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  • Small Animal Advice from Shires Vets

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If your pet has been diagnosed with Diabetes the following advice will help you get to grips with their medication and special needs.


  • Please store Caninsulin in the fridge at all times except when drawing up doses.
  • Ideally, Caninsulin should not be ‘opened’ for more than one month as the efficacy may be reduced.
  • Gently roll the bottle (but do not shake) before drawing a dose.
  • Insert the needle through the rubber into the upside-down bottle and draw back the required dose. Be careful to remove any air bubbles by removing the needle from the bottle, drawing the plunger out further and gently flicking the syringe with a finger.
  • Administer the prescribed dose two times daily (i.e. injections spaced 12 hours apart ideally)
  • Please do NOT alter the dose without having consulted a vet.
  • Be careful to draw up the dose accurately.
  • Give the injection at the same time as feeding (i.e. split food into two main feeds)
  • Inject subcutaneously (into ‘tent’ of skin picked up on scruff)
  • If not eating then do not give the Caninsulin injection. If part of food is eaten then dose as perscribed and return to normal dosing if appetite returns. Please speak to us if you have any concerns or if part consumption of food recurs.
  • Use each Caninsulin needle/syringe only once.

Other points:

  • Maintain a regular feeding routine; ideally with two main meals at the time of Caninsulin injections and if small snacks are given then keep them small but constant amounts on a day-to-day basis.
  • Keep ready a supply of runny honey/syrup in the cupboard in the case of a hypoglycaemic episode (low blood glucose): smear on your pets gums if he/she becomes depressed/wobbly/collapsed and if they not improve shortly and or if you have any concerns please contact us for advice or for an appointment.
  • Please dispose of sharps in the bin provided and return to practice for a fresh one when full.
  • Repeat prescriptions for Caninsulin and needles are available; please just phone our Reception giving 24 hour notice for further supplies.
  • As a minimum we need to examine your pet every 3 months; at which stage we may suggest blood samples for blood glucose, fructosamine (equivalent to the average blood glucose level over the previous 2-3 weeks) or even a blood glucose curve (your pet would be hospitalised for regular blood glucose checks during the day).
  • Please monitor your animal at home for changes in their diabetes and speak to us for advice if  you have any concerns, for example, changes in appetite, drinking or urination (amount or frequency or discomfort), changes in demeanour (lethargy/sleeping more etc).
  • Record insulin dosages in a diary (to help avoid forgetting/ double-dosing) alongside any comments on appetite/drinking/demeanour etc.

Cushings Disease

What is Cushing's Syndrome?

Dogs with Cushing’s syndrome produce excessive amounts of cortisol. This can have harmful effects on other organs and on the ability of the body to regulate itself. Cushing’s occurs in dogs who are producing excessive amounts of cortisol, an important hormone that helps to regulate the body’s metabolism. Cortisol plays a vital role in protein, carbohydrate and fat metabolism and is released into the bloodstream at times of stress to prepare the body for a flight or fight response. Cortisol is produced by the adrenal glands - two small glands located in the abdomen, next to each kidney. A hormone called ACTH controls the production and release of cortisol from the adrenal glands. ACTH itself is produced by the pituitary gland, a pea-sized gland located at the base of the brain. The concentration of cortisol in the blood of healthy animals varies greatly as the body’s demand for cortisol fluctuates. For example, during a period of anxiety or illness, it is normal for the adrenal glands to increase their production of cortisol. Once this period of stress has passed, the cortisol concentration in the blood returns back to normal. In dogs with Cushing’s syndrome, there is a chronic overproduction of cortisol over weeks and months. Although the concentration of cortisol in the blood of a dog with Cushing’s also fluctuates greatly, it tends to be, on average, much higher than in healthy dogs. The excessive amount of cortisol released into the bloodstream has a harmful effect on the function of many organs and the body’s metabolism.  

What causes Cushing's Syndrome?

Cushing’s will usually occur as a result of a tumour - often benign - of either the pituitary gland (most common) or adrenal glands (less common). Regardless of its cause, over time a dog suffering from Cushing’s will develop a combination of clinical signs which may initially be associated with the ageing process. Most dogs with Cushing’s (approximately 85% of cases) have a benign tumour of the pituitary gland. The tumour cells produce large amounts of the hormone ACTH, which in turn stimulates the adrenal glands to overproduce cortisol.

