VetInfo Digest               September 2003

 

VetInfo Digest Updates:

Flea Control

Vaccinations

New Test for Kidney Disease

Laser Declaw

Pet Insurance

Esophageal Feeding Tubes

Heartworm Transmission

Enrofloxacin Blindness in Cats

Lomotil Not Helpful for Tracheal Collapse

West Nile Virus

Legal Issue of Therapeutic Diets

Propofol

Cancer Definition

Cytauxzoonosis felis

NSAIDs

Questions Update

 

This Months Note:

Scheduling at a veterinary office is a difficult task. It takes a really dedicated staff to keep appointments on track while also accommodating the needs of clients to understand the health problems of their pets and to be prepared to deal with them. Some clients require longer office visits than the average because they have a stronger need to know the details of their pet's care, or because they have more difficulty comprehending directions and need to be carefully educated to ensure they can care for their pet's problems at home. Often, my receptionists are aware of these clients and schedule extra time for them. Some clients simply tell us they expect that a visit will have to be a long one and this is very helpful. We also try hard to schedule more time when an office visit will obviously require it based on the reported symptoms. This is an area in which you can help a great deal. If you give the receptionist an accurate and concise portrait of your pet's medical problems that have to be addressed during the office visit, it is much easier to adjust the time allotted to your pet's problems. Nothing is more frustrating in a veterinary office than the scheduled "yearly exam" that suddenly becomes a difficult case when the client mentions that the dog has been fainting once a week or that the cat has been urinating blood for a couple of days. We have a few clients who call to schedule a nail trim for one dog -- and then bring three or four dogs, two of which turn out to have ear infections or some other medical need. This type of activity really disrupts the schedule at our office. Sometimes we have to refuse to see any of the pets other than the one that was scheduled, which inevitably seems to upset the client. We wouldn't mind making the time for all four dogs if we were told they were coming. Work with your vet to help keep to the scheduled appointment times. Some vets never seem to get the hang of scheduling, but most work hard at it and want the day to run smoothly for everyone. All we need is a little help!

 

Updates to old issues of the VetInfo Digest

Flea Control

The January 2001 issue, www.vetinfo.com/subscriber/0101digest.html, contains an article on flea control. Since it was written, two things have changed. The first is that another good flea control product has become available, selamectin (Revolution Rx). The second is that a really wet and warm summer does seem to be able to support enough growth in the flea population to overwhelm even the new, very good, flea control products; imidocloprid (Advantage Rx), fipronil (Frontline Topspot Rx), selamectin and lufenuron (Program Rx). This year we have had to advise clients to treat their pet's environment (house, pen, yard, etc. ) for fleas as well as applying these flea control products. In a few cases it has been necessary to treat with more than one flea control product to keep fleas under control. This is possible with most of the new flea control medications but please let your vet help you make appropriate decisions about which flea control products to use if you must use more than one to get the flea explosion under control.

Vaccinations

In the January 1998 issue, www.vetinfo.com/subscriber/0198digest.html, I discussed the recommended vaccination interval for dogs and stated that I thought that a three year interval between adult vaccinations would be recommended soon. This did turn out to be true for our practice and for most veterinary schools, but the idea has been slow to catch on with most veterinarians. Recently, I was asked to clarify this issue and this is part of the reply that I made, in the effort to do that:

Veterinarians are really divided over the best way to vaccinate. These are the main camps:


Vets who think that vaccinations should be given every year. Their logic:

Vets who think that vaccines should be extended to every three years. Their logic:
It is obvious that some dogs react badly to vaccinations, either at the time they are given or several weeks later by experiencing immune mediated hemolytic anemia (IMHA). There is a documented rise in the cases of IMHA for the month following vaccination in dogs but it is a slight rise -- just barely enough to be statistically significant. Therefore, it seems important to give vaccinations only as often as is necessary. Vets who think that it is OK to go to much longer vaccination intervals based on the available information which is primarily derived from unpublished studies that have been widely publicized at meetings and other information sources, but who believe strongly in the value of vaccination. Their logic:
4) Vets who think that all vaccines are bad. I have to admit that I can't come up with any good logical reasons for vets to think this way, so it is hard for me to provide the logic that these vets use, unless it is simply that they have experienced some bad reactions and haven't been through a parvovirus, distemper, leptospirosis, etc. epidemic in their practice area.

