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Medical articles

Cat scratch disease

What is cat scratch disease?

Cat scratch disease (or benign inoculating lymphoréticulosis, or benign lymphogranuloma) is an infectious bacterial disease mainly transmitted as its name suggests by scratching a feline. This pathology can be due to two agents: Bartonella clarridgeiae and more often Bartonella henselae.

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What are the risks for humans?

This disease is sporadic ubiquitous. It is most often manifested in children by benign lymphadenopathy. Some severe atypical forms have been described, mainly in immunocompromised subjects.

In its classic form, CGD is a not very serious condition. Three to ten days after a skin breakage such as a cat scratch, there is the appearance of a papule or a vesicopustule and, in the case of very rare ocular contamination, the formation of a granuloma with or without conjunctivitis. This lesion most of the time disappears quickly. Then 2 to 3 weeks later, the typical manifestation arises: lymphadenopathy in general unique and persistent. The evolution is generally benign which does not mean fast.

How are we likely to be contaminated?

The main vector is cats, with stray cats infecting domestic workers via their fleas. Infection occurs in 10% of cases after a bite, in 75% after a scratch, but it can appear after a scratch of brambles, etc.

The dog (also infected with fleas) could also be a vector, but this remains debated.

It would also seem that fleas can directly inoculate the bacteria during bites in humans, but this would remain exceptional.

Note that the infection is not apparent in cats ...

How to protect yourself from this?

No vaccine is currently available. One of the major prevention methods is to prevent infestation of cats by fleas.

Prevention is also based on health measures:

- avoid cat scratches or bites (handle animals gently to avoid aggressive behavior and educate children so that they do not consider pets as toys),

- avoid licking wounds by cats

- disinfect wounds in case of bites or scratches

- wash your hands with soap and water after handling a cat ...
The removal of the claws of domestic cats is prohibited in France.

NB : The useful information you will find in these pages will not replace that which you will obtain from your attending physician. Do not hesitate to ask him about it.

References :

- ACHA PN; SZYFRES B.: Zoonoses and communicable diseases common to humans and animals. OIE 1989.

- E. PILLY, Infectious and tropical diseases - 19th edition 2004.

- Veterinary theses: KERMIN C. (1993), Nantes: Aspect of the main bacterial zoonoses in France, 1993; LODDE S., Toulouse, N ° 98-TOU3-4051, 1998.

- Chomel B. Cat scratch disease. Rev.sci.tech.off. int epizoo, 2000,19,136-150.

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Urinary incontinence

Urinary incontinence is common, especially in female dogs, and is as much of a problem for the owner as it is for the animal. It can be congenital or acquired.

80% of animals with urinary incontinence have urethral sphincter incompetence, a condition that can be congenital or acquired. It affects both sexes but females are much more predisposed. The factors favoring the appearance of sphincter incompetence are a decrease in the tone of the urethra, the length of the urethra, a bladder neck in the intra-pelvic position, a deficiency in the mechanisms controlling the lower urinary tract, a significant size of the animal, breed, ovariohysterectomy / oophorectomy, hormones and obesity. Large breeds (as well as giant breeds) are even more at risk; we will note in particular the Doberman, the Bobtail, the Rottweiller, the Weimaraner, the Springer spaniel and the Irish Setter.

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The caudal movement of the bladder that occurs when a dog lies down is more pronounced in bitches with sphincter incompetence. It is believed that the importance of the position of the bladder neck comes from the effect of abdominal pressure on the urethra which, if the cervix were in the intra-abdominal position, would counterbalance the increase in intravesical pressure. This transfer of pressure to the urethra is absent / reduced in dogs with the bladder neck in the intra-pelvic position.

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There is an association between sterilization and urinary incontinence, which is probably due to a lack of circulating estrogen, although an excess of gonadotropin could also be a contributing factor. In general, sterilized bitches are eight times more likely to be incontinent due to sphincter incompetence than whole bitches. Thus, if 100 bitches were not sterilized by the age of 10, two of them would be incontinent. If 100 bitches are sterilized, 16 of them will be incontinent by the age of 10. It is possible that sterilization before the first heat increases the risk of incontinence, although this fact has not yet been proven.

