Category Archives: preventive care

Shortage vs Planning

Back in 2011, the company that manufactures the drug we use to treat a heartworm infection in dogs stopped making the product.  The factory was old and couldn’t meet quality standards, so the FDA stepped in and recommended shutdown.  I found out from an interesting article that the factory is owned by a different pharmaceutical company than the one that owns the rights to the drug.

The resulting shortage led to a situation where veterinarians have to call the company that markets the drug (Merial) if we diagnose a dog with heartworm disease.  They determine if that patient is eligible for treatment with the medication.  A very small supply of the drug is being imported from Europe with FDA consent.  Yes, you read that properly.  Our federal regulatory agency is allowing a small amount of the drug to be imported by the company for sale here in the US so that we can treat the dogs that come up positive for heartworm.

A few reasonably obvious questions come up when we consider this situation.
Why are so many companies failing to produce the medications we need?
Why are many of these drugs produced in only ONE facility in the whole country?
Why is the FDA apparently cracking down on these factories?
Why can’t we import more of the drug?
What alternatives do we have?

Truth be told, I’m not certain of the FDA’s grounds for cracking down on these companies.  I’d think it was with the intent of keeping the safety and efficacy of our drugs intact.  That’s a good thing.  It’s also scary.  How long has substandard production been going on?  I can only suppose the reasons for one facility being the sole production site.

This whole situation is a real bear.  We’ve struggled at Pet Authority to keep stock of some of our most important drugs so we can treat our patients.  I can think of four drugs in addition to the heartworm treatment medication that have simply been unavailable at some point in the last 2 years.  It’s maddening.  There’s nothing we can do about it.

Well, that may not be entirely true.  There’s one drug shortage that wouldn’t affect our clients and patients much at all.  How much need would there be for the medication used to treat a full heartworm infection if pets were protected by monthly prevention?  Almost none.

Year-round prevention is the best way to keep your pet from ever needing to be treated for heartworm disease.  There are enough products out there with nearly 100% efficacy that even if one or more becomes unavailable, there are alternatives that will get you through.

Stated more simply:  heartworm disease is preventable.

I’ve lectured and guilt-tripped and begged and advised, but still, owners simply choose to stop giving prevention.  I see at least one dog every day that I practice that has not been given prevention monthly.  Often, missed doses are during the height of the summertime mosquitos; the highest risk.  I just don’t get it.

The mystery of drug shortages is an opportunity to look at how our behavior influences the lives of our pets.  The choices we make are a much more direct way to influence wellness.

Prevention over cure.

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Fecal Samples – The Necessary Grossness

I’m going to be making a light post on Sunday because of the holiday, so instead of a news post today, I’ll be tackling a bigger topic.

Fecal floatations are the focus of today’s post. We always ask owners to bring a stool sample with them when their pet visits the hospital. This is an opportunity for us to check for intestinal worms and other parasites. “Worms” are a well-known concept to most owners. What’s lacking is the information about how we find the little buggers. You’ll be getting an up-close and personal look today.

I want to give some kudos where they’re due. Our veterinary technicians are the people that usually set up, run, and interpret our fecal samples. They handle poop all day long without complaint. It’s a nasty part of making sure our pets are healthy (and by extension their families, too). Thank you, Technicians!

We’re looking for evidence of worms and other parasites. Most of these nasty critters are attached to the intestinal wall in some fashion, so we don’t usually them in the pet’s stool. However, they shed eggs into the stool, and those eggs are what we’re searching for. In order to find them, we have to separate them from the fecal material. This whole process is designed to concentrate the eggs in one spot that we can sample. This gives us the best chance of finding them, and by extension, diagnosing the pet with adult intestinal worms.

Each photo is described/explained -after- the photo.

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This is part of the equipment needed to run a fecal sample. The blue pegboard thing is a test tube rack. The clear plastic tube is a test tube with a cone-shaped bottom. We use disposable dixie cups to avoid cross-contamination. The tongue depressor is used to move the stool sample from one step to the next.

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Samples need to be fresh. If they’re dried out, old, or frozen, the eggs can be hatched or damaged beyond our ability to find them. We know it’s gross to have you bring in poop, so here’s the kudos to owners for taking care of the collection part of the process. However, on that note, please notice that we don’t need a lot of stool. That’s a 50-cent-piece size, which is more than enough. We’ve had owners bring in the entire ziploc bag of stool, which is far more than we need. Just one little bit of formed stool is fine. If for the sake of not vomiting, by all means, grab the pile and run with it. 😉

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In this step, the stool is in the dixie cup. We’re adding a special liquid (Zinc Sulfate solution) to the cup.

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In this step, the stool is being broken up and mixed thoroughly with the Zinc Sulfate solution. We have to break up the stool to free the eggs from the fecal material. The end result is dissolved poop. It’s gross, yes.

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We then use a small funnel with a coarse filter in it to strain out the big chunks. We pour the liquid into the test tube.

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The test tube has to be filled right to the top of the tube, plus a tiny bit extra. We want to get a slight bulge of fluid on the top of the tube. As you can see, the cloudy brown liquid is the dissolved stool sample.

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A very thin square of glass called a cover slip is placed atop the fecal tube. The surface tension of the liquid is used to make the cover slip stick to the tube.

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The tube is placed in our centrifuge. A balance tube is put exactly opposite the fecal sample and filled with liquid to approximate the weight. We have to have the centrifuge balanced or it will self-destruct. Think about it as the same problem an unbalanced washer gets. (Whump-whump-whump-whump)

I have to explain a little bit of chemistry/physics here, so bear with me. The centrifuge spins the samples at a very high speed. (Again, just like the spin cycles on a washer.) We do this to get all of the big chunks to go to the bottom of the tube by way of gravity. The zinc sulfate solution in the tube is more dense than water (higher specific gravity). The eggs are lighter than most of the stool particles, so they will float up to the very top of the sample when the sample is spun. They concentrate right up against the cover slip. This is the critical step to getting a good result.

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As you can see in this sample, a lot of the stool particles have collected at the bottom of the tube. There are still some suspended in the liquid in this sample, but that’s a bit atypical for us to see. Usually the fluid is nearly clear.

We lift the cover slip off the top of the tube. The liquid right at the surface of the tube is pulled along with the cover slip, sticking to the bottom of it. The eggs are carried align with this small fluid sample. We place the cover slip down on a glass microscope slide.

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Here you can see the microscope slide (rectangular glass) with the cover slip stuck to it (square bit with the white edges/corners). The microscope has several different lenses that provide different levels of magnification. When we “read a fecal” we observe every single bit of the cover slip, looking for eggs.

I’ll show you the eggs we find below:

Hookworm
Hookworm

Roundworm
Roundworm

Whipworm
Whipworm

So, that’s what’s involved with “running a stool sample.” It’s a lot more involved than it seems. It’s a very important part of the twice-yearly checkups we recommend for pets. Hookworms and Roundworms are parasites that can be transmitted to human family members and other pets, so you definitely want to be sure your pet is checked twice a year.

It’s also a reminder that heartworm prevention ALSO prevents intestinal parasites. Keep your pets and you family protected with monthly prevention!

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Filed under laboratory, parasites, photos, preventive care, technician, zoonotic

Guest Blog – Stray Cat Adoptions

Winter made its presence certain today when we woke up to some snow on the ground. Whenever the weather turns cold like this, I wonder what happens to all of the stray cats and dogs that have been outside since the summertime. I always hope that someone will be able to take them in so they don’t suffer from exposure to the weather or starvation. It’s a rough time of year.

We frequently see stray cats that are brought in for the winter. Most of the time, clients have the best intentions and I certainly applaud their generosity in opening their homes, hearts, and wallets for these ragtag pets. There are a few dangers that I wish clients knew about ahead of time, especially if there are already cats in the house.

This week’s post was written by Diane, one of our LVTs. She will touch on a few of the concerns we have when taking in a new cat.

—–

A gentleman was in the hospital with his dog recently, and mentioned that he got a cat. I said, “Oh, where did you get him?” He responded that the cat wandered to his house, and the man decided to keep him. The gentleman commented, “We figured he’s been around a while outside and is still alive, so he must be healthy because he hasn’t died from anything yet, right?” I shuddered and my mind raced with all of the possible diseases and problems I needed to warn him about. I gathered some informational brochures and started the conversation.

I started with zoonotic diseases, which are diseases that can be transmitted from animals to humans. Rabies is by far the most important and deadly disease, but not the most common, and is transmitted by a bite from an infected animal. Intestinal parasites carried by animals must be addressed first. Roundworms, hookworms, and toxoplasmosis are all parasitic diseases that are spread to humans by contact with cat feces in soil or cat littler. Cat Scratch Fever is a flea-borne infection typically transmitted by a cat’s scratch or bite. A stool sample to check for intestinal parasites is the best way to find out what a cat may be carrying inside.

