VetInfo Digest           July 2003

 

Do It Yourself?

    Vaccinations

    Heartworm Prevention

    Antibiotics

    OTC Pain Relief

    First Aid

    Surgery

    Fracture

    Homeopathy, Herbs

            * * * *

SARS and MonkeyPox

 

This Month's Note:

This month's topic is "do it yourself" veterinary medicine. In light of this, I have to tell a joke that almost fits the topic.

A physician with an interest in cars brings his vintage Corvette to his favorite mechanic. He's fond of the mechanic because he allows him to watch the work and participate a little where it's appropriate. As he is holding a nut with a wrench while the mechanic loosens the bolt it is attached to, the mechanic starts to compare their jobs. "You see, Doc, I had to talk with you about what was wrong with the car, listen and look for symptoms of problems, make a diagnosis and now I'm performing car surgery. Our jobs really are a lot alike. How come doctors make so much more money than mechanics?"

The doctor thought this over a minute and said, "You know, I think that you're right. The next time that you work on my car I'm going to pay you just what people would pay me. As long as you can work on it and keep the engine running, of course."

This does touch at the heart of the problem of attempting to provide medical care for pets. They are alive, they do feel pain and they do have emotions. You shouldn't set out to provide care until you are convinced that you can do it without causing unnecessary pain and without incurring unnecessary risks to you pet.

 

Vaccinations

Should you vaccinate your pets yourself? There are advantages and disadvantages to doing this and they could have a major impact on your decision.

The major disadvantages to pet owners vaccinating their own pets revolve around the safety of the process.

If your pet is aggressive when hurt there is an obvious reason to avoid causing pain, which sometimes occurs when pets are vaccinated. Anyone restraining your pet is at risk if he or she bites or scratches in response to a vaccination.

Vaccinations should be according to the label directions, either subcutaneously or intramuscularly. It is possible to administer vaccinations intravenously when attempting to make the injection, although this is a rare occurrence even when there isn't an effort not to hit a vein or artery. Withdrawing the syringe plunger slightly after the needle is in place can help to assure that the needle is not in a blood vessel. Blood will flow into the syringe if the tip of the needle is in a vein and the plunger is pulled back a little. Accidental intravenous injection of vaccinations can lead to a shock reaction. Intramuscular injections must be given in a site where it is unlikely that a nerve will be damaged by the injection. This is also a rare occurrence even when care is not taken to avoid nerves, but I have treated a patient with nerve damage from an injection administered at home by its owner.

Vaccines have to be cared for properly. It is slightly more likely that this will be the case when your veterinarian administers the vaccination, simply because the vaccine has usually traveled through fewer hands on its way to the veterinarian than on its way to the pet owner. If you purchase vaccine and it is obvious that it has not been refrigerated properly, it is best to return it and not to use it.

There are a number of vaccine manufacturers and the quality of their products can vary significantly. It is really hard for me, even with access to numerous veterinary publications, to evaluate which of these vaccines are best and which combinations of vaccine ingredients among the many offered give the best chance for adequate protection and good safety. If you do intend to vaccinate your own pet, take the time to research the vaccines and to make sure you purchase a good quality vaccine. For parvovirus, the high titer vaccines are best and for cats vaccines without adjuvents should be used, when possible.

Rabies vaccinations usually have to be administered by a veterinarian in order to meet legal standards. It is possible to purchase rabies vaccine but validation of administration is usually not accepted unless the certificate is signed by a veterinarian.

Vaccines are associated with a condition referred to as anaphylactic shock. This is a sudden severe shock reaction that can result in death in a matter of minutes. There are good treatments for this condition, such as epinephrine, antihistamine or corticosteroid injections that have to be administered very quickly after the onset of the reaction for best effect. These reactions usually occur after the first time a pet is vaccinated with a particular type of vaccine. If there is no access to emergency treatment there is a risk to the pet. These reactions are infrequent but almost all veterinarians who have been in practice for several years have seen at least one immediate severe reaction to vaccine administration. This particular risk is usually one that can't be avoided, so it is important to think about it before administering vaccinations. If an individual pet dies as a result of an owner administered vaccination, this could be devastating psychologically. On the other hand, if a dog or cat is part of a breeding colony and its value is more monetary, then the monetary risk of a vaccination reaction is low and the combined savings from vaccinating a number of dogs and cats can be great.

