-2 weeks, but severely affected dogs may require months to regain leg and bladder function.
Some severely affected dogs never walk again, and may have persistent urinary incontinence.
Maximal improvement occurs by 3 months after the initial onset and further improvement after this time is unlikely
Deep pain sensation (DPS)is an important prognostic tool for determining whether surgery will help, and prognosis is very poor in dogs that are paralysed and have no DPS. If treated surgically within 24 hours of onset, dogs with no DPS have a 50% chance of regaining the ability to walk, but chance of success lessens with further delay.
Some dogs can have recurrence of IVDD, with other discs developing the disease along the spine.
Exercise restriction with strict confinement and limited leash walking for toilet purposes only for 4-6 weeks
Hyperadrenocorticism arises from overproduction of glucocorticoid hormones by one or both of the adrenal glands (Cushing’s disease) or from chronic or excessive administration of steroid medications (Cushing’s syndrome)
Pituitary-dependant hyperadrenocorticism (PDH) develops when a tumour of the pituitary gland produces high levels of adrenocorticotropic hormone (ACTH), overstimulating the adrenal glands. PDH is the most common cause (85%) of Cushing’s disease in the dog and whilst most pituitary tumours are small, about 30% can be large enough to cause neurological signs as they enlarge.
Adrenal gland tumours occur in 15% of affected dogs, and half of these are malignant. Usually only one adrenal is affected and enlarged.
Iatrogenic hyperadrenocorticism arises from prolonged or excessive administration of steroids such as prednisone and dexamethasone. Since the pituitary gland constantly detects high levels of steroids in the blood, it decreases the production of ACTH, causing both adrenal glands to shrink. This may cause problems if the dog comes off steroid medications too quickly with a deficiency of naturally produced steroids within the body (Addisonian crisis)
Most affected dogs are middle-aged or older and miniature poodles, boxer and dachshund are especially predisposed.
Female large-breed dogs are more at risk from adrenal tumours.
Common signs include
Less frequently seen are
Increased thirst, urination and appetite
Obesity often with a classic pot-belly appearance
Thinning or darkening of the skin
Urinary tract and skin infections
Cushing’s syndrome is usually suspected based on a history of prolonged exposure to steroid medications.
Cushing’s disease requires laboratory tests as no clinical sign is specific for the disease. Routine bloods may show raised liver enzymes, cholesterol, blood sugar and white blood cells.
Several screening tests are used that involve measuring steroid levels in the blood after transient chemical stimulation or suppression of the adrenal glands. These include the ACTH stimulation test and low-dose dexamethasone suppression test. Both require day admission for obtaining blood samples at timed intervals.
Once Cushing’s has been diagnosed it is usually necessary to test to differentiate between PDH and adrenal tumours due to difference in treatment and prognosis. Such tests include the high-dose dexamethasone suppression test, abdominal X-rays and ultrasound, and CT or MRI imaging of the brain.
Unfortunately Cushing’s can often be difficult to diagnose as test results may not be clear-cut. The presence or absence of obvious clinical signs characteristic of Cushing’s are often used to further support or rule out the disease.
Cushing’s syndrome is treated by slow, tapered withdrawal of steroid medications. Too rapid a withdrawal can lead to Addisonian crisis.
PDH is usually treated with medications- mitotane or trilostane. Unfortunately radiation therapy is not available in Hong Kong.
Adrenal tumours may be surgically removable but are often so large or enmeshed with vital surrounding structures that medications are again used.
Treatment is complicated and usually involves frequent adjustments of drug doses and repeated lab tests. Also the drugs used are potentially toxic and require careful use and monitoring.
Most dogs with PDH improve with treatment but sadly the disease may still shorten the dog’s overall lifespan.
High blood pressure
Congestive heart failure
Acute breathing problems from blood clots within the lungs
Lymphoma is a cancer of the white blood cells known as lymphocytes, and the disease may originate in any lymphatic tissue in the body, including the lymph nodes, spleen, liver, bone marrow, and thymus.
