VetInfo Digest October 2000
This Month:
Package Inserts and Pharmaceutical Information
Feline Herpes Virus 1 and Cat's Eyes
This months quick thought:
I graduated from veterinary school in 1979. About two years into practice,
I met the first client who actually made me cry. I drove to her house
and saw her cat at 1 o'clock in the afternoon on a Saturday, just after
office hours. The cat had an abscess. I opened the abscess and gave her an
antibiotic, cephalexin, and headed home. When I got there, my wife told me
a client had called twice about her cat. It was the client I just left. She
wanted to know if I had forgotten to give her cat the penicillin injection
it needed. I explained that I thought cephalexin was preferable in this
case. She called me every fifteen minutes for the next six hours, just to
be sure I hadn't changed my mind, finally accusing me of not knowing
anything about how to treat cats. I started to cry out of frustration, got
in my car, drove to her house and gave the cat a penicillin injection. Not
many clients are this persistent, but many push hard for antibiotics,
making it clear that they will seek another veterinarian if they do not get
their way when they want an antibiotic or other medication. Please remember
that inappropriate use of antibiotics will eventually lead to bacteria that
are resistant to antibiotics and that inappropriate use of other
medications can also have bad effects. Don't ask your vet to practice bad
medicine just because it makes you feel better to be giving something to
your pet, rather than waiting for a disease to resolve on its own.* * * * * * * * * * * *
Prescription Inserts and Medication Information
Every medication comes with a prescription insert. The insert is a
description of the medication, a list of its approved uses, adverse
reactions and interactions with other medications, along with other
warnings and information necessary for its use. The prescription insert is
usually included in the box with ointments, eye medications and
individually packaged items. For pills, capsules and other medications
purchased in large containers and then dispensed, there is usually only one
insert per container, so you may not get this information unless you ask
for it.Some veterinary practices routinely remove the package inserts from
dispensed medications. I think that this is probably because package
inserts can be scary and because many medications are used for purposes
other than the approved ones, or in species other than those that are
listed on the prescription label. Removing this information cuts down on
frantic phone calls from owners who read that the medication is only
approved for dogs when they have a cat or that a medication is known to
cause liver failure in a small number of patients and wonder how the vet
knows their pet isn't going to be affected. I can understand the reasoning
behind this, but I think it is better for veterinarians to explain why they
are using a medication in variance with its package insert.It is a good idea to look at the package insert and to become familiar with
how to read one. The terminology is often in "medicalese" but despite this,
it is possible to interpret most of the information without a medical
dictionary.Veterinary preparations usually have a line of bold print below the
medication name on the label, which lists the species it is approved for,
or says "For animal use only" when it can be used in several species. There
can be some odd combinations on these labels, such as "For dogs, horses and
beef cattle". The approval process for medications is species specific,
meaning that a veterinary pharmaceutical company must test the medication
in each species listed according to the FDA guidelines, a process that can
cost millions of dollars. Therefore, it is not unusual for a medication to
be approved for only one species, even though it has uses in several, or
for a medication to be approved only for species in which there is enough
of a market to justify the approval. If there were a day when veterinarians
were restricted to using medications only in approved species, it would be
very hard to provide good quality care to dogs and cats and almost
impossible to provide care for birds, reptiles and other "exotic" species.
It is good to note whether the medication is approved for the type of pet
you have but unless there are specific warnings against use in a particular
species, your vet is probably using the medication appropriately even if
your pet's species is not on the label. It is always reasonable to ask
about this, though.Veterinary brand name medications will have the name at the top of the
insert, such as "Lasix" or "Synotic". Under this name there will be a line
of information listing the generic ingredients of the medication.
Medications that are generic usually have the generic name in bold print at
the top of the label and it will match the information in the composition
or description paragraphs further down the insert. The generic name of the
product is an important piece of information that you should familiarize
yourself with if you wish to find more information about a medication. It
is customary in veterinary medical research reports to use only the generic
name of a medication. It is frustrating when you do not know this name, as
it is sometimes impossible to guess it by using the brand name and it is
sometimes very difficult to find references to a product using the brand
name. If the medication will be used long term it is also good to know the
generic name in case it is available in a generic form, which is usually
less costly. There are some medications which seem to work better in the
brand name form, so if your vet really believes it is best to stick to the
brand name you probably should do that.The composition or description paragraph usually lists the components of
the medication, both the active ingredient and the inert ingredients.
