VetInfo Digest March 2004

Table of Contents:

Dermatophytosis - also known as ringworm, in dogs and cats

Lyme Disease

Tick Borne Disease Information Updates

 

This Month's Note:

 

Recent studies have been published on two topics that interest me a great deal. The first one was a study that showed that owner compliance in administering veterinary medications to pets according to label directions is roughly 50%.  Just about half the time pet owners fail to follow directions written on medication labels. In some cases this can be a life threatening mistake. In other instances it may be contributing to major health problems for both pets and humans through the creation of resistance to medications, especially antibiotics.  When a label says "use until gone" it is best to do that unless you have contacted your vet about a problem with the medication and he or she has agreed it should be discontinued. This is especially true for antibiotic medications.

A second study that I found extremely interesting was a comparison between the "ante-mortem", or before death, diagnosis at several veterinary teaching hospitals and the "post-mortem" diagnosis given by pathologists after post-mortem examination. It is generally assumed that post-mortem examinations allow for a more accurate diagnosis. If this is true, then even at major veterinary teaching hospitals, presumably equipped with the latest in diagnostic equipment and with several specialists at hand most of the time for consultation, the error rate in diagnoses given prior to death is approximately 33%. 

This is both a scary statistic and a reassuring one. It is scary that even today we can't do better than 66% accuracy in pre-mortem diagnosis. On the other hand, for veterinarians in small practices like mine, who are often faced with the need to explain to a client that our initial diagnosis was incorrect, it is reassuring to note that even with better equipment and more ability to consult with other veterinarians there is still an error rate that is not much better than ours. For pet owners the most important lesson in this study is to continue to ask questions and to allow additional testing when an initial diagnosis does not seem to be resulting in a positive result for treatment efforts and particularly when things seem to be getting worse instead of better.  There are often other possible causes for symptoms seen or alternatives to treatment that might work better.

 

Dermatophytosis  (Ringworm)

Ringworm affects cats more commonly than dogs and it affects both species less than many other common skin diseases. Unlike most of the other skin diseases that pets have, though, this disease is contagious to humans and it is not uncommon for pet owners who have affected pets to become infected themselves.  Diseases that can be transmitted from pets to humans are referred to as zoonoses or zoonotic diseases.

There are a large number of medications that have some effect on ringworm, but many are only partially successful in controlling the infections, which makes for a confusing situation for pet owners seeking treatment information. Even for veterinarians with access to medical books and journals the situation is still a little confusing as there is some disagreement among veterinary dermatology experts about the best methods for treatment and the effectiveness of various treatment methods. Keep this in mind while reading this article. I have tried to be careful to stick with the most commonly accepted information but it will be possible to find differing opinions.

There are several organisms that can cause ringworm infections. They are all members of the Dermatophyte family, so the disease is also referred to as dermatophytosis. The most common organism affecting cats is Microsporum canis, with some dermatologists estimating that it accounts for over 95% of infections (Foil, 1997) and others giving Trichophyton species a little bigger role in the development of ringworm in cats.  It seems clear that most cats who are carriers of ringworm without apparent infection are infected with M. canis, though. In dogs there is a much more even split among the various causes of ringworm, with M. canis thought to cause about 50% of infections and Microsporum gypseum and Trichophyton mentagrophytes causing most of the other infections, although there are a few more rare species of ringworm organisms.

When a pet in a household has ringworm it is somewhat likely that a human in the household is or will be infected with the organism. Studies have varied a little in the reported percentage of human infection in households with an infected pet but it is probably somewhere between 50 and 65%. Many people seem to be somewhat resistant to ringworm infection but others are very susceptible and  are likely to catch the infection quite readily from an infected pet. If you know that you are susceptible to ringworm it is important to consider having any cat that you adopt from a multi-cat household or environment, such as a shelter or cattery, tested for ringworm. This is probably a good idea in any case.

When most people think of ringworm they think of the classic lesion in humans, which is a red inflamed circle on the skin which looks a lot like a worm burrow, which is how this fungal infection got the name "ringworm" in the first place. Ringworm sometimes looks like this in dogs, except that the ring is located in an area of hair loss. Most cats don't get anything resembling a ring. They may have one or more areas of hair loss that can look like the hair just fell out with no effect on the skin or the skin may be a little crusty or inflamed. It would be nice if these were the only ways that ringworm infections presented themselves, but unfortunately there are many other possible appearances for ringworm lesions, including:

Ringworm Lesions on Cats

Ringworm Lesions on Dogs

It is important to note in dogs that bacterial skin infections are much more common in dogs than ringworm and staphylococcal (staph) skin infections in dogs  can look very much like the typical ringworm infection in people -- a round area of hair loss with a zone of reddened scaly skin along the edges of the area of hair loss.  If your vet suggests treating for a bacterial skin infection first, before trying to decide if ringworm is present, this is usually the proper advice, although it probably doesn't hurt to do a ringworm culture, especially if there is reason to be suspicious it might be the cause of a skin sore on a dog.

