Author: vetstream

Canine cutaneous mast cell tumors

Mast cell tumours are common tumours of the skin in dogs. Whilst many mast cell tumours can be cured by appropriate management, dogs that get one mast cell tumour can frequently develop other separate mast cell tumours elsewhere on their skin at other times in their life.

Mast cell tumours arise from a special type of cell that typically lives in the skin. These cells are normally involved in inflammatory reactions. Therefore, mast cell tumours can show any of the changes typically associated with inflammation like swelling and redness. In fact, it is common for owners to notice that the lump of a mast cell tumour has been fluctuating in size.

There is a marked variation in the behaviour of mast cell tumours and for this reason a tumour grading scheme is used. This scheme categorises mast cell tumours into three groups usually described as grades 1-3; sometimes the terms well-differentiated, intermediately differentiated and poorly differentiated are used.

The tumour grade significantly influences the treatment decision-making process. The higher grade a tumour is, the more likely it is to infiltrate into the normal looking body tissues around the tumour and the more likely it is to spread through the body via the blood or lymph systems.

Many of these tumours can be cured but only by appropriate intervention and there is great merit in finding out what grade a mast cell tumour is before definitive treatment is planned.

Mast cell tumours do not have a typical appearance and so any lump in or under the skin should be viewed with suspicion as it could be one. High grade mast cell tumours tend to look bad from the start. They can be big, red and frequently discharging serum or blood with no apparent border between the normal and the cancerous tissues.

Diagnosis is typically made by fine needle aspirate. This allows the collection of a small number of cells from a lump that can then be examined under a microscope. Sedation is rarely required and certain tumours, including most mast cell tumours, are very readily identified by this means.

Once a mast cell tumour has been diagnosed a complex series of decisions needs to be made. Ideally the grade of the tumour is determined first. This requires a biopsy to be obtained and submitted to a pathology laboratory.

Sometimes mast cell tumours are not identified until after surgery (to remove what had appeared to be an innocuous skin lump). The pathology laboratory describes the presence of a mast cell tumour and they will usually define the tumour grade and comment on the degree of invasiveness of the tumour. Under these circumstances further treatment is often necessary as the surgery has rarely been adequate to completely remove the cancer.

In the initial assessment of any patient with a lump that is considered likely to be cancerous, the local lymph nodes are examined by palpation. If they are enlarged, samples need to be obtained to determine whether there is evidence of tumour spread.

Low grade mast cell tumours can be cured in almost all cases. Surgical removal with appropriate margins of apparently normal tissue (1cm) is appropriate.

Intermediate grade tumours require wider margins (2-3cm). It is important to note though that approximately 1 or 2 out of 10 of these patients have spread of their tumour before the diagnosis is made. There is little point in successful removal of a single lump in the skin if cancer is left behind in other parts of the body.

Surgical removal of high grade tumours requires much wider margins of normal tissue to be removed. Approximately 8 of every 10 of these tumours have spread before the time of diagnosis and therefore the role of surgery in their management is limited.

Other treatments do exist for mast cell tumours. As a rule, they are less effective than surgery in that they do not cure the disease. However, there are instances when these treatments are more appropriate.


Radiotherapy or radiation therapy has a particular role to play in the management of mast cell tumours at sites that are not amenable to surgery, for instance the lower limb or around the face. Radiotherapy can dramatically affect the further progression of mast cell tumours, irrespective of tumour grade, with many cases failing to worsen for many months or even years after treatment. For this reason radiotherapy is also used in the post-operative management of some mast cell tumours, when there is a strong suspicion of incomplete removal.

By and large the side effects of radiotherapy are minimal; this is defined in part by the particular radiotherapy protocol used. Some animals develop reddening of the skin; others can develop skin ulceration. Skin related side effects can be irritating but tend to be short-lived. More serious effects can develop in the long term and for this reason radiotherapy is undertaken less freely in younger patients.


While there are countless descriptions of the use of chemotherapy in the management of canine cutaneous mast cell tumours in the veterinary literature, many of the successes reported have probably failed to recognise that a number of the cases described were already cured by the earlier administration of appropriate surgery. As a result, the stated responses to chemotherapy are likely to be overoptimistic. Having said that, chemotherapy may be appropriate in the management of metastatic mast cell tumours and some very favourable results can be seen.

Unfortunately, the response to chemotherapy can be unpredictable. While every effort is made to control the patients disease, it is not controlled at the expense of quality of life. The overriding philosophy in the management of all canine and feline cancer patients is the promotion of quality of life first and length of life second.

Designer drugs

2009 saw the arrival of the first veterinary designer drug, masitinib. This drug comprises a molecule which is specifically designed to block an enzyme important in the development of a proportion of canine mast cell tumours. Initial reports of its use are very encouraging.

The risks associated with the use of masitinib are limited. In trials a low percentage of cases developed haemolytic anaemia, reason unknown. A relatively high proportion developed low grade gastrointestinal signs (vomiting and diarrhoea) that rarely required treatment modification. Current data suggest that the best indication for masitinib is high grade metastatic or multifocal mast cell tumours.

Complete removal of a mast cell tumour that has not spread from its original site will result in a cure. This is the case for nearly all grade 1 or low grade mast cell tumours and more than three-quarters of grade 2 or intermediate grade tumours. Unfortunately in the majority of cases with grade 3 or high grade tumours this is not possible.

In cases with high grade tumours or cancer that has spread, it is unusual that patients live more than six months from the time of diagnosis, even with treatment. We may find that this changes as we gain more experience with the new designer drugs. A specialist veterinary oncologist would be able to offer the most up to date information in this respect.