Sometimes this paragraph is labeled ingredients or guaranteed analysis, as
well. Some pets are sensitive to medications such as neomycin (common in
eye and ear preparations) or may have sensitivities to ingredients that are
considered to be inert for most pets, such as beef or isopropyl alcohol. If
you know that your pet reacts to particular medications or to specific
chemicals it is a good idea to read the label insert. If a pet is sensitive
to penicillin it is a good idea to make sure that none of the ingredients
of the medication end in "icillin", since amoxicillin, ampicillin and other
penicillin derivatives are likely to cause problems in a pet sensitive to
penicillin. Another example of this principle would be looking for sulfa in
the composition of antibiotics for pets sensitive to sulfa drugs.Approved uses for medications are listed in the indications section of the
insert. These are often surprisingly limited. An antibiotic may be approved
for use only against Streptococcal bacteria, for instance, even though it
will inevitably used against other bacteria. In other cases, there may be a
long list of indications, each with its own description of specific
instances in which the medication is helpful. It is somewhat likely that
the medication will be used for something other than these indications in
your pet. It is reasonable to ask your vet about this type of use. There
are times when the use is pretty odd sounding, such as prescribing a cattle
deworming medication to kill the demodectic mange mites on your dog. The
package insert is not as helpful to you when the usage varies very
significantly from the approved species or use. It is reasonable to ask if
there are supporting studies that justify the use and if there are well
known reactions or side effects of such use, in this case. It is very
tempting for veterinarians and pet owners to use medications based on
testimonials of good effects in other pets, especially when approved
medications are not helping a pet. This is reasonable in many cases but it
is important to remember that there may not be much supporting evidence for
these uses.Many veterinary medications have a caution statement that says "Federal Law
restricts this drug (or device) to use by, or on the order of a licensed
veterinarian." It is important to remember that these are prescription
medications and that their use is regulated. A veterinarian can not legally
dispense a medication without a doctor/patient/client relationship and must
have a written record of the prescription included in the patient's medical
history. It is not reasonable to ask your vet to prescribe a medication
without an examination and appropriate lab testing, when necessary, to
confirm that a condition exists in a pet. It may be true that you can
identify the clinical signs of an ear infection accurately, but if it has
been more than six months to a year or so from your last visit, your vet
needs to see your pet again in order to legally prescribe medications.
Asking a vet to dispense a prescription medication without seeing your pet
is asking him or her to break the law.When medications are used for purposes that are not expressly approved or
in species that are not listed on the label, the medication is being used
in an "extra-label" manner. There are potential legal ramifications for
such use, so a veterinarian may ask a client to sign a form acknowledging
that a medication is being used for a purpose it is not approved for, in
their pet. This should not raise undue concerns since it is something that
the liability insurance providers for veterinarians push for, even though
it would be nearly impossible to practice veterinary medicine without
extra-label use of medications. Fortunately, for most medications it is
legal at this time for veterinarians to use medications in an extra-label
fashion. There are some rules and guidelines for this use. Veterinarians
should attempt to use an approved medication, if one is available, prior to
using an extra-label medication, unless there is some compelling reason not
to. Some of the products used by veterinarians are approved by the
Environmental Protection Agency (EPA) rather than the Food and Drug
Administration (FDA). On EPA labels there is often a statement that says
something like "It is illegal to apply this product in a non approved
fashion". For these medications, extra-label use is actually illegal. It
isn't likely that an individual would be prosecuted for inappropriate use
of the medications but most veterinarians are not eager to make non
approved recommendations for these products.The composition or description paragraph usually lists the components of
the medication, both the active ingredient and the inert ingredients.