With all this in mind, this is what I do for my canine patients:

I stick to a mostly every three year vaccination schedule for the rabies (after the initial one year vaccine) and DA2PP (distemper, parvovirus, adenovirus and parainfluenza) vaccine. I don't use coronavirus vaccine, leptospirosis (but I would as soon as I see enough cases to convince me it was a problem in my area), Lyme disease vaccine (probably would use this if I saw lots of cases but I'm not sure -- fortunately, I haven't had to make this decision) or giardia vaccine. I advise using Bordetella (kennel cough) vaccine on an "as needed basis", basically prior to boarding or for dogs that go to lots of shows or other events where there are other dogs.

When a dog reacts badly to the DA2PP combination vaccine and they have had at least the puppy series and one booster, I just don't give it again. I figure the risk to that individual from the vaccine probably exceeds the risk of the diseases during their lifetime (at least where I practice). If there are reactions to the rabies vaccine we pre-treat with antihistamines or corticosteroids and just give the vaccine, because it is required by law and because the risk to the dog of not being vaccinated is high --- not only from rabies but from the public health laws if it bites someone and isn't properly vaccinated. In Virginia, fortunately, 3 year duration vaccines are accepted for rabies protection. As long as the vaccine is being boostered instead of being given for the first time, corticosteroids do not cause significant interference with the production of an immune response to the vaccine.

This is how we handle cat vaccinations currently:

We give the kitten series for RCP (rhinotracheitis ( or feline herpes) , calcivirus and panleukopenia (feline distemper)) and rabies at >12 weeks of age. We vaccinate for feline leukemia in kittens, unless the owner is certain that the kitten will be an indoor only cat and there is little chance for contact with other cats who might carry the disease. We don't use any other vaccines at the present time. We are considering the use of the new FIV vaccine and may use it in the future.

We booster the vaccinations that seemed necessary at one year of age.

At this point we go to an every three year schedule for RCP and rabies but we don't give feline leukemia vaccination to cats again. Our logic is that most studies show that cats have a strong natural resistance to feline leukemia after they are about 18 months old, so vaccination doesn't seem warranted given the risk of vaccine associated sarcoma (cancer) in cats and the low risk of acquiring the infection as an adult. This is probably the most controversial decision we make about vaccinations (stopping the FeLV vaccine). We use the every three year rabies vaccines but it is possible to make a very good case for using PureVax (tm, Merial) rabies vaccine, which is thought to be less likely to cause cancer at vaccine sites. PureVax has to be given yearly as it is only approved for one year use.

One thing you have to remember about our vaccine protocol is that we developed it for our area. We live in a very rural community and we don't have dog parks or limited areas that lots of dogs play in --- we have mostly stay at home dogs who interact with a few dogs in their neighborhood. Our cat patients may also be less likely to interact with lots of other cats compared to suburban or urban cats, as well. So we made our vaccine protocol decisions with this situation in mind. Other vets have to make their decisions based on different circumstances that influence their decision making about the risks and benefits of specific vaccines in their practice area.

Testing for Kidney Disease


In the January 1999 issue, www.vetinfo.com/subscriber/0199digest.html, there was a section on testing for kidney disease. It is now possible to screen for kidney disease much earlier than it was possible to do this in 1999. There is a new test that has been approved for both dogs and cats now, the E.R.D (Early Renal Detection) test, which measures low doses of albumin in the urine. The presence of this protein in the urine, even in very low dosages, suggests that the kidneys are not functioning completely normally. This test is not completely specific for kidney disease because chronic inflammatory diseases will also cause the test to be positive. This is a good test for breeds and individuals with a strong tendency towards developing kidney disease, though. A positive test should prompt a careful search for chronic illnesses and if they are ruled out it is best to monitor kidney function very carefully in patients with previous positive test results. This test should be very helpful as a screening test for pets of breeds known to be prone to kidney disease and for individuals who seem likely to have problems for any reason.

Laser Declaw

In the February 2001 digest, www.vetinfo.com/subscriber/0201digest.html, I said that I thought that declawing using a laser was better than declawing surgically. While the initial reports supported less pain and less need to bandage following laser declawing, I have noted that the patients we see following laser declawing still have to have bandages in many instances and that published research on pain following declawing only supports the less pain theory for the day of surgery, making it questionable if performing declaw procedures with a laser is really worthwhile. In our case, when the neighboring practices purchased lasers it gave us a good excuse to quit declawing cats -- so we hope that over the long term it will prove to be a better procedure than the current reports indicate because we are reluctant to go back to performing declaw procedures in our practice.