Cancer in your dog – possible options

Cancer is the uncontrolled growth of abnormal cells. The speed with which a cancer spreads and the severity of the disease it causes depends on the type of tissue cell affected. As many as one in five dogs are likely to develop one of the many different forms of cancer at some stage of their lives. The risk of developing cancer increases with age. This means that, as dogs now enjoy a longer life expectancy through improved veterinary care, the number of animals with cancer has been increasing in recent years.

As with human cancers, the causes of cancer in dogs are still not well understood. Possible causes include:

  • Toxic chemicals or exposure to harmful radiation.
  • Abnormalities in the immune system that usually protects against infectious diseases.
  • Abnormal genes.

The signs of cancer are very variable and depend on the type of tissue cells involved, the site of the cancer and the stage of the disease. Animals with advanced cancers often show weight loss and loss of appetite. If your dog has cancer it may be depressed, vomit, have diarrhoea or constipation or fever. Your dog may also get tired easily because of other effects caused by the cancer, e.g. anaemia. Cancer can occur in any animal and at any age, but certain types of dog are more likely to get certain forms of cancer.

Yes, most forms of cancer can be treated, but this depends on the type of cancer involved and whether the disease has spread. The outcome of treatment can be very variable. In some cases treatment can produce a complete cure, or at least significantly increase the length or improve the quality of your dog’s life. Sometimes euthanasia is the only humane alternative to a slow and painful death.

There are three basic options for treating cancers; not all are appropriate for every case and sometimes a combination of treatments has the best chance of success. The treatment options are:

Surgical removal

Usually the best choice for most cancers of solid tissue. If the cancer is relatively benign, or if a more malignant cancer has not yet spread to other parts of the body, surgical removal often produces very good results.

Chemotherapy (drug treatment)

Chemotherapy is the best option for cancers affecting the blood or multiple areas of the body. Drug treatment may also prevent or delay the appearance of secondary tumours in other organs after surgical removal of the original lump. Chemotherapy is used to improve quality of life in pets and the side-effects of chemotherapy seen in people are usually not seen in dogs.

Radiotherapy (x-rays)

Radiotherapy is often effective when tests have clearly shown the extent and size of the tumour. The radiation is usually delivered by a special machine in a radiotherapy unit. A beam of radiation is most effective on cancers of the extremities (such as the limbs and head) where it is less likely to damage normal tissue before reaching the tumour.

Radiotherapy units are only located in a few specialised centres and your vet would need to refer you to a cancer specialist for this form of treatment. In some cases it may be possible to treat the cancer by injecting radioactive material into the body.

Discomfort can be severe when the cancer is advanced but most cancer-related pain can be controlled. Your vet will probably try a gentle painkiller at first and move on to more powerful drugs if these are required. Your vet will try to improve your dog’s quality of life rather than prolonging the life of your dog if it is suffering.

Careful attention to your dog’s diet may improve its quality of life. Dogs need extra food to cope with the effects of a fast growing tumour but many cancer patients have a poor appetite and so lose weight. Warming the food or feeding by hand may help stimulate your dog to eat. There are also special diets designed for animals with cancer that provide good nutrition even if your dog’s appetite is poor.

This is the question that every owner wants answered but, as with human cancer, it is impossible for your vet to give you an answer with any confidence. The survival chances will depend not only on the type and stage of the disease but also on your dog’s general state of health. You should discuss this issue with your own vet so that you can agree between you an appropriate treatment plan for your dog.

It is understandable that, faced with a diagnosis of cancer, you will feel frightened about the future for your pet. Discussing your fears with your vet is the very best way to obtain reassurance and an independent assessment that you are doing what is right for your pet.

Whelping – potential problems

Just like it is for women, giving birth is a completely natural process for bitches. In most cases the delivery will go smoothly and your bitch will manage better without any interference. However, you should keep a watchful eye on proceedings as problems can occur. If your bitch is having problems then early intervention could save her life as well as that of the puppies.

When bitches give birth we say that they are ‘whelping’ and there are three recognised stages:

  • Stage I: this usually lasts from 12 to 24 hours, during which time bitches may show changes in behaviour. They become reclusive, restless and start ‘nesting’ (trying to make a bed for the puppies). Bitches may refuse to eat and sometimes vomit. Panting and trembling may occur. In this phase the uterus (womb) is contracting and the cervix is dilating. Although you might see a clear and watery discharge from the vulva (around the back end of the bitch) no visible abdominal contractions are evident.
  • Stage II: begins when you can see the bitch starting to strain. These contractions will eventually result in the delivery of a puppy. Typically, there should not be more than 1-2 hours between puppies although great variation exists. The delivery of an entire litter of puppies can take between 1 and 24 hours. Increased puppy survival is associated with shorter total delivery time (less than 12 hours) and an interval of less than 2 hours between puppies. Discharge from the vulva during this time may be clear or bloody and this would be normal. Typically bitches continue to nest between deliveries and may nurse and groom puppies intermittently. As the next puppy starts to arrive panting and trembling are common.
  • Stage III: this is the delivery of the placenta. Bitches often deliver puppies and placenta alternatively until the delivery is complete but sometimes 2 puppies will be born and then 2 placentae. Try to keep a check that the same numbers of placentas and puppies have been delivered at the end.

Dystocia is the inability to expel a puppy through the birth canal. It is not uncommon in the bitch and can have several causes. The bitch may be in trouble if she is straining for a long time and no puppy is born – or if she strains for a while and then stops straining without producing a puppy or placenta.

If you think that your bitch is having trouble delivering a puppy you should contact your vet for advice immediately. The early diagnosis and treatment of dystocia can prevent the loss of puppies and perhaps even the mother.

