VetInfo Digest

December 2007

Table of Contents:

Is there Resistance to Monthly Flea Control Products?

This Month’s Note:

I didn’t put anything about the season in the main body of the VetInfo Digest this month but it is important to keep a few things in mind about pets and holidays.  Try to be careful not to overfeed pets with special treats. Throw the turkey carcass and ham bones away in a manner that makes it unlikely your pet will find and eat them.  If you use tinsel on your Christmas Tree make sure your cat can’t ingest it.  If you are planning on boarding your pet find out now what vaccinations the boarding facility requires and plan on bringing their usual foods so there isn’t a dietary change when they are boarded.  Try to make sure that pets have some quiet time if your house is overrun with guests.  Know where you need to take your pet if your usual veterinarian’s office is not open during the holidays.  Pets like presents, too!

Resistance to Monthly Flea Control Products or No Resistance to Monthly Flea control products?

According to Dr. Michael Dryden, widely recognized as one of the foremost researchers on fleas and flea control, resistance to the newer monthly flea control products fipronil  (Frontline Topspot Rx) and imidocloprid (Advantage Rx) has not been proven.  This seems to be a direct contrast to the web site of Dr. Kenneth Hnilica  (http://www.hnilica.com/images/flea_rdl_resistance.pdf ) and references posted there.  Most of the veterinary practitioners I know are strongly suspicious that there is a resistance problem developing in fleas to fipronil and possibly imidocloprid. To some extent this suspicion depends on which products are used in specific practices – where one product has been used for some time there is a higher suspicion of resistance.  

This topic has become more heated in the last few months due to fact that there have been a number of new products approved for flea control in a short period of time and all of them are hinting they are better than older products where resistance might be occurring.

The new products include Promeris ™, which is a topical that controls ticks and fleas,  Vectra 3D, a topical that controls fleas and ticks and Comfortis (Rx) an oral flea control medication that is reported to provide 30 days of protection against fleas with one oral dose.  If ticks are a problem it is likely that Promeris will work better than Vectra 3D for tick control, based on the ingredients. 

Comfortis offers an alternative for people who don’t like the topical flea products or whose pets seem sensitive to them.  A small number of dogs and cats are very bothered by the alcohol that the topical products contain, sometimes the point of developing hair loss and skin sores are the site topical are applied.  It will be nice to have a good alternative flea control product for these dogs.

Dr. Dryden makes the point that none of these products work well unless they are used consistently and according to directions.  There almost certainly is a bigger problem from people failing to put the topical on once a month than from true resistance.  Taking the time to review the flea control measures you have been taking with your vet and to ensure that you are using all flea products appropriately can make a big difference.  If you are sure you are using the products appropriately and still feel that you may be seeing some resistance in the flea population affecting your pets, switch products and make sure to use the new one appropriately, too.

Dr. Dryden’s recommendation is to use flea control products on an alternating schedule. His recommendation is to give a product that kills pre-adult fleas, such as Program ™ and also use a product that kills adult fleas.  An alternative would be to use one of the adult flea killing products one month and a different one the next month, such as an alternating schedule between Promeris and Vectra3D, for instance.  It is somewhat expensive to buy two of these products at the same time but if your pet has flea allergy it can be a great relief to them to keep fleas off, making the investment worthwhile. 

Giving a Better Medical History

Collecting and interpreting the clinical history is an extremely important part of the diagnostic process for a number of diseases and disorders.  In dermatology and neurology the history of the disease process is sometimes the only way to make a diagnosis.  It is critically important that you present the facts pertaining to any illness your pet has as carefully as possible.  Many clients make the mistake of making overly broad statements or failing to cooperate with the history taking for one reason or another.   Doing so can make it nearly impossible for your veterinarian to successfully diagnose your pet’s condition.

Some elements of giving a history and of making sure that the history is interpreted properly are very hard to master. You can give too much information almost as easily as giving too little information.  By using some examples of things that clients tend to say I hope to point out better ways to present the information.

