Mange Mites - Demodex Treatment

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Demodectic Mange Treatments

Question: Hello, my dog, Jake, was diagnosed with Demodectic mange about 3 weeks ago. Prior to that diagnosis, I had taken him to the vet because I thought he had ringworm. He had a red circular spot on his face near his eye that did not seem to be healing. During that visit, the vet said that he didn't think that he had ringworm. He said that he thought that he had a staph infection and put him on cortisone pills and antibiotics. Before leaving that day, I told the vet that I thought Jake also had an "anxiety licking disorder" because he would lick his forerms until sores formed. He did not address that issue, however. I gave Jake the Cortisone and antibiotics as prescribed. Within 2-3 weeks the red spots had spread from his face and forearms to the trunk of his body and his hind legs. I returned to the vet who then did a scraping and said that he had generalized demodectic mange. He prescribed mytoban and antibiotics. After reading about demodex I am concerned. Jakes age is uncertain, he was a sickly stray that I found in August 2000, who turned into a gorgeous full grown dog. At the time that I found him, the vet said that he was probably 10-12 weeks. That means that he is now 18 months old and was about 17 months old when he was put on cortisone. I have now realized that this summer, when he would have been about 12 months old, he started with the red spots on his forearms which I mistook as an anxiety related disorder. My questions are: 1) Since his first red spots appeared at about 1 year, do you think this is juvenile demodex? 2) Do you think that the cortisone treatment is what tipped the scales to allow this disease to change from localized to generalized? 3) I have insurance on Jake, and though I don't like high vet bills, am willing to spend whatever it takes to make him well. What is your very best treatment advice?

Thanks, Suzanne

Answer: Suzanne-

There are three treatments for demodectic mange that work for most dogs. The first is the use of amitraz pour on (Mitaban Rx) every other week for 6 to 8 applications or until 2 consecutive skin scrapings are negative, which probably cures demodectic mange in about 80% of dogs when application directions are followed, although this is just a guess based on averaging results from available studies. This is the only approved treatment for demodecosis. The second treatment is ivermectin given by injection or orally at the rate of 250ug/kg or higher (up to 600ug/kg in resistant cases) daily until two skin scrapings are negative, which probably also works about 80% of the time. This treatment has to be used very carefully in collies and shelties, who are more likely to suffer toxic reactions to ivermectin. The third treatment that is sometimes used is oral milbemycin (Interceptor Rx) given daily for six to eight weeks and my best guess is that it is about as effective as the other therapies. It is probably wise to be cautious about using this therapy in collies and shelties, too -- although we have done this on a couple of occasions without problems, so far.

Even though we use six to eight weeks as sort of a minimum therapy time, it is important to remember that it can take up to a year of therapy in some dogs to cure demodecosis. It might be possible to cure more dogs if intense treatment was used longer than a year but we haven't tried that.

Some dogs who do not respond to one therapy will respond to one of the others, so it is probably possible to cure demodectic mange in about 90% of dogs. In the remaining dogs it is usually possible to control the disease even if it can't be eliminated, by use of intermittent therapy. We have done once a month amitraz applications when this was necessary, in most cases. We have a couple of patients who we use ivermectin intermittently with (probably average two or three month long treatments a year).

It seems to help a lot to use an antibiotic for secondary bacterial infections during the first two to three months of therapy for demodectic mange unless treating an early case in which secondary bacterial infection hasn't occurred. It is also helpful to use an antibacterial and antiseborrheic shampoo to treat secondary skin disease and get rid of crusts and exudate on the skin. This is especially important when using amitraz.

There are a couple of legal problems associated with the therapy for demodecosis, which hamper therapeutic efforts in some patients. The first legal hurdle is that it is illegal to use an EPA approved product in a manner inconsistent with its labelling and Mitaban (Rx) is EPA approved rather than FDA approved. So once weekly dips, which seem to work better, are actually illegal. So is long term intermittent use. The second legal problem is that the use of ivermectin and milbemycin for the treatment of demodecosis is an "off-label" use. This isn't illegal, but when off-label treatments are used they are supposed to be used after an approved treatment fails. So technically, your vet should use amitraz first and then the other therapies. This is a problem due to the requirements for successful use of amitraz in some dog breeds (see next paragraph).

