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VetInfo Digest February 2004

Introducing a new pet into the household:
Behavioral concerns
Medical concerns
One vet's quirks
Atopica (Rx) from Novartis

This Month's Note:
This month I am including information on a new drug that has just become available for the treatment of itching associated with skin disease in dogs. The medication should be a good choice for many dogs with this problem. It may also be useful for skin disease and asthma in cats, although it isn't approved for this purpose. I suspect that there would be a lot of enthusiasm for the use of this medication among veterinarians except for one thing. The cost of this medication is likely to make most veterinarians and most pet owners think long and hard before using it.
I have no way of knowing how much it costs to manufacture medications. I know that the research and development is costly in some cases. In this case, I suspect it wasn't so bad, considering that the medication has been used "off-label" for skin diseases for several years by veterinarians and studies at several universities were done which showed that the medication was effective. Assuming that profit isn't the main motive behind the price and that it simply costs a great deal to develop, test and manufacture this drug, perhaps the most surprising thing is that a drug company brought a pet medication to market that may cost several hundred dollars a month for some patients.
My question is this: will my clients assume that they should get a discount on my professional services when I am charging them a thousand dollars or more for a medication each year since itmay be hard to pay for both things? If they do assume this, is it time that veterinarians stopped also being the pet pharmacy so that the cost of professional services is distinct from the cost of veterinary medications? I truly wonder if our profession will need to make this break in order to maintain a high professional standard for our true work, diagnosing and treating illnesses.

Introducing a New Pet into the Household
"How do I introduce a new cat (or dog) into my house?" is probably one of the hardest questions that people ask me on a regular basis. There is no easy answer to this question. There is a big difference between introducing a dog into your house who comes from a private home and one who comes from a large commercial breeding establishment. Similarly , a cat from an animal shelter or cattery is much more likely to bring a new infectious disease into a household than a kitten from the neighbor's house cat who is an "only cat". Your household may pose little risk to a new pet or may also be a major factor in decision making, depending on how many pets you already have and what kind of pets they are. Making decisions about quarantine periods, diagnostic testing to rule out chronic diseases and making a plan to safely introduce a new pet takes consideration of all of these types of factors.
When you begin to contemplate adding a pet to the household it is pretty important to think about the impact that it will have on the pets you already have. The age and health status of the current pets sometimes makes it necessary to choose a new pet with great care. Behavioral problems that may occur can sometimes be suspected from previous behavioral episodes but often seem to come as a complete surprise to my clients. Assessing your current household's existing health care needs and behavioral status is a wise course to take before you add a pet.
Behavioral Considerations
Dogs are a little more likely to accept a new addition to the house than cats, but this is just a general observation. Individual dogs can become quite upset at the prospect of sharing attention, food or family time. Some cats truly like having a companion even though cats are often more likely to appreciate a solitary lifestyle. I often recommend borrowing a friend's pet for a few hours when people are trying to figure out if their pet would like to have a companion. This has to be done cautiously, since there is some potential for a fight or a great deal of commotion when it turns out that a pet really doesn't want to share its house.
In general, if a cat is willing to tolerate a new cat being in the house at all it will generally accept a new cat over time. Cats who really want to live alone usually make that wish apparent right from the start. A calm new cat helps a great deal, too. In behavioral studies of cat interactions it has become apparent that cats who frighten easily can induce attacks on themselves, even from cats who generally do not exhibit aggressive behavior.
Dogs who will play with another dog when it comes onto their property or who have had companions in the past without difficulty will usually accept a new dog. A dog who is very wary of other dog's actions and insists that proper dog etiquette be followed in all first meetings is not as likely to accept newcomers. These types of dogs will sometimes accept puppies more readily than older dogs, possibly because they get some opportunity to shape the puppy's responses to them. In addition, puppies are more likely to accept a submissive role, which also helps limit the potential for a bad introduction.
There are a few things that can be done to help with the introduction of new pets. A relatively recent addition to this list is the use of pheromones to try to influence pet behavior. Synthetic pheromones that mimic calming or "friendly" pheromones are available. The dog hormone, DAP (tm) is meant to help create a calmer atmosphere and the cat pheromone, Feliway (tm), is similar to the one cats use to mark friends and friendly territory. The use of these pheromones for a day or so before introducing a new pet and for several weeks after the introduction of the pet seems to cut down some on aggression based on our clinical experience --- but it definitely does not eliminate problems entirely.