The diagnosis of dystocia can be based on the presence of any of the following criteria:

Prolonged gestation

If the pregnancy lasts longer than 70-72 days from the first mating, 58-60 days of dioestrus (metoestrus) or 66 days from the day of the LH surge or initial rise in progesterone during oestrus (known if ovulation timing was performed) then this is abnormal. Prolonged pregnancy results in oversized puppies that will not fit through the birth canal. Partial separation of the placenta can result in death of these puppies in the uterus.

Failure of normal labour

Labour should begin within 24 hours of a decline in body temperature below 37°C / 99°F and progress through the three stages to completion within 12-24 hours.

Failure of delivery of all puppies in a timely fashion

Delivery should occur within 1 hour of active parturition (visible abdominal efforts) or 4-6 hours of intermittent parturition. Call your vet for advice if there is:

  • 30 minutes of strong contractions with no puppy born.
  • 2-3 hours of weak contractions without a puppy being born.
  • 4 or more hours between puppies.
  • Obvious problem (pup hanging out etc.)

Foetal distress

If stillborn puppies are delivered then concerns must be raised for the remainder of the litter as yet unborn. If the unborn puppies have slow heart rates (your vet will be able to detect heart rates) this can also indicate distress.

Maternal distress

The puppies are also at risk if their mother becomes ill before delivery. If they are nearly at full term they may stand a better chance of surviving if they can be delivered and cared for outside the womb. If a bitch develops green or copious vulval discharge and/or bleeding during pregnancy then veterinary advice must be sought immediately.

Dystocia is due to either a problem with the mother or with puppy size or position.

Abnormalities of the uterus (womb)

These include poor contraction of the muscles of the uterus, abnormalities associated with foetal or maternal fluids or twisting or rupture of the uterus. Sometimes the uterine muscles never start to contract properly and a Caesarean operation must be performed to deliver the puppies.

In other cases labour may develop normally but is prolonged and the muscles of the uterus become exhausted before all puppies have been born. Intravenous solutions containing glucose and drugs may help to stimulate contractions of the uterus, but a Caesarean operation may still be necessary.

Disorders of the birth canal

Previous damage to the pelvis such as healed fractures can make the birth canal narrow. Some bitches have abnormalities of the birth canal or unusually small vulvar openings (these may require a partial episiotomy (surgical incision) to deliver puppies vaginally).

Puppy abnormalities

Includes puppies that are too large, or in a abnormal position, presentation or posture. Puppy oversize can occur with prolonged pregnancy in abnormally small litters and is a common cause of dystocia.

The normal position of a puppy before delivery is with the foetal backbone lying along the top of the womb. A mild dystocia may arise if they are lying the other way up. In most breeds puppies can be born normally in either anterior (head first) or posterior (back feet first) presentation. It is only a transverse (sideways) presentation that is associated with dystocia and this is rare. Deformed puppies may also become stuck in the birth canal.

If the puppy is not in the correct position it is not easy to correct this with the use of forceps or traction because of the small size of the birth canal of the bitch. If a puppy is stuck in the birth canal then a Caesarean operation is needed in most cases.

Breeds of dog where Caesarean delivery of puppies is usually required

If it is known in advance that problems are likely during delivery your vet will probably want to book the date of the Caesarean as a routine procedure. You should always discuss the options for your pet with your vet well in advance of labour to ensure you have the right plans in place.

Your vet will want to have an accurate history about ovulation timing and breeding dates, as well as any events surrounding labor and performing a careful physical examination. This will include examination of the birth canal for any abnormalities or the presence of a puppy stuck in the birth canal.

A hand held ultrasound may allow detection of foetal heart beats and abdominal ultrasound and x-rays can be very helpful in assessing puppy viability, litter size and puppy position. Blood tests to measure calcium and glucose levels are also helpful in identifying metabolic disorders contributing to dystocia. A uterine monitor can be used to evaluate the quality of uterine contractions.

With this information your vet will be able to advise you on whether a Caesarean operation is likely to be in the best interests of the mother and the puppies.

Uterine inertia simply means that the womb is not contracting adequately. Primary uterine inertia means that the uterus never starts contracting. In this case a bitch will show the first signs of labour but never progress beyond this. This condition is not common but can be due to the pregnancy consisting of only a single puppy. Your vet may need to give an injection to try to stimulate uterine contraction or, if this fails to work, then a Caesarean delivery may be needed.

Secondary uterine inertia occurs after the bitch has been in labour for some time. One or more puppies may have been born but then contractions stop before all puppies have been delivered. This condition is more common in older bitches and can be due to exhausted muscles in the uterus or to glucose or calcium deficiencies. Veterinary attention should be sought immediately as this condition may respond to intravenous treatments but often means that a Caesarean delivery is needed.

With help from your veterinary surgeon, your bitch should be able to produce a healthy litter of puppies. Early diagnosis of problems will help prevent any life-threatening emergency, to puppy or dam by suitable and timely treatment.

Pyometra (‘pyo’ or womb infection)

Pyometra is a common disease in un-neutered female dogs that requires major surgery to cure. Though potentially very serious, many animals respond well to the treatment and can expect to make a full recovery. The best way to protect your female pet against pyometra is to have her neutered.

Pyo = pus, infection; metra = womb or uterus. Pyometra is a serious infection of the womb resulting in the accumulation of infective fluid (pus) within the cavity of this organ. It is usually seen in older, female dogs who have not been neutered.

Pyometra may be classified as open or closed. In open pyometra, a common sign is a discharge from the vagina. This discharge may be bloody or yellow or cream coloured. In closed pyometra, no discharge to the exterior occurs.

If the pus does not drain out though the vagina, your dog may become very sick and develop toxaemia (blood poisoning). The presence of this poison in the body has serious effects on other body organs and systems and can lead to life-threatening conditions such as kidney failure. Untreated, pyometra can cause death from dehydration, toxaemia and kidney failure.