Sometimes this paragraph is labeled ingredients or guaranteed analysis, as
well. Some pets are sensitive to medications such as neomycin (common in
eye and ear preparations) or may have sensitivities to ingredients that are
considered to be inert for most pets, such as beef or isopropyl alcohol. If
you know that your pet reacts to particular medications or to specific
chemicals it is a good idea to read the label insert. If a pet is sensitive
to penicillin it is a good idea to make sure that none of the ingredients
of the medication end in "icillin", since amoxicillin, ampicillin and other
penicillin derivatives are likely to cause problems in a pet sensitive to
penicillin. Another example of this principle would be looking for sulfa in
the composition of antibiotics for pets sensitive to sulfa drugs.Approved uses for medications are listed in the indications section of the
insert. These are often surprisingly limited. An antibiotic may be approved
for use only against Streptococcal bacteria, for instance, even though it
will inevitably used against other bacteria. In other cases, there may be a
long list of indications, each with its own description of specific
instances in which the medication is helpful. It is somewhat likely that
the medication will be used for something other than these indications in
your pet. It is reasonable to ask your vet about this type of use. There
are times when the use is pretty odd sounding, such as prescribing a cattle
deworming medication to kill the demodectic mange mites on your dog. The
package insert is not as helpful to you when the usage varies very
significantly from the approved species or use. It is reasonable to ask if
there are supporting studies that justify the use and if there are well
known reactions or side effects of such use, in this case. It is very
tempting for veterinarians and pet owners to use medications based on
testimonials of good effects in other pets, especially when approved
medications are not helping a pet. This is reasonable in many cases but it
is important to remember that there may not be much supporting evidence for
these uses.Many veterinary medications have a caution statement that says "Federal Law
restricts this drug (or device) to use by, or on the order of a licensed
veterinarian." It is important to remember that these are prescription
medications and that their use is regulated. A veterinarian can not legally
dispense a medication without a doctor/patient/client relationship and must
have a written record of the prescription included in the patient's medical
history. It is not reasonable to ask your vet to prescribe a medication
without an examination and appropriate lab testing, when necessary, to
confirm that a condition exists in a pet. It may be true that you can
identify the clinical signs of an ear infection accurately, but if it has
been more than six months to a year or so from your last visit, your vet
needs to see your pet again in order to legally prescribe medications.
Asking a vet to dispense a prescription medication without seeing your pet
is asking him or her to break the law.When medications are used for purposes that are not expressly approved or
in species that are not listed on the label, the medication is being used
in an "extra-label" manner. There are potential legal ramifications for
such use, so a veterinarian may ask a client to sign a form acknowledging
that a medication is being used for a purpose it is not approved for, in
their pet. This should not raise undue concerns since it is something that
the liability insurance providers for veterinarians push for, even though
it would be nearly impossible to practice veterinary medicine without
extra-label use of medications. Fortunately, for most medications it is
legal at this time for veterinarians to use medications in an extra-label
fashion. There are some rules and guidelines for this use. Veterinarians
should attempt to use an approved medication, if one is available, prior to
using an extra-label medication, unless there is some compelling reason not
to. Some of the products used by veterinarians are approved by the
Environmental Protection Agency (EPA) rather than the Food and Drug
Administration (FDA). On EPA labels there is often a statement that says
something like "It is illegal to apply this product in a non approved
fashion". For these medications, extra-label use is actually illegal. It
isn't likely that an individual would be prosecuted for inappropriate use
of the medications but most veterinarians are not eager to make non
approved recommendations for these products.Contraindications are important to check for, especially when more than one
veterinarian is seen for a pet's care or when a specialist and general
veterinary practitioner are working on the same case. Contraindications are
preexisting conditions that make it unwise to use a medication. Examples
would be medications which can not be used when kidney or liver disease is
present, or should not be used in conjunction with another medication.