Although not a determining factor, obesity can worsen the degree of incontinence.

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Some less common causes of urinary incontinence:
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  • Congenital: ectopic urethra, bladder hypoplasia, persistence of the uracan canal, intersex or congenital neurological disorder

  • Acquired: prostate disease, bladder tumor, ureterovaginal fistula,

acquired neurological, detrusor hyperactivity / instability, incontinence due to over-capacity of the bladder associated with chronic retention.

History and clinical signs

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The owner will usually notice that his dog has developed urinary incontinence. The dog itself usually shows no clinical signs other than trying to clean itself. We will find traces of urine where the bitch is lying down because sphincter incompetence is increased when the dog is lying down. During continuous drip loss, it is better to think of an ectopic urethra (especially in young dogs) or a ureterovaginal fistula. Hematuria, dysuria and / or pollakiuria may be observed in dogs with prostate disease, bladder tumor, neurogenic disorder, or detrusor instability / hyperactivity. It is important to distinguish incontinence from a behavioral problem associated with inappropriate elimination such as loss of toilet. In this case, you will be more likely to have large puddles of urine in inappropriate places rather than small puddles in many different places where the dog has laid down. It sometimes happens that we notice that the dog is incontinent with the appearance of polydipsia caused by diabetes or Cushing's syndrome for example.

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Specific diagnostic techniques
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In the vast majority of cases in dogs, it is possible to make the diagnosis of acquired urinary incontinence following sphincter incompetence, based only on the history and physical examination; if the dog suffers only from this condition, no other abnormalities will be noted during the physical examination. As long as, apart from incontinence, the dog is in good general condition, it is possible to set up a trial treatment for this condition without carrying out further examination.

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Treatment

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The treatment of urinary incontinence due to sphincter incompetence can be medical or surgical.

Medical treatment may be hormonal or rely on the administration of sympathomimetic agents. Sympathomimetic agents improve continence control by increasing the tone of the urethra. The most widely used medical treatment today is an alpha-adrenergic molecule, phenylpropanolamine (Propalin®, Vétoquinol). Incontinent neutered bitches may also respond to the administration of estrogen such as estriol (lncurin®, lntervet). Some animals may respond well to the administration of estrogen or alpha-adrenergics initially and then the incontinence returns. In the case of estrogen, the receptors may desensitize. Estrogens sensitize the smooth muscles of the urethra to alpha adrenergic stimulation, so it is advisable to combine estrogen with an alpha adrenergic molecule in order to decrease the dosage of each drug and thus reduce their side effects. The success rate of treatment with these molecules in the long term is approximately 50%.

It is possible to use androgens in neutered male dogs, but the author's experience shows that the results are disappointing. We must try to make obese dogs lose weight. When a young bitch is incontinent, it is not recommended to sterilize her, or at least to wait until she has had her heat twice, because congenital sphincter incompetence can spontaneously heal after the first or second estrus in some cases.

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The main surgical options for treating urinary incontinence due to sphincter incompetence are:

  • To increase the resistance of the urethra by placing synthetic peri-urethral strips, an artificial sphincter or by performing intra-urethral injections with a hydrophilic molecule (collagen for example)

  • Increase the length of the urethra using bladder neck reconstruction techniques

  • To reposition the bladder neck in an intra-abdominal position by colposuspension (bitches) or pexy of the vas deferens, urethropexy or prostatopexy (male dogs).

Usually, the success rate for surgical treatment is 50%. It is preferable that a specialized surgeon performs these operations.

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What if his condition does not improve?
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If the incontinence does not improve following the medical treatment implemented as described above, additional examinations should be carried out to rule out other diagnostic hypotheses. To differentiate between the various other causes of urinary incontinence, an X-ray with contrast medium, ultrasound, and if possible a urodynamic examination, should be used. These techniques require special skills and a lot of experience.