Lumps that may last a few weeks or more frequently occur at vaccination sites. It is easier to identify these lumps as vaccine reactions if the vaccination site was recorded. Therefore, if you vaccinate your pet at home it is necessary to keep track of the injection site. This is particularly important in cats, who may develop cancers at vaccination sites. Make sure you can report the dates of vaccination to your vet when asked. This is particularly important when illnesses occur within a month of the vaccination. Your vet must know that vaccines were given and when, in this situation.

Perhaps the biggest paradox that I see in owner administered vaccination programs is that they are usually undertaken to save money but many of the people who come to our practice who vaccinate their own pets are so uninformed about what they should be vaccinating for, and of proper vaccination schedules, that they end up spending more money than if they had come to our practice for advice and vaccination administration in the first place. This is particularly true for kitten and puppy owners who follow published vaccination schedules in mail-order catalogs or from Internet sites that sell vaccines. I look at some of these lists of recommended vaccinations and the recommended schedules of vaccinations and just cringe. Almost no pet needs all the vaccinations recommended and the interval between vaccinations is frequently too short on these lists. A young puppy or kitten should be vaccinated by your vet at least once to ensure that there are no congenital or contagious health problems that must be addressed . It is reasonable to ask your vet what vaccines are recommended and at what interval for your area during this visit.

The advantages of administering vaccinations personally, rather than relying on a veterinarian, are mostly monetary, but there are some benefits other than cost. It is not fair to overlook the monetary advantages, especially for people who own a number of pets. No matter how much your veterinarian charges for vaccinations, it is likely that there is at least a $5 to $10 fee built into the vaccine charge for vaccine administration and often this fee is higher than that. For a pet owner with a number of pets, avoiding this fee can be a large savings and in the end, as long as the pet owner understands and is willing to take on the risk associated with vaccination, it is possible to put this money into use to provide for other health care needs. If vaccines are administered by the pet owner and periodic examinations are skipped, the quality of care for the pet may suffer dramatically, though. Paying your veterinarian for his or her expertise in detecting disease early and for advice on changing health needs as pets mature is worthwhile.

Administering vaccinations personally gives pet owners better control over what their pet is vaccinated for and when. This can sometimes be an important issue for pet owners, especially when dealing with a veterinarian who tends to want to give every vaccine available to every pet or a veterinarian who is adverse to vaccinations, or doesn't stock vaccinations, that a client may believe necessary. An example of this might be vaccination for Lyme disease (Borreliosis) when traveling from an area that doesn't have a problem with this disease to an area that does. In this situation it may be hard to find a veterinary hospital willing to order the vaccine for a single patient.

If your veterinary hospital refuses to sell vaccine to you, don't jump to any hasty conclusions. It is not legal to repackage bulk packaged vaccines for individual sale and most veterinary hospitals do not order individual dose vaccines made for retail sale. This is sometimes a decision made to discourage clients from vaccinating their own pets but it can be simply a business decision not to stock an item that isn't requested very often.

When vaccinations are being administered by pet owners there are some guidelines that should be followed:

1) Know what you are vaccinating for and whether it is important to vaccinate for those conditions in your area. You may have to do some research to figure this out.

2) Adequately restrain the pet.

3) Follow the label directions for administration of the vaccine. If the instructions call for an intramuscular injection make sure that you give it intramuscularly. Unless a specific injection site is called for, the easiest place to make intramuscular injections is into the big muscles that run along the spinal column.

4) After placing the needle under the skin or in the muscle, withdraw the plunger slightly to be sure that the needle is not in a blood vessel before making the injection. If any amount of blood at all becomes visible in the hub of the needle or tip of the syringe, do not give the injection. Intravenous administration of vaccines can cause really severe reactions.

5) It is probably best to give the vaccine at a time when your veterinarian's office is open unless you have ready access to a veterinary emergency clinic.

6) Cat owners must carefully consider where they give feline leukemia vaccines if they are given at home. Rabies vaccine and feline leukemia vaccine are the two vaccines most commonly implicated in vaccine associated sarcoma (cancer). Giving the vaccine as low as possible on a leg or part way down the tail has been recommended so that if cancer does occur the leg or tail can be amputated. An alternative is to vaccinate in an area in the flank where wide excision is possible. In cats, it is probably better to avoid vaccinations between the shoulder blades or over the ribcage, as these areas make tumor removal very difficult should one occur.