It can help when introducing a new dog into a household if the dogs first meet on neutral grounds. Introducing the new dog at the park or some other spot where neither dog feels the need to defend its territory can make the introductions go a little smoother. Obviously, this doesn't work when introducing a new dog to a household with cats. When bringing a dog into a household with cats it is sometimes helpful to keep everyone separated in different rooms for a few days so that they get used to each other's presence gradually before actually meeting. Keeping the dog on a leash and any really aggressive cats under control is safer than just letting the dog loose and hoping the cats will fend for themselves.
Introducing a new cat into a household that has cats is sometimes extremely difficult. It is helpful with cats to keep the new cat separate from the prior residents for a few days by keeping them in separate areas of the house, as well. It is helpful with cats if the rooms are switched around every day or so, making the cats a little more aware of each other. When it is time to make the actual introduction it is sometimes helpful to put the new cat or the resident cat (works best if there is only one) in a pet carrier so that the cats first meet with a barrier between them.
Where there are severe difficulties with introducing a new pet it can sometimes be helpful to use medications to calm one or all participants. For dogs the use of selective seritonin-uptake reinhibitors (SSRIs) such as fluoxetine (Prozac Rx) or partial SSRIs such as clomipramine (Clomicalm Rx) can sometimes be very helpful. These can work for cats but often the use of buspirone works better. In cats, buspirone is sometimes given to the cat being attacked because it seems to slightly increase aggressive tendencies and cat fights often end if the cat being attacked stands up for itself. Medications really should be a last resort but when the situation is really out of hand they can sometimes be helpful.
Both cats and dogs will sometimes simply refuse to accept a newcomer, continuing to feud or fight for months or years. I have several clients who have simply elected to keep their pets completely separated in these cases. Other than choosing to make one pet an indoor pet and the other an outdoor pet, this can be a complicated solution -- but it seems to work for some people. Behavioral problems are only part of the difficulty in introducing a pet into a new household. Medical concerns are often a major issue, as well. Cats are probably a little more difficult in this regard, as well, due to the prevalence of chronic viral problems in cats compared to dogs.
Medical Concerns
When a new puppy is going to be introduced into a household the biggest risk to the puppy is probably parvovirus. This virus can live in the environment for up to 9 months in ideal circumstances and probably lives in the environment for several months after an infection occurs in most cases. Compounding this problem is the fact that parvovirus infection in most older dogs is an in-apparent infection, causing no clinical signs or very transient diarrhea in most infected adults, even though they may be shedding the virus. If the household dogs are over 20 weeks of age and received proper puppy vaccinations they are probably not going to spread parvovirus to a puppy or to catch it if the puppy is infected when acquired. If a puppy is coming into a household to replace a puppy who died from parvovirus it is best to wait for several months before getting the new puppy since the virus often lives that long.
The biggest risk from a puppy to household dogs is probably distemper. There is some time (the prepatent period) between the time a puppy is infected with distemper and when clinical signs appear. During this time it is pretty difficult to tell if the puppy could spread distemper to the new household. Fortunately, distemper vaccination works pretty well, so if the household dogs are vaccinated properly they are very unlikely to contract distemper from an infected puppy.
Common nuisance diseases that new puppies can bring to a household include coccidiosis, roundworm infection, tracheobronchitis (kennel cough, Bordetellosis), lice, fleas, ear mites and sarcoptic mange. Most of these disorders can be detected during a physical examination, so it is important to have a puppy examined prior to bringing it home to the household. If the physical exam and the results of a fecal examination fail to show any problems it is still a good idea to observe a short quarantine period, ideally about 2 weeks, just to be sure that no latent illnesses will emerge and infect the whole household. I know that this is often impractical but when a quarantine period isn't possible it is more likely that disease problems will occur in the new puppy or the pets who were in the household when the puppy arrived.
There are a number of disease risks when introducing a new cat into a household with existing cats. The biggest problem is probably the introduction of feline upper respiratory disease into a household not having problems with it already. Cats who come from group situations are very likely to be harboring at least one upper respiratory virus and often are carrying more than one virus. Vaccinations against the most common upper respiratory viruses in cats, calicivirus and feline herpes virus I, do not prevent infection. This comes as a big surprise to many people, but these vaccinations only help to suppress symptoms of the upper respiratory infections. They do not prevent infection from occurring. In addition, it is now known that there are several strains of calicivirus and that vaccination does not protect against all of them.