Once ringworm is suspected, it is necessary to confirm the diagnosis. There are some ways of getting to a diagnosis of ringworm pretty quickly, but the most common "quick" diagnostic method, the use of an ultraviolet lamp to cause lesions caused by ringworm to fluoresce has some major drawbacks and it is questionable whether treatment for ringworm should be initiated based on the use of UV light (Wood's light) examination alone.  Veterinarians who are adept at identifying ringworm spores can sometimes make a diagnosis based on examination of hair or scale removed from the pet and examined microscopically.  An examination done by someone who is used to looking for ringworm is considered to be sufficient proof for treatment if ringworm is found but microscopic examination doesn't rule out the infection if ringworm is not identified. Even when spores are present and can be identified microscopically it is best to follow up with a ringworm culture to help determine the specific type of ringworm organism present in order to guide treatment choices as time goes on.

There are several methods of obtaining samples for ringworm culture. Using an ultraviolet lamp to help identify fluorescent material to culture is a reasonable use of a Wood's lamp in the diagnostic process. Using this method, fluorescent hairs are plucked or removed and cultured. We use a method referred to as a "toothbrush" culture because it gives us the most consistent results. In this culture method a toothbrush is used to brush the hair around suspected lesions and/or throughout the hair coat (especially when looking for inapparent carriers) to pick up loose hairs and dander. The toothbrush is then gently pressed into the ringworm culture medium and the culture is allowed to grow.

The growth phase for ringworm cultures is often frustrating for veterinary clients. It can take up to three weeks for a ringworm culture to grow.  It is thought that placing the culture plate in a darkened, moist and slightly warm environment (around 25 to 27 degrees Centigrade or 80 degrees Fahrenheit) is helpful in stimulating fungal colony growth and speeding up the culture results but it still takes three weeks before a culture can be declared negative even with this technique.

Once it is clear that ringworm is present, treatment should be initiated. It is important to remember that it may be necessary to treat all the cats in a household to clear the infection, since cats can be inapparent carriers of this disease. This is not as necessary when treating dogs in multiple dog households but all other dogs should be monitored closely for signs of infection and treated if necessary. Most of my clients really want to try to treat ringworm infections using topical medications. There are a lot of topical medications used for ringworm or other fungal infections in people and it is assumed that these will be equally effective in pets. I'm actually not sure how effective these medications are in people but in dogs and cats they do not seem to work well enough to eliminate ringworm infection entirely on their own, in most cases. Despite this, topical therapy for visible lesions is a good idea., to try to limit spread of infection from active lesions.

For cats, the most consistently effective topical therapy is probably lime-sulfur dip. This is unfortunate because this is also the product most likely to cause veterinary clients to call me and ask what I was thinking when I dispensed it. Lime-sulfur dip smells bad, turns fingernails yellow and is used as a sponge-on dip that should not be rinsed off after application. It makes white hair turn yellow (some say green) but this is a temporary effect. Humans applying this product should wear a mask, a water-resistant apron (or other protective clothing) and rubber, vinyl or latex gloves. Cats should be discouraged from licking the product off their hair when they are wet, to the extent this is possible. In Europe the use of enilconazole (Imaverol Rx) solution works well but this product is not approved in the U.S.  There is some disagreement about the effectiveness of miconazole shampoo for treatment of ringworm, in part because it has to be left on for at least ten minutes prior to being rinsed off and ten minutes is an eternity when dealing with a wet angry feline.  As far as I know, all other topical products are unproven for use in cats or have been demonstrated to be ineffective.  Some people do use OTC medications like Lotrimin or Lotrisone (Rx) and claim to see good effects from them but I'm not aware of studies that support these claims.  When using topical therapies in medium to long-haired cats it is probably essential to clip the hair coat in order to ensure success -- and it is better to do this even in short haired cats.