Ultimately, it really makes no difference who gives the vaccinations to a pet, as long as they get the protection they need. However, if administering vaccinations at home means that yearly physical examinations are also skipped, the consequences of this are often detrimental to the pet.

 

Heartworm prevention

I almost hesitate to mention this topic in the newsletter because I suspect that some of our subscribers don't realize that there is a less expensive way to prevent heartworms using products made for cows and horses that contain ivermectin. I'm not against saving money when it is possible to do so, but the risk of using these products is larger than most of the folks who use them realize.

The dosage of ivermectin for a dog is 6ug (micrograms, mcg) per kilogram of body weight. The largest size tablet, made for dogs who weigh between 50 and 100 pounds, contains 272ug of ivermectin. These tablets cost around $5 to $7 each. It is possible to purchase enough ivermectin to treat 1878 dogs who weigh 100 pounds for about $60 using cattle ivermectin. This works out to a little more than 3 cents a dose. Obviously the financial incentive to use this product exists, especially for people who own more than one dog.

The cattle solution of ivermectin contains 10,000ug of ivermectin per milliliter (cc). This means that the dosage for a 100 pound dog is 0.027cc, or approximately 3/100 of a cc. There are two problems with this kind of dose. It is so small that it is hard to be sure the dog takes it. It is also extremely tempting to give a higher dosage and lots of people who use the cattle solution of ivermectin do this. Fortunately, the toxic dosage of ivermectin is usually greater than 50ug/kg and often as high as 300 to 600ug/kg. Even with this kind of a safety margin, we have treated well over ten dogs whose owners managed to poison them with ivermectin solution. In this case, buying the tablets approved for dogs is a method of insuring that a safe dosage of a medication that is hard to dose in small quantities is given -- and that it is actually taken. Some people attempt to get around the problem of small dose quantities by diluting ivermectin solutions. There are lots of recommendations for dilution solutions, but none are close to reliable except dilution in propylene glycol -- and this is not an absolutely sure thing.

The horse pastes containing ivermectin are an even worse choice. It is extraordinarily easy to overdose a dog using the horse paste form of ivermectin and it is simply best to avoid using these, entirely.

It is hard for us to understand, but we see more dogs with heartworms whose owners have attempted to use cattle or horse ivermectin than among people who use the tablets. It seems inconceivable that people are under dosing their dogs but they are either doing that, or the dog is clever about avoiding swallowing the liquid, or else people who choose to try to treat their pets this way are less responsible about dosing. In addition, we have treated a number of dogs for ivermectin overdosing. Until last month, we had been successful in keeping all of these dogs alive with supportive care, often at great cost. The last patient someone inadvertently overdosed using cattle ivermectin died.

I understand why many of my clients use over-the-counter cattle ivermectin products to try to prevent heartworms in their pets. However, this does entail risk and for pet owners who really value safety in medications, there is no question that using the pre-measured heartworm tablets to ensure accurate administration of small doses is much safer.

 

Antibiotics

Many of my clients stockpile antibiotics. My best guess is that these are saved from times when they seemed better after a few days of antibiotic therapy and so they stopped taking the antibiotic or from times when they made the same decision about their pets. In general, it is better to take antibiotics as directed, which usually means taking them until they are gone. This is particularly important for urinary tract infections and bone or joint infections.

In any case, if you have antibiotics at home and you are tempted to give them to your cat or dog because there is a new bite wound or because a hot spot has suddenly appeared, at least take the time to make sure that you dose the medication correctly. If possible, check somewhere to make sure that the antibiotic is appropriate for the use that you intend. There are a number of antibiotics and each of them is more useful for some types of infections than for other types of infection. Our online drug formularies can help you make appropriate dosing decisions and contain some information on appropriate uses.

Dog Formulary:   http://www.vetinfo.com/subscriber/dogoralformulary.html

Cat Formulary:     http://www.vetinfo.com/subscriber/catoralformulary.html

If you use antibiotics before consulting with your vet, make sure that you tell your vet what you have been giving your pet when you do have the pet examined. If the antibiotic has been working well your vet may want to stick with it and if it isn't working well there is no reason to continue using it.