Amitraz works best on short haired dogs and on dogs whose medium to long length hair has been clipped completely in order to allow better exposure to the amitraz pour on. Longer haired breeds will need to be clipped repeatedly until therapy is successful, which can be a long time. It also works best when all scabs and sores have been cleaned off prior to application and when an anti-sebborheic shampoo has been used prior to application of the pour on and then the dog at least towel dried. Finally, it is necessary to sponge or pour amitraz onto the whole surface of the skin, affected as well as unaffected areas. If these steps are not taken, amitraz is much more likely to fail.

Now to get to your specific questions. 1) I think that this is almost certainly juvenile onset demodecosis. 2) I think it is very likely that the use of prednisone or other corticosteroids would cause worsening of demodecosis in a patient who had this condition and I think that it is likely to have done that in your dog's case. 3) I personally like the ivermectin therapy best at the present time, although we usually start with amitraz to try to stay on the right side of the legal issues. Be persistent with therapy. Most of the treatment failures result from giving up on treatment before it has a chance to work.

Mike Richards DVM 12/14/2001

Demodex treatment in Boxer

Question: Dear Dr. Richards, I have a 10 month old male Boxer named Max. He was diagonsed with Demodex when he was 6 months old. Max has been dipped in Mita-ban for four months, once every two weeks. Max's hair has grown back and have really had no more health problems due to his Demodex. However, on the 15th of January I was suppose to be dipping him for the last time, but when the skin scrape came back, it showed one dead mite on his chin. My vet has said to keep dipping Maxc until he finds nothing. He said to stop now I could run the chance of having the mites come back and be back to square one. How do you feel, should I continue to dip or is Max pretty safe.

Answer: Lisa-

I agree with your vet. You should continue the dipping, or use alternative medications for the demodecosis, until no mites are found on two consecutive scrapings. We usually scrape after each dipping once we get down to just a few mites on skin scrapings. If Max has not had problems with the dippings up to this time it is unlikely that continuing them would cause him any problems.

I'm glad that you have had the success you've had so far. Once in a while we find a patient who has to have occasional dipping in order to keep mites suppressed, because we simply can't get them to stay away completely. Most of these patients have only required once a month or once every other month treatments. Hopefully, though, Max will go on and be cured of this problem.

Mike Richards, DVM 1/23/2001

Demodex in toy breed treatment- continued

Question: I wrote to you recently about my chihuahua x toy terrier puppy with demodecis and my vet has now increased the Ivermectin to 300mcg per kilo given orally every second day and restarted the antibiotics which seems to have led to a significant improvement. Thank you. My question today is whether or not there is any way of testing for an underlying immunological problem and/or whether or not there is any way to boost her immune system. My vet was going to research whether an antiviral drug like Interferon to boost T cell production could be helpful and I wondered whether you are aware of any research in this area.I would be fairly reluctant to try this without some good supportive evidence that it can help as I know that Interferon has a range of unpleasant side effects. My vet seems to think that there is an increasing likelihood that my pup's problems may relate to an underlying immunological problem and seems concerned about the possibility of neurotoxic problems with really long term use of Ivermectin. Thanks, Caroline

Answer: Caroline-

I know of a number of patients treated with ivermectin for very long durations without any noticeable problems. Most of these patients are being treated daily with 225 to 300 ug/kg of ivermectin. It may be possible to avoid some of the adverse effects of amitraz (Mitaban Rx) by treating with yohimbine prior to dipping with amitraz but sometimes it is necessary to repeat the yohimbine to cover the whole time period when reactions occur. This might be an alternative choice if the ivermectin does seem to be causing problems at a later time. It is OK to use amitraz and ivermectin at the same time but I know that in your dog's case the amitraz seems to cause significant sedation so that can be held in reserve, too.

Humans have a lot of side effects associated with interferon use. Cats have few reported side effects from interferon use. I have only seen one study that I can remember on interferon use in dogs and there were no side effects noted in that study (it was on keratoconjunctivitis sicca, an immune mediated eye problem where tear production is inhibited). So I would think interferon would be reasonably safe to try but would have to be a little cautious in that recommendation until I was more sure of whether dogs are going to be like people or like cats in regards to side effects.