Sometimes the contraindications section may be included under the heading
precautions and sometimes there is a separate paragraph for interactions
with other medications, if this is a highly likely occurrence.It is important to let your vet know of preexisting conditions and to be
sure that all vets know what medications your pet is on. This is also true
when using over-the-counter products, such as herbal preparations or
antihistamines. Be sure that your vet knows of these medications prior to
mixing them with new prescription products or at least check the
prescription insert yourself for known contraindications.I think that many veterinarians really hate the portion of the package
insert that lists adverse effects and side effects. There are very few
medications that do not have some adverse effects. There are a number of
medications that can cause death in some pets, even though the odds of any
individual pet having a problem are very low. When reading adverse effects
it is important to keep some things in mind. Adverse affects such as
vomiting and diarrhea are seen in trials in which placebo medications are
given. It is hard to distinguish side effects like this from the
"background" level of vomiting and diarrhea that occur at any time due to
other diseases and disorders, for many medications. It is unusual for a
medication to have no potential side effects listed in the package insert
and it is also unusual for many of the listed side effects to occur. There
are many other times when there are more serious side effects listed in the
adverse effects or side effects sections of a package insert.The expected rate of occurrence of side effects is usually included in the
paragraph. For amitraz (Mitaban Rx) there is a warning that 40% of dogs
exhibited sedation after application of the product. With this kind of
incidence, it is best to plan for an occurrence of the side effect. Even if
you do not get the package insert, a side effect that occurs this
frequently should be mentioned by your vet. On the other hand, convulsions
occur less than 1% of the time and a lot of veterinarians will not mention
this side effect, because it is easy to assume that it will not occur and
discussing it will raise questions that take some time to answer. Amitraz
has one other side effect that is very serious. In clinical trials for the
medication, 3 dogs out of approximately 1100, died after application of
amitraz. This is a side effect that should be discussed with pet owners but
often is not. Again, the reason for this is probably a feeling that the
side effect is unlikely and that mentioning it may make the client refuse
necessary treatment -- but that is not an adequate reason not to mention
the known potential for a fatal reaction. This is perhaps the most
important reason to ask for the package insert when starting a new medication.Despite this seemingly dire warning, this is a time to remember that you
are in a situation in which you must determine whether the risk of adverse
side effects is justified by the seriousness of the illness or injury your
pet is suffering from. This can be a really hard decision. A good example
in veterinary medicine is the use of carprofen (Rimadyl Rx), one of the new
arthritis medications for dogs. This medication helps many older pets live
much more comfortable lives. It can be the difference between choosing
euthanasia for a suffering pet and several months, or years, of good
quality life. On the other hand, some pets who are given carprofen develop
severe liver disease and there have been deaths associated with the use of
this medication. It is important when serious side effects are possible for
a pet owner to understand exactly what might happen and to be informed of
the signs to look for when there are problems, such as loss of appetite or
depression.In addition to listing adverse effects, this portion of the package insert
will often list tests that are helpful in ruling out side effects. These
tests are often skipped in an effort to control costs for pet owners but
this may not be the best choice. If the package insert is checked, a
concerned pet owner may be able to request appropriate testing. It is also
important to check for recommended testing intervals, as some problems
occur after a few days but others are more common with chronic use of a
medication. Lab testing does not guarantee that there will not be problems
associated with the use of a medication but it does help to prevent problems.Veterinarians tend to become complacent about the potential side effects of
medications. I think this is just human nature. All of the package inserts
list a number of side effects and most of the time they do not occur. After
a while, it is easy to ignore the warnings. In most cases, when
veterinarians do not mention serious side effects, this is the reason
behind it. There is no intent to harm a pet or recklessness in medication
choice, but there is a failure to communicate to the owner the seriousness
of potential side effects because the veterinarian has become accustomed to
using a medication and has not experienced problems, making them seem less
likely. This is an especially prevalent problem on really busy days, when
communication time is minimized, anyway. Whenever you are starting a new
medication with a pet it is reasonable to ask for the package insert or to
ask for a review of potential side effects and adverse reactions.It is also important to look for warnings that apply to humans who handle
medications or problems that may occur if they are accidentally ingested or
applied topically. Since liability is almost certainly higher for injury to
a human it is surprising that veterinarians might forget this portion of
the warnings but I truly believe that veterinarians are worse about
conveying these messages than they are warnings about possible harmful
effects on pets. There are not many medications that are potentially
harmful simply by being handled and most are easy to think of, such as dips
for external parasites but there are some surprises. Chloramphenicol, an
antibiotic, appears to be very safe for pets but there is some evidence
that exposure to very small quantities of this medication can cause
aplastic anemia in humans and it is no longer available for human use due
to this effect. It is best to look for warnings that pertain to humans
whenever you think you may be exposed to a product topically or in any
other manner.Once in a while there are possible complications for other pets in a
household when a medication is dispensed. An example of this is the use of
tick collars with the active ingredient amitraz. For some reason these
collars are attractive to other pets and they will sometimes chew them
right off the pet wearing them and ingest the pieces. When this happens,
there is considerably more chance for a toxic reaction in the pet who
ingested the collar than in the pet who was wearing it. If there are
specific warnings about giving a medication to another species of pet, pay
careful heed to those. Permethrin, commonly used in over-the-counter flea
control products for dogs, can be very toxic to cats. There is a warning on
the package and in the package inserts for these products, but it has to be
read to be heeded. If you have multiple pets, it is important to think
about the potential for problems in the other pets from medications
dispensed for a particular pet.Administration and dosage information is included in all package inserts.