In dogs, topical therapy with the same products is recommended and they may be a little easier to use successfully since dogs are more tolerant of being dipped or bathed in most cases.  A single localized, or several small lesions in dogs may clear up entirely without therapy or with topical therapy alone. The kerion lesions that occur in some dogs often will resolve with or without treatment. Despite this, it is usually recommended that both dogs and cats receive topical therapy in conjunction with systemic anti-fungal medications and several veterinary dermatologists seem to be pretty convinced that topical therapy alone will not work in cats, at all. Systemic therapy  for ringworm takes the form of oral medications in dogs and cats. There are several medications that are at least partially effective against ringworm. Each has some advantages and some disadvantages.

Griseofulvin is the original oral medication for ringworm proven to be effective. It is relatively inexpensive. The cost difference in cats is not as pronounced due to the small doses necessary for the newer medications. Griseofulvin can cause a large number of side effects.  Vomiting and diarrhea are not uncommon when griseofulvin is administered. Neurologic signs such as difficulty walking occur in some treated pets.  Cats can develop bone marrow suppression that can be quite severe, leading to anemia and neutopenia. This effect is more likely to occur in cats with feline immunodeficiency virus (FIV) infection, so griseofulvin should be avoided in this group of cats.  If griseofulvin is given to pregnant pets it will often cause birth defects in the developing kittens or puppies.  Most veterinary dermatologists advise avoiding the use of griseofulvin in cats less than eight weeks of age and this holds true for at least small breed puppies, as well.  Despite all these side effects griseofulvin is used fairly frequently in veterinary medicine as the serious side effects are uncommon and the cost of griseofulvin therapy can be substantially less than the use of more modern medications.  There are two types of griseofulvin and the dosages are very different, so it is important that your vet prescribe the right dosage for the type of medication used and that if a prescription is written that the pharmacist understand that the type of griseofulvin dispensed is important. The dosage for ultra-microsize griseofulvin is 5 to 10mg/kg per day, which can be given as a single dose or split into two doses. The dosage for microsize griseofulvin is 25 to 50mg/kg per day, usually split into two doses.  Griseofulvin is more consistently absorbed from the digestive tract if it is given with a meal that contains some fat.

Itraconazole (Sporanox Rx) is a newer anti-fungal medication that is used pretty commonly for ringworm in cats and dogs. This medication is not approved for either species but seems to be safer to use than griseofulvin in most situations. In cats this medication must either be divided up into single use doses by a compounding pharmacy or by the pet owner.  One method of using itraconazole in cats is to divide up the dosage necessary by emptying the itraconazole capsule and carefully splitting the powder into individual doses and then mixing the powder with butter in a mini ice cube tray, making one individual dosage of itraconazole butter for each day.  The smallest itraconazole capsules I am aware of are 100mg, which is enough to make 5 individual doses for a five pound kitten. There are a number of dosing schemes that have been used to treat ringworm with itraconazole. The original recommendation was to use the medication at a dosage of 10mg/kg once a day until two consecutive ringworm cultures done at two week intervals were negative for growth of the ringworm organism.  Itraconazole is expensive, especially when compared to griseofulvin. This has led to efforts to find less expensive ways to use it, especially in multiple cat households where it is necessary to treat all the cats in the household to clear up ringworm permanently.  Using itraconazole continuously for a month and then using it on an every other week basis until there are two consecutive negative ringworm cultures is one way of cutting back on the amount of itraconazole necessary to treat multiple cats.  An alternative that  Dr. Karen Moriello (October 2003) recommends is the use of itraconazole daily for 15 days, then stopping testing for ringworm again. If the culture is positive or negative, wait two weeks and repeat the 15 day dosing period again. Once two consecutive negative cultures are obtained, discontinue the medication.

Veterinarians like new medications just about as much as human physicians do, so it isn't surprising that people have tried other anti-fungal medications in dogs and cats.  One new medication that has been used for ringworm in cats is terbinafine (Lamisil Rx). This seems to work when dosed at 30mg to 40mg/kg once a day, based on a study by Dr. Moriello, but doesn't seem to offer any advantage over the use of itraconazole, which is currently less expensive. Another medication that is being used to treat ringworm is lufenuron (Program Rx). This isn't really a new medication in veterinary medicine but it was developed for use in flea control, so this is a new use.  The original studies promoting the use of lufenuron were very positive, with response rates reported to be as high as 80%. However, newer studies seem to cast some doubt on this success rate, although there are controversies about the dosages used and the conditions the studies were performed under. At this time, the best I can say about lufenuron is that we seem to have some success with it, using a 100 to 120mg/kg dose, giving the medication two days in a row and then every two weeks until we get two consecutive negative ringworm cultures. Over time, it will become more clear whether lufenuron really has a big role to play in the treatment of ringworm in either dogs or cats.