There are tests for specific immune deficiencies but there has to be some degree of suspicion for a particular problem to make these tests practical because there are a lot of known immune deficiency disorders at this time. Before going with this approach, I would really recommend a complete lab work up, including a broad blood chemistry panel, total blood cell evaluation and perhaps X-rays of the chest and abdomen. If all of this fails to point out a problem then it might be a good idea to consider asking about referral to a veterinary immunologist or hematologist for a review of potential problems with neutrophil disorders or other immune system problems.

I haven't been too impressed with any of the medications or food additives that are supposed to stimulate the immune system, yet. Hopefully an underlying problem can still be identified and treated.

Mike Richards, DVM 4/10/2000

Demodex treatment for toy breeds

Question: I am a subscriber living in NZ. I have a 4 month old Chihahua X English Toy Terrier female puppy who was diagnosed as having severe generalised Demodecis at 11weeks. She had previously been found to have Ringworm.She received Griseofulvin for 6 weeks and has been having weekly injections of Ivomectin. She has also had a total of six weeks on antibiotics for secondary bacterial skin infections.She had a good initial response to the Ivomectin, with a brief flare up following her final vaccination,but over the past two weeks has again developed red scabby patches and hair loss over her throat and face which seem to be getting worse and spreading despite continued weekly Ivomecitin injections.In the time she has been receiving treatment she has only had a few days of looking completely clear, immediately prior to this last flare up. . It seems that Ivomec and Ectodex are the only treatments available here and there is a warning not to use Ectodex on Chihahuas on the bottle. What would be the dangers of using Ectodex on her? (my vet doesn't know why Chihahuas are specifically excluded from treatment). Is it likely that increasing the dose of Ivomec would be helpful? She currently receives 0.08ml but I'm not sure of the concentration.Any information or advice would be greatly appreciated Thank you Caroline

Answer: Caroline-

Ectodex (Rx) is the brand name for amitraz in some areas of the world. In the U.S. this product is Mitoban (Rx). Toy breeds are thought to be more susceptible to central nervous system depression from this medication, making use of it in these breeds more of a risk.

The most common recommendation for ivermectin use, currently, is to give it daily, orally, for at least six weeks and longer, if necessary. There isn't any reason that the dosage couldn't be given by injection but ivermectin injection stings and dogs get tired of it when given at this frequency. The minimum effective dose reported in the literature is 225mcg/kg of body weight once daily. The maximum recommended dosage I have seen is 600mcg/kg of body weight. It is best to start at the lower dose and slowly increase the dosage, if necessary. This is an unapproved use of ivermectin in the United States but I think that many dermatologists feel that ivermectin is safer to use than amitraz and so there is a tendency to use it even though it is unapproved.

Milbemycin (Interceptor Rx) is also reported to kill Demodex mites but is usually a third choice in treatment due to cost and lower success rates. This is an option if you wish to avoid the use of amitraz, though.

If you have to use amitraz it is acceptable to give the dog the antidote for toxicity, yohimbine, prior to dosing with the amitraz. After all, you only need the toxic effect for the mites, not the pet. Yohimbine has a shorter duration of action than amitraz, so if it is necessary to use yohimbine it may also be necessary to give it more than once.

Administration of antibiotics appropriate for secondary skin infection during therapy for demodecosis helps a lot, in some patients.

Good luck with this. I can provide references for your vet, if necessary.

Mike Richards, DVM 3/12/2000

Demodex mites - New treatment?

Question: Have been told Pfizer has a new treatment out for this problem that may be less toxic that Mitaban and Ivamectin. Unable to find except a new parasitic trtment for cattle/pigs which said it is not for dogs and can be deadly to them. To continue....my dog has now been put on Ivamectin liquid (into it 3 days). Told it will take a couple weeks or more for it to work, if it does. Her feet are extremely sensitive, one hind foot so bad she cant stand to put it on the ground and sometimes falls over. I asked for some type of topical pain med for her feet...told to use an aloe vera cream of some type (fm hlth food store). She shivers because she hurts and can hardly walk out to do her business very far. I asked if she shouldn't also be on antibiotic, which seemd to help her when she was having mitaban dips and was told no. She had one negative scraping after dips, but it has returned with a vengence. She has a problem with two of her feet bleeing some. Xrays showed calc area, radiologist said may be tumor, etc. Was refrred to Internal Med Specialist. An ultrasound by Internal Specialist DVM revealed she had a calcified gallbladder (tols not unusual for old dog) and some minor calc. of lungs. Blood tests were not sent with her records. She has been on thyroid med since she was about 2 yrs old when she was properly diagnosed. As a pup and young dog she had many skin probs ...told due to allergies...for which Prednisone was given. Later, I was given antihistamines to help her thru allergy season...to which she responded well. Has not had Pred for years now.....and allergies seemed to go away. Does Pfizer have something new for Canine Demodex ? HELP. I love this dog and can't stand to see her suffer like this... I know she can be a normal happy dog when this problem is taken care of. 2nd half of first msg (if you got it) THANK YOU IN ADVANCE