The other cause of Cushing’s (approximately 15% of cases) is a tumour of one (or very rarely both) of the adrenal glands, which produces excessive amounts of cortisol. Irrespective of the cause of Cushing’s syndrome in your dog, the result is always the same - more cortisol is produced than is actually needed by the body. This results in the slow development of a combination of clinical signs that are classically associated with Cushing’s. IF LEFT UNTREATED... your dog may develop other serious conditions which will weaken its body and require further costly treatment. Aside from the impact on your dog’s quality of life, if left untreated Cushing’s syndrome increases your dog’s risk of developing several serious conditions such as diabetes mellitus (a deficiency of insulin resulting in high blood sugar), blood clots in the lungs/ brain/ legs, kidney infection, urinary tract infection and inflammation of the pancreas.

Diagnosis of Cushing's Syndrome

Initial signs might alert your veterinary surgeon to Cushing’s syndrome. Diagnosis is not always straightforward. Your dog will need to undergo a series of blood tests. Cushing's is more often seen in older dogs and in smaller breeds of dog. Hair loss, pot-belly, skin diseases, changes in behaviour, frequent urination and a ravenous appetite are some of the most noticeable signs. Cushing’s is usually seen in older dogs (10-15yrs old). Small breed dogs are more likely to develop the disease. The most common signs of the disease are very similar to those associated with the normal ageing process. This can make it difficult to diagnose and later monitor. It is always a good idea wherever possible to keep a note of the changes you see in your dog’s habits, behaviour and appearance. The most noticeable signs of Cushing’s syndrome include:

  • Large water intake
  • Frequent urination and possible incontinence
  • Ravenous appetite
  • Pot belly
  • Thin skin
  • Hair loss or recurrent skin diseases
  • Muscle wastage
  • Lethargy
  • Excessive panting

Not all dogs will react to the disease in the same way and your dog may not necessarily display all of these signs. If you become concerned with your dog’s welfare, you should consult your veterinary surgeon immediately. Your veterinary surgeon will initially suspect Cushing’s syndrome based on the clinical signs your dog is showing. You may have taken your dog for a check up because you have noticed that it is drinking and urinating more than usual. Your veterinary surgeon may have noticed a change in your dog’s appearance, such as a prominent “pot belly”. Sometimes, the results of a routine blood test may lead your veterinary surgeon to suspect this condition. In most cases, the changes in your dog’s appearance and behaviour caused by Cushing’s occur very gradually, making them easy to overlook. Once your veterinary surgeon suspects Cushing’s, he/she will need to perform blood tests to confirm the diagnosis. A blood test to assess your dog’s general health is also recommended. You might remember that the concentration of cortisol in the blood of both healthy dogs and dogs with Cushing’s fluctuates greatly throughout the day. It is for this reason that a diagnosis cannot be confirmed by just one measurement of cortisol. The two tests that are used to confirm a diagnosis of Cushing’s are called the ACTH stimulation test and the low-dose dexamethasone suppression test. It may be necessary to perform both tests.

In the ACTH stimulation test, blood is taken to measure cortisol before and after your dog is given a synthetic version of the hormone, ACTH. This test assesses how well your dog’s adrenal glands control the production of cortisol.

Managing Cushing's Syndrome

Cushing’s syndrome is not curable but with medication (Vetoryl®) it can be very effectively controlled; maintaining a good quality of life for your dog for years to come. Vetoryl®, which is the only licensed treatment for use in dogs, contains the active ingredient trilostane, a drug that rapidly reduces the production of cortisol by the adrenal glands. Your dog will need to be carefully monitored and return for follow-up appointments on a regular basis. Once your veterinary surgeon is happy that your dog is stable, you will normally need to visit every three months to make sure nothing is affecting your dog’s condition. At some stage during therapy, it might become necessary to adjust the dose of Vetoryl® prescribed. Your dog will begin Vetoryl® at the recommended starting dose dependent on its bodyweight. You should then make an appointment for your dog to see your veterinary surgeon after 10 days. Your dog should be regularly examined and monitored using blood tests. Your veterinary surgeon will assess your dog’s response to Vetoryl® treatment by:

  • Looking for an improvement in clinical signs: In most cases you can expect to see a decrease in your dog’s appetite and the amount they drink within the first couple of weeks on treatment. Other clinical signs may take 3 to 6 months to improve.
  • Performing blood tests: The results of routine blood tests and an ACTH stimulation test are used to assess the effectiveness of Vetoryl® treatment at 10 days, 4 weeks, 12 weeks and every 3 months after starting treatment, depending on your vet's individual recommendation.

Your dog should be closely monitored in the early stages of therapy so that the dose of Vetoryl® can be adjusted to meet its specific needs. This also helps to minimise the risk of side effects or complications that could be harmful to your dog.

Once your veterinary surgeon is happy with your dog’s progress, it is strongly recommended that you visit your veterinary surgeon every 3 months for regular monitoring so that dose adjustments can be made as required.