The next topic of conversation was about two viral diseases that the new cat could be carrying without any signs. Feline Immunodeficiency Virus (FIV) and Feline Leukemia (FeLV) are diseases in cats found in every region of the country. Each is highly contagious fro cat to cat. They can be fatal infections. Both have few outward signs initially, and no “sure” signs. [Dr.H adds: when a sign of disease is 100% certain to be from that disease, we call it a pathognomonic sign. FIV and FeLV don’t have pathognomonic signs.]

These viral diseases are associated with illness and death of more cats than any other disease. The viruses work by weakening a cat’s immune system. Without testing, there is no way to know whether the cat is infected. Without a diagnosis, the cat cannot be treated properly. In some cats, signs don’t appear for weeks, months, or even years after they are infected. Testing is important so we know whether a cat is carrying these diseases.

Infected cats can show vomiting, diarrhea, weight loss, weakness, fever, pale gums, dull or matted hair coat, swollen lymph nodes, mouth sores, or behavior changes. If the cat has been living outside for months or years, a new owner might not be aware of these sometimes subtle changes.

[Dr.H adds: Upper respiratory diseases, fleas/ticks, and ear mites are also very common problems seen in stray or orphan cats. While these problems aren’t generally life-threatening, they can be a serious headache for a new owner. These problems are highly contagious and rapidly spread to other cats in the household. Fleas and ticks are also a risk to humans. Vaccination and treating external parasites are a critical part of a “new stray cat” vet visit.]

If a person wants to bring in a stray, it’s imperative that the cat is examined and tested before coming into contact with people or other pets. Testing, vaccinating, and deworming should be performed, and a quarantine period may be appropriate, too.

I thanked the client for his willingness to give a stray cat a permanent home, but also tried to show him the risks a cat with an unknown history can bring. A full health check with the veterinarian is the first step to providing a loving, caring home.

——

Diane’s focus on the viral diseases is very appropriate. I counsel all owners of newly acquired cats to allow us to perform the simple blood test that can detect FIV and FeLV. Results are available within 10 minutes right in the hospital, and the test is quite sensitive. There are some nitpicky concerns with the age of testing for FIV, but FeLV can be tested for at *any* age.

I feel that knowing the viral status of new cats is the most important first step. These diseases will shorten a cat’s life considerably. While some owners are able to take in a cat that is positive for one/both of these infections, some owners don’t want to put their other cats at risk. In a rescue situation, the resources that will be spent on a cat with a generally fatal viral infection could be used to rescue several other healthy cats. It’s a very sticky situation wrapped up in ethics and harsh realities. Ultimately, as each owner or rescue group makes a decision about how to handle these cats, one thing is clear: it’s better to know what you’re dealing with. Testing is step one!

Please ask questions. We’ve brushed the surface of adopting a new cat, so I know there must be some things that you’d like us to go over in more detail. Thanks for reading!

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Filed under ethics, fleas, guest, infectious diseases, parasites, preventive care, vaccines, zoonotic

Holiday Hazards

The holidays are coming on quickly. This time of year always presents some unique challenges for pets and owners. I’m hoping that a little forewarning will help you avoid some of the hazardous things that pets will encounter during the holiday season.

Foods

Changes in a pet’s diet — even just a small bite of something — can set off a cascade of nasty illness. While some dogs and cats seem to have an ironclad digestive system, most do not. They can’t tolerate foods outside their normal diet. New treats, canned foods they’re not used to, new foods, and “people food” can cause digestive distress. This distress usually means vomiting and/or diarrhea. However, inflammation of the pancreas can result (pancreatitis), and that can mean a hospital stay or even death. Please think twice about food gifts for pets. Advise guests that handouts aren’t acceptable (unless they’re from the pet’s usual treat jar). Even ONE bite of food can be enough to seriously harm a pet. Just don’t do it!! (PLEASE don’t give alcohol to your pets, either.)

Don’t forget about overtly toxic foods: onions, grapes, raisins, chocolate, bread dough, and the artificial sweetener xylitol.

748px Pumpkin Pie Slice

Toys

I think it’s great to provide enjoyable things for pets…as long as they’re pet-friendly. Remember the cautions we discussed with chew toys a while back. Watch out for objects that could cause pets to choke or have an intestinal obstruction. Kids’ toys can present an attractive chewing experience for a dog, so warn your children to pick up their new things.

Antifreeze

I’m listing this separately because it’s so incredibly dangerous to pets. The fluid is very attractive to cats and dogs for some reason. They’ll readily lap it up. Even relatively small amounts can be enough to create toxic damage to the kidneys. By the time a pet’s kidneys are failing from ingestion of antifreeze, our treatment options are limited, and the prognosis is guarded. Some pets can recover, many will have permanent kidney damage, and some will die. There’s an antidote that can be given if the ingestion was recent enough, so if you see your pet lapping up antifreeze, GO TO THE HOSPITAL IMMEDIATELY.

Decorations

Pets might not understand that certain holiday decorations aren’t for chewing. Young pets experiencing their first holiday season aren’t likely to realize that these new things are off limits, since they weren’t part of early training experiences. The usual suspects include: tinsel, lights, tree decorations, ribbons, bows, potpourri, and Christmas tree water with fertilizer. Cats seem to be especially fond of ribbon, which can cause a very very serious type of intestinal obstruction.

800px Tinsel 3

Weather

This may seem like a no-brainer, but I’d rather talk about the obvious than fail to provide the warning. Dogs and cats can suffer from hypothermia and frostbite. Thin or light-coated dogs will have more trouble keeping warm outside when the weather’s frigid. Sweaters or jackets will help if a pet is going to be outside for a while. The basic way to judge is to watch for shivering. Dogs shiver from the cold for the same reasons we do. Just be sensible about the amount of time your pets spend outside. Frostbite doesn’t seem to be that big a concern for dogs, but it is for cats, namely on their ears. If you have outdoor cats, provide a shelter and a heat source for them. The same goes for dogs.

Keep your pets off the ice on lakes, ponds, or other bodies of water. We’ve treated a few cases of near-drowning and hypothermia from dogs that wandered out of the yard and onto the ice, then fell through.

Be aware that outdoor cats will often crawl up into a car’s engine bay or wheel well to get heat from the engine. Check your vehicle before you drive away!

Some ice-melt products can be harmful if a pet’s feet come into contact with them. Don’t allow pets to eat the melt products, either.

655px Kö Hund mit Nerz Januar 2012

I know it must seem like I’ve taken all of the fun out of the holidays. (I promise it’s still more fun than having to come see me at the hospital!) Safely enjoying the time together isn’t hard. The warmth and companionship you provide is the best gift of all. Stick to the safest ways for your pets to have a good time: petting, playing, walks, and grooming.

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Cold Weather Doesn’t Mean Bugs Are Dead!

The incredibly warm winter we had last year, coupled with the high heat this summer, has created a bumper crop of bugs for Fall 2012. We’re finally getting some relief from the heat, but that’s not exactly the best news for pets and parasites.

It’s tempting now that the weather is cooler, especially at night, to assume that the risk for fleas, ticks, mosquitos, and other parasites is over with. This is absolutely not the case! It’s still vitally important that pets continue their parasite prevention products. Here’s why:

Fleas start looking for warm bodies when the weather gets colder. They don’t survive in cold temperatures if they’re exposed, but they can easily overwinter on animals. They can also survive in cool temperatures in the house for long periods of time. Once we’ve had a couple of good, hard frosts, it’s safe to assume that the flea population outside has -decreased-, but it’s not safe to say it’s eliminated. Contact with pets, wild animals, or infested houses/buildings can allow fleas to get a foothold on your pet and house in the wintertime. We advise staying on topical flea/tick prevention year-round exactly for that reason. Frontline Plus and K9 Advantix II provide great protection against fleas and ticks.

Mosquitos can also be found indoors as the weather cools off. I’ve killed two in my own house in the last few days. Mosquitos put dogs and cats at risk of getting heartworm disease. Heartworm disease can be fatal in both dogs and cats. Cats are especially hurt as we don’t have an effective way to treat heartworm if a cat contracts the disease. The risk of transmitting West Nile Virus is also a human health risk. Be sure to have your screens in good repair and be watchful for mosquitos in the house. Heartgard Plus, Triheart Plus, and Advantage Multi all protect pets from heartworm disease.