A less common problem, stump pyometra, occurs in females who have been spayed (neutered), but in which a small remnant of womb remains within the body and becomes infected. Because only a small amount of womb is present, signs tend to be less severe, but this condition also needs treated to prevent complications.

Each time a female has a season (usually about twice a year) she undergoes all the hormonal changes associated with pregnancy – whether she is pregnant or not. The changes in the womb that occur with each cycle make infection more likely with age. Infection is usually caused by a very common organism called E. coli. The disease often occurs in the weeks or months following a heat or season period. Injections with some hormones to stop seasons or for treatment of other conditions can also increase the risk of pyometra developing.

Pyometra is obviously only seen in females (since males do not have a womb). It is more common in older females (above 6 years of age). The signs usually develop around 6 weeks after the female has finished bleeding from her last season.

Early signs of pyometra may not be very obvious. You might notice that your pet is just licking her back end more than usual. She may be off colour and off her food. Often she will be very thirsty and because she is drinking so much may start to wet in the house. Sometimes the pus escapes from the womb and a reddish-brown or yellow discharge may be seen at the vulva. As she gets more ill she may start to vomit, become very depressed and unwilling to get out of her bed.

Symptoms are likely to worsen over a period of days to several weeks. If untreated signs progress to dehydration, collapse and death from toxic shock.

Your vet will probably suspect what is wrong with your pet from your description of the symptoms although they may want to do some other tests to confirm the diagnosis and also to make sure that your pet is well enough to withstand an operation.

Blood tests may be taken to see if the toxins from the infection have entered the blood and could be affecting organs elsewhere. X-ray and ultrasound examinations may be undertaken to confirm that the uterus is enlarged.

Once the diagnosis has been confirmed your pet should have an operation to remove her womb as soon as possible. This is the same operation as carried out to routinely spay a female dog, however in a sick animal suffering from pyometra it carries much more risk. The risk of not operating is even higher; most animals will die if surgery is not performed. If the womb is not removed, toxins are released from the infection which get into her blood and make her more and more ill. Eventually these toxins can cause kidney failure.

Before performing the operation your vet may want to give your pet some fluids (into her vein) and antibiotic treatment. Surgery might be delayed for 12-24 hours to give your vet time to get your pet into a better condition to tolerate the surgery. She may need to stay in hospital after surgery for continued treatment.

Very occasionally dogs have been treated with special hormone injections to empty the womb without having to perform an operation. However, this treatment is only considered in valuable breeding bitches and is often not successful.

In very old animals with pyometra and clear evidence of organ failure, e.g. kidney and liver failure, or where other major problems such as serious heart disease exist, euthanasia may be the kindest option.

Pyometra is a serious disease and unfortunately a proportion of patients will not pull through despite treatment, owing to organ failure and complications. Overall, many dogs do recover remarkably well and it is certainly well worth pursuing treatment.

If your pet recovers from the operation then there is a good chance she will return to her former health. In fact many owners report that after the operation their dog is better than she had been for a long time before. It may be that the infection had been building up for a long time before the animal became really ill.

The only way to be sure your pet won’t develop this condition is to have her neutered. If you are not intending to have puppies from her then she should be neutered at as young an age as possible. Not only does this remove all the complications associated with the reproductive cycle but, if a female is neutered before her first season, she is also protected against mammary (breast) cancer developing in later life. Ask your vet for details about the best time to have your pet neutered.

Although pyometra may be more common in bitches that are not neutered and have never had puppies, it is not exclusively a disease of these animals. Breeding does not guarantee protection and indiscriminate breeding of pet dogs is not to be encouraged.

Hand-rearing puppies

Fortunately it is very unusual for a mother to be unable to rear her puppies herself. Taking on the task of bringing up a litter of puppies is rightly daunting and it requires considerable dedication for the first 4 weeks. If you are placed in the situation of having to rear puppies by hand you should contact your veterinary practice for advice.

It is uncommon for puppies to need to be totally hand-reared. It is very rare for bitches to be unable to produce sufficient milk, but sadly if the mother has died, is ill, or has abandoned the litter it may be necessary to step in. If a foster mum can be found then this is ideal as the puppies will be brought up naturally. A foster mum could be a bitch having a false pregnancy or one that has lost her own litter or only has a few puppies. If you have a very large litter the mother may be unable to feed all the puppies and supplementary feeding should be carried out although the puppies can be left with their mother at other times.

A note of caution – if a mother is rejecting a particular puppy from a litter there is a good chance that she knows that it’s unhealthy and this is the reason for rejection. Although you can find nothing wrong with it and hand-rearing this puppy may be successful there is a high chance that you will not succeed.

New puppies should be introduced very carefully to a potential foster mother. The foster mum is more likely to accept them if they smell of her. This can be achieved by letting the puppies cuddle up on a piece of bedding that the foster mum has been sleeping on. Do not wash the bedding first as you want the scent to rub onto the puppies. After a short time the foster mum can be introduced. The introduction must be closely supervised to ensure the foster mum accepts the puppies and doesn’t harm them.

There are a number of milk products available which have been correctly formulated to replicate bitch’s milk. Cow’s milk and human milk substitutes are not recommended as the quantity of protein, fat and carbohydrate differ from that in bitch’s milk.

Recommended milk substitutes:

  • Welpi – designed especially for puppies.
  • Pedigree Instant Milk Substitute – designed especially for puppies.
  • Lactol – suitable for puppies but not species specific so the above formulas are preferred.

These formulas are available from your veterinary practice and you should seek advice on their use. It is essential to make up and use formula milk according to the manufacturer’s instructions. Signs of under nutrition include failing to gain weight, crying and inactivity, however over feeding can be just as dangerous. It is important to increase the volume given as the puppies get bigger.

