Health

There has been a great deal of publicity regarding the health and wellbeing of pedigree dogs in the UK over the past couple of years. The good news is that conscientious Boxer breeders have been working hard to address most serious health concerns in the breed for a number of years, long before Professor Patrick Bateson’s recommendations were published at the beginning of 2010.

With the expert guidance of the Boxer Breed Council’s Health Committee, breeders have been able to significantly reduce, and in one case completely eradicate some of the most significant problems in the breed. The first of these was the elimination of the neurological disease Progressive Axonopathy (PA) by selective breeding, which resulted in no further cases after 1982. Two other conditions are currently covered by UK Boxer Health Committee guidelines, these being Aortic Stenosis (or Sub-Aortic Stenosis) and Boxer Cardiomyopathy.

Please note that while the majority of Boxer breeders are reputable, there are still dealers / pet shops and some sellers posing as responsible breeders who do not follow the recommended health testing advice, and have little regard for the wellbeing of the puppies they produce, or the welfare of the dogs they breed from. Buying a puppy from anywhere but a responsible breeder is at best a serious risk, and also perpetuates the problem of irresponsible breeding. Always ask for copies of health testing documentation, and ask to see the puppies with their dam to ensure they are of sound health and temperament.

It is also important to bear in mind that however carefully bred your Boxer is, as with any animal, there can be no guarantees that it will always remain healthy.

CONDITIONS AFFECTING THE BOXER

Aortic Stenosis

This a heart condition which occurs when there is a narrowing of the Aorta, usually just below the valve. This forces the heart to work harder to pump the necessary amount of oxygenated blood out of the heart to the rest of the body. This can result in thickening of the left heart muscle (hypertrophy) and also increased pressure. Reduced flow can cause fainting (syncope) and even sudden death in extreme cases. The turbulence of the blood as it is forced through the narrowed opening can be heard by stethoscope and is called a ‘murmur’.

During the 1980s breeders were becoming concerned about the number of Boxers that were dying suddenly, and a large number of these were found to be as a result of AS. Since then, through testing and careful selection of breeding stock, there has been a significant reduction in the number of Boxers with severe, symptomatic murmurs. As it would have been detrimental to the breed if only murmur-free dogs (grade 0/6) were used for breeding, the advice was given to breed away from severe murmurs by selecting dogs who were grade 0 or 1/6 (minor murmurs), or grade 2 dogs could be considered in extenuating circumstances. Over the years the testing has been refined thanks to the hard work of cardiologists and those involved with the Health Committee. A list is published on the Breed Council website which shows all dogs and bitches who achieved grade 0 or 1.

Detection of heart murmurs under the Heart Scheme is by auscultation (listening with a stethoscope) by a designated cardiologist who is trained to differentiate between the different grades of murmur. Affordable heart testing is available at many of the breed club shows. Puppies under the age of one year can have innocent murmurs which disappear with age, so testing should be performed after the dog is 12 months old, even if it has already been tested at a younger age. Not all murmurs are caused by AS, and if a significant murmur is detected further diagnostic testing, such as Echocardiography, may be advised to confirm the cause.

Boxer Cardiomyopathy (ARVC)

ARVC (Arrhythmogenic Right Ventricular Cardiomyopathy) affects Boxers more than other forms of heart muscle disease. It differs from cardiomyopathies seen in other breeds because it is caused by the presence of fatty, fibrous tissue in the heart muscle that causes an electrical disturbance, rather than dilation or thickening of the heart tissues, although these can be present as and end result of ARVC.

The electrical disturbance causes irregular and ineffective heart beats. If multiples of these beats occur in a row at a fast rate, the heart does not have enough time to fill with and pump enough blood to the body. This leads to signs of syncope (collapse), weakness, exercise intolerance, and even sudden death, often during exercise but occasionally even when at rest.

Affected Boxers can develop symptoms at any age and of these there are three different categories of symptoms: concealed (no signs, but arrhythmias present), episodic fainting (syncope), usually associated with exercise or excitement, congestive heart failure or sudden death.

At present there is no definitive screening test for ARVC carriers, although a great deal of research is being carried out, and some advances have been made. It is very difficult to identify asymptomatic carriers. Arrhythmias are usually in the form of VPCs (Ventricular Premature Complexes), and these can be detected by electrocardiography (ECG). This is where the dog wears a portable ECG recorder for 24 hours. If significant VPCs are detected then an affected dog can be identified, but the absence of VPCs during that time doesn’t guarantee that the dog is clear – as arrhythmias can happen at any time.