Some intestinal worms can survive in colder temperatures, though most are killed by freezing. The eggs, however, can survive winter conditions outside. When the weather isn’t cold enough to have the ground frozen, dogs are at a much higher risk of exposure by getting mud on their feet. They may lick their feet, which inadvertently allows them to ingest the eggs found in soil. There’s always the risk of contracting parasites from another animal’s feces, too. Yes, that’s a disgusting thought, but dogs eat a lot of disgusting things. Keeping your pet on monthly heartworm prevention also provides protection against various internal parasites. Heartgard Plus and Triheart Plus both protect dogs from hookworm and roundworm infections. Topical Advantage Multi protects dogs from hooks, rounds, and whipworms.

Colder weather isn’t a good justification for slacking off on parasite prevention. Pets and people are still at risk of infections and infestations by parasites and the diseases they can carry. It’s far better to stay on the prevention than to try to fix a problem after it shows up.

Snow dog

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Chronic Kidney Disease – A Case for Early Detection

Chronic kidney disease is a common diagnosis in veterinary medicine. It’s a disease for which we have no cure, only the ability to slow it down and manage the other symptoms. Ultimately, it’s fatal. The really nasty part is that we have a hard time finding it before a vast amount of irreversible damage is already done. I’ll give a little background into what’s happening with kidney disease, then talk about what we can do to treat it.

The kidney is a remarkable organ. It filters waste products out of our blood so that they can be excreted in the urine. They manage the balance of water and electrolytes (salts) in our bodies. They also make a hormone that tells the bone marrow to produce red blood cells. (Red blood cells carry oxygen throughout our bodies.) The kidneys you’re born with are the kidneys you have for the rest of your life. They don’t regrow, and “healing” is a limited ability for this important organ.

On a microscopic level, the kidney is quite complex. The illustration below shows the arrangement of blood flow and filtering in the functional unit of the kidney: the nephron (neff-ron). Tiny little arteries carry blood into a tangled ball of blood vessels called the glomerulus. Around that ball is a cup-like structure called Bowman’s Capsule. The vessels in the glomerulus are designed so that waste products and water are leaked out. Some other things the body prefers to keep are also filtered out. These wastes and other things are then collected by the Bowman’s Capsule. Bowman’s Capsule is connected to a big U-shaped tube (cut off in this illustration) that gives the kidney a chance to recollect the good things that were leaked out of the glomerulus. Those things are reabsorbed or transported back into the blood. Some new things are excreted, while others are traded out and sent into this U-shaped tube. Eventually, the U-shaped tube hooks up with a bigger tube that travels to the middle of the kidney. In the middle of the kidney, all of this waste material and whatever water the body is getting rid of is collected, then piped down to the bladder. Of course, this waste fluid is urine.
500px Physiology of Nephron svg

In chronic kidney disease, a variety of different things can go wrong, but in the end, it’s the nephrons that are destroyed. As nephrons are destroyed, the kidney begins to lose its ability to do the work it needs to do. This can be a very slow process, taking years in some cases. As with most things in the body, there’s some redundancy in the kidney to allow for a certain amount of damage without the body suffering for it. The kidneys can do their job well enough even with some loss of nephrons. Eventually, there’s a threshold after which the kidneys can’t keep up and things start to go very wrong. We can’t easily detect a problem until things start to go wrong, which is why this is such a nasty diagnosis to make.

Perfect kidneys are at 100% function. As we talk about percent damage, keep in mind that we’re referring to the grand total sum of both kidneys. It’s possible that one kidney can be damaged more than the other, or undamaged, but we aren’t distinguishing for the purposes of this post. The end result of damage to the kidneys is that the nephrons are destroyed, leaving scar tissue where functioning kidney used to be.

Chronic renal disease en

When 2/3 of the kidneys’ functional capacity is gone, leaving only 33% working, the kidneys lose their ability to manage water balance in the body. Water is allowed to leave the bloodstream at a rate that will dehydrate the animal. This is the earliest sign of chronic kidney disease. It can be subtle. The urine will seem more dilute. Pets will begin to drink more water and pass more urine. In truth, the urine production goes up because of the inappropriate loss of water, so pets drink more to remain well-hydrated. We can detect this low urine concentration when we run a urinalysis. Sometimes, we can detect protein loss in the urine, too, which is a sign of trouble. A pet may begin losing weight.

When 3/4 of the kidneys’ functional capacity is gone, leaving only 255 working, the kidneys can no longer keep up with the removal of waste products from the blood. Byproducts of metabolism begin to build up in the bloodstream. We can detect these rising values on bloodwork, namely the serum chemistry. As these waste products rise, we begin to see effects in the animal. Appetite drops because of nausea and irritation of the stomach lining, followed by vomiting. Dehydration and weight loss occur, as well as significant loss of muscle mass. At very high levels, these wastes can directly impair brain function, too. Other effects of advancing kidney disease can include high blood pressure and anemia. Sadly, many of the pets we diagnose arrive with lots of these clinical signs.

There are lots of treatments available for renal disease, but remember that none of them are a cure. Chronic kidney disease is managed, not fixed. We lower the protein intake of a pet’s diet to decrease the waste-filtering workload of the kidney. We also keep the phosphorus low in the foods we feed to help prevent some other complex but highly damaging changes in calcium and phosphorus levels in the blood and bone. There’s an oral medicine to help with that problem as well. We can give injections of the hormone that makes red blood cells be produced. We can give fluids under the skin to help flush the wastes out through what’s left of the kidney. Some animals respond very well to these treatments. Cats tend to do better for longer periods of time than dogs. Each patient is different in terms of response to treatment and the rate the disease progresses. Some patients survive only a few months. Others can go years before we lose the fight. We manage the patient, not the numbers on the lab work, with the goal being good quality of life. The sooner we start treatment, the better most animals do!

Running lab work is the ONLY way we have to watch for the emergence of chronic kidney disease. The clinical signs that owners see are present early on, too, but they start out subtly. Most of us don’t notice a gradual change like this until it’s further along. Annual urinalysis helps us detect the changes that signal early kidney disease. Bloodwork may also show subtle signs earlier in the process, so that’s also a valuable tool.

The take home message here is this: RUN ANNUAL LABWORK ON YOUR PETS! It’s the best way we have to watch for early signs so we can begin treatment early.

Please ask questions. This is a complex disease that I could talk about for pages and pages, so I simplified the basic discussion for today. I’m happy to expand on any aspect if there’s interest!

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Lifestyle Evaluation

Flying Dog

We’ve talked pretty extensively about vaccinations and other preventive healthcare recommendations. For both dogs and cats, the list of things available to help care for them on a daily basis is huge. Not every pet needs everything we have to offer, however, so many of these recommendations are based on an evaluation of a pet’s lifestyle. We try to determine exactly what risks each pet faces based on how they live their lives with their owners. From there, we’re able to select the essential parts of that pet’s care plan. This way, we’re addressing the actual risks for that pet without giving things that aren’t needed. Medications and vaccines are two very specific things that we don’t want to overdo. I’d like to take some time today to talk about the risk factors that we evaluate for each pet.

Indoor or Outdoor Living

Almost all dogs go outside. The cats we see are generally indoor-only, though we do see indoor-outdoor or outdoor-only cats once in a while. The outdoors is a high-risk place for many reasons. Parasites (hookworm, roundworm, fleas, ticks, toxins, heartworm), physical dangers (cars, sharp objects, bodies of water, predators, wild animals), and environmental risks (heat, cold) are all found outside the house. Infectious diseases like distemper, parvo, rabies, leukemia, feline respiratory disease, and FIV are all out there lurking in the environment. Depending on a pet’s time spent outside, we will determine which vaccines and parasite prevention products are needed. Sometimes, outdoor living indicates a need for additional blood testing. This is primarily for cats as we test for Feline Leukemia and FIV.

As a reminder: ALL pets, dogs and cats, indoor or outdoor, are at risk for heartworm disease and should be on monthly prevention.

Social Activity

Pets that have social contact with other pets are at risk for sharing infectious diseases and parasites. There is also the risk of fights. Wild animals are another risk for pets that are out and about, especially at night. Going to the groomer, boarding, obedience or recreational classes, dog parks, or nose to nose contact at a fence or window screen are all ‘social’ activities that bring along the risk of disease transmission. Additional vaccines such as Bordetella and Feline Leukemia are indicated for pets that have social activity.

Travel

Owners that take pets along with them on vacations have a unique set of challenges to overcome. Pets may get carsick. Traveling to other countries requires very, very specific procedures for having the Rabies vaccine up to date. Certain areas of the country put pets at risk for contacting diseases or dangers not found here in Michigan. Rattlesnakes, poisonous toads, plants, tick-carried diseases, toxic plants, and exposure to extremes of heat/cold all come into play when pets travel. Even going “Up North” here in Michigan presents additional risks (ticks and wildlife, primarily). Pets traveling to the ocean can become very sick if they drink too much saltwater.