Frequently asked questions:

Why do I have to give Vetoryl® every day? The active ingredient in Vetoryl® is a drug called trilostane. Trilostane is a short-acting drug which needs to be given every day to control the disease. How do I give Vetoryl® to my dog? Vetoryl® comes in a range of capsule sizes. Your veterinary surgeon will advise you of the right dose for your dog. We recommend that you GIVE YOUR DOG HIS/HER VETORYL® WITH A MEAL IN THE MORNING, as this will make it easier for your veterinary surgeon to perform monitoring tests 4-6 hours after dosing. What should I do if I forget to give a capsule? Speak to your veterinary surgeon. DO NOT give a double dose the next day. How long will my dog require treatment? Most dogs need to be given Vetoryl® every day for life. How long will it take for my dog to improve on treatment? The clinical signs of Cushing’s such as lethargy, increased drinking, eating and urination improve quickly - often within the first two weeks of treatment. Skin changes and hair loss take up to 3 to 6 months to improve. What is my dog's long term prognosis when their Cushing's disease is controlled? The median survival time is 2-3year (ranging from weeks to years) so is variable between individuals. Will I need to revisit my veterinary surgeon? Yes. It is important that your dog revisits your veterinary surgeon for assessment and monitoring tests at 10 days, 4 weeks and 12 weeks after starting Vetoryl®, and thereafter every three months. The time interval for repeat checks will be discussed by your vet for your individual dog. If your dog becomes unwell at any time whilst on Vetoryl®, stop treatment and consult your veterinary surgeon as soon as possible. Does Vetoryl® have any side-effects? Vetoryl® is well-tolerated by most dogs. If your dog develops any signs of illness while on Vetoryl® including lethargy, vomiting, diarrhoea and anorexia, stop treatment immediately and contact your veterinary surgeon as soon as possible. What costs are involved? Cushings disease can be quite costly to manage due to the medication cost and requirement for repeat blood testing to ensure over- or under-dosing is not occurring. We would rather you are aware of potential costs from the beginning to help you make informed decisions when investigating and starting treatment.

ESTIMATED costs for Managing Cushing's Syndrome

(Based on Shires Vets prices in January 2015) Diagnosis of Cushings Disease after initial blood screen:

ACTH stimulation test (initial)                    £95

LDDST (40% of dogs require this additionally)        £120 One month's supply of Vetoryl for your dog (NB dosage and hence cost may change/ increase depending on response to medication)    

  • 10Kg dog                                £54
  • 10-20Kg dog                            £66
  • 20-40Kg dog                            £105

Repeat ACTH stimulation test plus electrolytes (at 1 month then every 3 months, possibly progressing to every 6 months if condition is stable)        £97 Repeat Consultation (when vet examines to check progress)    £22 Next consult: Check up ~10-14 days after starting Vetoryl (ideally a morning appointment) unless vet stipulates otherwise. Next ACTH stimulation test 4 weeks after starting Vetoryl (morning appointment, we will keep your pet with us over lunchtime to perform this test). Please ensure you don't run out of Vetoryl before this appointment (phone reception for repeat prescription if needed). Repeat Prescriptions: Please try to give us 48 hour notice when you require a repeat prescription of your Vetoryl. Written prescriptions are available on request for medications (Current charge £14 for written prescription lasting 3 months) if you wished to source your medications from another vet/ pharmacy/online pharmacy.

Pre-operative information

Before the anaesthetic

Dogs and cats undergoing general anaesthesia require a period of starvation to prevent vomiting while anaesthetised. If vomiting was to occur while the patient was unconscious, it is possible that the vomited material could enter the lungs and cause pneumonia or death. Therefore, it is extremely important that your pet is not allowed access to food prior to anaesthesia, for the period of time prescribed by your veterinary surgeon. In general, for dogs and cats, this is usually a minimum of 6 hours. Commonly, food is allowed up to bedtime the night before the planned procedure.

Smaller patients, such as rabbits, mice, birds etc. are often not fasted at all prior to anaesthesia, as this can have detrimental effects on their blood sugar levels.

It is not usually necessary to deprive your pet of water before an anaesthetic, although all other liquids, such as milk, should be removed at the same time as any food.

Please make sure your dog has had a chance to go to the toilet before taking it to the surgery, but avoid a long period of vigorous exercise – a short walk on the lead is sufficient.

This leaflet is designed to help answer some of the questions you may have regarding the administration of a general anaesthetic to your pet. If you have any further queries or concerns, please speak to your veterinary surgeon or nurse.

The need for anaesthetics

While most routine diagnostic procedure such as x-rays are performed in conscious humans, veterinary patients are seldom co-operative enough to lie still for the periods of time necessary to perform these tasks and so general anaesthesia or heavy sedation is often required in animals.