Pet Insurance

In the February 2002 digest, www.vetinfo.com/subscriber/0202digest.html, there was a discussion about pet health insurance. Several additional pet insurance companies have begun providing pet insurance since that article was written. Consumer Reports (tm) came out in July 2003 with an article that still says that using pet insurance is not economically sound but I think that if you read the article carefully you'll note that this is still based on the premise that euthanasia is an option if the expense of a particular procedure is too much for a pet owner to pay for. I think that the cost of veterinary care will continue to rise and that there are a large number of pet owners who will not be satisfied with euthanasia as the solution to a pet health problem that could be remedied. I can't argue with Consumer Reports that there is always the option of euthanasia in veterinary medicine but I still think that for many owners pet insurance is worth considering. If money is the major concern, it is much cheaper not to have pets at all.

URLs for some pet insurers:

http://www.petshealthplan.com , http://www.healthypetinsurance.com , http://www.petinsurance.com

 

Esophageal Feeding Tubes

In the March 2000 issue, www.vetinfo.com/subscriber/0300digest.html, there was a note about using esophageal feeding tubes instead of stomach tubes implanted into the stomach. This is such a huge improvement in the care of cats with hepatic lipidosis that I just have to mention it again. These tubes are easier to put in, easier to maintain, they cause less problems and they work just as well. It is critically important to ensure that cats with hepatic lipidosis receive adequate calories. Placing an esophageal feeding tube allows owners to feed their cats much easier and more efficiently. We used to view feeding tubes as a desperation measure but we sometimes find ourselves wishing we had put a tube in much earlier now, since the acceptance of these tubes is higher than the older methods of tube placement and the effect better if they are used early, especially for hepatic lipidosis in cats. Don't hesitate to allow your vet to place an esophageal feeding tube if it seems necessary to do so.

Heartworm Transmission

In the March 1999 digest, www.vetinfo.com/subscriber/0399digest.html, I discussed a new theory that heartworm transmission required that a specific number of "warm" days in a mosquito's life after it was infected with heartworm disease must occur before it would transmit the heartworms. This theory has been better publicized now but it is still not completely accepted by veterinarians. Despite this, it does appear to hold up under scrutiny. In most areas of the country it is not necessary to give heartworm medication all year to prevent heartworms from a medical point of view. The argument is still out on whether it is necessary to advise using the preventatives all year because of human nature, though. Some people really do appear to forget to start the medications again if they take a few months off during the year. In this same issue we briefly discussed heartworm disease in cats. The only addition to information already in the older digests that I need to make is that it is very easy to confuse heartworm disease with asthma in cats. It is beginning to seem like early heartworm disease may be the cause of asthmatic symptoms in a fairly large number of cats and that these cats may not ever develop adult heartworms. It is important to consider the possibility of heartworms as a cause for coughing and wheezing that might seem like asthma. If heartworms are present the asthma may spontaneously clear up if the cat does mange to control the heartworm disease, which many do. If your cat has been diagnosed with asthma and you live in an area with heartworms be aware that it is possible that heartworms are the actual cause of the cat's problems and that if that is the case, the asthmatic signs might go away if the cat survives the heartworm infestation. Heartworms may not develop into adults, arresting the problem or the adults may die quickly, since cats are not the natural host of this disease. Heartworm treatment still isn't recommended for cats but if you see dramatic improvements in the asthma signs it may be possible to stop treating it, if heartworms was the actual cause of the signs and they are gone.

Enrofloxacin Induced Blindness in Cats

In the April 1999 issue of the digest I recommended using enrofloxacin (Baytril Rx) once a day at 20mg/kg dosage for Pseudomonas infections. This is still a good recommendation for dogs but enrofloxacin has been shown to cause blindness in some cats at high dosages, so it is best to stick to the minimum dosage of 5mg/kg once a day in cats.

Lomotil for tracheal collapse hasn't been helpful

In the March 2000 issue, www.vetinfo.com/subscriber/0500digest.html, I recommended trying Lomotil (Rx) for tracheal collapse, based on advise in a chapter from "Kirk's Current Therapy XII". At this time it really seems like this doesn't work very well. We are currently using low dose prednisone therapy as our mainstay of treatment for this condition, supplemented when necessary with antibiotics and/or cough suppressants.