It is best to know the status for feline leukemia virus infection of both the new cat and the household cats prior to introducing a new cat into a household. FeLV infection is possible to detect very early in the infection using the standard in-clinic ELISA tests. It is extremely important to remember that this test is very accurate for detecting cats who do not have FeLV virus in their circulatory system, so a negative test is very reassuring. On the other hand, this test is much less reliable when a positive test result occurs in a cat who is healthy based on the results of physical examination. If any of the cats should test positive on ELISA testing when clinical signs of illness are not present, it is best to do an IF A test to try to confirm the infection. This test must be sent to a laboratory capable of running it, so it can take a few days to get test results. If there is a positive test on the ELISA test and a negative IFA test, it is probably reasonable to introduce the cats to each other, but there would be a small amount of risk associated with this decision.
Feline immunodeficiency virus (FIV)status should be determined whenever possible, as well. There is a long period of time between initial infection with FIV and when antibodies to the virus appear in the blood stream. All of the current in-clinic test kits test for antibodies against the virus rather than for the virus itself. This means that there is a two to three month time period when it is not possible to detect FIV infection. Tests for FIV are not considered to be conclusive in kittens until the kitten is about 4 months old due to the potential for maternal antibodies to be present in the kitten, causing false positive results and the pre patent period causing false negative results. There is no way to completely eliminate the risk of an inapparent FIV carrier other than a 3 to 4 month quarantine period, so this is an important consideration when adding a kitten to a household with FIV negative cats.
Many of my clients who adopt kittens are worried about feline infectious peritonitis. This is a mutant form of feline coronavirus. There is a screening test for exposure to feline coronavirus (usually referred to as an FIP titer). If the household cats are all negative for antibodies to feline coronavirus it is best to make sure that the kitten is also negative for this disease. In this situation bringing a cat into the household who has feline coronavirus infection could lead to all the cats being exposed, increasing the risk of FIP in the household. On the other hand, if the household cats test positive for exposure to this virus and the kitten is negative, the risk to the kitten of developing FIP is slight but present. If both the kitten and the resident cats already test positive for exposure to FIP then there isn't any increased risk to either the kitten or the resident cats if the kitten comes into the household.
Even though testing for exposure to feline coronavirus is relatively easy to do, I don't recommend it in most circumstances in my practice because the percentage of cats who carry this virus is pretty high and most of my clients are not trying diligently to keep a feline coronavirus negative household. This testing makes the most sense for people who are keeping a group of cats who have been able to successfully avoid exposure to feline coronavirus in the past.
Cats can be carriers of Microsporum canis, one of the organisms that causes ringworm. It is possible for a cat to carry this fungus in an infective state without any evidence of skin disease. It is more common for kittens with ringworm to have small areas of hair loss, often on their face or feet, though. Anytime there is hair loss in a kitten this disease has to be suspected. Since an infected kitten can infect other cats as well as people, ringworm can be a serious problem if a new cat is carrying it. We recommend testing any suspicious spots when examining kittens and for our clients with a strong need to keep ringworm out of a cattery or household we do toothbrush cultures of the kitten's fur to rule out ringworm. This test takes up to two weeks to produce a negative result, so some quarantine period is necessary if there is a need or desire to rule out ringworm prior to introducing a kitten into a new household.
Coccidiosis is an intestinal parasite that is common in both dogs and cats. This protozoan is pretty hardy and is extremely difficult to prevent entirely in kennel and group dogs situations. It is usually responsive to therapy, although it can take more than one try with medications to eliminate it. Having your vet check a stool sample for the presence of this parasite, as well as worms, is a good idea prior to introducing a new puppy or kitten into a household with other pets.

Personal Quirks
Every veterinarian who has practiced for more than a few months has developed some quirks -- or at least some beliefs that don't match generally accepted thinking among veterinarians. I am not an exception to this rule. This month, I would like to disclose some areas where my thinking is different than that of mainstream vets and why I think the way I do. Past issues of the VetInfo Digest contain a few articles about major differences that I have with mainstream thinking among veterinarians. I'll try not to go over the differences that have already been detailed in previous articles in depth again. Please keep in mind that when anyone's view differs significantly from the majority opinion it does have to be taken with a grain of salt.