It may also however affect the skin, eyes, central nervous system, gastrointestinal tract, liver, and lungs.
This cancer can be aggressive if left untreated, but may respond favorably to chemotherapy, adding months and sometimes years to a pet’s life.
The exact cause of lymphoma is unknown but a genetic predisposition may exist, because certain breeds, including the golden retriever, boxer, and bull dog, seem more prone.
Clinical signs depend on the area of the body affected.
Most commonly one or more of the lymph nodes are enlarged, and some dogs may also have enlargement of the liver or spleen.
Depending on site of disease, other signs include breathing difficulties, blindness, seizures or lumps on the skin.
Some dogs may present with a fever and poor appetite, and may be losing weight.
With enlarged lymph nodes which can be felt on a clinical examination (multicentric lymphoma), diagnosis can be relatively straightforward, but if the tumour is within a more internal organ it can be more difficult to detect and diagnose.
The tests performed do depend on location, but at Acorn we may recommend:
Treatment and Prognosis
Treatment depends on the organs involved, but most cases require chemotherapy as the disease is spread throughout the body.
A variety of chemotherapeutic protocols are available, consisting of combinations of oral and injectable medications.
Modern protocols are able to provide maximum effect, with minimal distress and nausea to the patient, but serious discussion is recommended before the process is embarked upon.
The goal of chemotherapy is to achieve long-term remission and good quality of life.
Prognosis is best in dogs that achieve complete remission, and tolerate the chemotherapeutic medications.
Treatment of multicentric lymphoma in dogs has an approximate response rate of 80-90%, with average survival times of 9-12 months after the start of treatment.
Unfortunately lymphomas involving other organs, such as the skin, the intestines, or the respiratory system, or cases with very high blood calcium levels, have lower remission rates.
In dogs that do not receive chemotherapy, survival time may be as short as 4-6 weeks and in these patients, oral steroids may be used temporarily to alleviate some of the clinical signs.
In almost all cases lymphoma will eventually come out of remission, with recurrence of clinical signs such as lymph node enlargement or spread of the cancer to other organ systems. Sadly these dogs respond far less well to repeat courses of chemotherapy drugs.
At Acorn we believe that serious thought and discussion is required between vet and client before the decision as to whether to undergo chemotherapy or not is taken. We always place your pet’s interests first and aim to give an informed and realistic appraisal of prognosis and outcome.
A complete blood count, biochemistry profile or urinalysis
Fine-needle aspiration of a lymph node or mass, with examination of cells under the microscope
Biopsy of enlarged lymph nodes or other organs
X-rays and/or ultrasound to evaluate for internal organ involvement
Bone marrow aspiration if bone marrow involvement is suspected
Chronic Kidney Failure
Chronic renal failure (CRF) is long-standing kidney damage and dysfunction manifested by dilute urine and build-up of waste products (urea, creatinine, phosphorus) in the body.
The kidneys three main functions are:
Consequently when renal tissue is damaged, the clinical signs and problems that result are linked to the compromise of these functions.
It is common in older dogs but is also sadly seen in younger ones too.
In many cases the original cause is never found.
Identifiable causes include kidney infections and stones, incomplete recovery from acute renal failure and diseases of the glomerulus such as glomerulonephritis or protein-losing nephropathy. In younger dogs, congenital kidney disease such as kidney dysplasia may be the cause.
CRF may be detected on routine blood and urine tests prior to the onset of signs and diagnosis at this early stage allows treatments to be initiated that may slow further progression.
Early clinical signs include increased drinking and urination (PD/PU) weight loss and reduced appetite.
In later stages vomiting, dehydration, lethargy and bad (uraemic) breath are seen.
Initially full biochemistry, electrolytes and haematology are performed on a blood sample, looking for build-up of waste products indicating poor renal function.
Urine is tested for protein (lost by the kidneys in CRF) and dilution (determining the ability of the kidneys to concentrate the urine and thereby conserve water)
Additional tests may include urine culture to screen for underlying infection, radiographs and ultrasonography, and blood pressure measurement. In some cases a kidney biopsy may be indicated.