Fort Dodge Laboratories (tm) developed a vaccine against ringworm. The vaccine is still licensed but is not used much as it became clear that it did not prevent infection even though it did seem to lessen the clinical signs of disease in cats who did subsequently become infected with ringworm. This result just wasn't good enough to compel most vets to use the vaccine.

It is necessary to try to eliminate the ringworm organism from the environment in order to claim complete success in treating ringworm. This can be a difficult task, especially in a multiple pet household.  Ringworm spores can remain infective for at least a year in the environment and possibly longer. The most effective method for reducing the amount of infective spores in a house is to vacuum the house daily and to throw the vacuum cleaner bag out each day, or to disinfect vacuums without bags. The HEPA filters that some vacuum cleaners have is effective at removing ringworm spores, as well. Any surface that can be treated with a disinfectant that will kill ringworm should be regularly disinfected. The most commonly used disinfectant is dilute chlorine bleach. I have seen recommendations for dilution from 1:4 to 1:30 for killing ringworm. We have usually stuck with a 1:10 ratio of bleach to water and we seem to be having good success with this dilution. Bleach can be corrosive and it may damage some surfaces and obviously may change the color of fabrics, so it has be used with caution.

Probably the three biggest mistakes made in treating ringworm are failure to clip the hair coat short in cats, failure to treat the environment and stopping therapy too early. Treatment is usually discontinued too soon when the follow-up ringworm cultures are not performed on all pets who might be affected or treatment is stopped before two negative culture results are obtained.  Ringworm can be quite frustrating to eliminate once it gets into a household but it is worth the effort to get rid of it entirely to keep it from coming back over and over again.

Lyme Disease

Any pet who is exposed to ticks runs the risk of developing a tick borne disease. This group of diseases is becoming more and more commonly recognized as better tests are being developed to identify and detect tick borne disease.  There continue to be problems in sorting out whether pets who have evidence of exposure to a tick borne disease actually have the disease, though. This problem makes it difficult to know how and when to treat pets who seem to have evidence of tick borne diseases and how to tell when treatment was successful.

The tick borne disease that most people seem to be familiar with is Lyme disease, caused by the organism Borrelia borgderferi. This disease causes swollen joints in dogs, often the carpal or "wrist" joints of the front leg, swollen lymph nodes, fever and is probably responsible for a percentage of the cases of severe kidney failure in dogs in areas in which the disease occurs.  Some dogs may develop neurologic disorders. Whether or not the Lyme disease bacteria can cause disease in cats is still somewhat of a controversy. It is clear that the organism can live in cats long enough to cause them to develop titers to the disease but much less clear whether cats go on to develop Lyme disease.

There are several key points about Lyme disease in dogs that are extremely important to keep in mind. The first of these is that 97 percent of the cases of Lyme disease occur in just 12 states. These are Connecticut, Rhode Island, New Jersey,  New York, Delaware, Pennsylvania, Massachusetts, Maryland, Wisconsin, Minnesota, New Hampshire and Vermont. There are some small areas along the West Coast of the U.S. that also have fairly high incidences of this disease, although they account for less than 1% of cases, overall. (Littman MP, 2003). If you do not reside in one of these states and have not recently visited one of them, it is a good idea to view a diagnosis of Lyme disease with some skepticism -- although the suspicion of Lyme disease should set off a search for other tick borne infections as several of the tick borne disease have very similar signs.

Another important point to keep in mind about Lyme disease is that 95% of the dogs who have titers to this disease have no clinical symptoms and will not develop clinical symptoms of disease. This can make it very hard to be certain that Lyme disease is causing disease when a positive titer is present and to rule it out in endemic areas since many dogs in areas in which this disease is common will test positive at almost any time if tested.  Clinical signs of Lyme disease must be present as well as a titer to the disease in order to make a diagnosis of Lyme disease.

Finally, one of the new lessons about tick borne diseases that has resulted from the availability of DNA testing and increased vigilance is that many dogs who have one tick borne disease have two or even three tick borne diseases at the same time. Therefore, when a dog presents with clinical signs of Lyme disease and a positive titer for the disease, it is still a good idea to at least consider the possibility that another disease maybe present, especially if the response to treatment is not good, as most dogs with Lyme disease affecting their joints will respond to therapy with appropriate antibiotics pretty quickly.