In the late 1990s three unrelated families of Boxers in the UK were identified as being affected by ARVC. More information about this, along with a list of dogs that have been linked to transmitting the disease, is published on the Health Committee’s website to enable breeders to breed away from the problem.

ARVC is extremely variable in its prognosis. Treatment is in the form of anti-arrhythmic drug therapy or a combination of drugs if heart failure is also present. Many dogs will continue to enjoy many years of quality life, but sadly in severe cases some dogs will die suddenly, even with close monitoring and treatment.

Cancer

Boxers are significantly more likely to develop cancer than many other breeds, and this predisposition is thought to be hereditary. Cancer occurs when cells in the body continue to multiply uncontrollably and this happens when the cell’s DNA code has become mutated. This can be due to environmental factors (for example, ultraviolet light can trigger skin cancers) or can be inherited. The mass of cells that results is called a tumour, and these can be benign (the cells remain local and do not spread throughout the body), or malignant (metastasize and spread into other areas of the body). Benign cancers are usually manageable and pose little threat to the health of the dog, whereas malignant cancers are much more harmful, difficult to treat and often life-threatening.

Symptoms of cancer can vary, depending on the type of tumour. If your Boxer experiences any of the following it is best to get them checked by your vet immediately: Weight loss, vomiting and diarrhoea, lethargy, lack of appetite over a time, difficulty eating or drinking, lameness, pain, any lumps and bumps, sores, difficulty breathing, any unusual discharge or bleeding, enlarged lymph nodes.

Some of the most common forms of cancer in Boxers are:

Mast Cell Tumours: often appearing as lumps on the skin, and can have almost any appearance from small, non-painful masses to rapidly growing, inflamed ulcerated areas. They generally occur in middle aged dogs but can appear earlier. Diagnosis is by Fine Needle Aspiration or biopsy, and prognosis depends on the grade of the tumour when detected, from 1-3. Grade 1 tumours have a good prognosis after surgical removal whereas grade 3 are considered very aggressive and the prognosis is poor.

Lymphoma / Lymphosarcoma: Lymphomas arise from the white blood cells called Lymphocytes. Swollen lymph nodes (the glands under the neck, in front of the shoulders or behind the knee, or around mammary glands of bitches) can indicate the disease and the lumps often appear suddenly and there is often a dramatic increase in thirst. Prognosis depends on the extent of the disease, and is variable.
Brain Tumours: There are several types of cancer that occur in the brain. Mental disturbances (sleeping a lot, appearing dazed and confused), agitation (pacing, repetitive behaviour) signs of pain with no obvious cause and balance disturbances are some of the symptoms. There can also be a marked change in temperament.
Histiocytomas: These are benign tumours that are very common in Boxers, particularly in young dogs. They can look similar to mast cell tumours, so it is important to get any skin lump checked by the vet and biopsied to confirm the diagnosis as soon as possible. Histiocytomas are caused by proliferation of histiocytes, cells that are part of the immune system. They are usually red-raw in appearance but are not painful, unless they become knocked or damaged when they can bleed and become ulcerated. They can appear suddenly, often almost overnight, and can grow rapidly. Many histiocytomas will disappear by themselves, but they may need to be surgically removed, especially if they are prone to being knocked or becoming infected.

Hives and allergies

Boxers occasionally suffer from hives which are caused by an allergic reaction. Sometimes the cause will be apparent, e.g. a wasp sting, or other unusual substance the dog has come in contact with, but other times the cause may remain hidden. Your Boxer will quite rapidly develop bumps that range from 1-2cm in diameter and can cover the body, resembling ‘bubble-wrap’. Usually itching and general discomfort is present. It is vital that you keep a close eye on your Boxer to ensure that anaphylaxis does not occur. This is when the body goes into a full-blown allergic shock and there is immediate danger of death caused by the airways swelling up. If your dog has any difficulty in breathing this is an emergency and they should be taken immediately to the vet. As soon as hives are noticed it is a good idea to administer an antihistamine which is safe for Boxers. There are several antihistamines that are safe to use, but you must always seek veterinary advice before administering any drugs to your dog. Chlorphenamine maleate (PiritonTM) is often advised at a dose of 4mg for an adult Boxer, every six hours for two doses. Diphenhydramine (NytolTM) is also used at a dose of 1mg per lb, so for a 50lb adult this would be 50mg. If no improvement is seen, then contact your vet for advice.