Management revolves around supporting the remaining kidney function, reducing the load on them and also treating the patient for the resultant deficiencies.
Currently no treatments are available to reverse CRF, and the goals are to slow progression and treat the clinical signs, thereby maintaining quality of life.
A special diet with less protein and phosphorus is the most effective measure and can double lifespan in CRF dogs compared to those still on normal diets.
Control of phosphorus levels in particular are important and if diet alone is not sufficient, phosphorus binders such as aluminium hydroxide can be added to the food.
If chronic dehydration is present regular injections of fluids under the skin (subcutaneous fluids) may help with frequency varying from twice daily to twice weekly, and can be done by the owner at home.
High blood pressure (hypertension) can be controlled with various drugs, as can a raised calcium level.
Potassium supplementation and erythropoietin injections to stimulate red blood cell production may also be needed, although, unlike cats, dogs rarely develop low potassium levels from CRF.
Follow Up Care and Prognosis
Frequency of further tests depends on the severity of the CRF present and can range from monthly in severe cases to every 6 months in early, stable cases.
CRF is a progressive disease but rate of deterioration is highly variable. Whilst lifespan is impossible to predict, animals diagnosed with early CRF have an average lifespan of 3 years whilst those with advanced disease may succumb within weeks to months.
filtrating toxins (BUN, creatinine and phosphorus) out of the blood into the urine, but saving the nutrients in the blood such as proteins and vitamins
concentrating the urine and thereby preventing dehydration
the production of erythropoetin, a hormone that stimulates red blood cell production
The cartilage rings of the trachea (windpipe) are shaped like the letter C lying on it’s back, with a small membrane closing over to make a complete circle. In some dogs, as they age these can lose their rigidity, making them prone to collapse.
During episodes of collapse the windpipe flattens leading to anything from mild to severe, life-threatening obstruction.
This is mainly a disease in small-breed dogs such as the miniature Poodle, Chihuahua and Pomeranian. Whilst some dogs can start to show signs at an early age, generally it is older dogs that are affected, with degeneration of the cartilages having occurred over some time.
Affected areas can be within the neck region, within the chest, or along the entire trachea.
Collapse most commonly results in difficulty breathing, cyanosis (tongue and gums turning blue), exercise intolerance and fainting. Many cases develop an intermittent “goose-honking” cough that can occur suddenly.
Clinical signs are more common when the dog is excited and breathing faster and more deeply, thereby exerting greater pressure differentials on the trachea.
Unfortunately, because collapse is intermittent, chest X-rays only demonstrate collapse in around 60% of cases, although taking many shots may increase the chance of picking up a collapse. X-rays are still compulsory however in order to rule out or confirm other heart and lung diseases as cause of the signs.
Video X-rays (fluoroscopy) show the movement of the trachea throughout the entire respiratory cycle and so are sometimes more able to pick up the collapse.
Endoscopy with a small fibre-optic viewing scope into the trachea is perhaps most reliable, allowing actual visualization and exact localization of collapse. This has some inherent risk due to partial obstruction of the trachea during the procedure and so is not always used in all patients with suspected collapse.
Medical therapy is usually effective in dogs with mild signs and may include cough suppressants, bronchodilators and antibiotics for secondary infections.
Steroid anti-inflammatories are often used to reduce swelling, whilst tranquillizers can reduce the fear and excitement that can exacerbate an episode.
Some dogs may have concurrent conditions, such as laryngeal paralysis, and may benefit from correction of these, whilst obese dogs should be placed on a diet.
Any situation that may induce panting and excitement, such as high temperatures and humidity, should be avoided if possible.
Because of the inherent risks and potential complications related to tracheal surgery, most cases are managed medically whenever possible.
Surgery is reserved for those dogs with severe collapse and little or no response to medications. As the cartilages deteriorate some dogs initially responding to medications may become resistant to them.
The purpose of surgery is to support the cartilages and maintain normal tracheal diameter.
