You are an important part of the health care of your pet. Your dog or
cat can't speak for itself and is dependent on you to make sure the vet
knows the symptoms and history of an illness. Your pet is also dependent
on you to ensure that medications are given correctly and that follow-up
care or testing is done. Your pet may be in pain which you can determine
but that is not readily apparent to your vet. It is critical that you be
prepared to deal with emergencies and that you know in advance what the
arrangements are at your veterinarian's for emergency care.
1. Make a list of the problems your pet is having. Try to note
when they started and anything unusual that might have occurred around
the time the problems started. The more complete this list is, the less
likely you are to miss an important clue your vet needs.
2. Make a list of all medications your dog is currently taking.
This includes aspirin or other over-the-counter medications, heartworm
preventatives, flea control products, prescription medications, food supplements
and herbal or homeopathic medications. Drug interactions and drug side
effects occur in pets, too!
3. Make a list of other things you have questions about and supplies
your pet needs. It is frustrating to get home and realize you forgot to
buy the heartworm preventative or the special diet your pet needs.
4. If you have to drop your pet off at the vet's or if it is
necessary to allow someone else to bring your pet to your vet, make sure
you send contact information so that your vet can reach you by phone.
5. If your pet has a chronic intermittent problem with seizures,
respiratory difficulty, behavioral quirks or other problems that may not
be seen during a routine exam it is a good idea to bring a videotape of
these episodes if possible. It really is true that a picture is worth a
thousand words, sometimes.
6. If you can not give a pill, do not take pills home from your
vet. Many medications come in liquid form and if a medication is important
enough to prescribe it may be necessary to hospitalize a patient to ensure
that it is given if you can not give it at home.
7. Do not leave your vet's without a clear understanding of your
responsibilities in continuing the care. If your pet has a bandage or stitches
you must know what care is necessary at home. If you will be administering
medication you must understand the directions. Do not be embarrassed to
ask directions again - an again. If your vet's explanation is difficult
to understand ask if the veterinary technician can translate for you. Many
times the support staff is better at explaining directions for aftercare
than the vet.
8. Make sure you tell your vet if you believe that your pet is
in pain. There are very few situations in which pain relief medications
interfere with treatment. There are a lot of situations in which pain relief
will speed recovery from an illness or injury.
9. If you get home and find that you are still confused or forgot
to ask a question, call your vet's office and ask for help.
10. Call your veterinarian's office and ask what to do
if an emergency arises outside of normal operating hours. If your veterinarian
refers to an emergency clinic at night, get the phone number and directions
for driving there. Write it in the phone book on the page with your vet's
phone number or some other easy place to find it. If local veterinarians
provide emergency relief on a rotation basis, find out how to get that
number --- if it is too late and you are having an emergency, listen to
the recording -- it might say more than just "We're closed".
If your vet leaves a phone number and you get another answering machine,
talk to it and remember to leave your phone number! Veterinarians get a
lot of phone calls and many use an answering machine to screen them, now.
If you want to get a return phone call you have to remember not to use
the phone continuously after calling, too!
Your vet wants your pet to stay well and to get better quickly when
illness or injury occurs. Veterinarians understand that they are part of
a health care team that includes you. In order to "win the game", teamwork
is necessary. Do your part!
Medicating for seizure control
One of the hardest questions to answer with certainty in veterinary
medicine is when to start seizure control medication. Traditionally, the
answer has been to try to control seizures when the interval between seizures
is less than a month, on the average. If there is a reason behind
this practice, I am not aware of it. This situation seems to be changing.
Many veterinary neurologists now advise starting seizure control more quickly
than we did in the past. New information which suggests that just having
seizures makes it easier to have more seizures and that seizures occurring
in one side of the brain can cause a "mirror" seizure to occur on the other
side of the brain make early control of seizures more appealing. The drawbacks
of seizure control are still the same, though. Seizure control medications
must be given every day. All of the seizure control medications available
for pets have side effects and some of them are significant. Phenobarbital
is the most commonly recommended seizure control medication for both cats
and dogs. It is addictive, it makes almost all pets appear drunk for the
first week or two of use, it makes many pets drink more and eat more and
it can cause liver damage. Other seizure control medications have their
own problems.
I am still not sure what the best approach to seizure control
is. I try to judge how the owner feels about the seizures, how the
dog or cat handles them and the chance for drug reactions and for compliance
with medication requirements (phenobarbital is addictive and it is very
important that the owner follow directions for its use). It is best
to regulate phenobarbital by testing the blood level of the medication
on a periodic basis. Owners must be prepared to do this. When the time
seems right considering all of these things, we medicate.