Antibiotic dosing for pets seems very different than dosing for humans, to me. Veterinarians almost always dose antibiotics based on body weight but human drug dosing doesn't seem to be based on variances in body weight among humans in most instances. People sometimes seem to need much smaller or much higher doses of a particular medication compared to pets. It is hard to overemphasize the need to at least find appropriate dosing information before using antibiotics. When possible, resist the urge to use antibiotics without guidance, as bacterial resistance from inappropriate use of antibiotics is a valid and growing concern in both human and veterinary medicine.

OTC pain relief

When a pet is hurt or injured almost all clients want to provide pain relief medications for their pet. Some will resort to human over-the-counter (OTC) medications for pain.

Dogs tolerate aspirin and acetaminophen fairly well. The dosage of aspirin is approximately 10mg/lb of body weight for dogs, given every 12 hours. Dogs can tolerate ketoprofen (Orudis KT, tm) fairly well for up to five days and it may be more potent than aspirin. Most of the other common non-steroidal anti-inflammatory medications are not a good idea to give to dogs. Ibuprofen is reported to cause gastric ulcers within 6 days in the majority of dogs it is administered to, for instance.

Cats should not be given acetaminophen (Tylenol Rx). It is particularly important to pay attention to all the ingredients in a product when attempting to use antihistamine products in cats, since many products containing antihistamine also contain acetaminophen. Used carefully, aspirin is reasonably safe for use in cats but it is best to consult your vet before giving aspirin to a cat, anyway. Due to the extended half-life of aspirin in cats, it must be given no more frequently than once every 48 hours and longer intervals often work well. No other OTC non-steroidal anti-inflammatory medications should be used in cats.

Glucosamine and chondroitin products seem to be safe for both dogs and cats. The usual dosage is 500mg of glucosamine and 400mg of chondroitin per 25 lbs. of body weight, per day. There does not appear to be any benefit to giving more than 1500mg of glucosamine or 1200mg of chondroitin per day to dogs over 75 lbs. in body weight, though. It may take several weeks to see any benefit from glucosamine and chondroitin products. It is unclear which of these two ingredients is more likely to be effective so we recommend giving both at the current time.

 

First Aid

First aid for pets doesn't vary tremendously from first aid for people, with a few exceptions. There are a few do's and don'ts that are helpful to understand, though.

First, it is really helpful to keep good bandaging material at home. There is no substitute for TelfaPads (tm) or other nonstick first layers. Good quality gauze is just indispensable for good quality bandages. Conform (tm) is my favorite, but at least buy five or six rolls of a soft stretch gauze. These types of gauze conform well to irregular shapes and are much more comfortable for the patient. Cast padding or roll cotton can be indispensable if a bandage must be padded, especially when a padded bandage is used to limit movement in a fracture until definitive care can be provided. Vet-Rap (tm) or similar self-adhesive stretch bandaging material is the best top layer for a bandage after application of a Telfa Pad, Conform gauze and cast padding, if necessary. The stretch gauze and Vet-Rap layers can be applied too tightly if it the material is stretched much as it is put on, so be careful of this. These materials make bandaging relatively easy.

Duct tape over a rag will almost never control bleeding. If you are tempted to apply this type of bandage you are better off just using the rag to allow you apply direct pressure to the wound and holding it in place with your hand.

Bandages are dangerous if applied too tightly or allowed to twist around the leg after application. If you apply a bandage you must watch it carefully for signs of swelling above or below the bandage material. It is always better to remove a bandage if there is any suspicion it may be causing problems. I can't think of any exception to this rule.

Eye injuries should be treated by a veterinarian. Do not put any type of eye drop or ointment on an eye until the extent of the injury is known, except saline solution or artificial tears to keep the eye moist, if necessary. Using the wrong type of eye drops can severely complicate healing when eye injuries are present.

 

Surgery

It may sound odd to include "do it yourself surgery" in the list of things to talk about, since it is not conceivable for most people to consider at home surgery on their pets. However, we occasionally encounter people in our practice who try surgery at home, sometimes minor and sometimes major.