Puppies should increase in bodyweight by 5-10% per day for the first two weeks of life (after the first day – it is normal for them to lose weight in the first day of life). Failure to grow at this rate may indicate underfeeding or ill health. It is helpful to weigh each puppy every day and to keep a growth chart so you can see that all the puppies are growing well. They should be weighed at the same time of day, e.g. just before a certain feed and you certainly need to take into account whether the puppy’s stomach and bladder are full or empty at the time of weighing. Carefully clipping a little fur from a part of the body and carefully recording this may be helpful.

Milk substitute should be made up fresh for each feed and warmed to 38°C / 100.4°F (body temperature) before feeding.

It is very important that you feed puppies very slowly, keeping their heads up to allow them to swallow. If you give milk too fast it might go down the wrong way (into the air passages) which could lead to pneumonia.

If you are trying to save a weak puppy it is safer to feed it using a stomach tube rather than giving milk via the mouth. This should not be attempted by an untrained person and involves passing a suitably sized tube through the mouth, down the throat and into the stomach. Milk is then placed into a syringe and injected down the tube into the stomach. A veterinary nurse will be pleased to show you how to feed the puppies initially.

For the first week of life feed normal puppies using a syringe with a teat attached. Nursing bottles can be purchased in pet shops and through your vets but these are not recommended until the puppy has a good sucking reflex.

Supplying colostrum

Colostrum is a special kind of milk that contains antibodies to protect the puppy during the first few weeks of life. Puppies that have inadequate colostrum are less likely to survive. Colostrum only works if ingested in the first 12 hours after birth. After this time the puppy’s stomach and intestine change so that they digest the antibodies rather than allowing them to be absorbed intact as is necessary. Also, after the first 12 hours, the mother begins to stop producing colostrums and switches over to producing normal milk.

So, if at all posible, try to obtain colostrum and get this into each puppy in its first 12 hours after birth. If this is impossible it can be substituted, to some extent, by a veterinary surgeon injecting the puppy with serum.

New born puppies need to be fed every 2 hours from birth up to 7 days of age. From 8-21 days this can be decreased to every 3 hours. The amount fed should be increased to compensate for this at each feed. At 4 weeks of age feeding every 4 hours is recommended along with the introduction of solid puppy food. Between 5-6 weeks you can slowly decrease the amount of milk provided and increase the amount of solid food as long as all the puppies are feeding well and gaining weight. By 6 weeks the puppies should be fully weaned, being fed entirely on puppy food.

The following equipment is recommended:

  • Syringes –  2ml for puppies.
  • Teats – assorted sizes available depending on the size of neonate.
  • Cotton wool.
  • A room thermometer – those sold for horticulture are suitable.
  • Another thermometer to measure the temperature of the milk prior to feeding is also needed.
  • Scales – it is vital to weigh the puppies accurately each day. The scales will need to weigh accurately to the nearest 5g and ideally to the nearest gram.
  • Sterilising Fluid – e.g. Milton, to keep equipment sterile. Equipment should be sterilised and stored without rinsing, then rinsed thoroughly just prior to use. As well as not being good for the puppy if ingested it may put them off feeding if they can taste it.

New born puppies need to be kept clean and dry. After feeding you should clean their mouths with warm boiled water and cotton wool, drying afterwards. More importantly you need to encourage urination and defaecation. This would normally occur when the dam licks and stimulates their genital areas. You can copy this by rubbing the area with warm, damp cotton wool. This should be carried out every 2-4 hours until 3 weeks of age when they should be able to urinate/defaecate voluntarily.

New born puppies are unable to regulate their own body temperature. They need to be kept in an enclosed controlled environment of approximately 25-30°C / 77-86°F, free from draughts. This can be achieved by thermostatic controls on a radiator, hot water bottles wrapped in towels, heat pads or infra-red lamps.

Heat pads should be designed for animals and be wrapped in towels or paced under vet beds. If used incorrectly they could burn the puppies as they generally reach temperatures of 52°C / 125.6°F. Infra-red lamps should not be placed directly over the neonates and must be at least 5cm away. Place a room thermometer in among the puppies.

Bedding should be soft and warm, eg towels, and needs to be easily washable. Newspaper is suitable to start teaching the puppy house training – again from 3 weeks of age. Soft, warm bedding should still be provided.

Puppies are able to crawl at birth so should be quite mobile although they will be sleeping for a while from the anaesthetic if born by caesarian. Standing occurs from 10 days. By 3 weeks of age puppies should be able to walk around. Puppies are born with their eyes closed. They generally open them between 10 -14 days.

Do puppies need socialising?

Socialisation is very important in all dogs. This period should start from 4 weeks of age in puppies. It is essential that puppies become used to being carefully handled and are acclimatised to everyday noises and situations, e.g. the vacuum cleaner, hairdryer, car and washing machine etc. This enables them to learn that these experiences are nothing to be afraid of.

It is also a good idea for puppies to meet other animals. Ensure that all animals introduced are fully vaccinated and that they will not harm the puppies. Puppies that are hand-reared generally do not have much resistance to disease until they are vaccinated so it is vital that all animals introduced to them are completely fit and well. Puppy socialising classes should be encouraged once fully vaccinated.

Puppies can be vaccinated from around 6 weeks. Early vaccination may be beneficial in hand reared puppies who will not have received appropriate protection from their mother’s milk (inadequate colostrum).

If’ you are at all worried or just require advice then please contact your veterinary practice. New born animals are very fragile and can deteriorate rapidly if their needs are not fully met. After the first day, each puppy should maintain or gain weight each day – contact your veterinary practice if this does not occur.