Therefore, while you may think it relatively unusual, your pet may need to be anaesthetised for something as simple as an x-ray of its leg. It might seem logical to assume that heavy sedation may somehow be safer than a full general anaesthetic, however, this is not necessarily the case and you should be guided by the advice of your veterinary surgeon as to which they consider is most appropriate for the particular situation.

Although modern sedative and anaesthetic agents are very safe, all anaesthetics do carry a small risk to the life of the animal. This is usually minimal, but any concerns should be discussed with your veterinary surgeon.

The night before:

For dogs, cats and ferrets please remove food at 9pm the night before a planned procedure. Ensuring your pet has an empty stomach will reduce the risk of your pet regurgitating under the anaesthetic or sedation.

Water can be safely left down for your pet until you bring them into us the next morning. Please keep cats indoors the night before with a litter tray to prevent access to any food.

Dogs should be taken out for a short walk on a lead to empty their bladder and bowels before coming into the surgery.

For small pets (rabbits, guinea pigs and the like) it is very important that they have constant access to food and water right up until they come into the surgery.

Please ensure that you bring some of their usual food with them with them, and it’s a good idea to bring their normal drinking bottle or bowl with you.

The morning of your pet’s anaesthetic:

You may be given a specific time to bring your pet to the surgery. If not, please arrive between 8.30-9.30am.

If your pet takes any regular medication then please check with the surgery beforehand whether you are to give this on the morning of admission.

For most procedures you will be seen by the admitting nurse, however if we have not seen your pet before, or they are booked in for complex investigations you may be admitted directly by the vet involved in your pet’s care for the day.

At admission you will be asked to read and sign a consent form for the procedure. The consent form explains that there is always a potential risk involved with any anaesthesia or sedatives, however here at Shires Vets we use human standard anaesthetics which are very safe and the risks involved are minimal.

You will be asked to leave a contact telephone number. Please ensure that you can be immediately contactable between 10am and 2pm.

Please read the consent form carefully at admission. The person signing must be over 18. You may request an estimate for the procedure, either prior to or at the time of admission.

However please be aware that this is an estimate only and that further costs may be incurred should complications arise, or should a procedure prove to be more complex than first thought.

We will make every attempt to contact you should a procedure look likely to exceed the estimate by more than 20%.

After admission

Once your pet has been admitted, they will be weighed and an injection of a pre-med will be given. This is a sedative injection which also gives pain relief as well. Your pet will then be settled into their kennel for the day. All patients are housed in their own kennel, and dogs, cats and small pets all have their own wards.

Please be aware that your pet will have shaved areas. Your pet will be anaesthetized by the veterinary surgeon performing the procedure, and the anaesthetic will be monitored throughout by one of our veterinary nurses or student nurses. After the procedure your pet will be returned to their kennel to recover, where they will be offered a drink of water and food if necessary.

We will advise you at admission how to contact the surgery to check on your pet’s progress. In most cases we will telephone you once your pet is in recovery.

The majority of our patients return home bright and bouncy the same day. You will have written discharge instructions when you collect your pet detailing their home care.

If you have any questions or concerns then please do not hesitate to contact us.

Pre-operative blood tests

We are able to offer pre-operative blood tests to check your pet’s internal organ function and to ensure that there is no sign of infection or anaemia. Many of the drugs we use are excreted by the liver and kidneys and if your pet has underlying liver/kidney condition, the anaesthesia may make this worse. We would strongly advise you to consider this test if your pet is over 7 years of age, or has any history of medical problems. However we are happy to take a preoperative blood sample on any pet should you wish.

Intravenous fluids

If the preoperative blood sample indicates areas of concern, if your pet is elderly or if your pet has previous history of liver/kidney problems then we will advise that your pet receives intravenous fluid therapy for their anaesthetic. This will assist in maintaining their blood pressure under anaesthesia and help to prevent any further problems. Also, there has been recent change in regards to Metacam (a painkiller) and anaesthesia; the drug company advise that all patients undergoing anaesthesia and receiving Metacam are given fluid therapy. We have been giving Metacam prior to surgery for years with few problems; however, legally we now have to offer fluid therapy throughout to all patients.


Without sending your pet’s lump to the laboratory we cannot give you a guarantee what the lump is. Histology usually takes 5-10days.

Please be aware that these extra tests/procedures will incur further charges above any estimates that may have been given.

Puppy training and development

Physical examination

This should be something to get your puppy used to from a young age. I will demonstrate how to do this with your own puppy, being able to examine your puppy means that when they have to come to see us it will be a much easier and calmer experience.