If you have a pet that seizures, there are other considerations besides
when to medicate. To protect your pet from injury during a seizure,
try to make sure that your dog's habitat is as safe as possible for a pet
that might lose consciousness. Try to block access to any areas of the
house or yard that could be dangerous, especially balconies, open staircases,
swimming pools and other similar hazards. Keep track of when seizures occur.
Sometimes a pattern will emerge that helps your veterinarian determine
the cause. Labwork to determine if there is a treatable underlying cause
should not be overlooked. Finally, don't worry more than necessary about
seizures. Death during a seizure is pretty unusual. This is a major worry
for many pet owners but it does not happen often. There is almost always
time to work out a good diagnostic and treatment plan with your vet..
Heartworm medication - lapse in medication
Most veterinarians spent a great deal of time educating their clients
on the risk of using daily heartworm preventatives when heartworm infection
is present. It was important to do this because dogs really could die if
they had circulating microfilaria (baby heartworms) and they were given
diethylcarbamazine (Nemacide Rx, Decacide Rx, Filarabits Plus Rx others).
When owners missed a few days of preventative we emphasized the importance
of checking for heartworms before restarting the medication. For a long
time, these were the only heartworm preventatives and this was the best
advice.
Several years ago two new medications were approved for heartworm prevention,
ivermectin (Heartgard Rx) and milbemycin (Interceptor Rx). The monthly
heartworm preventatives work to kill heartworm larvae that are 45 days
or less in age, or even older in some cases. Since an every 45 day dose
would be hard to remember and provide no leeway for error, the pills are
approved for monthly use. This is good but sometimes people forget for
even longer than the "safe" two week period. What should be done when this
happens?
Monthly heartworm pills are reasonably safe to use even if heartworm
disease is affecting a dog or cat. They do not cause the severe reactions
when microfilaria are present except in rare instances. If you are
using monthly heartworm preventatives and find that you have skipped a
month, or even more, start the medication again immediately. If it has
been less than 6 months since the last pill it is not usually worth checking
for heartworms prior to restarting the pills. It is very important to check
for heartworms at least five months after restarting the pills, though.
If heartworms were contracted during the period the pills were not administered
it will take approximately six months after the infection is acquired from
the mosquito until the heartworms are sufficiently old enough for the current
heartworm tests to work in detecting them. Heartgard (Rx) will provide
protection for 60 days if two pills are given after exposure at thirty
day intervals. This means that if you skip an entire month and then give
the pill for the next two months consecutively, it will probably still
work to cover the missed month.
Do not wait to restart monthly heartworm medications because you think
you must have your dog tested! Put your dog back on the medications
as soon as you discover your error and then remember to test for heartworms
in six months. If you are using daily heartworm preventatives, the old
rules still apply!
Heartgard (Rx) is approved for use in cats. The infection rate for heartworms
in cats tends to be about 10% of the rate of infection of dogs in the same
area. In an area in which heartworms are common it would be a good idea
to consider the use of heartworm preventatives in cats that go outside
at all.
A true story (slightly altered for privacy purposes) about
heartworm prevention from Dr. Mike's files:
There is a small neighborhood in my practice area that is isolated on
a peninsula jutting out into the Mobjack Bay. Over the course of about
a year, dogs kept mysteriously dying in this neighborhood. Several of the
owners called to report possible poisonings to the animal warden. We autopsied
several dogs from the area at the animal warden's request. All of them
had heartworms and we could find no evidence that poisoning or malicious
injuries were affecting these dogs. It just seemed like bad luck in the
neighborhood.
Then one day we drew blood from " Fred", a cute little mixed breed dog
with a very concerned owner. Fred lived right in the middle of the neighborhood
with all of the problems. On examination of the blood we determined that
Fred had heartworms. His owner was shocked. Fred was a well cared for,
much beloved pet. "I give him his heartworm preventative everyday," said
his owner, "How can that be?" I have to admit that I was taken back
a little by this development, too. I began to ask questions, trying to
find the answer to this dilemma.
"How do you give him his heartworm pills?" was the first one that came
to mind.
"I put them in his food, wrapped up in a little cheese. He really likes
cheese." was the reply.
"Are you sure he eats his food everyday?" I asked. "Yes", came
the immediate answer. "I feed him on the back porch when I leave in the
morning and his food is always gone when I come home at night."
Immediately it occurred to me what was happening. Fred might have liked
cheese but he didn't necessarily like cheese with a heartworm pill in it.
The rest of the neighborhood dogs weren't so picky. And they had helped
Fred eat his meals. Unfortunately the diethylcarbamazine snack had killed
several of them. The neighbors were right. Their dogs had been poisoned.
That, combined with their negligence in keeping their own pets on heartworm
preventative had combined to produce the mystery deaths.
We treated Fred for heartworms and put him on monthly heartworm
pills, insisting that his owner watch him eat them. The mystery deaths
stopped.