Kidney failure associated with Lyme disease has been suspected for some time but absolute proof that it occurs still seems to be lacking. Despite this, it is a good idea to monitor the urine of dogs suspected of having Lyme disease for protein loss. If it becomes evident that a proteinuria (increased protein in the urine) is present, then aggressive treatment for this condition should be considered. This would include the use of doxycycline (an antibiotic), an angiotensin-converting enzyme (ACE) inhibitor such as enalapril, supplementing omega 3 fatty acids in the diet, low dose aspirin therapy to inhibit blood clotting and regular monitoring of blood pressure, with additional medications for hypertension if it does occur. Kidney failure associated with Lyme disease is reportedly difficult to treat successfully but early detection may help. If your vet suspects that your dog has Lyme disease, watch carefully for signs that might indicate kidney failure, such as increased drinking and urinating, weight loss or unexplained vomiting or diarrhea.

Vaccination for Lyme disease continues to be a pretty controversial topic among veterinarians. I know several veterinarians who practice in areas in which Lyme disease is prevalent who strongly believe that vaccination is beneficial. On the other hand, some veterinary specialists are pretty convinced that there are dogs who develop the inflammatory arthritis and possibly even kidney failure due to immune mediated reactions that can occur in response to the disease or the vaccine. Since these are the most serious consequences of Lyme disease it is worrisome that vaccinating dogs may be causing reactions in some dogs who would never be exposed to Lyme disease naturally.

Good tick control is the best way to prevent Lyme disease. At the present time the best tick control product based on our clinical experiences is fipronil, the active ingredient in Frontline (Rx) and Frontline Topspot products. This product usually provides good tick control for a month when applied properly. An equally effective (or possibly slightly more effective) product is an amitraz impregnated tick collar (Preventic tm) but we are hesitant to recommend this product because it is toxic if ingested. It might seem silly to worry about a dog eating its flea collar but it has happened at least three or four times in our practice and I know of a case in which a toddler ate a dog's amitraz tick collar. Since this can be a fatal mistake, we have some problems with recommending amitraz impregnated collars even though they do control ticks very well. Another alternative is the use of permethrin, either as a spray used prior to times of potential tick exposure or as a longer acting spot-on product in concentrated formulas such as Biospot (tm), Defend (tm), Hartz Control (tm) or Advantix (Rx). The biggest problem with these products is that they don't last a month based on our experiences using them. I think they provide good tick control for about 10 to 14 days.  I think that at least some of these products are approved for use every two weeks and it would be best to apply them at that interval for good tick control. Do not use permethrin based products on cats.  Permethrin can kill cats and there is no really good antidote for this toxicity.

There is a test kit available to veterinarians that tests for heartworm disease, Lyme disease and ehrlichiosis. This test is pretty good at detecting antibodies to Lyme disease.  It is thought to be pretty specific, meaning that that there are not many false positive results.  Antibody detection is sufficient evidence of exposure to Lyme disease because dogs reliably produce antibodies  within a few weeks of infections (before clinical signs are likely to occur) and for some time after infection occurs. Routinely testing for Lyme disease in the absence of clinical signs presents some problems, though. The most important one being that 95% of dogs with positive titers will not ever develop Lyme disease so there is no clear course of action in response to a positive test. It is almost certainly better to wait for clinical signs to appear before recommending treatment but this may be hard to do after telling a dog owner their dog has a positive titer. This may truly be a case in which it is better not to test routinely for a disease.  Sometimes it just makes more sense not to confuse everyone.

 

New Information on Tick and Vector Borne Diseases

The ability to do DNA testing has led to the discovery of new tick borne diseases and the recognition that many of the older diseases have been classified incorrectly or have more ability to cause disease than was previously recognized. Information in this field is changing fast and it is sometimes hard just to keep up with the name changes. This is a brief overview to help you keep up with the changes if you find yourself searching for information on one of these diseases.

Feline hemobartonellosis is now called feline homotrophic mycoplasmosis (FHM). If your veterinarian is as old as I am, he or she might refer to this disease as feline infectious anemia. This is a disease which causes anemia in cats and is thought to be spread by insect vectors and bite wounds, although it is unclear how big a role each of these plays in the transmission of the disease. There are two different strains of this organism, one of which is now referred to as Mycpolasma haemofelis and the other is in the process of being renamed but will probably be Mycoplasma haemominutum. There is a third organism, Mycoplasma haemocanis, which causes similar disease in dogs, although much less commonly than in cats. These organisms all try to live in red blood cells, leading to immune destruction of the cells in an attempt to kill the parasite. Traditionally this disease has been diagnosed by recognizing the organism in blood smears but this test is pretty unreliable.