You should check:

  • Eyes/ears
  • Mouth
  • Paws, nails and legs
  • Neck/back
  • Tail
  • Tummy

General health

  • Eyes/ears – should be clear and free from discharge
  • Skin/coat – skin shouldn’t be flaky or greasy and the fur should be free of mats. Grooming is the best way to check the coat and can be a good bonding exercise for you and your puppy.
  • Teeth – check for any inflammation (red) of the gums, bad breath, plaque or damaged teeth
  • Exercise – monitor any decrease or reluctance to exercise
  • Appetite and thirst – any quick changes in eating or drinking If you have any concerns please contact the surgery.



  • Usually their first season is between 69months depending on the breed.
  • We can spay from six months of age and either preseason (before the first season) or post season (neutering 3 months after a season)
  • We have 2 approaches:
  • Routine ovariohysterectomy, this is where we make an incision into your pets midline and remove the ovaries and the uterus. Recovery normally takes 510days.
  • Laparoscopic (key hole) – we may 2 small incisions into your pets midline and remove the ovaries only. They are normally back to their old selves the day after surgery.


  • We can castrate them from 6 months of age. The behavioural impact of castrating male dogs is important and can be discussed on an individual basis.
  • We run adolescent clinics at the practice from 56months of age, these clinics provided help and advice on neutering and the health and wellbeing of your puppy.


All puppies should be fed a good quality puppy food ideally until they are 12 months.

Puppies have small stomachs so should be fed little and often. It is best to have set meal time.

How often to feed your puppy:

  • 8-12 weeks = 4 meals a day
  • 12-16 weeks = 3 meals a day
  • 16- 24 weeks = 2-3 meals a day


The critical time for socialising a puppy is 4-16 weeks. It is to the puppy’s advantage to be exposed to as many people and animals as possible. As owners we have a responsibility to protect them from bad experiences in this time; the puppy must be exposed to in a controlled way. A chart is included in this pack that you can use to ensure as much socialising is done. All training and socialisation should continue right into adulthood, a dog’s character tends to be set at 18months of age. Anything done after this age will take longer with a reduced lasting effect.


Exploratory behaviour is part of growing up for a puppy; it is how they learn about the environment around them, smelling, licking and chewing. Playing and teething however can some time result in mouthing/chewing behaviour and it may be object or human orientated. The puppy should be encouraged to chew a variety of safe toys by substitution. Sometimes aversive therapy is needed such as bitter apple spray or Tabasco sauce on chair legs. Bones are best avoided since they are too hard and can also be the cause of gastric upsets, aggression and sibling rivalry.

Play and exercise

Play fighting with other dogs is healthy and normal and should be encouraged. Wrestling with human owners should be discouraged since it teaches dogs the kinds of lessons they should be learning with and about other dogs. Play with owners should involve throwing ad fetching not tugging games, toys are more enjoyable for a puppy if they are not left lying around but are brought by the
owner when its play time. Healthy dogs should exercise well and rest well. Restlessness, pacing, attention seeking behaviour and other behaviour problems may arise from under stimulation and under exercise.


This is a normal behaviour for puppies from 12 weeks and does not need to be discouraged or punished. It is not indication that a given male will need to be castrated.

General training

This should start as soon as the puppy has settled in. Learning is rapid between 8-12 weeks of age. At this early stage it is easier to wait for behaviours to be performed spontaneously then reward and attach a command. This way the puppy cannot fail and learns quickly the associations between command, action and reward. Rewards need not and should not always be food. Puppies should learn and want to perform behaviours to please their owners, not because there is something in it for them.


You should groom a dog with equipment that mimics a massaging action and removes dead hairs and debris. Start as soon as possible.


Owners are required by law to fit their dogs with a means of identification whilst in a public place. Dogs should be trained to accept a collar and lead whilst puppies and to walk without pulling. Choke chains are not acceptable; they cause neck damage and pain.

From 2016 it is the law to have every dog microchipped.

Problem behaviours

Jumping up

This is a common problem. It is normal behaviour for a puppy but an undesirable for us. The puppy wants to get to our mouths as it would have done to its mother when it was younger.

Training for this problem should begin straight away. First the puppy should be taught to sit on command and then asked to sit before it gets anything it wants or needs. The puppy should never get attention for jumping up. Petting, light scolding or pushing the puppy away will reinforce this behaviour. How far you need to go in your ignoring response will be related to the severity of the jumping up. You should keep your arms folded and turn away from the puppy until they learn to calm down and sit.


Play biting is also a natural behaviour that is undesirable and dangerous if not corrected from a young age. Family members should not engage in rough play, wear gloves to permit hard bites, or encourage the puppy to attack and bite hands or feet. Harsh or physical corrections should be avoided. No striking, thumping on the nose or a fist in the mouth

The puppy should never receive any kind of attention for biting. All attention is withdrawn especially the arms and even to turn and walk away if the puppy’s excitement continues.