It really is a Hospital
Perhaps you have never really considered how a veterinary hospital is
funded and what that means for your pet. Human hospitals are supported
through government assistance, including programs such as Medicaid and
Medicare, tax-relief if they are nonprofit and other subsidies. They often
have auxiliary organizations providing equipment and volunteer help. Veterinary
hospitals are not usually eligible for nonprofit status. They are not supported
through government assistance, third party insurance payments or community
donations in most cases. Veterinarians provide the entire funding for their
hospitals through the profits from pet owners who use their services and
through paying lower staff salaries and accepting much lower average salaries
than physicians, despite having nearly identical college requirements and
skills. Veterinarians subsidize almost all surgeries, extended hospital
stays and especially spay/neuter procedures through the profits from other
areas of the hospital, including vaccinations and medications dispensed.
There had to be some high profit items to make this system work. For
years these items have been vaccinations and routinely dispensed medications
such as heartworm preventatives. It was inevitable that it would occur
to someone to try to take the profit without providing the rest of the
services. Catalog companies and "vaccination clinics" stepped in, providing
lower cost but no other costly services to eat up profit. They were able
to offer substantial discounts in some cases while still making a profit.
The concept has been popular among consumers who failed in most cases to
understand the long term implications.
When you send your money to catalog companies you are hurting your pet's
chances of having the best medical care, especially if you live in a rural
area. There will be less money available for equipping a hospital. Less
money for continuing education. Less money to purchase current medical
references. Your support of your veterinary hospital is necessary for all
these needs. Your pet benefits directly from money you spend there. Can
the same be said for a catalog company?
It is possible to purchase vaccinations and certain prescription medications
for your pet through catalogs or at a discount at vaccination clinics.
Please consider the implications of this when making this decision.
The overall cost of veterinary care will almost certainly have to rise
if vaccination is taken over by discount companies. Veterinarians aren't
very likely to give up and go out of business. They will just have to raise
the fees for everything else. The profit will have to return to veterinary
hospitals. Instead of saving money, low cost vaccinations will just be
an additional expense that has been added to the total cost of caring for
your pet.
Health Alerts:
When we discover new information that may affect your dog or cat, we'll
do our best to keep you informed in our Health Alert section.
Acetylpromazine (Acepromazine and PromAce Rx) may cause fatal reactions
when administered to Boxers. This information is currently of the anecdotal
variety -- meaning that it has been reported but not confirmed, to the
best of our ability to tell. However, one of the reporting sources is the
University of California at Davis veterinary school, so we feel it is worth
reporting. Acetylpromazine is used commonly as a preoperative sedative
and for treatment of motion sickness. If you own a boxer it would be good
to pay attention to the sedatives used in treatment of your dog. This medication
may also lower the seizure threshold in dogs prone to seizuring. Acetylpromazine
should not be used in epileptic pets unless absolutely necessary.
Carprofen (Rimadyl Rx) is a very effective medication to relieve pain
in arthritic dogs. It has been marketed based on an increased safety
profile in comparison to other non-steroidal anti-inflammatory medications
in dogs. However, it may cause liver damage in some instances. So far this
has only been reported in Labrador retrievers. The incidence of problems
seems low. It would still be a good idea to monitor your dog to be sure
that appetite remains normal and no other signs of illness occur when using
Rimadyl. If you have a Labrador, be extra careful.
For some time (two to three years) veterinarians have recognized that
fibrosarcomas in cats seemed to be associated with vaccination sites.
Currently, it is estimated that about 3 cats in 10,000 will develop a fibrosarcoma
at a vaccination site. This is a serious form of cancer and it is often
fatal. At present, most veterinarians feel that the risk of not vaccinating
is greater than the risk of vaccination, despite the possibility of fibrosarcoma
developing in injection sites. New data on vaccine longevity from Cornell
University shows a strong probability that the combination vaccines containing
rhinotracheitis, calicivirus and panleukopenia have at least a three year
duration of immunity. It may be prudent to consider extending the period
between vaccinations in housecats since their risk of exposure is low,
at least for these viruses. If you would like more information on fibrosarcoma
formation at vaccine sites you may wish to read the recommendations of
the Vaccine-Associated Feline Sarcoma Task Force, a joint effort of several
feline medical associations and vaccine manufacturers at http://www.avma.org/vafst/default.htm.
Our webserver went down during the last week in September. You may have
noticed that our site is currently unavailable. We hope to have this situation
rectified by October 15th. If repairs to our IP's site takes longer than
that we may need to move VetInfo to a new server. We are hoping we do not
have to do that. We are sorry for the inconvenience to our readers.
A final note:
We thank you for supporting VetInfo and
the Vetinfo Digest. Thanks!
Vetinfo Digest is a production of TierCom, Inc. Pet Health Division.
This page was last edited 06/21/04
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