Perhaps the biggest difference between our practice and the "average" veterinary practice is that we do not keep any patients in the hospital overnight except in very unusual circumstances. In the last two years I think that we have had a total of three or four nights when there has been a patient in our hospital. No one is here at night, so I don't see any reason why pets should be here. I know that this is sometimes an inconvenience for my clients but the ones that really object usually find other veterinarians pretty quickly. When a pet really needs hospitalization we ask the client to transfer them to the local emergency clinic (EVC) for observation at night and to bring them back in the morning. Fortunately, most of my clients are pretty good at caring for their pets when they have to be, so we don't have to send them to the EVC very often. Originally my thinking was simply that I hated being in the hospital and didn't see much reason to stay, so why should I make pets stay overnight? Over time I have realized other benefits, the most obvious one being that if a pet is at home someone is at least there with it who can report a problem if one occurs. I really do think that being home helps our patients recover more quickly in most cases, as well.
I don't think that surgery for cranial (anterior) cruciate ligaments works well enough to make it worthwhile. This is definitely not the majority opinion among veterinarians but I do think that most of the long term studies of this surgery support this position. The possible exception is the tibial plateau leveling osteotomy (TPLO) surgery, but only because it hasn't been widely available long enough for long term studies to have been done. This makes it possible it is finally the surgical answer for this disorder or possible that it will be like all the other procedures that have been attempted in the past for correction of this problem -- possibly beneficial in the short term but not able to prevent the longer term problem of secondary arthritis.
Most veterinarians and every single veterinary dental specialist I have corresponded with or spoken to insist that it is only possible to do a good job cleaning a dog or cat's teeth when they are under anesthesia. With only mild reservations, I can agree about dogs. I strongly disagree when it comes to cats, though. I attempt to hand scale the teeth on every cat that seems to need it when I do yearly physical examinations. In most cases I think this can be done successfully. Cats have fewer teeth than dogs and cats usually form tartar on the side of the teeth toward the lips only. This makes it possible to reach all the teeth and to find most of the tartar. Surprisingly, most of my feline patients are pretty good about letting me scale their teeth. Obviously this doesn't work for all cats but it works for enough of them that I think it is worth doing. I really believe that we see a lot less dental disease in our patient population since we started this practice. I suspect that this is something that may never catch on in the general veterinary community but I think it works pretty well.
When cats have kidney failure or require fluid therapy for other reasons on a frequent basis, we teach our clients to give the fluids at home. This is easy to do, hard to mess up and cats would rather be at home than in our office, almost universally. I can't really understand why many veterinarians are reluctant to teach, or even allow, their clients to give fluids. We have been doing this for twenty-four years and have not had a single client injure their cat or cause a serious complication with the fluid therapy. We tend to send home IV fluids for dogs in most circumstances and we teach clients how to give fluids through an IV catheter that we place, but this is not quite the same thing. We do want to recheck the catheters daily and so clients usually have to come back to the office frequently when dogs are getting fluids, with the exception of small dogs who can be given adequate fluid volumes subcutaneously. If your pet needs fluids it is worth asking your vet if he or she will teach you to do it so that it can be done at home. Don't be too surprised if your vet won't go along with this idea but don't be afraid to ask.
I think that all diabetic pets should be monitored at home using blood glucose monitors, if possible. There really are some pets who won't allow their owners to get even a small blood sample and a few clients who simply are too phobic about blood or needles to do the testing, but not too many. Home testing allows more efficient monitoring of blood glucose curves which really helps a great deal in establishing proper insulin dosages.
I have heard lots of reasons why veterinarians are opposed to at home glucose monitoring, including fears that it will "turn off" clients, that the meters are not accurate enough and that there are risks to the client when attempts are made to get blood from pets. I think that all of these things are true at times but that they are simply risks to be understood and managed. We compare results from home glucose meters to our lab machines pretty frequently and we have not yet seen a meter whose readings weren't at least 5% different than our lab machines (which we test for accuracy). This is just something to account for, not a reason not to do the testing. The meters are most accurate in the normal blood glucose ranges and get more and more inaccurate as the blood glucose levels get very high or very low -- but in these ranges accuracy isn't nearly as big a concern as knowing that you are in those ranges and correcting the situation.
We have been able to help our clients gain really good control over their diabetic pets on a pretty consistent basis and a big part of that success has been the use of at home blood glucose testing. It is a little daunting at first, but it is worth trying.
Several times in the last year or so I have pointed out that the interval between vaccinations should be examined and in most cases lengthened. We are currently using an every 3 year schedule for most of the core vaccinations (after the first year boosters) and have not seen problems using this approach. I do practice in a rural area where infectious disease is less of a problem for my patients, but I suspect that this success is not entirely based on geographical location. I suspect that it would be reasonable to extend the vaccination interval for a longer period of time and that eventually we will. I'm not a fan of checking titers to see if the vaccines are working. There is too much variability in titer testing to make it really useful based on what I can discern from the literature. We picked our current interval based on a couple of small studies in which vaccinated pets were exposed to viral agents (challenge studies) to see if they would get sick. So far, for the most common vaccine components the length of protection has been significantly longer than three years. It does help to have a significant portion of the population well protected against viral agents to reduce spread of the diseases, though. In order to ensure that this is the case we will probably stay with the three year interval for now.