Vaccine Income Revisited

In the May 2001 issue I discussed the "new" recommendation to give some vaccinations at three year intervals instead of yearly. At that time, there was a great deal of fear among veterinarians, including us, about the loss of income that might come from this move. Now, two years later, I am happy to report that our practice has not suffered a detectable loss of income and we seem to be seeing a trend among our clients towards putting the money that might have gone into vaccinations into other routine care, such as dental cleansings, that have previously been somewhat neglected. It is nice to see that veterinary clients really are willing to take good care of their pets, even if we don't use the "hook" of vaccinations to get them to come in yearly for examinations.

West Nile Virus in Dogs and Cats

In the same issue, I reported that West Nile Virus seemed like it would be a rare infection in dogs and cats, although there were some cases reported. This is still pretty much true, although there have now been about a dozen cases in dogs in which the clinical signs and isolation of the West Nile Virus suggest it was the infectious agent. Cat cases are not surfacing at the same rate but probably can occur. The best thing to do is to try to avoid letting your dogs and cats out at dawn and dusk when mosquitos prefer to be out. Pyrethrin based flea sprays such as Adams (tm) provide some mosquito repellent effect, which seems to last an hour or so. The spot on products containing permethrin (Biospot tm, Hartz Control tm, Defend tm and Advantix tm) will repel mosquitos pretty effectively for a week or two.

Legal "No Man's Land" for Therapeutic Diets and Other Diet Tidbits

In the June 2000 issue I discussed therapeutic diets. In that article I stated that these diets are not actually "prescription" because they are not medications and that this is actually a marketing decision. This year we received correspondence from our state board that said that these diets existed in a sort of "no man's land" and that it was necessary to have a doctor/client/patient relationship in order to sell the diets. We have a lot of transient traffic because we live in a sort of resort area and so we have always sold these diets to people who said their pets were being fed the diet and they needed it. After receiving this letter, we have stopped doing this. I'm not sure how many veterinary practices were like ours in their policies, but if a veterinarian refuses to sell these diets it may be due to receiving a letter similar to the one we got.

In this same issue I briefly discussed renal failure diets. The most recent research on these diets suggests that dogs benefit from early use of moderate to low protein diets when they have kidney failure but that in cats it is better to wait until the kidney failure is a little more advanced before switching to the low protein diets. At the present time the guideline values for when to start the diets are when the BUN reaches 80 mg/dl or the creatinine reaches 3.5 mg/dl. These are probably going to be modified over the next few years, but it really does seem like it is better to start the diets a little later in cats than in dogs.

A new diet for overweight cats has recently become available, m/d (tm) made by Hills. This diet is sort of like the Atkin's diet for cats -- high protein, higher fat, lower carbohydrates. It is reported to work well for many overweight cats and is worth considering, especially if lower calorie, higher fiber diets have failed to help produce weight loss for your cat.

Propofol

In the June 1998 issue of the digest I wrote about anesthetics. At that time we had not used propofol (Propoflo Rx) at all. We do now stock this anesthetic agent and we use it occasionally. It is very quick acting and it is cleared from the circulation very quickly, as well. For this reason, we like it for very short procedures, such as fish hook removal, because it allows us to have an anesthetized patient for the procedure who can walk out the door on his own a half hour or so later. This is pretty nice on a busy Saturday morning (when most fish hook injuries occur). While we have not had an adverse event with Propofol, yet, I suspect that we will some day. The safety margin for this anesthetic appears to be wider than for the older injectable short acting barbituates, but not enough to make it absolutely worry free. Our practice is a little odd in that my wife and I trade off as assistant to each other, so we almost always have a veterinarian acting as anesthetist for these procedures. This is very helpful. A good technician would be just as useful as I am, but not quite as good as my wife, I suspect. Propofol is a white liquid that looks a lot like milk and it is injected intravenously. If your pet is anesthetized with it, make sure that someone is watching him or her. While this anesthetic agent is only approved for dogs, it is being used in cats, especially for short emergency procedures such as urinary catheter placement for cats who have urethral blockages.