Diet

It’s important for us to know what a pet is eating. This means that owners need to be honest and fully disclose all of the things a pet is eating. Often, owners are embarrassed to tell us that a pet eats people food or gets a lot of treats. They don’t want to be “in trouble” with the vet. It’s far more important to speak up so that we can come to a plan together that will fit that pet’s life. Treats aren’t all bad, and not all people food is bad. We do have to be very careful about things like onions, garlic, grapes, and raisins. Cats have special dietary requirements, too. Both dogs and cats can benefit from an individualized nutritional plan, so it’s in their best interest to have open and honest owners!

Exercise

This is another topic with a heavy guilt attachment. Most of us should be more active for our own health. The same goes for our pets. We’ve got a little sign in our break room that says, “If your dog is too fat you’re not getting enough exercise!” As we learned with the recent news post on exercise regimens, it’s important to ease pets into more activity.

Other Illnesses & Age

Not every pet is in perfect health. Just as in people with chronic problems, pets that have diabetes, abnormal thyroid function, cancer, digestive problems, allergies, and so on all need to have those problems taken into account as we choose a preventive health care plan for them. Pets with cancer should be vaccinated less or not at all. Pets with diabetes have to have a very specific diet. Environmental allergies are aggravated by being outside more. Arthritis can be a bigger problem for pets that are active. Aging pets need to have more testing of their organ health.

As you can see, there are many factors that are evaluated to help us choose a preventive care plan. The questions may seem tedious and overly long for owners when they come in, but the truth is that without that information, we can’t offer our best possible care. The more we know, the better we can serve the unique needs of your pet.

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Quality of Life

Last week, I talked about pain in our veterinary patients. I’m going to expand on that topic today by discussing how we evaluate “Quality of Life.”

Whenever we see a patient for an appointment (for any reason, well or sick), we perform a physical examination. We also ask for an extensive history about food intake, weight gain/loss, activity level, general attitude, and any concerns the owner may have. An assessment of a pet’s level of pain is also included in the examination and history.

Once we have all of our information organized, we have a good idea about whether a pet is healthy and doing well, or not. For the pets that are doing well, there’s not much that we need to do beyond routine preventive care with vaccination, parasite prevention, bloodwork and stool checks. However, many of our patients will have a problem that needs to be addressed. We spend time talking with the owner about what’s wrong and what can be done about it. We put a plan into action to help the pet, then re-evaluate at some point in the future to reassess the situation.

Some conditions can’t be cured, only managed. They become an ongoing part of our evaluations and plans. As patients age, we see problems begin to arise that are simply consequences of being older. Arthritis, loss of sight, lumps bumps and tumors, dental disease, mental decline… these are just a few of the chronic issues we deal with on a daily basis with our older pets.

It rapidly becomes very important to look at the big picture. We understand that older pets or certain illnesses are going to mean that a pet isn’t “100% healthy and problem-free.” Bearing that in mind, we ned a way to evaluate whether a patient is living a good life. We need to know if the treatment we’re providing is good enough that we aren’t being unfair to our pets by asking them to suffer. These are difficult subjective questions to talk over with owners. Each pet requires an assessment based on a smaller number of very specific guidelines which help us decide if a patient is doing well enough or needs more intervention.

One of the least specific questions we ask is, “Are there more good days or bad days?” This one’s tough for the veterinary team but great for owners. You know your pets better than anyone, so you’ll know if they’re having a bad day. You’ll recognize subtle changes in personality, activity level, enjoyment of toys/treats/activities, and sleeping patterns. Many older pets do have some days that are worse than others, and we have to be lenient about that. Things aren’t going to be perfect. That being said, a pet that’s having more bad days than good ones needs help to get back to more good days than bad.

Back in 1993, the United Kingdom’s Farm Animal Welfare Council developed a way to evaluate living conditions for farm animals. They’re quite easy to adapt to companion animals, too. They utilized a concept called “The Five Freedoms.”

1. Freedom from Hunger and Thirst
2. Freedom from Discomfort
3. Freedom from Pain, Injury, and Disease
4. Freedom from Fear and Distress
5. Freedom to Express Normal Behavior

These five criteria touch on the most basic parts of a life that we could consider ‘good.’ The most basic things — eating, for example — MUST be present for that animal’s life to be considered good. Without those, we’re doing any animal a disservice by continuing without changes to improve the animal’s status.

A veterinarian named Dr. Villalobos created a Quality of Life Scale that can be used to evaluate domestic pets. Each of the following criteria is evaluated on a 0-10 scale, with 0 being worst and 10 being best. It’s useful for both the veterinary team and the owner to fill this out for patients who need evaluation. We each have unique insights that, when combined, provide the most accurate assessment of quality.

HURT – Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet’s pain successfully managed? Is oxygen necessary?

HUNGER – Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?

HYDRATION – Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.

HYGIENE – The patient should be brushed and cleaned, particularly after elmination. Avoid pressure sores and keep all wounds clean.

HAPPINESS – Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet’s bed be close to the family activities and not be isolated?

MOBILITY – Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)

MORE GOOD DAYS THAN BAD – When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.

A score over 35 is considered an “acceptable” quality of life. Download a nice PDF of the assessment sheet here.

This is always a touchy area with owners. I believe the most owners know in their hearts when quality of life isn’t good enough. However, acknowledging that means that we have to accept the fact that a pet is in trouble and needs help, or will need to be put to sleep. If the condition that is causing life to be poor is easily addressed, the pet gains tremendous benefit and can have quality go way up. Sometimes, though, the harsh reality is that there will be a limit to what can be done. We have to be fair, we have to be selfless, and we have to be realistic. Letting go is insanely difficult, a fact that -any- pet owner understands. From my side of the table, I have seen clients make poor decisions about quality of life that they ultimately regret. I don’t say this to be judgmental or to preach. Seeing the truth is difficult at best, not to mention emotionally painful in many ways.

The Quality of Life assessments, when started -early- and used often, can help us identify small problems before we’re trying to push a boulder up a hill. All too often, I see pets that have had declining quality of life that the owner overlooked until it’s so bad that the pet is in horrible shape. In some cases, the owners elect to euthanize. In others, they ask, “What can we do to save him?” That second question is guaranteed to bring about an extremely difficult answer. Whether it’s the high financial cost to try to get a pet with lots of problems back on its feet, or a disease we simply can’t do anything about at that point, the pet is the one who has suffered its way to that point in time.

We can do so much better than that. Every single one of the quality criteria in that list can be worked on and improved. “Pawspice” care can be a wonderful way to ease pets through their golden years, but only if we have the courage and dedication to acknowledge that it’s needed.

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Obesity

CDC Overweight and Obesity map3

This map details the increasing proportion of our own human population classified as overweight or obese. It’s a frightening statistic, given the knowledge we have that being overweight causes many, many dangerous diseases. Diabetes, heart disease, high blood pressure, arthritis… it’s not a pretty list! Even so, our public perception of what an acceptable body looks like has shifted toward being overweight. It’s beyond the scope of this blog to discuss the human portion of this problem in-depth. Suffice to say that I think it’s important not only for our own lives, but for those of our pets.

What does normal body weight look like on a dog or cat? Have a look at the chart below. We score body condition in dogs and cats on either a 5 or 9 point scale. Pet Authority uses a 5-point scale similar to the chart. The “3” is ideal. There is an hourglass-shaped figure at the waistline (between hips and last rib), you can feel the ribs when you rub back and forth on the chest, and the belly curves up toward the pelvis. Compared to the overweight and obese pets, many people feel that normal body condition is too skinny. Not the case!!
Bodyscore img assist custom

Studies have been done that describe the prevalence of overweight pets at about 50%. I believe that here in Michigan, it’s closer to 70%. Very few of the pets I see, dogs or cats, are a normal, healthy body weight. It’s just as important for pets to be a normal body weight as it is for people. We’ve proven that diabetes, arthritis, heart and lung disease, and liver problems in cats can all be tied to an above-normal body weight. The bottom line is this: overweight pets do not live as long as pets with normal body weight. One study showed that overweight Labrador Retrievers lived about 1.8 years less than their normal-weight counterparts.

Let me state that more clearly: You are taking almost 2 years off your pet’s life by allowing obesity!