Lots of vets are unwilling to switch away from yearly vaccinations. To some degree this is an economic concern but I have talked to enough of the reluctant vets to know that some of them really aren't sure that the vaccines will provide adequate protection for longer intervals. In dogs this is a small issue since harmful reactions really do appear to be rare events. In cats the issue is of much more concern due to the link between administration of vaccines (and other injectables) and cancer formation at injection sites. This provides a clear reason to avoid vaccination when it is not necessary. As time goes on I think that most vets will recognize the importance of this problem and move towards longer vaccinations intervals for their cat patients. One exception to this rule is the use of PureVax (Rx), a rabies vaccine made without adjuvents (substances to stimulate an immune response) that must be given yearly but is much less likely to cause cancer since it has no adjuvents.
I think that pain control is a major component of successful therapy for pancreatitis. I have run across several veterinarians recently, including at least one veterinary emergency medicine specialist, who disagree with this assessment. All I can say is that since we started using good pain control medications as early as possible in suspected cases of pancreatitis, we have seen a reduction in the number of days patients suffer with this condition and less really severe disease. We often give both a narcotic pain reliever and an injectable non-steroidal anti-inflammatory to provide as much pain relief as we possibly can. Some day the proponents of withholding pain control might prove they are right but until then I will continue to give pain relief medications as it seems to work well in our patients.
Bloat, or gastric dilitation-volvulus (GDV) is a condition in which air is trapped in the stomach due to a shift in its position (usually). Large buildups of air can occur quickly, making some dogs appear to have swallowed a beach ball or something similar. There is a long standing argument among veterinarians about whether it is better to treat this condition medically at first or whether to proceed with surgery quickly. I definitely fall in the camp of veterinarians who think that dogs with GDV should be taken to surgery as quickly as possible -- or at least anesthetized as quickly as possible. It is surprising to me how much better the vital signs are of patients within seconds of anesthesia. It is truly scary to anesthetize a patient who is bordering on severe shock or who may already be in circulatory collapse but this is one situation in which I am convinced it is the proper course of action.
With the advent of endoscopy, improved X-ray techniques and ultrasonagraphy, there seems to be a growing reluctance among veterinarians to pursue exploratory surgery. While this is often a good thing, I still think that early use of exploratory surgery as a diagnostic tool, as well as an effort to cure a problem, is a valid procedure and one that is often more valuable than the imaging techniques. There are times when delaying surgery to exhaust every noninvasive way to diagnose an abdominal problem leads to unnecessary complications. The most important of these instances is when an intestinal obstruction is suspected. In this case, exploratory surgery should be done sooner rather than later. It is disappointing when surgery is performed and nothing conclusive is found but looking at this as the best way to get that diagnosis makes it a little easier to understand.
Most of the veterinary anesthesia specialists currently teach veterinary students not to "mask" induce anesthesia. This usually includes techniques that don't actually involve having the pet breathe through a mask, such as Plexiglas induction chambers. They base this recommendation on analysis of things like blood pressure during induction, the release of adrenaline and related hormones and the lack of swift induction of anesthesia so that an endotracheal tube can be quickly placed to "capture" the airway. To some extent, this is good advice, especially for young veterinarians who aren't experienced at placing endotracheal tubes. We don't use an induction chamber and I can't speak to the experience pets have when these are used. An induction chamber is usually a clear box that looks like an aquarium that the anesthesia and oxygen are pumped into until the pet falls asleep. We use a real mask and we hold our patients while applying it. This may not be good for us (another risk pointed out by anesthetists) but most of our patients accept this procedure without too much excitement, especially when we have used a sedative and/or narcotic pain reliever as a pre-medication. The ones that won't usually make it apparent pretty early in the process, making it possible for us to change plans. If your vet is comfortable with using mask induction and provides some comforting support during the induction for the pet I think that the procedure provides enough advantages, especially the ability to quickly revive the patient by stopping the gas flow, to make it worthwhile.