Bloat / Gastric Torsion (Gastric-Dilation Volvulus)

Deep-chested breeds of dogs are prone to developing GDV. The stomach becomes bloated with gas and can rotate on its axis (torsion), causing the oesophagus to be closed off and preventing the dog from vomiting or belching to relieve discomfort. Often the spleen becomes entrapped as well, and its blood supply is cut off. It is a medical emergency and death can rapidly occur, so veterinary attention should be sought immediately. Symptoms include a distended abdomen (tight like a drum), agitation, wretching without being able to vomit, and dribbling. Successful treatment involves surgery to un-twist the stomach and it is often stitched in place to prevent torsion recurring. Shock is a real danger and this, and damage to internal organs often causes death.

Limiting risk factors is important. It is sensible not to feed one large meal per day, split it into two smaller portions. It is wise not to exercise your Boxer directly after feeding (some advise 1-2 hours rest). However, bloat often occurs in late afternoon / evening and not always after exercise, so be watchful for symptoms. Some advise using a raised feeding bowl, but a recent study at the University of Perdue by Dr. Larry Glickman has found that this significantly increased the incidence of bloat. Likewise, previous advice to soak dry food in warm water for 10-15 minutes was also found to increase likelihood (possibly by starting off fermentation of the food prior to ingestion). It is worth bearing this information in mind when deciding how to feed your Boxer.

Corneal Ulcers:

These can occur when the surface of the eye becomes scratched. Due to the physiology of Boxers’ eyes, the cornea often doesn’t heal as rapidly as other breeds. If your Boxer has scratched their cornea, they will probably be in obvious discomfort, finding it hard to open the eye fully and trying to rub it. You may notice an opaque area or eroded area and your Boxer’s eye will look red and sore. This can rapidly get worse if treatment isn’t sought quickly. There are different approaches which can be taken. The more conservative approach can involve topical vitamin E, antibiotic / atropine drops and an E-collar to prevent the dog traumatising the affected eye even more. Often, more aggressive treatment is needed ranging from surgical debridement of the area, sowing over of the third eye-lid to protect the area while it heals, or creating a conjuntival flap which is sewn over the ulcer to provide a blood supply to the area and promotes healing.

Skeletal Scurvy Osteodystrophy)

This is a disease which can affect puppies as they are growing rapidly (usual range between 2 – 8 months of age). It is an extremely painful condition which affects the growth plates at the ends of the bones in the limbs, causing symptoms of pain, limping and swelling of the growth plates. Vitamin C deficiency was thought to be a important factor, however this has been called into question by more recent studies which show that the disease is much more compex than this. It has been shown that puppies which are over-supplemented, in particular with Vitamin D, minerals and calories, are much more prone to HOD, so it is sensible to avoid giving too many vitamins and minerals, or over-feeding. Good brands of complete food are already balanced, especially if they are formulated for puppies and, or breed type. More detailed information can be found in the study by T. M. Lenehan and A. W. Fetter (Textbook of Small Animal Orthopaedics 1985) http://cal.vet.upenn.edu/projects/saortho/chapter_50/50mast.htm#f
and, as always, talk to your vet if you have concerns.

Hypothyroidism

Boxers can be prone to having an underactive thyroid, particularly as they move from middle-age to latter years. Hypothyroidism can affect almost every organ system in the body, so a range of symptoms may be apparent. These often include lethargy, weight gain, dry scaly skin, hairloss with hyperpigmentation (darkening of the skin), depression, cold intolerance, general discomfort and behaviour changes. These symptoms can come on gradually so be watchful, and ask your vet to run a blood-test to check for an underactive thyroid if you suspect your dog might be suffering for this reason. Dogs respond well to thyroid supplementation in the form of daily tablets, and the effect is often a quite dramatic recovery.

GENERAL BOXER HEALTH AND WELLBEING

Diet and feeding:

It probably goes without saying that your Boxer should have a good quality, balanced diet. Different breeders advocate different diets, ranging from dry complete foods to BARF feeding (Biologically Appropriate Raw Food). Boxers are prone to having sensitive stomachs, so it’s likely that foods full of wheat and fillers won’t suit your Boxer’s digestive system. If your dog is intolerant of its food, it is more likely to develop colitis. This is inflammation of the colon resulting in diarrhoea, and mucus in the stools possibly with blood as well. Boxers are an athletic breed and often do best on foods rich in highly digestible proteins which are relatively calorific. It is worth bearing in mind that the more expensive complete foods often work out more economical as your Boxer will need a smaller amount per day than cheaper brands that contain more bulky, lower-quality ingredients. All dogs should have access to clean water.