Why are pets overweight? Because we, as humans, think that food is love. (These are my personal opinions, here; please feel free to debate or chime in with your own reasoning!) The simple truth is that we, as human caretakers, are the biggest factor in our pets’ body condition. WE control the amount of food and exercise they get. WE control our perception of what ‘fat’ and ‘ideal’ is. Pet obesity is, for the vast majority, our fault. We feel that dogs need to have lots of treats, a ‘little extra’ food, or to be rewarded with food items for good behavior. I’m not opposed to giving treats or rewards. I am opposed to giving so many that the dog is overweight. Dogs don’t seem to mind so much if it’s just one treat or twenty — they enjoy the interaction with the owner. They will also likely be just as excited to get a low-calorie treat as one of the high-calorie ones. I think there’s a big cultural influence at work in the Midwest, too. When we get together with family, friends, or coworkers, the events often center around food. Our weather is such that it’s hard to get enough exercise in the winter. These things contribute to difficulty keeping dogs skinny. However, we still control the food bowl! It’s one thing if we’re fatter in the winter. It’s a whole other thing if we allow our pets to eat the same amount when they’re not getting as much exercise. (Are you seeing a theme here? We’re the ones at fault.)

Please don’t get the idea that I’m immune to these problems. My own cat, when she was younger and healthy, got to be overweight. I ignored it for about six months before doing anything. I ended up having to buy her a low-calorie food to get her weight back to normal. I did it, though, and she’s now over 15 years old and doing remarkably well. I know for a fact that if I’d let her continue to get fatter and fatter, she wouldn’t be here today. This is something that *can* be fixed, that *is* a solvable problem.

I’ve stood on my soapbox plenty long, here. I’d like to finish out the post today by listing a few little tips on how you can reduce weight in your pets. They’re not meant to be condescending. Sometimes, the simple truth is quite hard for us to see until it’s pointed out.

A special note on cats: PLEASE come talk to us at an appointment or at least call to discuss weight reduction in cats. If it’s not done very very carefully, cats can become deathly ill with fatty liver disease. You need a careful plan for cat weight reduction!!!

•Increase exercise. Dogs and cats both need to have exercise daily. Running around on their own in the backyard isn’t usually enough. Walk dogs and get cats to play for 10-15 minutes a day, at least. Check out The Indoor Pet Initiative for great cat tips.

•Decrease treats. You don’t have to eliminate treats completely. Just realize that milk bones, pig ears, rawhides, jerky treats, etc. are all adding calories to the daily diet. Break treats up or buy really tiny ones. Use green beans or carrots (cut into tiny pieces!) for treats.

•See if your chosen food brand includes a “Low Calorie” or “Weight Loss” formula to help you reduce calories. If not, we have some prescription weight loss foods available to help. For dogs, you can reduce the daily feeding amount by 5-7% every month until the body condition is ideal.

•Use non-food toys to encourage chewing and other play activities.

Good luck! Don’t let your pet become a statistic!!

AVMA collection of pet obesity research papers.

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Of Mange and Mites

I’m going to sneak in a “by request” post this week. I didn’t have an opportunity to photograph a spay procedure on Wednesday, but as soon as I can get an image set together, I’ll post that. The topic today will be “mites.” While there are a ton of different mites, I’m going to show you the three we deal with most commonly. The first two are seen primarily in dogs, and the third in cats.

Demodex (Red Mange)

Demodex mites (Demodex canis) are allays found in the skin of dogs in small numbers. They live in the hair follicles and oil glands. Humans have a couple of varieties of mites, too, that live in eyelash/eyebrow follicles. People and dogs don’t trade Demodex back and forth. Dogs generally don’t infect one another with mites, either. The body usually keeps the population under control so that there aren’t any problems. In some patients, the immune system can’t keep the mite population under control. When mites overpopulate, they damage the hair follicle. Hairs fall out, causing bald patches (usually a circular spot). These patches really aren’t itchy at first. However, the follicles are damaged and inflamed, so secondary infection sets in. This bacterial infection causes a lot of itching, swelling, scabbing, and oozing. Dogs can have these small spots spread all over the body, too. That’s called Generalized Demodicosis. Here are some pictures of the mites and the skin of an affected dog. Notice the cigar-shaped body of the mite.

Demodex Milbe adult

Demodexdog

We diagnose Demodex taking a scraping of the skin to examine under the microscope. We apply a little mineral oil to the skin, squeeze the skin to push the mites out of the follicles, then scrape the skin with a special little spatula. We have to scrape deep enough to get some bleeding: it ensures that we’ve obtained material from inside the follicles where the mites hide. We examine that under a microscope to look for mites or mite eggs.

Demodex is treatable. The spots of hair loss can be treated with an ointment called Goodwinol. It contains a naturally substance called rotenone that kills Demodex mites. (Interestingly, rotenone is used by indigenous tribes to kill fish for food.) Dogs that have the generalized form have to have special baths/dips with a drug called amitraz. Amitraz does have some side effects: drowsiness, drooling, and loss of appetite. Most are very temporary. If they’re severe, they can be treated with an antidote. Treating generalized Demodex can take months. Some patients need to have dips forever to keep the infestation controlled. Alternative treatments include use of ivermectin or milbemycin (the ingredients in heart worm prevention) on a daily basis for 3-8 months.

Cats have their own type of Demodex. We treat much the same as in dogs. I think I’ve only seen one or two cases of this in the last 7 years at Pet Authority.

Sarcoptes (Sarcoptic Mange)

Sarcoptes scabei is a very different problem than Demodex. These mites are highly contagious, so affected animals can give mites to animals contact. Boarding facilities, kennels, groomers, and the vet’s office are common places for exposure. Two to six weeks pass before dogs show signs of infestation. The mites burrow through the skin, leaving behind substances and eggs that cause dogs to have an allergic reaction. Affected dogs are insanely itchy. They literally can’t do anything but itch and scratch and chew. Their hair falls out, the skin gets crusty, may have a rash, and both dogs and owners are miserable. The most common sites for lesions are the ears, elbows, and hocks (ankles).

Here are pictures of the mites and the skin damage they cause. That’s a red fox, which normally has a fluffy tail and bright orange hair coat. The poor guy is a mess! Dogs look this way or worse when they have scabies.

Sarcoptes scabei
Sarcoptesmmite
Sarcoptesfox

We diagnose Sarcoptes by attempting a skin scrape. Scrapes are not done as deeply as when we’re looking for Demodex. Scrapes find Sarcoptes only 50% of the time. This is one of the very diseases we diagnose and treat based on the examination and history.

This is a zoonotic disease! You can catch sarcoptic mange from your dog. The rash is usually in a limited area, and as long as the dog is treated, the human infestation will go away without treatment. Sometimes people do require treatment by a dermatologist.

Treament is very easy. There are topical medications (Revolution/Selamectin), injections (ivermectin), dips (amitraz and lyme sulfur), and oral medications (milbemycin). Most patients are cured within a few weeks. We also treat patients with antihistamines and steroids to reduce the itching.

Otodectes (Ear Mites)

This mite affects cats more than dogs. Ear mites are officially named Otodectes cynotis. They live in the ears and cause intense itching. They also leave behind a very crusty, sticky black material that is distinct from other types of discharge we see in ears. These mites are highly contagious among cats and from dogs to cats or vice-versa. If a household has more than one pet, all of them need to be treated. Fleas can also carry mites and eggs from pet to pet and into the environment.

The mites are visible with an otoscope when we examine the ears. We take a q-tip sample from the ear and inspect the debris under the microscope. It’s easy to see these mites. They’re similar to the Sarcoptes mites in appearance. Thankfully, these are easy to diagnose. Here’s a picture of the mites and the ear discharge.

Otodectes

Otodectesear

Otodectes are easy to treat. Topical medications (moxidectin, selamectin, ivermectin) are all very efficient at killing these mites. We to treat for 3-6 weeks. The only trouble is that these mites can live in the environment, and once in a while they are found on the animal’s body as well as in the ears. The topical medications we use for flea control work for treating mites anywhere on the body. Environmental treatment is also advised, which includes vacuuming/washing and application of an insecticide.

That’s the tour of the microscopic critters that can infest pets! It’s honestly one of the grosser things to investigate. Parasites are exceptionally good at doing what they do. In a clinical way, it’s fascinating, but it’s also enough to keep you awake at night! The best way to prevent all of these disgusting passengers on your pets is to keep them healthy and protected by a topical flea prevention and/or flea/heartworm prevention product.

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Why Spay?

I hope everyone has had a chance to be outside this weekend to enjoy the unseasonably warm weather! I’ve still got a gut feeling that we’re going to pay for this later with bad weather but I’m not about to miss a chance to enjoy it.

I still want to cover a topic today that I believe isn’t as well explained as it should be: spay surgery. I always welcome respectful debate about topics I cover, so I hope to encourage readers to ask questions or offer opinions. I have to manually approve each comment that’s made, so it may take a day for them to appear on the blog.