Puppies should receive frequent opportunities for exercise and play. Puppies that receive a good amount of exercise and stimulation have less energy to play and attack people.

Toilet training

Newspapers should only be used to mop up mistakes. The puppy should be taken outside to the appropriate are frequently. You should encourage the puppy to play, which then encourages elimination. When the puppy squats to urinate/defecate give a command e.g. “be quick” or “wee wee” and when they have finished the elimination you should immediately reward with food, play or effusive praise.

In this way the puppy learns to toilet on command, which means they are less likely to toilet away from the approved areas or without a command. Mistakes such be rewarded as such and not punished in any way. Punishment is often misunderstood or teaches them to toilet cryptically.

Interpreting body signals

We can never hope to understand every bit of body language that goes on between dogs but a few pointers will often help you to read the situation and how to react.

How dogs interact with other dogs is very different to how dogs interact with other humans. The more a puppy has been socialised with other dogs the more chance it has of reading a situation when meeting other dogs.

The best way of a dog to dog greeting is off the lead, as this allows them to display normal greeting behaviour and space to get away if needed. The less you try to interact with your dog at this point the better, interfering means interrupting this greeting. This means that your dog will never get to interact properly and in turn can lead to them and others becoming frustrated or confused.

Interactions with humans are mainly down to how a puppy has been trained and socialised. Barking, overexcitement and fear can all be related to how a puppy has been raised. If a puppy has been exposed to as many different types of people as possible they learn to cope with most situations.

Generally barking is seen by some people to be a fearful response. Fear would be hiding behind something, standing there and barking is like shouting, a bold gesture which normally is reinforced by whatever they are barking at going away, e.g. the postman.

What is normal?

No two puppies are the same; every puppy has its own personality.

Training classes

These are a great place for puppies to socialise and learn. It is recommended that you go along to the class without your puppy to see what the class is like and how they like to run the class. Find a class that suits you and your puppy.


This should be consistent, clear and well timed. It should NOT consist of physical punishment, tapping on the nose or threatening with a rolled up newspaper. Puppies should learn that human hands are for positive experiences or else they become confused about signals and may react defensively to similar gestures.

Punishment should be noise (rattle can), withdrawal of affection/attention, water pistols or any tactic that causes the puppy to blame itself for its punishment.


What is hyperthyroidism?

Hyperthyroidism (overactive thyroid disease) is a common disease affecting older cats whereby one (or both) of the thyroid glands in the neck become enlarged and produce excessive thyroid hormone. This is usually a benign enlargement but can rarely (1-2%) be a malignant tumour. The excessive thyroid hormone sets the cat's metabolism into overdrive, burning up energy.

What signs may suggest hyperthyroidism?

Common signs may include weight loss despite a good or increased appetite, increased thirst, poor fur condition, hyper-active behaviours, sickness or diarrhoea. The vet may detect a fast heart rate, abnormal heart rhythm or murmurs and an enlarged thyroid gland.

How do we diagnose the problem?

Generally, hyperthyroidism is easily detected with a blood test (total thyroid level) which we can perform at our in-house laboratory at Shires Vets. It is important that we also check your cat's kidneys and other organ function to ensure no other concurrent problems are present.
If signs are suspicious of hyperthyroidism but the total thyroid level is normal then we may request further thyroid parameters to be tested by an external laboratory.

Why treat hyperthyroidism?

Untreated, hyperthyroidism greatly shortens lifespan, leads to heart failure, high blood pressure (which can cause sudden blindness & kidney damage), further weight loss and loss of quality of life. However, compared to some other older cat problems, we have several successful options to help manage the condition in the long-run and give them a good outlook.

How can I treat my cat's hyperthyroidism?

There are several options for you to consider, each with potential pros and cons and each may suit different individual cats, households and budgets. Daily tablets or gel smeared on ears can be used lifelong to manage the condition and is most common. A prescription thyroid diet ongoing can control the signs. Radioactive iodine administration is a treatment option which has a high success rate of curing the problem and is probably the 'gold standard choice'. Surgery to remove the affected glands can cure the problem equally. Further information of each of these options follow. It should be noted that on treating your cat's hyperthyroidism a hidden kidney disease could be uncovered with the reducing metabolic rate. We therefore suggest monitoring kidney function (especially over the initial 12 months after treatment) periodically. Hypertension (high blood pressure) can occasionally develop, even during the first year of managing hyperthyroidism, so ideally this is also monitored, as appearance necessitates treatment to prevent other organ damage (see above 'why treat hyperthyroidism').