Prosthetic rings or coils can be applied around the external surface of the windpipe, a technique mainly used for collapses within the neck region.
Expandable tubular implants (stents) inside the trachea are mainly used for collapse within the chest cavity or collapses along the entire length of the trachea. These are usually placed with the aid of endoscopy or fluoroscopy and have to be placed exactly to prevent potential complication.
Medical therapy may provide relief for the entire life of the patient. When surgery is successful it often reduces clinical signs and improves quality of life.
It should always be remembered that tracheal collapse is a progressive disease.
Seizures: Causes and Diagnosis
Seizures, also called convulsions or fits, are sudden neurological events that cause change in consciousness and involuntary movements. Duration can last from a few seconds to several minutes.
They are classifies as generalized (grand mal) involving all the body, and partial (petit mal) involving just one area of the body.
There are three categories of cause
Structural brain disorders can include congenital birth defects such as hydrocephalus, brain tumours, traumatic brain injury, vascular strokes, degenerative changes and infections.
Metabolic disorders include severe liver and kidney disease, electrolyte imbalance (sodium or calcium), low blood sugar, high blood pressure and various poisons (such as organophosphate insecticides)
Age, breed, history, description of seizure (video of seizures at home are very useful) and clinical findings are important.
During a generalized seizure the animal is unconscious and unresponsive. They may fall down. The limbs are often rigidly stretched or jerking (paddling) as if running. There may be chewing and hypersalivation, and the dog may urinate or defecate.
During a partial seizure, jerking or twitching of the head or a single limb may occur. There may also be confusion, excessive barking or unprovoked aggression.
Some animals have abnormal behaviour before seizures (preictal) including restlessness, nervousness and attention seeking.
Some also have abnormal behaviour afterwards (postictal) including restlessness, panting and hyperactivity. Some may appear confused or blind. This period can last from several minutes to 24 hours.
Animals with brain diseases and metabolic or toxic problems will often have other clinical signs such as vomiting, diarrhoea, weakness and weight loss. Young animals may be stunted in size.
Animals should have full physical and neurological examinations, routine blood and urine tests and possibly radiographs.
However identification of specific brain disorders requires more specialized imaging such as MRI. At Acorn we can rapidly arrange a CT or MRI scan if required.
Collection of cerebrospinal fluid for examination is also sometimes useful.
If an underlying cause is identified then specific treatment can be started for that disorder.
structural brain disorders (such as tumours)
Metabolic problems and toxins affecting brain function
Seizures where an underlying disorder cannot be identified (idiopathic epilepsy)
Symptomatic treatment to control the seizures may also be initiated depending on their frequency, duration or severity. As a general rule of thumb treatment is started if seizures occur more frequently than once a month, if multiple seizures occur within a 24 hour period, or if the underlying disease cannot be cured.
Follow-up and Prognosis
This is highly dependant on the underlying cause. Prognosis is good if it can be resolved and guarded if it cannot be treated.
It is recommended that the owner keep a diary of timing and frequency of seizures, which will often occur in clusters, and this may well aid in further follow-up.
Prognosis for idiopathic epilepsy is normally good as many of these seizures can be controlled.
In the warmer months one potential concern for dog owners is snake bites.Almost all species of snake are shy and will avoid human contact if possible, and over 90% are nocturnal.
Unfortunately our canine friends are more inquisitive and therefore in more danger of getting bitten. In Hong Kong, the main time of risk is March to November.
Snake bites tend to occur on your pet's head or neck, but are also seen on the legs and trunk. Bites involving the trunk of the body have a poorer prognosis.
Species of snake that pose a risk to dogs through envenomation are
Larger pythons, whilst not venomous, may predate smaller dogs.
Envenomation (the injection of poison) does not always occur, and remember that many species of snake in Hong Kong are not (or only mildly) poisonous. Usually if the snake is not poisonous or the venom was not injected, the pain, swelling and bruising at the bite site will be minimal.
Body systems affected may include the nervous, cardiopulmonary and coagulation systems.