Commonly called a “spay,” this surgery is actually an ovariohysterectomy (OVH or OHE). It’s performed under general anesthesia with the obvious intention of preventing pregnancy in a female dog. Female dogs that are going to be used for breeding can’t be spayed, of course. If an owner is absolutely certain that a dog will be having a litter of puppies, there’s really no discussion to have. In the US, veterinarians remove both ovaries and almost all of the uterus from a female dog. In other parts of the world, the surgery may be only an ovariectomy, with just the two ovaries removed.

Most veterinary hospitals recommend that all female dogs get spayed. The age at which the surgery is performed is variable and ranges from 16 weeks to 6 months. The procedure is extremely routine for veterinarians. That’s a good thing! Procedures we do frequently have better outcomes and fewer complications. Patients are usually recovered by 10 days post-operatively. In most cases, I don’t think clients are given enough information about the procedure, why it’s important, and what to expect during and after the surgery. Clients are left with questions and anxiety. I can talk more about the procedure itself at another time if anyone is interested.

Population control is one of the most commonly cited reasons for spaying. The harsh truth is that far, far too many dogs are put to sleep in the US each year because they do not have homes. Most families are utterly unprepared for the amount of work (and cost) involved with having a litter of puppies, especially if the dog becomes pregnant against the owner’s intentions. Please don’t misunderstand. Population control is good! It’s a social and ethical goal that is sometimes hard for clients to connect with.

There are other direct health benefits from a spay. First of all, we eliminate the risk for cancer in the ovaries. Removal of the ovaries also stops the dogs from having heat cycles (estrus cycles). If the uterus is removed, we drastically reduce the risk of future uterine infections. If a female dog is spayed before her first heat cycle, we reduce her risk of developing mammary (breast) cancer by about 90%. If she is spayed after her first heat, we only reduce the risk by about 70%. That may not sound like much, but if it’s YOUR dog at higher risk, it’s risk that’s directly tied to you and your pet’s well being. I have lots of owners tell me that they “just want to have one litter,” then spay the dog. I also hear frequently, “We think it will be good for the kids to see our dog have a litter.” The vast majority of these clients never do breed the dog, which puts her at risk for the problems just mentioned.

Let me be clear: not spaying your female dog puts her at higher risk for two types of cancer and/or a life-threatening uterine infection. I don’t say this to use fear as a tool or a weapon. I think it’s critical that owners understand what the consequences of their choices are. In the last 5 months at Pet Authority, we’ve had at least 4 uterine infections and three mammary tumors. All of these dogs were unspayed females between 5 and 10 years of age. These are very real consequences that we see in practice.

In order to be fair, I need to mention some of the possible complications of the spay surgery. We do have to open the abdomen during this procedure, so complications with the incision (hernias, the incision opening up, etc.) can occur. These things are very rare if the post-operative rules are followed closely. Spayed dogs do have a lower metabolism than unspayed dogs, so they will not need as much food. (Spaying doesn’t make dogs fat. Overfeeding does.) Some female dogs will develop urinary incontinence at some point after the spay. We believe that this is related to the lack of hormones that the ovaries would normally release. This incontinence is treatable and in almost all cases and will be controlled as long as the dog stays on the incontinence medication.

Each owner needs to weigh the benefits, disadvantages, and costs associated with doing or not doing the spay procedure. Having an adult female dog spayed because she has a uterine infection more than doubles the cost of the surgery. It’s a higher-risk procedure because the dogs are already sick. I’m aware that a spay is not a cheap procedure. I wish we could make the surgery less costly without sacrificing patient safety. I also don’t believe owners would be comfortable hearing from us that we can do something at less cost with “only a little more risk.”

The bottom line, in my opinion, is that we can do a female dog a lot more good by spaying her than by not. We can minimize risk during anesthesia with good, safe practices. We can eliminate or reduce some cancer risks. We can nearly eliminate the chances of a life-threatening infection occurring. I just don’t see where the drawbacks are.

Thanks for taking the time to read my perspective on a somewhat controversial topic. Please ask questions, share information, or offer your opinion. Respectful debate is a healthy, beneficial thing. 🙂

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Canine Influenza

H3n8
Influenza viruses have plagued man for a very, very long time. They’re highly adaptable, showing the ability to jump from species to species. They change frequently, making it hard to develop protective methods to stop infections from spreading. They’ve been responsible for some of the deadliest disease outbreaks on the planet.

In 1918, a particularly nasty flu virus swept the globe. This vicious strain was thought to have come from a mixing of avian and human flu in pigs. In 2 years, between 50-100 million people died (3% of the world’s population). This flu pandemic killed more people in a year than the Black Plague killed in 100 years. The most deaths occurred in young, healthy people, which are normally the most resistant to disease. It’s believed that these people had such a violent immune reaction to the virus that their own body was damaged to the point of death.
CampFunstonKS InfluenzaHospital

Needless to say, we need to take Influenza viruses very seriously.

In 2004, a large number of racing Greyhounds at a track in Florida got sick with respiratory signs. The disease resembled kennel cough, but some of the dogs were far sicker than is usually seen with ‘regular’ kennel cough. Extensive testing eventually revealed that an equine influenza virus had changed just enough to allow it to infect dogs. Currently, this virus has not infected any people.

Canine influenza has the official “name” of H3N8. These letter-number combinations describe the viruses based on their structure. The “H” stands for hemagglutinin protein; “N” for neuraminidase protein.
Perro tosiendo

Signs and symptoms in dogs include cough, runny nose, fever, and in some patients, severe respiratory distress. While most dogs don’t get severely sick, about 8% do develop severe or life-threatening illness.

Spread and infection in dogs happens by aerosol transmission. Dogs that cough and sneeze send little droplets of moisture into the air that contain the virus. Normal breathing can also spread the virus in the air. People and inanimate objects that are contaminated by respiratory fluids from a dog can pass the infection on to other dogs. Once a dog is infected, it will actually be able to spread the virus for a few days before it shows any signs of being sick. Places that have lots of dogs in an enclosed area are massive risks for transmission of Canine Influenza: boarding facilities, daycare, groomers, veterinary hospitals, kennels. This is a completely new virus for dogs, so 80% of those exposed to the virus will get sick.

Testing and treatment are both available. Samples of respiratory secretions or blood testing can be done to determine if a dog with respiratory illness is suffering from the H3N8 virus. Treatment is generally just supportive care. IV fluids, antibiotics to prevent a bacterial pneumonia from happening, and time. The severely affected dogs may need oxygen therapy or intensive care. Most patients will survive H3N8 infection.

A vaccine is available for Canine Influenza. Dogs have to be vaccinated twice, about 3-4 weeks apart, to be protected. The vaccine has to be boostered once a year. While the vaccine does greatly reduce the chances of a dog becoming gravely sick from H3N8, it does NOT completely stop the infection from occurring. It’s the only vaccine on the market at this time.
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Do dogs in Michigan need to be protected? That’s a good question. Better than half of the states in the US have had canine influenza outbreaks, but Michigan is not currently one of them. Ohio and Illinois have had outbreaks. Somehow, we’ve dodged the bullet so far.

There are two choices: vaccinate BEFORE the outbreak, or vaccinate after. I certainly can identify with not vaccinating dogs for something that’s not even present in the state yet. However…The first choice is preferable because of the ease with which H3N8 is transmitted. Once it gets into the population here in Michigan, it is going to rapidly spread. Because it takes 6 weeks for the vaccine to reach peak effect, it may be difficult to protect dogs in an area where the virus has already shown up. A giant rush to get vaccinated will also cause high numbers of dogs to visit the hospital, which is just asking for trouble because of the way influenza is transmitted.

I prefer to give as few vaccines as possible, so we are recommending the influenza vaccine for any patients that are ‘social’ dogs at this time. If your dog goes to the groomer, boards anywhere, goes to daycare, goes to a dog park, travels to other states, goes to dog shows, or is social with other dogs in the family or neighborhood, you should strongly consider the vaccination. (These recommendations are the same for the Bordetella vaccine.) The vaccine is safe and we’ve been using it since 2009 when it was approved for use in dogs.

You can read more about the H3N8 virus and vaccination at the vaccine manufacturer’s website.

More information about Canine Influenza can be found here.

The AVMA’s page about Canine Influenza is a very detailed look at the virus.

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Flea Alert!

The bugs are on the muscle! We’ve seen a huge surge in flea cases in the past few weeks. I’m not sure if that’s because of the cold snap or just normal seasonal changes, but yikes!

While fleas might seem like an annoyance at worst, they can actually cause a number of very serious problems. One of the most dangerous has to do with the fact that fleas drink blood.

If you recall from the entry about blood samples and labwork back here, blood is “soup.” The red blood cells comprise, on average, about 30-50% of the blood’s volume. It’s lower in puppies and kittens. Average adult dogs run between 37 and 55%, generally. This percentage is measured with something called a packed cell volume, or PCV. This diagram indicates that the PCV is simply a percentage of the amount of red cells compared to the full volume of blood. In this diagram, the PCV is 46% (0.46).