Oral anti-thyroid medications

e.g. Vidalta, Felimazole

  • Most common form of management. No anaesthetics or surgery required. Treatment at home with visits to vets for checkups.
  • Requires ongoing daily dosing as stopping them causes relapse of signs.
  • Recheck appointments with the vet to check thyroid blood levels 3-4weeks after starting tablets or adjusting the dose then every 3 months.
  • Some cats are not amenable to having tablets, however, it is worth trying with pill giver or hiding in food. Vidalta is given once daily, Felimazole twice daily
  • Possible side effects include sickness, diarrhoea, poor appetite, lethargy, skin irritation, anaemia and white blood cell disturbances, which are uncommon but generally resolve with stopping medication. Alternative options would then need consideration.
  • Estimated costs: £25-35 per month for either brand of tablet. When first introduced or after a dose adjustment we would reassess and recheck thyroid levels after ~3 weeks. 3 monthly checks once stable would be necessary to ensure your cat is on the right dose of medication as this can change over time. Each repeat consult is £22.25; Thyroid test is £28.44; kidney blood tests (~£10) and blood pressure checks (£25) would be additional if chosen.

Topical methimazole gel

  • This is a topical gel that you would smear on the inside skin of your cats ear twice daily with gloves which contains a similar drug to above tablets.
  • This medication is unlicensed (i.e. full testing has not been undertaken to prove efficacy and safety) however in cats who are impossible to tablet this option has proven effective in some cases.
  • Side effect risks as above plus risk of absorption through skin being ineffective.
  • Estimated costs: £30-60 per month for the gel depending on dose required. Reassessments same as for tablets.

Radioactive iodine treatment:

  • This is a safe and effective option which is 90-95% effective at curing hyperthyroidism completely. Effects are often seen within a month, though may take up to 6 months.
  • This is only performed at a few specialist centres in the UK, but involves injection of radioactive iodine under the skin which has its effects only in the overactive thyroid tissue. Your cat would then need hospitalisation at the centre for 5-7days whilst the radioactivity reaches safe levels for you to handle at home afterwards for the following month.
  • Estimated costs: full evaluation of kidneys, urine testing & blood pressure etc before referral to the specialist approx. £150. Radioactive iodine treatment £1800 (at Hyperthyroid Cat Centre, Wetherby)

Prescription diet control

  • Success has been seen in cats fed solely this iodine-restricted diet (Hills Y/D). It avoids surgery or tabletting and is available in wet/tinned and dry/biscuit forms. It is an option suited to indoor-only single-cat households.
  • If the cat eats any other food or hunts then the benefit is negated and hyperthyroidism persists. It the cat develops other disease later in life or goes off the prescription diet then, again, the hyperthyroidism returns.
  • Estimated costs: Dry form approx. 80p -120p per day. Wet form more expensive, but could feed mix of both if prefer.

Surgical removal of thyroid gland (Thyroidectomy)

  • Thyroidectomy involves removing the enlarged thyroid gland, on underside of neck near windpipe, to stop the excess thyroid hormone production. This effectively stops excess production from the affected gland.
  • However, it should be noted that cats have two thyroid glands and frequently the other gland becomes enlarged. Typically 75% of cats will need the other thyroid gland removed in 6-24 months.
  • To reduce anaesthetic risks it is preferable to reduce cat's thyroid levels to more normal levels before surgery, so tablets, topical gel or diet could be used to achieve this initially (2-3 months)
  • It is not advisable to have both glands removed at the same time, even if the 2nd gland is small at the time as surgery can disturb the parathyroid glands and lead to more serious complications involving low calcium. The parathyroid glands are involved in regulating calcium levels are closely attached to the thyroid gland and surgery aims to identify and preserve this tissue, however, one potential complication of surgery (quite commonly seen if two-sides removed but possible if only one-side removed) is low calcium which causes twitching, weakness and possible fitting and death if undetected. This can be managed with supplementation whilst the tissue recovers if occurs.
  • Additional, hidden thyroid tissue can rarely exist and would not be removed by such surgery. In some cats, the enlarged thyroid is not palpable on the neck which means surgery cannot be pursued as an option.
  • Estimated cost surgery: ~£350 (includes anaesthesia, fluid therapy, surgical removal of single gland, pain relief, post op checks etc)

Atopic Dermatitis

Dogs with this common skin disease will show a variable degree of itchiness. Inflamed ears, feet, belly, groin and armpits are the typical affected areas. Self- trauma from biting and scratching plus secondary bacterial and yeast infections all worsen the itchiness and can significantly affect your dog’s comfort and enjoyment of life!

The below information is intended for owners who’s dogs are suspected to have allergic dermatitis caused by environmental allergens (e.g. grass or pollen allergies or indoor dust mites allergies). There are several other causes for similar itchiness which your vet will consider first. For example skin scrapes and bloods may be taken to rule out sarcoptic (fox) mange mites and a strict diet trial will be needed to rule out itchiness due to food allergy. Bloods can be taken to suggest what your pet may be allergic to, however, we have to be aware that false positive results are possible.