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If urinary incontinence due to sphincter incompetence is confirmed following additional examinations, and if the animal does not respond well to medical treatment, it is advisable to consider surgical treatment.

Since sphincter incompetence is common, empiric therapy can be tried without much risk of getting worse even if the diagnosis is incorrect. Medical treatment for this condition does not usually incur excessive costs, although there is a good chance that it will have to be continued for life. However, if the incontinence persists, it will be necessary to carry out additional examinations which will then inevitably increase the bill. Surgical treatment for the different causes of incontinence will cost more initially but may be more cost effective than medication in the long run, especially in large breed dogs. Obese dogs should also be tried to lose weight to improve their continence control.

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Behavior Articles

Signs of illness in cats

Cats hide their illnesses ...

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It is well known that cats are animals that hide their illness, weakness or pain, especially in cases of chronic diseases (dental, kidney or heart). It is a remnant of their wild existence, where they absolutely had to avoid attracting the attention of possible predators.

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But this obviously poses a problem for the owner who will not necessarily see the signs showing that his cat is sick in time. It is therefore all the more important to be observant and to know how to identify what is "normal" in the behavior of the cat, and what is not.

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What should be observed?

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  • his weight: did he gain any? Lost ?

  • his food and water consumption: is he losing his appetite or eating more? Is he more thirsty than usual?

  • its cleanliness: does it go in its cash register more often? Less often ? Does he sulk at her? Is he making weird noises? Is he urinating more than usual?

  • its energy, its activity, its mobility

  • the quality of his sleep

  • his physical appearance: does he always dress well? Has he lost some hair, has it tarnished?

  • his behavior: his interactions with humans and other animals

  • his expressions: does he vocalize more than usual or, on the contrary, is he silent?

  • his breathing

  • the color of his gums

Also watch for vomiting, diarrhea, blood in urine, discharge from the eyes, nose or genitals, unsteady gait, or difficult breathing.

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Cats of course like to hide in quiet, hidden and dark places such as closets, wardrobes, bedspreads. It is usually normal not to see them for a while. However, when they are sick, they also hide to keep as much energy as possible and avoid the risk of pain.

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Prevention and regular check-ups are the best weapons to detect a possible disease early and treat it quickly. Your veterinarian should ask you the right questions, especially about the sometimes subtle changes that your cat may have manifested, and which may have an impact on his quality of life. A preventive follow-up at each stage of his life is the guarantee of a long healthy life.

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Articles about surgery

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Stomach torsion in dogs

If your dog is trying to vomit without success , seems to be bent forward and has difficulty getting up, and his abdomen is tense, hard to the touch, contact your vet immediately : these symptoms potentially indicate a stomach twist. (also known as gastric dilation or volvulus), the second leading cause of death in dogs after cancer.

The animal's stomach is strained due to excess gas and therefore twists, which cuts off the blood supply. These twists are mostly seen in large breed dogs with large chests such as Saint Bernard, German Shepherd, and Danish Mastiff.

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Symptoms

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A twist commonly occurs after the dog has eaten a heavy meal, followed by strenuous activity. Here are the signs to watch out for:

  • abdominal pain

  • distended abdomen

  • retching without vomiting

  • hyperactivity

  • accelerated breathing

If you see any of these signs, it is a veterinary emergency.

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What treatment?
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Once the animal is taken care of, the veterinarian will assess its condition. If the dog is in stable condition, the vet will try to relieve the pressure in the stomach. If this is not successful, surgery will be needed to stop the twist.

Even if the procedure goes well, there may be complications afterwards. Twisting of the stomach can disrupt blood flow, electrolyte levels, and body fluid balance. The dog may therefore need to remain hospitalized for at least a week.

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Other cases

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Without always talking about torsion of the stomach, your dog may show signs of swelling of the abdomen:

* Bloating : the stomach contains too much gas, but is not twisted. The causes and clinical signs, however, are the same as in the case of torsion, and can lead to it. It is therefore necessary to take the dog to the vet fairly quickly.

* Massive lesions : These can be enlarged organs, due to cancer or another disease, for example a swollen liver in dogs with heart failure or Cushing's disease.