The severity of envenomation is related to the time of the year, the volume of venom present in the snake, the location of the bite, the number of bites, and the amount of victim movement after the bite (movement increases the spread of the venom). The amount of venom is not related to the size of the snake.
There may be one or several small puncture wounds, bleeding, bruising or immediate and painful swelling at the site of the bite. Many toxins cause rapid vasoconstriction at the bite site, leading to tissue necrosis (breakdown)
The more severe systemic signs may take up to several hours to appear and include low blood pressure (hypotension) and shock, weakness, muscle tremors, vomiting, and neurological signs including depressed respiration.
Immediate First Aid
Banded and Many Banded Krait
Pit Vipers (Mountain, Point-scaled, Green)
Identify the snake if possible.
Restrict your dogs movement.
DO NOT incise the bite wound to suck out the venom
DO NOT apply a tourniquet without veterinary assistance.
DO NOT apply ice to the area.
Seek veterinary attention immediately.
It is important that your dog be kept quiet and the bitten area immobilized if possible to decrease the spread of the venom. The area around the wound is clipped and cleaned to check the extent of injury.
Intravenous fluids are given to help prevent low blood pressure and oxygen is given to animals with depressed respiration.
Antibiotics are used to prevent secondary infections.
Pain medication is provided as necessary.
Laboratory tests to check for bleeding problems and organ damage are advised and may be repeated to check for deterioration.
Blood transfusions may be necessary in cases of severe coagulopathies.
Antivenin may be administered at the discretion of the attending veterinarian, and to be most effective, should be given within 4 hours of the bite. It becomes less effective as more time passes.
All snake-bite victims should be observed for a minimum of 12 hours, even when there are no clinical signs. If clinical signs are present, the length of observation is increased to 48-72 hours, as damage to organs may not appear immediately.
Trying to identify or even see the snake responsible can be almost impossible.
At Acorn we use modern combined antivenins. These contain within a single vial antivenin to a variety of snakes grouped by their effect on your dog’s systems. Our staff can assess your dog and give relevant antivenin without the need for snake identification.
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Lipid keratopathy is the accumulation of fatty substances, ususally cholesterol, in the cornea of the eye
There are three main causes:
Lipid appears as a shiny, crystalline material in the front third of the cornea. The surface (epithelium) is usually unaffected, and with the exception of lipid punctate keratopathy in Shetland Sheepdogs, is not painful.
Location, progression and shape may vary depending on the cause
A thorough eye exam is performed to look for any prior or active inflammation and damage, and may include fluorescein dye, tear testing and pressure measurements.
A 12 hour fasting blood sample may be measured to rule out high cholesterol and underlying causes of hypercholesterolaemia such as hypothyroidism.
A diagnosis of the inherited form is made when all other causes are ruled out.
No specific drugs exist for this condition. No topical or systemic drugs are available to remove the lipid, which will also invariably return if removed surgically.
Fortunately vision is not affected to a significant degree and most inherited versions progress to a certain point and then remain static.
For dogs with high cholesterol low-fat diets are indicated, and any underlying causes such as hypothyroidism should be corrected.
Control of any inflammation or dry eye is also important.
Monitoring and Follow Up
Most monitoring is related to the presence of underlying inflammation or metabolic or hormonal problems. Cholesterol and thyroid tests may be repeated periodically.
The owner should notify their vet if the lesions change appearance or size.
Long term prognosis is normally good as it does not usually affect vision and is painless. Most animals are not at all bothered by it.
Spontaneous, inherited forms in many breeds including Siberian Husky, Cocker and King Charles Spaniels, Beagle, German shepherd and Boston Terrier. The reason for deposition is unknown and both eyes are usually affected.
Lipid may be deposited in the eye as a result of other ocular disease such as ulceration, inflammation or dry eye.
Lipid may occasionally occur as a result of high blood cholesterol (hypercholesterolaemia), affecting both eyes. Causes include high dietary fat intake and underlying causes of hypercholesterolaemia such as hypothyroidism, Diabetes mellitus and Cushings