Docking puppy tails and removing dewclaws is probably the most common surgery performed by pet owners in our practice. Most of the people who do this are dog breeders and it is usually done at 3 to 5 days of age. At this age, these are pretty minor surgeries. While I can't really see much increased risk, or increased pain, when these procedures are done at home, the cosmetic results are sometimes less desirable than when the surgery is done by a vet and sutures are used to close the skin edges. We have tried to provide pain relief for puppies during tail docking and dewclaw removal procedures without coming up with a really successful method for doing this. Using gas anesthesia has resulted in a puppy death and using local anesthetics in small puppies is difficult as the dosage needed to cause toxic effects is often lower than the dosage needed to anesthetize all the surgical points. So there is no real pain control advantage in having a veterinarian do this surgery. Experience and cosmetics are the main differences.

Every now and then we have clients who try to remove warts or tumors by tying string or dental floss around them. Sometimes this even works if the string is tied tightly enough and the dog or cat doesn't chew at it. Other times it results in pretty bad infections, though. I think that this technique has enough potential for complication that I would discourage its use.

We have some clients who try major surgery, including ear crops, spays, neuters and suturing major wounds. It may sound unbelievable that people would try these surgeries but they do. All of these surgeries are very painful and it simply isn't acceptable to cause this kind of pain when it is possible to avoid it by taking a dog or cat to a veterinarian who can provide anesthesia and pain relief. Even if anesthesia is available surgery can be difficult - we have finished two spay surgeries initiated by physicians who couldn't complete them due to anatomical differences between pets and humans!

Wound suturing seems to be very irresistible to a certain group of our clients. For some reason, really macho men seem to find some sort of ego boost in suturing wounds on their pets. Suturing wounds is not all that difficult. Choosing appropriate suture material seems to be a stumbling block, though. It is not a good idea to use cotton thread or silk thread to suture wounds. It is a really good idea to make sure that the wound is actually clean before suturing it. Many wounds require antibiotic therapy. Suturing can actually make these wounds worse if antibiotics are not provided, because abscesses may form in the closed wound. Local or general anesthesia should be used when suturing wounds, except in a few cases in which it is possible to use a "fine needle" suturing technique, in which suture is passed through a hypodermic needle that is pre placed through the wound edges. If it is possible to close a wound with four or less needle placements, it is reasonable to argue that pain is the same for suturing or administering a local anesthetic. This is really only true if the wound doesn't require much cleansing. Except for people without access to veterinary care within a reasonable time, there really isn't any justification in suturing wounds. Super gluing wounds is usually a bad idea, even though these types of glue are similar to surgical glues. The OTC glues seem to cause more irritation and our impression is that there is a fairly high infection rate when these are used to close wounds. In an emergency, if you must attempt suturing of a wound, nylon fishing line is the best choice for suture material and even this should not be used in any place it can not be removed. Most wounds will heal without suturing if kept clean. Even in emergencies it is often better just to take good care of a wound and to let it heal on its own.

I think that cuts that are confined to the foot pad generally do as well without suturing as they do with suturing. This is a case where people frequently bring the pet to us with the expectation that we will be able to provide better care than they can at home. When we tell them to clean the foot pad with running water several times a day and wait for it to heal on its own, they are sometimes disappointed. Usually not as disappointed as when we get talked into suturing a foot pad and the stitches wear out in two or three days and the wound opens back up, though.

 

Fractures

It is not unusual for pets to suffer fractures of one or more legs. These broken bones are frequently very distressing to the pet owner and there is a strong tendency to try to do something for the pet. In general, fractures that occur above the knee or above the elbow should not be splinted prior to bringing the pet to the veterinarian's for repair. Fractures that are below the elbow or knee should be splinted or supported in some manner, in order to prevent the bones from displacing too far and especially to prevent twisting of the leg around its long axis, which cuts of the blood supply to the area below the twist.

Splints can be made from lots of materials. Most households have either newspapers or magazines. Both of these work well as temporary splints. A whole section of the paper can be made into a "U" shape and taped in place on the leg. It is best not to apply duct tape directly to the hair when applying a splint, because it can be very hard to remove.