False pregnancy

Some unneutered female dogs develop changes several months after a season. This is often referred to a ‘false pregnancy’ or ‘pseudopregnancy’. In most animals this is not a serious condition but it can be inconvenient for the owner and disturbing for the animal. Usually the condition resolves without any treatment but if you are not thinking of breeding from your pet then it is worth considering neutering to prevent this condition.

After oestrus (heat or season) in the female dog or cat the same hormonal changes occur whether or not she is pregnant. The phase of the heat cycle after oestrus is called dioestrus. During dioestrus levels of the hormone progesterone rise. In normal females dioestrus ends spontaneously if they are not pregnant. In pregnant females dioestrus ends as the female goes into labour.

All entire females undergo the same hormonal changes whether or not they are pregnant. This means that after oestrus changes occur in the body to support a pregnancy. For 2-3 months hormonal levels are similar to those in pregnant females. It is this part of the heat cycle that can result in a ‘false pregnancy’. ‘False pregnancy’ could be said to occur ‘naturally’ during dioestrus in all females (since they undergo the same hormonal changes whether or not they are pregnant).

At the end of this period (when a pregnant female would be giving birth) progesterone hormone levels drop and this can fool some female into thinking that they have given birth and need to care for their puppies. Sometimes behavioural changes develop and females may ‘adopt’ a cuddly toy and protect it like their young, in others physical changes may also occur including milk production.

Signs of false pregnancy usually develop around 2-3 months after the previous season. It can be very difficult to know whether a female is actually pregnant or is having a false pregnancy. If you are not absolutely sure that your pet could not be pregnant then you should visit your vet and ask them to check her over.

Each affected female will show different signs including:

  • Poor appetite, lethargy and depression
  • Nest building behaviour and ‘adopting’ toys
  • Behavioural changes, including aggression
  • Mammary development and milk production

In some animals the signs are very subtle, in others they can be dramatic. Signs of false pregnancy may develop after the first season and usually get more obvious with each heat cycle.

In the vast majority of cases false pregnancy is not a serious condition and you should not worry too much. Most females remain well throughout. Try to treat your pet the same as normal and don’t encourage her abnormal behaviour. If she shows a preference for a particular toy and tries to guard it, take this away from her for a few weeks. Encourage her to undertake her normal activities and try to distract her from any ‘strange’ behaviour with more interesting activities like play.

If your pet’s mammary glands develop and she starts to produce milk you should probably get her checked over by your vet. In most cases milk production dries up without any treatment but some females lick at themselves and stimulate more milk production. This can be uncomfortable for her and there is the risk of an infection (mastitis) developing.

You should also see your vet if your pet is off her food for more than 24 hours, if she has abnormal discharges from her nipples or vulva or she seems unwell in other ways. These may be the signs of more serious problems developing.

In females who have mild signs treatment may not be needed. In most cases the signs will resolve without any treatment as the hormone levels alter as the cycle continues. However in some cases (particularly where behavioural changes are very marked or a lot of milk is being produced) you may want to try to settle the signs more quickly.

There are a number of drugs that may help to reduce the duration of the signs but these will rarely stop the problems immediately. Many of the drugs used are hormones which may be given to stop milk production or affect hormone levels (cabergoline, bromocriptine, megestrol acetate or testosterone). These drugs can sometimes have significant side-effects and so are only used if signs are causing significant problems, or as a last resort.

The best way to control false pregnancy is to neuter the female. Preventing further seasons will prevent the problem happening again. However, if your pet has suffered from false pregnancy, it is important to let the signs abate before neutering. The operation should not be carried while she is still producing milk as it can then be very difficult to stop this.

Once a female has had a false pregnancy they tend to have recurring false pregnancies at every oestrus and signs may last for many weeks. Drug treatment can help during the false pregnancy, but the best solution is spaying, after the false pregnancy has ended. If your pet has suffered a false pregnancy discuss the options for treatment with your vet.

Eclampsia (puerperal tetany)

Canine eclampsia, also sometimes wrongly called  “milk fever”, is a dangerous condition brought on by low levels of calcium in the blood stream. It is also called hypocalcaemia and puerperal tetany and needs emergency veterinary attention.

Eclampsia is most commonly seen in small or medium-sized bitches a few weeks after whelping. If your dog is in this category you should watch out closely for this condition. It has been shown to be more likely to occur with large litters as the demands on bitches to feed these pups are greatest.

Signs most commonly develop during the first 3 weeks of nursing although it can be seen in the last few weeks of pregnancy and as long as 6 weeks after birth.

The very early signs of eclampsia are easily missed by the owner. These include tiredness and reduced appetite. At a later stage bitches with eclampsia show marked changes such as shivering, restlessness, panting, and incoordination. Some bitches show signs of pain and may rub their face and bite at their feet. They often do not respond to the owner in the usual way. If the disease progresses without treatment bitches may have seizures and very high temperatures of up to 41°C / 106°F. The condition can worsen rapidely (1-2 hours) and immediate help is necessary.

Eclampsia is caused by low blood calcium (hypocalcaemia ). Some bitches are predisposed to develop the condition and their risks can be increased by inappropriate nutrition – “Home made” diets are usually at fault. A common mistake is for owners to add extra meat to the bitch’s diet. This causes a mineral imbalance and can upset the levels of calcium in the blood.

Bitches with large litters are particularly at risk because they are producing more milk – milk contains quite high levels of calcium and when puppies start to take large amounts of milk (10 to 30 days after whelping) the bitch may find it hard to maintain sufficient calcium in her blood. Milk production has priority over the blood stream for calcium!

Eclampsia is a life-threatening condition and your vet will need to start treatment straight away. Intravenous fluids are given to replace calcium and energy levels. It is vital that the bitch is monitored closely during this time and your vet may want to admit her to the hospital for this treatment. In addition to correcting the calcium levels other emergency treatment may include lowering of body temperature with cool baths.