Answer: C.-

Pfizer has a new medication available, selamectin (Revolution Rx), which kills sarcoptic mange mites but NOT demodectic mange mites, at least according to its label. It is fairly closely related to ivermectin, as the name of it suggests.

Ivermectin is reasonably safe to use for demodectic mange and some dermatologists use it as a first choice product for this condition now, despite the fact that amitraz (Mitaban Rx) is the only approved medication for the treatment of demodecosis. We use it in some of our cases and have not yet run into a major problem with toxicity.

Whatever you do for the demodex is likely to have be continued long term. In older dogs this disease shows up because there is something causing problems with the dog's immune system. Hyperadrenocorticism, liver disease or major stresses such as cancers are possible underlying causes of the occurrence of demodectic mange in an older dog. In many cases it simply isn't possible to eliminate the underlying cause, so the demodecosis has to be continually suppressed.

I think antibiotics are good idea when there is significant inflammation and infection around the feet or other areas affected by demodecosis. I honestly think it helps to resolve the demodecosis to get rid of other infectious agents for awhile. So I'd tend to be in favor or their use. Ask your vet about this again.

I don't see any reason not to use pain relief medications, either. It is important to be sure that there isn't an existing problem that they might worsen (especially liver disease) but even in that case it is usually possible to use at least one of the available pain relief medications. Ask your vet if he or she would like to walk around on feet that look like your dog's feet look, without pain relievers. If the answer is "no" then ask why it seems reasonable to expect your dog to do that. Your vet might have a justifiable concern about pain relief medications but he or she should at least be able to tell you exactly what that concern is and it should be important enough to offset the obvious discomfort associated with not using pain relievers.

It is really important to search for the reason that demodecosis has suddenly appeared in an older dog. I hope you are able to find and treat an underlying cause because that would give your dog the best chance for recovering from the demodecosis completely, with treatment.

Good luck with this.

Mike Richards, DVM 12/2/99

Mange treatment

Question: Whatever happened to just plain ole sulfur and oil applications for tx of mange. All the recommended txs I see on all the web sites call for vet visits and expensive drugs. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$. Seems the most logical and common sense approach is to try least expensive FIRST, then go the big bucks route. B. D

Answer: B.-

I think that you can tell from reading our web site that we will recommend inexpensive treatments when they are likely to be helpful.

Motor oil is not safe to use on pets. Since that is usually the oil recommended by home remedy enthusiasts in my area, I am assuming it is the one you are referring to, too. It is better now than it was when cars burned leaded gas but it still can cause gastrointestinal problems.

Lime-sulfer dips will kill Sarcoptes mites but not Demodex mites. Other sulfer containing products do not appear to work for mange based on a fairly large number of cases I see in which they have already been tried. They do sometimes help with skin conditions that aren't actually caused by mange mites but which get called "mange" because people are not aware that this is a description of a specific disease rather than a description of the symptoms of hairloss and itchiness associated with the mites.

Demodectic mange will often clear up without any treatment at all, making almost any treatment appear successful at times. This is why we recommend not treating this form of mange at all unless it becomes generalized (affects more than five or six spots on the body). If it does become generalized, there is no effective home remedy that I am aware of.

Sarcoptic mange is easier to kill, does not require many visits to treat and there are safe and effective medications available for treatment. In this case, a questionable home remedy doesn't make economic sense. It is cheaper to use an effective medication before secondary complications from the mange sets in. Michael Richards DVM 12/2/99

Demodectic mange - new treatment options

Q:Hi,

I've been treating 2 dogs for quite some time that were born with demodectic mange. These puppies (approx. 3 months old at the time) were dumped in a nearby park and my husband and I adopted them and have been treating them for this mite. We started in September of 1997, treating them with a shampoo of benzoil peroxide and then dipping them with Midoban dip. We did this every 2 weeks with both animals. We kind of got off of the "routine" somewhere around November/December and basically had to start all over.