500px Packed cell volume diagram svg

In a heavy infestation, fleas can drain a smaller pet’s blood to the point that the number of red blood cells decreases to a dangerous level (anemia). The fleas are drinking down cells faster than the bone marrow can replace them, so the eventual result is that the anemic pet can’t carry enough oxygen in the blood to keep itself alive. Severe flea anemia can kill a pet!

There are also additional complications that can result from a heavy flea infestation: infection with blood parasites called hemobartonella and babesia, as well as autoimmune problems can all have a link to flea infestations.

Patients with flea anemia can be saved with aggressive care. Usually, a blood transfusion is given to replace the red blood cells. Transfusions tend to take the patients out of critical trouble, but of course longterm attention to flea control is needed or the newly replaced cells will be consumed by the fleas.

Topical products that safely kill fleas are the best way to go. Vectra 3D, K9 Advantix, Frontline Plus, and Advantage are all good products.

I do not recommend the store brand products, nor do I recommend Hartz or Sargents. Flea baths can be dangerous for a wide range of reasons. Some flea collars are alright, but unless they’re used correctly (which they usually aren’t), they’re not very successful.

Preventing flea infestations in pets and your home is easy to do and relatively low-cost. Given the trouble and expense of treating your home and sick pets, it’s a bargain to stop the parasites before they gain a foothold. Just remember that ALL pets in the household need to be protected with a flea-control product to stop a home infestation from occurring.

Here’s hoping we can keep a Flea-Free Fall in sight!

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Vaccines – Controversy and Facts

This week we’ll get to the real grit that inevitably comes up when vaccinations are discussed. I had hoped that the most current set of recommendations from one of our oversight committees would be published in time to include them in this post. Unfortunately, as far as I know, they’re not yet out in the wild. I’ll touch on that a little as we go along with the discussion.

I’ve got a number of specific things that I definitely want to bring up. I’ll be keeping a close watch on the comments, as always, so please ask questions! This is an opportunity for you to find out about the aspects of vaccination that we don’t often get to talk about during visits. I may even utilize questions in the comments for additional posts.

I want to state right up front that with each patient, we evaluate whether the benefits of vaccination outweigh the risks of vaccination. We don’t take vaccines lightly. They’re essentially a drug, and there are side effects and complications and potential adverse effects from administering a vaccine. While the rate of reactions is quite low for most vaccines out there on the market, the complications can be severe. For each patient, we determine the risks of the patient’s lifestyle and recommend appropriate vaccines. We strive to minimize the number of vaccines given to all patients.

Vaccinations are an area of medicine that is under intense scrutiny by veterinarians, human health professionals, pet owners and parents. This is a heated topic to say the least, but I’m thankful for any respectful debate. We can only learn more and try to apply that knowledge to better care for our patients. I hope that our clients feel that we aren’t just accepting old dogma for our recommendations. I was certainly proud to find out that we are in compliance with the most current recommendations for canine and feline vaccination according to the oversight groups.

Vaccine Reactions

Reactions to a vaccine are varied both in severity and frequency. They span the range of very mild problems like being sleepy for a day or being a little sore, on up to life-threatening anaphylactic reactions. The overall reaction rate for the vaccines we use is honestly really low. We used to see a lot more reactions — at least a few a month. Now, I’m surprised to see one every few months.

Pain and soreness are easily countered by giving a dose or two of an anti-inflammatory (an NSAID). Occasionally we’ll have a little inflammatory nodule under the skin that goes away within a few weeks. Those nodules are usually due to the Rabies vaccine, which has an adjuvant.

Severe reactions may include signs like vomiting, diarrhea, weakness, and shock. Pets have to be treated with an injection of Benadryl and a Glucocorticoid steroid, or in very severe cases, epinephrine. I’ve had to give IV fluids, epinephrine, and the benadryl and steroid to just a few patients in the 10 years I’ve been a practicing veterinarian. Even the animals that go into anaphylactic shock are relatively easy to save. They bounce back quickly once the medications are on board. In the future, these pets are given medication prior to the truly necessary vaccines to prevent a reaction. We stretch out the frequency of vaccines and try not to give too many in one visit. Most patients do really well, and we’ve been able to have the benefits of vaccination outweigh the risks so that patients are protected from deadly diseases without suffering the reactions from the vaccines.

Adjuvants, Vaccine-associated Sarcomas, and other Vaccine Complications

As we discussed in the earlier posts, some vaccines contain an additional ingredient with the sole purpose of increasing inflammation in the spot the vaccine is administered. This irritating substance causes white blood cells to move into that area and subsequently be exposed to the pathogen in the vaccine. The idea here is that for killed pathogen vaccinations, the dead virus/bacteria alone wouldn’t be enough to stimulate an adequate immune response. The adjuvant creates that immune response through irritation/inflammation. The trouble, of course, is that you’re injecting a lipid or a metallic substance that causes significant inflammation and tissue damage. It’s difficult to know how much is exactly enough, and the sweet spot between adequate response and an overblown response isn’t always easy to hit, either. The complications from this aren’t very common — 1 in 1000 to 1 in 10,000 for most — but they can be severe. If your pet happens to be that 1, it doesn’t matter how many did NOT have the problem.

One of the complications that can arise is an immune response that ends up attacking another part of the body. Usually, it’s the red blood cells or platelets. This is clearly a very serious disease (immune-mediated hemolytic anemia or immune mediated thrombocytopenia) that requires aggressive treatment. Patients can die from these complications. There is a theory that thyroid problems in dogs may be linked to overvaccination with the DHPP vaccine. There’s no conclusive proof published that I’m aware of. I’ve had one case of anemia that I know was associated with vaccination in the 7 years I’ve been at Pet Authority. That patient survived and is doing very well. She leads a normal life, but we don’t vaccinate her anymore for fear of triggering a relapse.

Cats can have a very unique and devastating reaction to some injections (including vaccines, or any other drug). About 1 in 1000 to 1 in 10,000 cats will develop a very serious cancerous tumor at the injection site. We believe that the adjuvant in the vaccine is a major component of developing these tumors. However, affected cats also seem to have a genetic predisposition to developing this cancer, too. It’s a multi-factor disease that nevertheless is often terminal for the cat. Recombinant, adjuvant-free vaccines are the best way to avoid this complication in cats. We have switched over to the recombinant vaccines whenever possible for the cats in our practice.

Duration of Immunity

This is probably one of the most-asked about aspects of vaccines and immunology. “How long are they good for?” It’s a topic that has been at the center of the most fierce debate between the veterinary community and everyone else. It has also been a source of debate within the veterinary community. I’m going to speak about what we know now, and how Pet Authority has put this knowledge to use.

We know that recombinant vaccines and modified live vaccines are the best ways to develop a good, strong immune response in the safest way possible. We know that -viral- vaccines and recombinant vaccines stimulate a very good longterm (cell-mediated) response in patients. There also tends to be a very strong humoral response that produces a lot of antibodies. We know that puppies and kittens require a series, and then a booster 1 year later, to produce a response that gets both antibodies and cell-mediated immunity to an appropriate level. The question is, what happens after that 1 year booster?

For viral diseases, which are in vaccines like DHPP and FVRCP, the immunity produced lasts longer than 1 year. We no longer vaccinate for distemper annually. After that 1-year booster, we vaccinate every 3 years. It’s widely accepted that nearly all patients will be adequately protected for 3 years and do NOT need to be vaccinated annually for DHPP or FVRCP.

Rabies is a special case because of the public health aspects involved. The FDA and State laws usually determine how often a pet is vaccinated for rabies. Two factors are involved: how long the company says the vaccine is good for, and what the state laws demand for the number of years between vaccines. Dog rabies vaccines have adjuvant and are good for 3 years in almost all cases (so long as the vaccine label says 3 years). The only time you vaccinate more frequently is when laws say you have to. For cats, the vaccine is a recombinant canarypox vaccine, but the label is only good for 1 year. This annual revaccination is less dangerous for cats than giving the adjuvanted 3-year labeled vaccine. We utilize a recombinant feline rabies vaccine for almost every feline patient.

Feline leukemia is also currently an annual vaccine due to manufacturer label. We do utilize a recombinant leukemia vaccine. My hope is that eventually, the company will state their support of a 3-year interval here, too. Theory suggests it should be adequate, but we don’t have the testing to back that just yet.