When given intravenous calcium patients generally stabilise within 10-15 minutes and the temperature is reduced to normal via the cool bath.

You need to be aware that bitches that have had one episode of eclampsia are more likely to have recurrent bouts and great care should be taken later in the same whelping and at subsequent pregnancies.

After initial emergency treatment calcium supplementation should be continued (your vet will supply tablets). Supplement the puppies’ intake with a milk replacer as soon as possible to decrease the milk demands on the bitch. Puppies should be weaned as soon as possible.

In future pregnancies you should provide your bitch with a high quality commercial food but don’t over supplement with calcium or unbalanced meat products. Diets should not be supplemented with calcium as this can negatively influence the bitch’s ability to activate calcium when needed.

Cryptorchidism (retained testicles)

When a male puppy is in the womb its testicles are drawn up inside the body. After birth the testicles begin a journey from inside the tummy (abdomen) to the scrotum. Both testicles should have descended to the scrotum by six month of age and be easy to palpate. If testicles do not end up in the scrotum by this age they are said to be ‘retained’. Retained testicles are a relatively common occurrence in male puppies, particularly in certain breeds. If your puppy has retained testicles we will probably recommend an operation to remove them (castration).

If one or both testicles cannot be found in the scrotum by the age of 6 months the dog is considered to be a cryptorchid. Your vet should check for the presence of testicles in the scrotum at the examination at time of first vaccination. If they are not present there by 3 months it is very unlikely they will ever be.

Usually one testicle can be felt in the scrotum but the other has not completed its journey from the abdomen. It may have become stuck anywhere along the way and in many cases your vet will be able to feel the testicle somewhere under the skin. Often the missing testicle is still inside the abdomen and therefore cannot be felt at all.

In most cases cryptorchidism is caused by a defective gene. In order to cause this condition the gene is usually present in both the mother and the father. Since the defective gene may be passed on to future generations animals that are cryptorchid should not be allowed to breed. Breeding should also be avoided from the mother and father of affected animals.

After birth testicles descend into the scrotum because this is colder than the normal body temperature of the animal. If a testicle remains inside the body for many years it is more likely to develop cancer. The cancer of retained testicles is serious and causes significant changes such as hairloss and anaemia (due to excessive hormone production) as well as spreading to other parts of the body.

Another possible serious complication is that of ‘testicular torsion’. If the testicle remains in the abdomen it may become tangled in the ligament that attaches it to the body wall. This can cut off the blood supply to the testicle causing severe abdominal pain. As the testicle is not visible it can be quite difficult to work out what the problem is.

Dogs with both testicles retained are usually sterile (unable to father puppies). Those with one normal testicle can still be fertile, although the quality of their sperm is reduced.

Animals with retained testicles are also more likely to have other genetic defects like umbilical hernias and an abnormal penis.

To avoid future complications dogs with retained testicles should be castrated. Removing retained testicles can be a difficult operation as they may be located anywhere in the abdominal cavity. Sometimes the internal testicle can be detected – usually by ultrasound but often it is too small to be seen clearly. In any case your vet will need to open up your dog’s belly to remove the missing testicles. This should be done before the dog reaches middle-age to reduce the risk of the retained testicle becoming cancerous.

Since the animal is not suitable for breeding (due to the high risk of passing on the condition) both testicles should be removed – even if one is in the scrotum. This is important to prevent possible future confusion. If the puppy is rehomed and only one testicle is found in the scrotum further surgery might be carried out to try to locate the (already removed) other testicle.

Breeding from your dog

A bitch (female dog) can produce 1-2 litters of puppies each year. If you are not intending to let your bitch have puppies then you might consider having her neutered. However, if you do decide to breed from your bitch there are many things to consider to ensure that both mother and puppies are strong and healthy.

A bitch in season will often attract an army of potential suitors from the local dog population and around the time she is most fertile she may become desperate to escape to meet up with them! You will probably want to have some say in her choice and it is essential to keep her securely indoors and walk her on a lead or away from other dogs during this time. There are already many unwanted dogs and puppies, the majority arising from the consequences of such chance matings.

If you have a pedigree dog you will want to find a partner of the same breed so that the puppies are purebred and you should speak to an experienced breeder of your breed well in advance of planning the mating. Information on local breeders can be obtained from the breed club secretary or the Kennel Club web site –

Certain breeds have particular problems when giving birth so it is advisable to speak to an experienced breeder of these breeds before going ahead with a mating. There is a high incidence of some genetic problems in certain breeds and many breeds operate screening schemes to prevent breeding from affected animals. Your dog may have to undergo X-rays, eye examination or other tests at your vets before being mated.

Bitches should not be allowed to have puppies until they are fully grown and are mature themselves. This age will vary from breed to breed and between individuals. The first season may occur between 6 months and 18 months of age but few recommend allowing a bitch to become pregnant at her first season. Most breed societies recommend breeding from bitches that are older than 2 years at the time of birth.

Most bitches develop a pattern of seasons which usually occur with a regular interval between 5 months and 1 year. Seasons usually last around 3 weeks and bitches are most receptive around 10-14 days into the cycle

Bitches are usually mated twice during the receptive period. You can start counting the days of her cycle from when you first see signs of bloody discharge at the vulva. However some bitches have very light discharge and you may easily miss the first few days.

The best way to find the right time of mating is to do some blood tests starting around day 7-9. Bitches produce a hormone called progesterone at the time that they release the eggs (ovulate) to be fertilised and this can be used to time the mating. The tests have to be repeated every 2-3 days to find the right time for mating. If the bitch ovulates between day 12-15, as most of them do, two or three tests should give you the expected result. ‘Late’ bitches can require more testing, but it is worth doing these tests as these bitches would not conceive at the normal time.