Cancer Definition

The July 2001 issue of the digest contained a discussion about cancer. Since that time it has become apparent to me that veterinarians and physicians define cancer differently and that this is sometimes a source of confusion for pet owners. Physicians tend to talk about tumors, lumps or growths when discussing uncontrolled but benign cell growths. They use the word cancer when describing a tumor, lump or growth that is likely to spread aggressively locally or to spread to other areas of the body. So in human medicine the word cancer is almost by definition a malignancy. Veterinarians were mostly trained to use the word cancer when describing any uncontrolled cell growth and then to append "benign" or "malignant" to the description. So veterinarians talk about cancer when referring to benign growths or to growths that are likely to be malignant. I have had several people ask me what "benign cancer" can possibly mean, since they are accustomed to using the word cancer solely to describe malignancies. Some veterinarians are adopting the human definitions but I really believe that veterinarians are using the terms in the more correct manner. After all, it is pretty hard to describe some forms of cancer as a growth, lump or tumor as they really don't resemble any of these things.

Cytauxzoonosis felis

In the July 2002 issue, www.vetinfo.com/subscriber/0702digest.html, I discussed Cytauxzoonosis felis, a parasite that is becoming more prevalent in the Southeast and causing domestic cats to die. This parasite is transmitted by ticks and the incidence has increased this year compared to last. There is no treatment yet for this disease, so good tick bite prevention is important for cats who are exposed to ticks. Fipronil (Frontline tm, Frontline Topspot tm) is still the best tick control product for cats but it doesn't always prevent the tick from attaching. Watch carefully for ticks and remove them as soon as you see them.

Non-steroidal Anti-Inflammatory Medications

In several issues of the digest I wrote about new non-steroidal anti-inflammatory (NSAID) medications becoming available for dogs. None of these have been approved for cats in the U.S., yet, but meloxicam (Metacam Rx) is approved for cats in other countries and is now available in the United States, as well.

It was not possible to say what sort of complications might arise for these medications when they were introduced. In almost all cases, there has been hope for a NSAID that would provide excellent pain relief without any complications. None of the new NSAIDS achieves this perfect state. All of them now seem roughly equivalent in the number of reported complications, although problems have varied a little from drug to drug. It is best when contemplating the long term use of any NSAID to ask your vet to run a blood chemistry panel and CBC to make sure that your dog or cat does not have a pre-existing problem that might complicate the use of the medications. It is also a good idea to repeat at least a portion of this labwork one to two weeks after starting the NSAID to be sure that it isn't causing any complications. It is also important to think about blood testing earlier when any complications arise while using these medications and even to consider routine blood work once every 3 to 6 months when using a NSAID medication chronically. Most vets are reluctant to ask clients to do this much lab work just to use a new medication -- but we should be doing this if we really want to be cautious about avoiding unnecessary complications. Pain control is important and it is worth taking some risk to achieve a better quality of life. It is also reasonable to try to keep the risk to a minimum by spending the money necessary to check for problems prior to use and while using these medications.

It's not only vets wondering about vaccinations

Have any of you noticed the recent articles on resistance to smallpox virus in people? The same controversy is going on with regard to smallpox vaccination in people as we are experiencing in dogs and cats over vaccinations. There is evidence that some immunity to smallpox persists for at least 75 years, at least in some individuals. The question seems to be, is it enough? Many immunologists suspect that it is, because having some functional memory cells that can identify a virus or bacteria makes it possible for the body's immune system to react quickly. Other immunologists aren't so sure -- and no one is going to do disease challenge studies with smallpox virus in people anytime soon. Despite this problem, I hope this research will help shed at least a little light on how long vaccines can be expected to last in dogs and cats.

Updates on Questions and other Issues

At the current time I am answering most questions from subscribers within a day or two. If you ask a question and don't get a response in this time, please feel free to send the question again. This is particularly important if you ask a difficult question, as I sometimes have to think about these questions, or look up information to answer them and this process sometimes results in setting the question aside and forgetting to get back to it. Emergency and urgent questions still should be asked of your own vet first. In emergencies, getting to your vet quickly can make a huge difference, so don't waste any time writing me before going to your vet.

The recent sobig virus caused such an increase in email traffic on our site that we are nearly certain we probably deleted some questions. Please be careful to put "subscriber question" in the subject line of any email with a question. Any other information you want to add might be an additional help in sorting through the mail, but this is the phrase that we look for before deleting mail.

We want to be sure that subscribers realize that we do not necessarily endorse the advertisers on our site. In fact, we have a contract with an ad agency that precludes picking advertisers individually. This seemed like a good way to avoid any conflict of interest, but it has resulted in some advertising from companies that we do not wish to appear to be endorsing.

 

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This page was last edited  06/21/04

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