* Loss of muscle mass : Cushing's disease can cause muscle loss, giving the impression of an enlarged abdomen.

* Accumulation of abdominal fluids : caused by heart failure, hypoprotidemia, or peritonitis.

* Pregnancy : If the owner is unaware of a female's gestation, an enlarged abdomen may suggest stomach twisting.

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What prevention?

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If your dog is too gluttonous and / or a thief between meals, take care to place his food out of his reach. Give her two or three small meals a day, rather than one large one. Sequence meals in several times if your dog tends to swallow everything at once. And don't give him intense exercise right after his meal.

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Presence of a foreign body in the pharynx

Foreign bodies stuck in the pharynx are common in cats and dogs; we find them more particularly among young people because they are very curious. They are usually ingested as a result of play, or when trying to swallow large or irregularly shaped pieces of food. Very large objects can obstruct the airways and cause suffocation. When a foreign body becomes anchored in the soft tissues of the pharynx, it often causes an abscess which will swell and sometimes even occlude the pharynx.

Differential diagnoses
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  • Pharyngeal tumor, e.g. tonsillar carcinoma, polyp in the eustachian tube

  • Pharyngeal wound

  • Tonsillitis

  • Malformation of the pharynx in predisposed breeds

  • Upper respiratory tract disorder

  • Fracture of a hyoid horn.


Clinical signs
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Although there are several diagnostic hypotheses to consider, when the problem appears suddenly and the animal appears in respiratory distress, the suspicion of a foreign body blocked in the pharynx will be the main diagnostic hypothesis. Sometimes the owner knows exactly what the problem is and / or the foreign body is easily visible on physical examination.

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The classic clinical signs of a foreign body in the pharynx are pawing towards the mouth, the impression that the animal is choking, and ptyalism, which is sometimes tinged with blood. If the nasopharynx is affected, the animal sneezes and produces loud noises and snores, especially in cats. It often happens that the animal refuses to eat, and when it tries, it almost suffocates.

Usually over time, the distress caused by the presence of a small foreign object subsides, and symptoms become more subtle. They include a refusal to feed, swelling, and pain in the parotid region or throat. If there is adenomegaly of the retropharyngeal lymph nodes, their increase in size may cause signs of confusion with a protrusion of a cervical disc. Migrating foreign bodies that are not removed (eg spikelet) can cause fibrosis affecting the masseters and making it difficult to fully open the mouth, even under general anesthesia. If the foreign body is large, eg a bullet, occlusion of the pharynx may cause severe dyspnea or asphyxia. Chronic nasopharyngeal foreign bodies can induce the development of a mucopurulent nasal discharge.

Specific diagnostic techniques

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It is sometimes possible to see the foreign body during the examination of the oral cavity without sedation. When there is a strong suspicion of the presence of a foreign body but it is not visible, or it is difficult to examine the oral cavity, a complete examination should be performed under general anesthesia. We can thus examine the oropharynx, the nasopharynx, and look for the presence of sores or pharyngeal fistulas. It is essential to have good quality lighting; you can use a headlamp, a laryngoscope or a flexible endoscope. It is necessary to linger on the examination of the tonsillar crypts and nasopharynx, reflecting the soft palate.

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X-rays will allow detection of the size and position of a foreign metal or bone body, as well as any displacement of soft tissue in the cervical region secondary to the formation of an abscess. ultrasound of the cervical region can help locate a radiolucent foreign body and determine the nature of swelling at the base of the neck. Imaging should always be used when a foreign body is suspected but cannot be seen, or when an entry point can be seen.

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Treatment
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Once the foreign body has been identified, it should be removed and then controlled for edema, pain or pharyngeal infection. It is sometimes possible to remove some oral foreign bodies without sedation, especially if it is accessible and has not perforated an oral structure. However, animals with a foreign body blocked in the pharynx usually need to undergo general anesthesia. The pharyngeal wounds must be explored well to remove all the debris of a foreign body and then flush them with lukewarm saline solution. Before flushing, you must put an endotracheal tube perfectly adjusted to the tracheal diameter and tilt the animal's head downwards to avoid any false route. Broad-spectrum antibiotics will be given if there are lesions in the pharyngeal wall. NSAIDs will be used to reduce soft tissue swelling and pain.