There are other signs to look out for like the bitch standing and turning her tail and her discharge changing from bloody to a lighter colour.

The hormonal changes following a bitch’s season follow a very similar pattern whether or not she is pregnant. Therefore many bitches develop a so-called ‘false pregnancy’ and often show changes in behaviour and may even show mammary development and milk production.

It can be very difficult to be sure your bitch is pregnant merely by feeling her tummy. In the early stages the developing foetuses are very small and easy to miss. If only 1 pup is present it might be difficult to locate even at full term. The best way to confirm that your bitch is pregnant is to ask your vet to perform an ultrasound scan around 2-3 weeks after mating. At this time the scan should also give an indication of roughly how many puppies are present. Of course some of these foetuses may not make it to full term but it provides a good guide to litter size.

There is also a blood test for a hormone called ‘Relaxin’, the pregnancy specific hormone in dogs. This test can be useful if ultrasound is not available.

In the last third of the pregnancy you may want to increase the amount you feed your bitch. However, if she has a large number of puppies (or they are large) the distended womb may fill her belly and make it difficult for her to eat larger meals. It is a good idea to split feeding into 3 smaller meals throughout the day.

Many breeders will switch to feeding the bitch on puppy food in the last trimester, as this has higher energy and protein level as well as more calcium and phosphorus (minerals which are important for the development of healthy bones and teeth).

When your bitch has given birth she will need a secure bed in which to raise the puppies. Prepare this a few weeks before the puppies are due so that the mother can get used to sleeping there and is settled for the birth.

Normal pregnancy in the bitch is 63 days from conception, although smaller dog breeds often have shorter pregnancies. The time from mating to conception can be very variable in the dog and it is possible for conception to occur up to 7 days after mating.

Calculation of the delivery date is best based on results of examination of smears taken from the vagina or hormone tests made before conception. Alternatively ultrasound in the first few weeks of pregnancy may allow ageing of the foetuses.

Lungworms in dogs (Angiostrongylus)

Referring to Angiostrongylus vasorum as a lungworm is quite misleading. Although the early stages of the parasite do affect the lungs and severely infected dogs may show signs of coughing, other signs are far more common. These lungworms (Angiostrongylus vasorum) are also known as the French heartworm.

This is a parasite where the adult worm infects dogs but the young stages are carried by slugs and snails. The parasite itself may not cause the dog any problems unless present in very large numbers. However, in order to survive in the blood vessels the parasite releases substances which affect the clotting of the host’s blood. Thus infected dogs are more prone to bleeding than normal dogs. This bleeding can pose a life-threatening risk to an affected pet. Thus this parasite is can be more dangerous to a dog than the more common worms that live in the intestine and it is very important to take precautions to prevent infection.

This disease used to be confined to dogs living in the South of the country (especially the South East, South West and South Wales). However, in the last ten years the disease has become much more common and has been seen in dogs as far North as Scotland. All dogs in the UK should now be considered potentially at risk.

The adult worms spend most of their lives in the blood vessels close to the heart. However, when the eggs laid by the adults hatch, the immature worms (larvae) force their way through the walls of the blood vessels and into the lungs. The dog then coughs up the larvae and swallows them. The larvae pass into the faeces which is in turn eaten by slugs and snails (which love dog poo!).

The larvae develop in their new host until this is eaten by a dog. Slugs and snails often crawl into dog’s food bowls or onto toys if these are left outside. Dogs also eat these garden pests when drinking from outdoor water sources and eating grass. Once back in the dog the young worms make their way back through the dog’s body to the blood vessels.

Many infected dogs show no signs of illness. Dogs that are unwell show a wide range of symptoms: breathing problems, coughing, bleeding excessively from cuts or bleeding internally with no signs of trauma, anaemia and loss of condition. Other animals may show neurological changes including seizures. If your dog is unwell in any way make an appointment to see your vet.

Not all dogs with lungworm show breathing-associated signs. The adult worms in the blood vessels and heart can cause heart failure but also produce a substance to stop the blood clotting. This can cause your dog to bleed, with or without an injury. The bleeding can take place inside the body and may affect the brain or eyes resulting in seizures or blindness.

It is unlikely that your vet will know straight away what is wrong with your dog and they will need to do a number of tests in most cases to make the diagnosis. If you live in an area where lungworm is common your vet may be more familiar with the disease and may be suspicious of the signs at an earlier stage. If there is a suspicion that your dog is infected your vet can do a test for lungworms.

The infection can’t pass direct from to dog without first passing through a slug or snail. However, if you have several dogs living in the same household and one is found to be infected it is likely that the others will also be at high risk of infection. The common lungworm of dogs (Angiostrongylus vasorum) does not affect cats or people.

The aims of treatment are to eliminate the lungworm infection and also to manage the clinical signs. There are a number of drugs that can be used to eliminate the worms but infected dogs should be monitored carefully when receiving treatment as the sudden killing of the worms could result in a severe allergic reaction.

If your dog has severe signs (particularly affecting the brain or signs of heart failure) your vet will want to keep your pet in the hospital for specialised care.

Most dogs go on to make a full recovery with appropriate treatment. However, infection can prove fatal for some dogs despite intensive treatment.

Most dogs are infected by contact with slugs or snails (and usually from eating these) – so if you can reduce your dog’s exposure to these that will reduce the risk.

Regular treatment of your dog with a product that can kill the worms can help to protect them against infection. The standard worming treatment that you give your pet every 3 months or so may not protect them from lungworm infections. You will need to get additional treatment from your vet and this may be given in the form of a monthly spot-on (at the back of the neck) which will protect against lungworms and treats your dog for other common parasites such as fleas, worms, and mites. Contact your own vet for further advice on the risks to your dog and how to manage them.