So again we gave them Mitoban dips every other week, along with some antibiotics to help clear up secondary skin infections and also an EFA - Essential Fatty Acid supplement. Of the two dogs (one of which is mostly chow {The Female} - and one of which is chow and shows some german shepherd {The Male} - we don't know what else they are mixed with. We were able to get a "negative" skin scraping on the Male dog in April and we were able to get him neutered. Subsequently, the Female had come into heat just prior to the male's neutering. I believe that her coming into heat set her back as we are still dipping her and seem to be going through the entire process all over again.

My question to you is... Do you know anything about Ivermect liquid (for pigs and cows), to be effective in treating demodex mange in dogs? (by mouth)

My vet has said something about treating the female with monthly heartworm medicine on a daily basis. She said that sometimes they can get the pharmaceutical companies to donate just out of date medicine and then the vet can pass it on to us. Have you heard anything on the use of Heartworm medicine to treat this same mange? Also, can this disease, once cured... come back? I would think that treating them with something internally would kill something in the bloodstream better than a "topical" dip which doesn't really work that way. Is that a correct assumption?

Any comments or suggestions you have would be greatly appreciated.

Thank you... Michelle (concerned dog owner)

A: Michelle-

When amitraz (Mitaban Rx) dipping is not effective in controlling demodecosis there are two alternatives that may help. The first is administration of ivermectin either orally or by injection in high dosages. This use is considered to be experimental for dogs and there have been a number of suggested dosages, dosing intervals and durations of admistration suggested for this medication. Your vet will probably have a dosing plan he or she is comfortable with. We have used ivermectin for this purpose with good success in several dogs. The other alternative is to give milbemycin (Interceptor Rx) heartworm preventative on a daily basis at the same dose as it is given monthly for heartworm prevention. This is also considered to be an experimental use in dogs. I have not tried this due to the cost of the tablets but this is also supposed to be helpful in treating demodecosis. If you have not shaved the dogs prior to dipping with Mitaban you should consider doing this. It is supposed to work much better when the dogs are shaved prior to use. There are also suggestions for using amitraz in an "off-label" manner to increase its effectiveness. Many vets use it weekly instead of every other week and in desperate situations veterinarians will sometimes dip the dog daily but only cover half of the body with the dip each day. We haven't tried this either, but only because we haven't had to yet.

We try to get owners to let us spay female dogs with this condition since they do often get worse when they go into heat and we have not seen much worsening of the disease due to surgery. It is possible that surgery could induce enough stress to make the Demodex infestation worse but we have not had that experience yet. We do not wait for the infection to be cleared prior to spaying.

Demodecosis can return after an apparent "cure". This normally happens when the dog's immune system is compromised later in life due to an illness or when chronic use of immunosuppressive medications is necessary for another condition. A lot of dogs do not ever have completely negative skin scrapings for this mite but can be well managed with monthly dips or sometimes by dipping at even longer intervals than this. These dogs are always subject to a flare-up of the demodecosis if they are sufficiently stressed.

Good luck managing this situation.

Mike Richards, DVM

Demodectic mange treatment

Q: Dear Dr. Mike; Our 8 month old female boston terrier was diagnosed with demodectic mange. Our vet recommended an ointment named "goodwinol." The puppy has a good appetite and is currently on Pedigree puppy chow, mixed with canned pedigree food. We noticed the loss of hair on her left shoulder and on her left paw about 2 months ago. Our Vet said that two treatments are the ointment, and a more toxic treatment of dipping. Our vet also said that the dog may outgrow the problem. Is our Vet on track with the diagnosis and medication? Thanks; Mike & Carol Staples

A: Mike and Carol-The standard treatment for localized demodectic mange (occurring in less than 5 spots) is to use Goodwinol ointment on the spots and wait for them to disappear. Personally, I don't think Goodwinol ointment does much, so I just tell people to wait and see if the spots disappear and do nothing. Lots of clients aren't comfortable doing nothing, which is probably why Goodwinol continues to be recommended.