It is important to remember again that many medications are used for
purposes other than they are approved for and that the dosage may vary
significantly for an alternative use. However, if you read the package
insert and your vet has advised you to give a dosage that is different from
the dosage information it is best to call and ask if the dose is correct.
During the time I have been in practice, I have given incorrect dosing
advice to clients on several occasions. I have been fortunate that
pharmacists caught two of those errors and that no harm was done but that
was mostly luck. Just like other veterinarians, I am human and I do make
mistakes. You should not be bashful about asking if a mistake was made if
you find dosing information in the package insert that makes the dose given
to your dog seem questionable.In some instances, the package insert will be for human usage, as many
veterinarians use generic medications from human sources or write
prescriptions that are filled at pharmacies. There can be significant
differences between human dosages and pet dosages for some medications, so
do not be overly concerned if there is a variance in these doses, but do
call your vet with any concerns. I get a phone call from a human pharmacist
almost every time I prescribe meperidine (Demerol Rx), since dogs need
dosages much higher than those customarily prescribed for humans for this
medication. Pharmacists do not always have access to dosing information for
pets so you will have to call your vet to be sure that the dosage
prescribed is the dosage your vet intended.It is a good idea to look for information regarding storage of medications
while checking out the package insert. Some medications must be kept in the
dark or dispensed in amber vials. Some medications must be refrigerated and
others should not be refrigerated. Most medications should be stored at
temperatures below 86 degrees Fahrenheit ( 30 degrees Celsius). This means
you can't carry them around in your car for long periods and then use them
later!There is a growing trend among pharmaceutical companies to provide not only
a package insert, geared towards to the veterinary professional but to also
include a client information page that is meant to be distributed to the
veterinary client. This is a good trend and if you receive one of these
information sheets it is definitely worth reading it.The last part of the package insert is information on the medication
manufacturer. This can be useful to know if there is an adverse reaction,
especially if it is an unexpected one. Most veterinary pharmaceutical
companies will communicate with pet owners when problems occur, although I
think that they almost all prefer to talk to the veterinarian who
administered the medication, if possible.It is not necessary to ask for the package insert for every medication
dispensed for your pet. It is a good idea to think about asking for this
information for any medication that will be used chronically, though. I
have less than ten clients who will ask me for the package inserts for
medications but I have at least fifty clients who ask for a run down of the
possible side effects, problems in humans, risk to other pets in the
household, dosing and storage information. Either approach is acceptable to
me and I consider these clients to be good pet owners, not a pain in the neck.I know that many people are not going to be assertive enough during an
office visit to ask for the prescription insert and that in some instances,
it will not be possible for the veterinary hospital to supply it, if it is
asked for. However, if you have a strong interest in knowing the contents
of the prescription inserts and wish to have a collection of the inserts
from most of the medications approved for use in pets, you can purchase
"Veterinary Pharmaceuticals and Biologicals" from the Veterinary Medicine
Publishing Group, ISBN: 0-935078-73-8.* * * * * * * * * * * * * * * * * * * * *
Feline Herpes Virus 1 and Cat's Eyes
Feline herpes virus 1 is also called rhinotracheitis virus. It is one of
the most common causes of upper respiratory disease in kittens, probably
causing about 45% of the cases of runny eyes, runny noses and upper
respiratory illness in young kittens. This portion of the feline herpes
virus infection normally lasts between 10 and 21 days. This is a long time
and veterinarians, responding to frustrated kitten owners, usually end up
prescribing one or two antibiotics during this time period. Most of the
time, by the time the second round of antibiotics have been given, the
virus finally runs its course and the signs of the disease disappear. At
this point, the kitten's owner usually wonders why the second antibiotic
wasn't used first, since it obviously worked better, and forgets that this
was a viral infection. In some kittens the infection lasts much longer than
three weeks.Chickenpox in humans is caused by a herpes virus. Many years after being
infected with the chickenpox virus, people may experience a resurgence of
the virus, which is referred to as shingles. Cold sores may be caused by a
herpes virus. When people are stressed or ill with another disease, cold
sores often reappear. This family of viruses does not die completely when
the signs of disease go away. It hides in nerve tissues and waits for the
opportunity to strike again. Feline herpes virus has the same habits.