There is no question that surgical repair of a fracture will provide a better chance of good quality bone healing than splinting a fracture. Surgery is not always an option that people can pursue due to financial concerns. Casts are sometimes appropriate in this case but casts have inherent risks in pets that make them a difficult choice. The most important one is that pets can not tell you when a cast is bothering them --- so it is critically important that you monitor the cast at least twice a day for any sign of irritation, odor, wetness, serum leakage, blood or any other problems at all. Contact your vet immediately for cast removal if these signs occur. We are often more willing to apply a padded bandage and splint than to apply a cast. We show clients how to make the padded bandage and how to apply a temporary muzzle to protect themselves and the pet. Once the client is comfortable making padded bandages and the fracture is stable enough to allow bandaging without much risk to the pet, we believe that it is reasonable for pet owners to change the bandages themselves.

Almost all fractures will heal sufficiently to control pain associated with the fracture over time. Even though we prefer surgical repair of fractures, when it isn't possible we do not feel that euthanasia is a necessary consequence. Most pet owners can learn to care for a fractured limb well enough to give the pet a chance to recover.

 

Homeopathy and Herbal Medications

Some studies estimate that the use of homeopathic medications by pet owners is fairly high. A rough average of the studies shows that about 40 to 60% of pet owners have tried a homeopathic or herbal medication for their pet.


Homeopathic medications are made by heavily diluting substances that cause symptoms similar to a disease. The dilutions are often so high that there is probably none of the original substance in the medication, at all. The theory is that the essence of the medication continues to exert an effect that is actually magnified by the extreme dilution, as long as the medication is shaken vigorously during the dilution process. The bottom line on true homeopathic medications is that they don't do much, if anything. The term "homeopathic" has been applied to a great many medications that do not strictly adhere to this theory, confusing this issue somewhat, but these medications need to be judged on an individual basis since they don't fit the standard theory.

Herbal medications, on the other hand, do often exert a strong effect on a patient, including the potential to cause death, in some cases. When pet owners use herbal medications to treat pet illnesses they should consider this to be practicing veterinary medicine. It is not reasonable to consider herbal medications safe simply because they can be obtained without a prescription. When using herbs it is best to know what they can do, to attempt to find pet-specific dosages and to follow dosing instructions and warning instructions closely. One of the great difficulties in herbal medicine is dosing. If the active ingredient of a herbal preparation is known and dosing standardized, there isn't any difference at all between using the herb and using any other medication. However, when using herbs for which this information is not known, or in a form such as fresh herbs or homemade extractions, the dose of active ingredient is not likely to be known and dosing becomes very much an art rather than a science. Experience in the use of herbs may matter a great deal in this circumstance, so think carefully before experimenting on your pet.

 

Itch Control

When itching is caused by allergies it is usually necessary to treat the itching symptomatically because curing the allergy isn't possible. In this instance, there are several things that pet owners can do at home that can be very helpful. The simplest thing is keeping a pet cool. Heat aggravates skin itchiness, so keeping a pet in the air conditioning can help a great deal. Maintain good flea and tick control and avoid taking pets out when mosquitos are most active. Antihistamine administration can be very helpful. Among the OTC antihistamines, dogs seem to respond best to diphenhydramine (Benedryl Rx) and clemastine (Tavist Rx). Cats seem to respond best to chlorpheniramine (Chlortrimeton Rx). Administering marine fish oils (generic or 3V Capsules tm) in high dosages can be very helpful. In general it is necessary to use dosages between 2 and 10X the label dose on these products to help with itchiness, though. Vacuuming with a vacuum cleaner with pollen filters can be helpful. Keeping any moist areas of the skin dry can prevent secondary bacterial or yeast infections. It may take a combination of several of these therapies to control itching, or it may be necessary to see your vet for prescription medications if at home therapy just doesn't provide enough relief.

 

SARS and Monkey Pox

There is still no evidence that SARS affects domestic pets, so even in areas in which outbreaks are happening, your pets are not a major risk to your health. 

The recent monkeypox outbreak in the U.S. appears to be under control, but this is a good web site for info: http://www.cdc.gov/ncidod/monkeypox/index.htm. It is probably best to avoid buying exotic pets that are imported from other countries in order to minimize the risk of exposure to exotic diseases for you and your pets.

 

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 2003, TierCom, Inc. Thanks for your support!