Approximately 80% of dogs with localized demodectic mange will outgrow the condition. It is important to know if your pup will outgrow this condition on its own if you intend to breed her. If she does not outgrow it without medication other than Goodwinol and perhaps antibiotics for secondary infections, she should not be bred. If she does outgrow it then it is probably not genetic in origin and it is OK to breed her.

If she does develop generalized demodicosis there is only one approved treatment, which is amitraz (Mitaban Rx) dipping. This works well between 50 and 80% of the time to control generalized mange. When it doesn't work there are alternative unapproved treatments. Check our dog index for more information if you ever need to know more about these treatments.

So, my advice in localized cases of demodecosis is to do nothing and wait. Goodwinol is not harmful, probably isn't helpful but is definitely OK if you need something to do while you wait. Most of the time this will work out OK. If not, there are treatment options.

Mike Richards, DVM

Demodicosis treatment

Q: demodecosis in 2y old pit bull txed with ivomec 1x already and did well but recurred and now back on ivomec, primor any news on immunoregulin to stim. tcells?

A: salmatt- I do not know of any information that suggests that Immunoregulin (Rx) is helpful in treatment of demodicosis but it may be. We have had pretty good luck using amitraz (Mitaban Rx) for demodecosis and it is currently the only approved treatment. We find that ivermectin (Ivomec Rx) helps in the control of cases that do not seem to be "curable" but have not had a case yet in which it seemed to eliminate the mange entirely. We use it after Mitaban hasn't worked, either, so that may make our success rate lower than someone who uses ivermectin first.

Mike Richards, DVM

Treatments for demodicosis

Q: Dear Dr. Mike, My husband and I have a thirteen month old chocolate lab. When he was about four months old, he was diagnosed with a generalized case of demodex (he had red, pussy bumps all over his belly). At that time, we were given a generic Keflex for him to take twice a day. Also, we were to take him in for a Mitaban dip every two weeks. We finished his antibiotics and continued his dips for six to eight weeks. Our vet did a skin scrape and found no mites. He gave us a medicated shampoo to use if we saw any more red bumps. Well, at the end of March or early April, the bumps were back on the underside of his neck. There was no puss this time, just scabs. The shampoo did not help at all. When we took him back to the vet, we were told that we may have stopped the dips too soon last time and to give him another round of antibiotics and at least eight more dips. His condition has cleared considerably since we started the dips and finished the pills, but every now and then we see a small patch of hair loss. I'm getting worried that our course of action may not work. Do you have any suggestions for treatment? Should I just keep up the current treatment and hope that his immune system will strengthen and beat the demodex? Will we ever be able to work him at the duck blind or will the marsh water irritate this condition? I'm getting desperate! Any advice you could give would be greatly appreciated. Thanks!

A: Jennifer- There are three potential treatments for demodicosis. The only approved one is the Mitaban (Rx) dip. In some cases it won't completely clear a mite infestation. We usually either ivermectin or milbemycin (Interceptor Rx) when Mitaban fails. Ivermectin is given at high dosages, potentially within the toxic range, for this condition. Despite this, we have not had a toxicity problem yet and feel that it has helped some dogs become mite free-- but not all. Milbemycin is given at the standard heartworm preventative dosage but given daily for 6 to 8 weeks. This can get pretty expensive and we haven't actually tried it yet so I don't have much personal experience to offer. We have usually resorted to using Mitaban and/or ivermectin on a monthly basis to control the Demodex and let the dog live with it.

I don't see any reason why your dog couldn't hunt while affected with demodicosis if it is mostly controlled. You might want to ask your vet about this too. I live very near the Chesapeake Bay and many of my patients spend a great deal of time in the water. I don't remember any complications that seemed to be related to this in demodicosis cases.

The other possibility is that the mites are gone but that your dog has another problem or is simply highly susceptible to staph skin infections. Many Labs are. In these cases, repeated use of antibiotics may be necessary but usually the skin disease can at least be controlled. If allergies or an unrelated immune system problem is present it may be necessary to diagnosis this and try to control it. Getting control of allergies is harder in a dog prone to demodicosis since the use of corticosteroids can make return of the demodicosis a problem. Allergy testing and the use of hyposensitization should be considered for these dogs.

Mike Richards, DVM

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Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...

 

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