Bacterial diseases such as leptospirosis and lyme don’t generate a very strong immune response. They’re killed bacteria or parts of bacteria, which doesn’t do a good job of stimulating cell-mediated immunity. Therefore, these vaccines are given annually. The one change we’re making is that for both diseases, a dog can be late by up to 12 months and NOT require a 2-vaccine series to reestablish immunity again. Please keep in mind that if your dog is overdue, it is NOT protected from lepto and lyme! Don’t be late for the vaccines! Bordetella is another vaccine that has to be boostered more frequently due to the killed bordetella portion of the vaccine. We recommend boostering the nasal bordetella vaccine every 6 months for at-risk patients.

Titers

Titers are hand and glove with Duration of Immunity. A titer is a measure of the amount of antibody circulating in the bloodstream that matches a particular disease. When we get a ‘distemper titer’ for example, we are measuring how much antibody a dog has in its bloodstream that will fight off distemper virus if the dog is exposed.

I’m of mixed feelings on titers. For some disease (canine distemper and rabies), there is a specific amount of antibody that is considered the minimum for protecting a pet from getting the disease. However, for many other diseases a titer may be misleading. We know that immune responses are composed of two parts: antibody and cell-mediated memory. A LOW titer means a patient has low levels of antibody. However, that patient may still be protected by its cell-mediated immune response. A HIGH titer may not be enough to protect a patient against some diseases. It’s very hard to imply protection from a titer level for most diseases. I don’t recommend titers to our clients unless they -really- want to stretch out those vaccine intervals beyond 3 years. The titers are expensive, may or may not be an accurate measurement of immunity, and the vaccine risks are generally low. I think that putting dogs on a 3-year interval and skipping the titers is the most practical option we have that doesn’t ignore current data.

I think that touches on the majority of the big points of contention in vaccine theory for dogs and cats. If I’ve missed something that you’d like me to comment on or explain, please leave a comment. This is one of my favorite areas of medicine, so I welcome discussion. I hope everyone has enjoyed the holiday weekend!

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Feline Vaccines

Cats finally have their turn this week as we look at vaccinations. I need to bring up a special concern that guides a lot of the decisions we make about vaccinating cats.

Some time ago, an association was found between vaccines and a very nasty kind of cancerous tumor in cats (fibrosarcoma). It was initially believed that adjuvanted vaccines (particularly rabies and leukemia) were directly causing these tumors in cats. What we’ve learned since then has indicated the following:
-Between 1 in 10,000 and 10 in 10,000 cats will develop a sarcoma
-There is a genetic predisposition for developing fibrosarcomas.
-Adjuvant plays a part in development of fibrosarcomas
-ANY injection can lead to a fibrosarcoma

These factors have led to some major changes in the way we vaccinate cats. It’s important to minimize the number of injections that we give cats. We also try to give non-adjuvanted vaccines whenever possible. Lastly, for vaccines that must still have an adjuvant, the type that is used creates the minimum amount of inflammation possible while still ensuring that the vaccine works.

Distemper

Just as the canine distemper vaccine contains several pathogens, the vaccine we refer to as ‘feline distemper’ also contains multiple portions. Feline Viral Rhinotracheitis, Calicivirus, and Panleukopenia are the components. It’s generally abbreviated as FVRCP.

FVR = Feline Viral Rhinotracheitis
FVR is a herpes virus. It causes respiratory and eye infections. It’s highly contagious by way of oral, nasal, or ocular discharge/contact. Sneezing, coughing, eye discharge, and nasal discharge are the clinical signs that we look for. Some patients will develop a fever, lethargic behavior, or stop eating. Treatment includes supportive care, and most cats recover without complications. Sometimes, a chronic infection results. Also, any cat that contracts FVR will always have the virus, which can flare up in times of stress or other illness. Think about it like cold sores in people (also caused by a herpes virus). This is a modified live vaccine.

C = Calicivirus
Calicivirus is another respiratory/ocular viral disease. It can also cause lameness/musculoskeletal pain and gastrointestinal disease. It’s a highly contagious disease that commonly causes persistent infections. When cats are affected by Calicivirus, they can have fever, lethargy, lack of appetite, ulcers on the tongue, lips and nose, pneumonia, or leg pain.

P = Panleukopenia
Feline Panleukopenia is the cat’s equivalent of canine parvovirus. In fact, feline panleukopenia mutated and became canine parvovirus. Panleuk attacks rapidly growing cells, especially in the bone marrow and gastrointestinal tract. This disease is often fatal. It’s highly contagious. Treatment is just supportive care – IV fluids, antibiotics, and nutritional support. This is a very, very nasty disease.

Some FVRCP vaccines also include a Chlamydia portion. This is a bacterial disease that causes an eye infection. We don’t see a lot of chlamydia cases at the hospital, so we don’t utilize a vaccine with this component

Rabies

Rabies virus behaves in cats the same way it does in dogs. We have something of a dilemma in cats with Rabies vaccines, though. The 3-year product has an adjuvant, which we know increases the risk of a sarcoma tumor. However, the safest Rabies vaccine out there (a recombinant vaccine) has to be given yearly – which means more frequent vaccination. It’s believed by most veterinary specialists that vaccinating more frequently with a non-adjuvanted vaccine is the least risky option.

Bordetella / Kennel Cough

Cats can catch the bacterial portion of this disease, which is caused by the Bordetella bronchioseptica bacteria. This is ONLY an intranasal vaccine in cats and contains killed bacteria.

Leukemia

Feline Leukemia is a viral disease easily transmitted by bites, casual contact, shared food dishes/litterpans, or transfer from a mother to kittens in the womb or through her milk. Some cats become sick right away. Others can completely clear the virus from their system. Others will have the virus hide in the body and show up again later as they cause severe disease or cancer. Anemia, immunosuppression, and nervous system disease can all result. The vaccine we use for Leukemia is a recombinant vaccine that doesn’t have an adjuvant.

There are two vaccines available for cats that aren’t used by our practice. One is for feline immunodeficiency virus (FIV). That vaccine often doesn’t work very well, and it causes cats have a false positive FIV test result. The other is for feline infectious peritonitis (FIP). That vaccine doesn’t seem to help much at all (and in some studies caused WORSE disease), so we don’t use it.

Kitten Vaccine Series

Maternal antibodies and an immature immune system can create a situation where a single vaccination may not generate a good immune response in a particular kitten, just as with puppies. Therefore, we initiate a series of vaccines that are administered on a regular schedule. This creates a response in the vast majority of patients that is sufficient to protect that kitten from the diseases it is likely to encounter.

We start the series at 6-9 weeks of age with an FVRCP combo vaccine. We continue the distemper series with a vaccination every 3-4 weeks until the kitten is 16-17 weeks old. We try to schedule these so that the kitten doesn’t get more than 3 FVRCP vaccines in total. I personally try to ensure that kittens don’t get more than 2 vaccines at or after 12 weeks of age.

Rabies is given after 12 weeks of age and before 6 months of age. This vaccine’s administration is determined by laws in the particular state. In Michigan, The very first Rabies vaccine a cat gets is good for 1 year. On the next vaccination, if we use the safer recombinant Rabies vaccine, it will again be good for one year. Some clients elect to use the 3-year vaccine (which I do NOT recommend!).

Bordetella intranasal can be given once a kitten is 12 weeks old. Only a single vaccine is needed to produce adequate immunity. This is recommended for any kitten that is going to go outside or be boarded or groomed.

The Leukemia vaccine used to be recommended only for cats that go outside or have exposure to other cats outside the household. However, the new AAFP guidelines have advised that all kittens get vaccinated for Leukemia as part of their initial series. One year later, if the cats are definitely indoor only/low risk, the vaccine is not continued. If the cats have decided they’re going to be indoor-outdoor or have exposure to other cats, the vaccine can be continued. The Leukemia vaccine’s relative safety, we feel that protecting kittens from this dangerous disease is far more important than the risks from vaccination.

Nearly all kittens are finished with their vaccine series by 16 weeks of age. We need to see cats 1 year after the vaccines are completed. FVRCP is boostered at that time, as is Rabies. Depending on a cat’s exposures and lifestyle, we may booster the Bordetella and Leukemia. The final kitten visit and this 1-year booster are the two most important vaccinations in a kitten’s life. At that point in time, we begin to decide on the frequency of vaccinations by taking into account a pet’s lifestyle, exposure to pathogens, health status, and age. While there is a recommended schedule for cats in general, we make a point to administer only the vaccines that are needed by each individual patient.

With the use of non-adjuvanted and/or recombinant vaccines, we’re able to vaccinate cats with far less risk than previously. The number of sarcoma tumors is being watched closely and studied extensively. The need to protect cats is far more important than the risks of vaccination. We still try to minimize the number of injections (vaccines or medications) a cat gets.

You can read more about Feline Vaccine-Associated Sarcomas here.

Thanks for reading!

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