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Pharyngeal wounds usually heal very quickly. There are very few that need to be sutured, but if so, you should put as few stitches as possible. If it seems difficult or painful for the animal to swallow food, it will be offered a little softened ice, and once it has started to eat, it will ingest the soft food more easily.

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Specific treatment of the most frequent foreign bodies in the pharynx

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Fish bones, irregular bones (vertebrae): thin (cartilaginous) bones often get stuck in cats, they are typically found planted 1 horizontally in the pharynx and anchored in soft tissue. They can be easily removed with a hemostatic forceps, but general anesthesia is usually required. Oddly shaped bones are often found in dogs, they are easy to find and remove. Tissue damage is often minimal.

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Hooks: Cats are affected when they play with flies or eat the bait. Dogs can also eat the bait or catch a moving fishing line. Whenever possible, when there is a line attached to the hook, try to preserve it and prevent the animal from swallowing it. The barb of the hook makes its extraction very difficult when trying to pull it out, so it is easier to extract it by pushing it through soft tissue. If the hook eye is large or there is not enough room to handle it, it may be necessary to cut the hook in half before it can be removed. However, the majority of hooks are made of very strong steel and can only be cut with a suitable hacksaw (not a nail clipper). Hooks that have migrated from the pharynx will sometimes lodge in the esophagus or stomach. In this case, an X-ray and endoscopy should be taken to determine the exact position of the hook and assess tissue damage. Some can be removed by endoscopy, otherwise they have to operate.

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Threads and needles: the needle can go through the pharynx or go deep into the root of the tongue. Unlike hooks, they are usually easily removed with hemostats. It is useful to preserve the thread that can be attached to the needle in order to locate it more easily and to be able to move it during extraction.

Spikelets, blades of grass, burrs of certain plants: these foreign bodies are generally ingested when the animal licks itself or ingests plants. The spikelets often sink into the crypts of the tonsils, and the blades of grass will often lodge in the nasopharynx, behind the soft palate. The spikelets will start to migrate through the mucosa if they are not found and not removed quickly, making their location even more difficult and causing a sharp inflammatory reaction in the soft tissues.

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Balls: This usually happens when the dog catches a ball that is too small for its size. The bullet is then stuck at the back of the mouth above the root of the tongue. Breathing is then severely compromised and the risk of death from asphyxiation is very high. By the time the animal is presented, it is usually in severe dyspnea and everything should be done so that the animal is not stressed and calms down. The easiest way is to remove the bullet with short-acting general anesthesia, but all the materials needed for an emergency tracheostomy should be prepared before induction. Once the dog is anesthetized, we will fix the ball by manipulating the larynx from the outside, then we will catch it with a large clamp. It often takes a lot of effort to get the ball out. During this operation, the dog usually cannot breathe, so the ball should be extracted as quickly as possible if a tracheostomy has not been done. You can facilitate the removal of air-filled balls (eg tennis balls) by piercing them first, so that they flatten when caught.

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Wood splinters: they are found in dogs who play with pieces of bots or who have destructive behavior. Although the dog is sometimes presented with typical clinical signs of distress and suffocation, it is very common for these signs to have become chronic. Splinters are often the cause of abscess formation at the base of the tongue or in the upper cervical region, but are difficult to identify and locate. Since they are not radiopaque, ultrasound is more useful than X-ray in detecting them.

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Stick penetration injuries: These are common and occur when a dog catches a stick while playing. These injuries should always be fully examined under general anesthesia. Tissue damage can be significant and is often heavily contaminated.

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Follow-up and care

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If the diagnosis is made quickly and the foreign body is removed without general anesthesia, the cost will not be excessive and the animal will only need a few medications to recover. On the other hand, if the signs persist after the removal of the foreign body, one must quickly seek another cause.

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