We try to restrain our cat patients as minimally as possible. Sometimes I even give injections without any restraint effort at all. For the most part this has worked better in our practice than trying to provide adequate restraint by forcefully holding a cat still or placing it in a restraint device such as a cat bag. Overall, this seems safer to me than struggling with the cat for control but this is just a judgment thing. I know that I get bitten or scratched at times due to the lack of restraint but I'm pretty sure that it is less frequently than some times in the past when one of my technicians has been determined to get complete control of a cat prior to working with it. This advice runs strongly counter to the advice given by veterinary liability insurance companies and I suspect that it might not be feasible in areas in which lawsuits are more common than in rural Virginia, but it is a better way to work on cats much of the time.
We give our canine patients lots of treats. It is sometimes a little odd to be telling a client they need to cut back on dog treats while everyone in the office is giving their dog a treat, but we want our patients to feel like they've had a good visit. For most dogs, lots of treats helps form this opinion. It is often possible to give a puppy a vaccination without any evidence the puppy noticed if it is busy eating a puppy biscuit. Some of out patients had reputations for being quite aggressive at other veterinary offices but will let us work on them pretty willingly. This doesn't always work but it works well enough that we would recommend it. If your vet doesn't give out treats take some with you and give them to your dog during the examination or visit, as long as you are careful not to interfere too much with the examination or medical procedures. Some dogs are too nervous or upset to even consider eating a treat but this really does seem to make a difference in the attitude of many of our dog patients.
I'd like to say we have found a similar way to ease the anxiety of vet visits in cats but most of them won't take treats from us. We tried hard to find a treat that was irresistible to cats but even the most attractive treat we have found, Pounce (tm), just isn't as successful for cats as almost any treat is for dogs. We still try sometimes but we're used to rejection from our feline patients!
One of the things that really drives me crazy about doing the VetInfo web site is the number of times when it seems apparent to me that it is reasonable to test for a condition but the veterinarian handling the case refuses to do so. I know lots of reasons this might happen. Some clients balk at testing costs and vets usually know who they are. A physical examination may be strongly suggestive of another condition and the vet may be reluctant to spend a client's money for a test they consider unlikely to produce a diagnosis. There are often differences of opinion over the value of a particular test procedure. Finally, some clients ask for tests that really don't make sense because they don't have enough medical perspective to see that a situation simply isn't likely to be a problem they have read about. Still, when a client is asking me to do a test because they have reason to suspect a problem, I tend to go ahead and do the test as long as it doesn't have strong potential for harming my patient. My reasoning is simple. You can't know for sure that a test isn't going to be useful until you run it -- with a few exceptions.
If I added up all the times when I have been truly surprised by test results it would have to number in the hundreds of cases. I am even willing to run tests that I really don't believe are useful, such as feline infectious peritonitis tests, as long as the client is willing to listen to my explanation of what the problems with a test are and how that affects their usefulness. If a client wants to try to save money on testing then I think their best bet is to rely on my experience, which is almost always greater than theirs, on which tests to run to get the most information for the least cost. If a client wants to test for things I wouldn't include in my initial or follow-up testing but they feel it is important, I include their tests as long as they understand that they are making the decision to spend the money. Every now and then a client asks for a test that I would not have included in my original diagnostic plan that turns out to be an important part of the diagnostic process. In at least one instance, I know that a client's insistence on testing for something I wasn't considering saved their pet's life. Sometimes it does seem like a client is doubting my abilities when they ask for a specific test procedure and I can understand how it can be very tempting to tell them I know best. However, I'd rather do that by running the test. If I'm right, then I can feel a little smug. If I'm surprised by the result I have the opportunity to have a live patient at the end of the day. I win either way.

New Medication
Novartis (tm) has recently gained FDA approval for the use of cyclosporin to treat itchiness (pruritis) associated with allergies in dogs. The brand name of this product is Atopica (Rx). The dosage is 5mg/kg and the medication is meant to be used daily for long term control of pruritis and skin lesions associated with pruritis. This could be a major improvement in therapy for dogs who are sensitive to the side effects of corticosteroids. While it isn't approved for cats, cyclosporin has been used to help control asthma in cats who are sensitive to steroids and unwilling to allow therapy using inhalers. The price of this medication is truly astounding, though. I suspect that the cost for using this medication for a 50 pound dog will exceed $200 per month at most veterinary hospitals. For dogs over 65 pounds it will be necessary to administer multiple tablets per day, making the medication difficult for most pet owners to afford for large and giant breed dogs. Even with this in mind it is good to have another option for control of pruritis associated with allergies in dogs, since this can often be an extremely frustrating condition for both the pet owner and the dog.

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This page was last edited 06/15/04

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