Kittens who recover from the illness do not actually free themselves of
this virus. It lives in the trigeminal nerve ganglion, safely out of reach
of the immune system, and waits for an opportunity to cause disease again.In cats, the most common signs of recurrence of herpes virus 1 are
conjunctivitis and keratitis. Conjunctivitis is inflammation of the soft
red tissues inside the eyelids and lining the eye socket. Keratitis is
inflammation of the cornea, the clear portion of the eye. In adult cats,
particularly adult cats that live alone or with one or two other cats,
herpes virus probably causes over 95% of the cases of conjunctivitis and
keratitis. Herpes virus conjunctivitis and keratitis often affect only one
eye in adult cats but they can be bilateral. This is different than the
original disease in kittens, in which both eyes are usually affected.
Recurrences of the virus also often last the same length of time as the
original infections, 10 days to three weeks. There may be noticeable
sneezing along with eye irritation, but often there isn't much nasal discharge.If there is only conjunctivitis and sneezing, it is not necessary to use
anti-viral medications to treat the recurrences of herpes virus. Most
ophthalmologists recommend using a tetracycline or broad spectrum eye drop,
usually containing two or more of the following medications; neomycin,
polymyxin B, bacitracin and gramicidin. For feline herpes virus it is not
considered to be a good idea to use gentamicin (Gentocin Rx) eye drops or
to use a corticosteroid eye drop, such as dexamethasone, prednisilone
acetate or betamethasone (Gentocin Durafilm Rx). The antibiotic ophthalmic
preparation is used to prevent secondary infections and the most common
offenders are gram positive bacteria, susceptible to the triple antibiotic
preparations and mycoplasmas or chlamydia, most susceptible to
tetracyclines. In addition, l-lysine, an amino acid that can be purchased
at pharmacies and health food stores appears to interfere with herpes virus
replication and continuous use of 250 to 500mg per day of this amino acid
can help control recurrences of herpes virus infections. Some veterinarians
think that alpha-interferon is also helpful and usually recommend giving
this on a rotating schedule of seven days on and seven days off medication.The most frustrating form of herpes virus infection in cats is keratitis.
Once herpes virus gets established in the cornea of the eye, it can be very
hard to eliminate. It can take months, to a year or more, to get control of
herpes virus keratitis in a cat. If the keratitis can be confirmed as a
herpes virus lesion it is best to start anti-viral therapy. Herpes virus
causes dendritic (branching or lightening strike appearing) erosions of the
corneal surface. These are so typical for this virus that their presence is
considered to be enough to justify anti-viral eye therapy. The best way to
identify the virus specifically is through polymerase chain reaction (PCR)
analysis, although at the present time, a really reliable lab for this test
is not available. Hopefully, that situation will change soon.The best anti-viral eye drop for herpes virus in cats is trifluridine
(Viroptic Rx). It must be used every 2 hours for 24 hours and then every 4
hours until the cornea is no longer ulcerated, then every 6 hours for an
additional two weeks. The eye drops are fairly expensive and if the owner
can not handle administration of the drops, the intensive care charges at
the veterinary hospital are very expensive. These drops are also very
irritating to the eye and it can be very hard to administer them, since
the cat will become an unwilling participant in the process. It is best to
administer l-lysine and to consider administering alpha-interferon, if
desired, whenever keratitis is present.The second choice in medications is idoxuridine drops, which have to be
compounded at a pharmacy, as there is no manufacturer for these drops at
the current time. These drops must be used at least every 4 hours and are
not as effective as trifluridine. Some veterinarians use dilute betadine
solution (1:20 to 1:50 dilution), one drop every four to six hours. This is
an inexpensive approach to anti-viral therapy and it apparently works for
some cats but I haven't tried it, just because it sounds terrible to me.There have been several periods while I have been in practice when
anti-viral eye drops have not been easy to get. I can tell you from
experience that herpes virus keratitis and corneal ulcers associated with
herpes virus can take a very long time to heal if treatment is not
available. In some instances, cats have been so miserable that we
considered removing the affected eye just to provide them with some relief
from the discomfort the viral eye damage was causing. If your cat has
persistent eye disease and your vet is unsure of what is causing it, or is
hesitant to prescribe anti-viral eye drops if the problem is known to be
herpes virus related, please ask for referral to a veterinary ophthalmologist.Much of the information for this report was obtained from a seminar on
ophthalmology by Dr. David Ramsey and from information in "The Textbook of
Veterinary Internal Medicine" written by Dr. Alice Wolf.* * * * * * * * * * * * * * * * * * * * * *
Michal Justis handles the web editing tasks for the VetInfo web site. She
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This page was last edited 06/20/04
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