At the present time there is a new test using polymerase chain technology (PCR testing) that can more accurately detect this disease. Treatment for FHM usually consists of administration of doxycycline for 2 to 3 weeks. If necessary, it is acceptable to give prednisone or other corticosteroids to control the immune response while the antibiotic has time to work. In most cases treatment will control clinical signs but it is unclear whether it is possible to totally eliminate the organisms and recurrence of disease has been documented.

American canine hepatozoonosis is a relatively newly recognized tick borne disease caused by the organism Hepatozoon americanum, carried by a type of tick, Amblyomma maculatum, which is commonly referred to as the Gulf Coast tick. As you can imagine based on the name, this is a disease found in Southern states. This disease causes severe illness characterized by fever, pain, lameness and accumulation of mucopurulent material around the eyelids. White blood cell counts can be very high and anemia may be present. Changes in bone and other organs are sometimes seen. A related disease caused by Hepatozoon canis, recognized more widely in Europe, Asia and Africa, causes less severe symptoms in most dogs, consisting of fever and sometimes anemia. Diagnosis has been most accurate through muscle biopsies but Oklahoma State University has developed a blood test (serology) for this disease. (Vincent-Johnson NA, 2003). Treatment for this disease currently requires using a combination of antibiotics (trimethoprim-sulfa, clindamycin and pryimethamine) and long term use of decoquinate (Deccoxx Rx) to control relapses. With aggressive therapy there is a fairly good prognosis for long term control of this disease. If your dog has a real mystery disease with some or all of these symptoms, it may be worth asking your vet to check for this disease.

There is a saying at sporting events, "You can't tell the players without a scorecard". This seems to hold true for several organisms previously classified as members of the Ehrlichia family, which was formally part of the rickettsial disease family but now is considered to be part of the Anaplasmataceae family. Since these diseases occur all over the world, it is probably easiest just to list the reclassified names of several ex-members of the family to aid in searches for information on these diseases. Ehrlichia equi is now Anaplasma phagocytophilia. Ehrlichia platys is now Anaplasma platys. Ehrlichia risticii is now Neorickettsia risticii. Salmon disease, which occurs in the Northwest U.S. is now thought to be caused by Neorickettsia helminthoeca. Ehrlichia canis, Ehrlichia chaffeensis and Ehrlichia ewingii all got to keep their names. While this family of organisms has mostly been associated with disease in dogs, cats can develop diarrhea due to Neorickettsia risticii and an unclassified Ehrlichia organism has been isolated from several sick cats.

It is my intention to cover these diseases in more depth next month but I wanted to introduce the topic this month because tick season is all year in some areas and will start soon in many others and it is a good time to plan a tick control strategy now. Keeping pets away from ticks is the best plan but is often impractical. Tick control in the environment outside of a kennel or small yard is pretty difficult so for most pets tick prevention will depend on using one of the products discussed earlier in the newsletter. As we discover more tick diseases and new manifestations of older tick borne diseases it is becoming increasingly clear to me that good tick control might eliminate a number of the mystery diseases that sometimes occur in dogs and cats.

 

New Web Servers - Let Us Know if You Have Problems with the Vetinfo Site!

We have moved our three major web sites (www.vetinfo.com, www.vetinfo4dogs.com, www.vetinfo4cats.com) onto a dedicated server. This has been a headache for the last couple of weeks but I think we have the kinks worked out now. If you haven't updated your bookmarks you might want to -- we are not updating the information on dog or cat health care on the original VetInfo site but we are updating it on the other two sites as new information is developed.

 

The VetInfo Digest is published by:

TierCom, Inc.

P.O. Box 476

Cobbs Creek, VA 23035.

 

The opinions expressed in this newsletter are those of Michael Richards, DVM., author.

Copyright 2004, TierCom, Inc. Thanks for your support!

This page was last edited  06/16/04

 Subscriber homepage |Backissues  | Breed index | digestindex |

Vetinfo | vetinfo4cats| vetinfo4dogs 

| Canine  Encyclopedia |
  Feline Encyclopedia| VetInfo Digest |Links |Zoonotic info

Please do not send anything in attachment form. We will not be able to open it due to security risks. 

This page is authored by
Dr Michael Richards, DVM
and produced by TierCom, Inc.
Opinions expressed are those of  Dr. Richards.
Designed and edited by Michal Justis
copyright ©1996-2004 TierCom, Inc