Whatever you feed your Boxer it is important to maintain a healthy body weight. You should see a visible waist between the ribcage and the hips when you view your dog from above, a tuck-up from the side, and be able to feel the ribs under the skin easily.

Exercise and Grooming:

In order to keep your dog in perfect condition he will need a good amount of daily exercise. The best form is a good run in the park to expend the energy that Boxers are renowned for, but also lead walks are beneficial. Puppies and junior Boxers should not be over-exercised as they are rapidly growing and too much exercise can damage their bone growth-plates. General advice is to limit exercise to approximately 5 minutes per day per month of age, although this can be hard to stick to with a young Boxer who has bundles of energy. Boxers will keep going so it is your responsibility not to overdo it. Be sensible, let them run on soft ground and avoid too much pavement pounding. Remember the adage ‘A tired Boxer is a happy Boxer’.

Boxers are fairly low-maintenance breed where grooming is concerned. A quick brush with a rubber glove will remove dead hairs. It is important to regularly check and clean ears to avoid wax-build up and this will prevent yeast infections. Toe nails will also need to be kept short, this can be done with clippers or alternatively a hand-held grinding tool (e.g. a Dremel) can be easier and less likely to damage the quick and cause bleeding. Dogs can often get stressed out by nail trimming, so introduce with plenty of positive praise and rewards when from a very young age.

Dental care is important. It is a good idea to get your Boxer used to having his teeth brushed with a toothpaste designed specifically for dogs. You should also check their mouth for ulcers and bad breath can be a sign of an underlying problem that needs to be checked out. Chews and sterilized bones help to keep teeth and gums healthy and reduce tartar build-up. As your dog gets older it may be necessary for them to have their teeth scaled by your vet. Gingival hyperplasia is a condition common in older Boxers, where the gums grow over the teeth. It is important to keep the gum margins clean, to remove hairs that may become trapped under them. Severe cases may need veterinary treatment.

Ear care should also be routine. Regularly check inside your dog’s ears and clean if dirtly. Dry cotton wool is good for this. If there is excessive wax build up with redness and / or a smell, then there may be an infection (otitis) with the possibility of ear mites. Usually, if these are present, your Boxer may head shake and scratch its ears. See your vet for some medicated drops. Ear problems can become chronic and recurrent if not treated quickly.

Parasites:

It is very important to follow a comprehensive worming regime for your dog, in order to keep it, and the people who come into contact with it, healthy. Tablets can be given to control tapeworm and roundworms. There are also topical ‘spot-on’ preparations that control most worms, but not tapeworms as yet.

Lungworm

This has recently become a serious problem, particularly in certain areas of the UK. The Lungworm Angiostrongylus vasorum, is passed onto dogs by slugs and snails which carry the third-stage larvae of the parasite. The larvae migrate to the dog’s lungs where they cause damage to the tissues. Symptoms can be coughing, fatigue, bleeding from gums, but there have been many sudden deaths of dogs where no symptoms were previously noticed.

A spot-on control is available (Advocate, which is licenced to treat fleas and a range of other parasites). Visit www.lungworm.co.uk and discuss prevention with your vet.

Fleas and Ticks

These are small external parasites that feed on the blood of dogs. Fleas can be seen crawling in your dog’s fur, and will also leave ‘flea dirt’ (particles of dried-up blood) which can be combed out and easily identified on a moist paper towel. Ticks burrow their mouthparts into a dog’s skin and remain attached while they feed on its blood. As they do so, they fill up and increase in size. Ticks should be removed as soon as they are seen as they can pass disease to your dog. Use tweezers and grip the exposed part nearest your dog’s skin, then pull steadily without twisting until it comes out. There are several flea treatments, and flea and tick preventatives on the market, so discuss these with your vet.

Copyright Janet Longley 2010

References:

UK BOXER CARDIOMYOPATHY IN PERSPECTIVE by Bruce M Cattanach BSc PhD DSc FRS Published in Boxer Showcase, Dog World, July 2008

Glickman, L., Glickman, N., et al.: Analysis of risk factors for gastric dilatation and dilatation volvulus in dogs. J. Amer. Vet. Med. Assoc. 204:1465-1471, 1994.

T. M. Lenehan and A. W. Fetter (Textbook of Small Animal Orthopaedics 1985) – http://cal.vet.upenn.edu/projects/saortho/chapter_50/50mast.htm#f