Atopic dermatitis can take some time to diagnose whilst other causes of itchiness are ruled out. It is important to know that this disease can only be managed, it CANNOT BE CURED. Once a diagnosis has been made, however, there are several actions and medications that can significantly reduce the itchiness for your dog. It is common to use a combination of the recommendations below to improve your dog's comfort.  Here we provide an overview of the options for you to consider which may then be discussed with your vet at Shires Vets. Costs and practical factors all need to be considered alongside the severity of your pet’s itchiness. Treatment efficacy percentages stated below are estimates from experience and published studies.

Allergen avoidance

For dogs allergic to outdoor allergens (e.g. grass and tree pollens) avoidance is nearly impossible, however washing/wiping off your dog's feet and body after walking in grass/ outside may help remove some allergens. If blood tests highlight indoor house dust mite and storage mite allergy then several things can be done to help reduce exposure. The avoidance tips below are rarely a complete treatment in themselves but can be used in conjunction with other treatments.

  • Use a plastic cover over pet's bed
  • Use filtered vacuum cleaner
  • Use hypoallergenic mattress and pillow covers
  • Use anti- mite spray in areas of house where pet lives (e.g. Indorex, available to purchase through Shires Vets)
  • Wash bedding in very hot water (>70C)
  • Avoid letting pets sleep on stuffed furniture
  • Avoid stuffed toys
  • Freeze soft toys for 24hours every month
  • Keep pets in uncarpeted rooms
  • Run air conditioner during hot weather
  • Kennel dog outside

Steriods (e.g. Prednisolone, Medrone)
These are of low cost & high efficacy (~90%) however high side effects risks (increased thirst, urination and appetite, panting, pot bellied, skin thinning and susceptibility to skin infections, liver, kidney and intestinal effects) when used in the long term. Available in tablet form.

Antihistamines (e.g. Piriton, Tavegil)
These human drugs can be used ‘off licence’ in dogs and are ~20-30% effective. Drowsiness is the main side effect. Tablet form. Low cost and available from Shires Vets or your local chemist.

Cyclosporin (e.g. Atopica)
This is a licensed veterinary drug with high efficacy (~80%) and high cost (eg ~£90/month for 10Kg dog; £260/month for 30Kg dog). Tablets or liquid forms. Allow 6-8 weeks before can fully judge if effective. Cyclosporin uncommonly causes side effects (sickness & diarrhoea most common, overgrowth of gums, muscle weakness or cramps – resolve with stopping treatment).

Oclacitinib (e.g. Apoquel)
This is a licensed veterinary drug with high efficacy (~80-90%) and moderate cost. Tablet form. Uncommon side effects include vomiting, diarrhoea, anorexia.
This drug was released in early 2014 and at Shires Vets we have multiple dogs successfully managed with the drug, however, there have been significant production issues. Please discuss with the vet as to whether this option is currently available.

Desensitisation vaccinations
From the blood test results a vaccination can be ordered containing tiny amounts of these allergens which are injected under the skin to your dog initially twice weekly then monthly to desensitise your dog to the allergens. If successful it would then be maintained monthly lifelong. 25% are controlled with vaccinations alone, 50% show benefit from vaccination (reduced pruritus). 2- 9 months before the benefits are seen. Moderate costs (~£250 for vaccine for 1st ~12months then ~£200/yr for monthly top up injections). Uncommon side effects (rare anaphylactic reaction to vaccine).

Essential Fatty Acids
In food tablets/ spray. 10% effective. Relatively cheap, no real side effects (occasional diarrhoea).

Managing secondary skin infections
Antibiotic courses are sometimes required to treat secondary bacterial infections. Medicated veterinary shampoos to control secondary yeast and bacterial infections (eg malaseb/ microbex).

Shampoos to sooth irritated skin
These can be used twice weekly to help manage itchiness. (e.g. Allermyl & other quality veterinary shampoos are available at Shires Vets). Fairly effective alongside other treatments. Low- moderate cost.

Steroid spray (e.g. Cortavance)
This can be used to target especially itchy areas. Moderately effective and some costs. Good for when one location of hairless skin (e.g. on belly) is affected.

Regular flea treatments
Although your pet may not be allergic to the fleas themselves, flea bites can trigger flares of allergic skin disease and a veterinary flea treatment should be applied regularly to all atopic dogs.

Anal glands
Many dogs experience bottom irritation due to full anal glands. Those affected should have their glands emptied regularly (ask your vet!) to reduce itch stimulation on overall skin condition.

The above information is intended for owners of dogs who are under the care of Shires Vets. The information is for guidance and consideration only and should be discussed further with your vet.