One of the stumbling blocks to taking histories is the tendency of veterinary clients to use the phrase “all the time…,” as in “my cat scratches all the time,” or my dog “coughs all the time”.  It is rarely the case that this description is true. It is much better to think about when your pet is itchy or when it is coughing.  A dog that is itchy enough to stop playing or eating to take the time to bite at an itchy area has a much more severe problem, in most cases, than the dog that is OK during the day but notices that it has some itchiness at bedtime and spends twenty minutes thumping a leg on the floor before going to sleep.   A cat who coughs once a week and seems to get up some fluid when it coughs is likely to have a very different condition than a cat who coughs hard ten or fifteen times in a row and seems out of breath when the coughing bout is over.  In cats, in particular, the frequency of the coughing attacks is an important part of the history so it is very important to try to give an accurate estimate of the frequency that coughing occurs.

It may seem incredible but several times a year I ask a client “what’s wrong with your pet?” only to get the reply, “I don’t know, you’re the doctor, you tell me.”   On the off chance you would consider saying this to be funny rest assured that it has been heard before.  Most of the time when clients say this to me they really are refusing to give any information.  It sometimes helps if I remember to say “What brings you here with Spot today?” rather than “what’s wrong with Spot.”   I am not at all sure why it would matter how this particular question is asked, but it definitely does.   Try to keep in mind that you are the only link your vet has to the history of the problem affecting your pet and it is your responsibility to convey the history as accurately as you can.

In general, when you are attempting to give a medical history, think of giving the following information or being prepared to answering the following questions:

The age, breed and sex of your pet.  If the age is unknown or is an estimate, make sure that your vet is aware of this.  If you know your pet is a mix of two specific breeds, make this known. If you are pretty sure what one parent’s breed was but not the other’s let that be known. If you really don’t know what your dog’s lineage is, say that, too.

Has your pet been out of state or out of the country lately?  Was it acquired locally or did it come from a distant breeder – even if that was several years ago?

What are you currently feeding your pet?  It is really helpful if you know more than “dry food” or “canned food”.   If you are feeding a home-made or raw food diet, please bring a list of the ingredients if possible.   It is very helpful if you measure the amounts that you feed your pets.   Most of the people who tell me they feed their pet “a cup” of food aren’t referring to a measuring cup. They may be referring to almost any size cup, right up to a Big Gulp ™ container.  If you know with reasonable accuracy how much you are feeding your pet it really can be helpful to your vet.

Is your pet is an inside only pet,  an inside mostly pet who is supervised outside, an inside mostly pet who gets to run unsupervised for an hour or so a week, a mostly outside pet in a confined area or an outside pet able to roam freely?  If necessary, divide these categories up even more. Any time spent outdoors means your pet is not an “inside only” pet.

What vaccinations have been given to your pet and when were they given?  This is fairly easy to answer if you use only one vet but consider bringing this history with you when traveling or if it is necessary to see another veterinarian for an emergency or urgent care need.  Personally, I think it is best to travel with a copy of the pet’s entire medical history but some veterinary hospitals seem to discourage pet owners from seeking copies of their pet’s medical records.  It is worth contesting this practice, in my opinion.

Has your pet had a prior medical problem that might impact the current problem?  If you are not sure, it is probably better to mention the past medical condition than to leave it unsaid.  Once in a while this does cause confusion but more often it is helpful.

When that was the very first time, ever, your pet exhibited the current problem?  This is especially important for skin disease and for neurologic disorders.  The age of onset of skin diseases and seizure disorders is a very important clue.  Many skin diseases and neurologic problems have fairly distinct times when they are likely to occur for the first time.

When was the first time your pet exhibited signs in conjunction with the current reason for seeking veterinary care.   An example of the difference between this question and the last one would be something like, “My dog is licking her feet and shaking her ears.  The first time this happened was when she was one year of age but she seemed OK after that was treated   ---  until a week ago, when the symptoms started up again.”

Did the current problem suddenly appear or were there signs of problems for a while but only now are they bad enough that it seemed necessary to seek treatment?  Have the signs of problems changed since they were first seen?

Has your pet been treated for this problem before?  Did the treatment work?  Whether the treatment worked or not it is best if you know what the treatment was and your impression of how well it worked. It makes little sense to repeat treatments that were not helpful,  at least most of the time. There are also times when response to treatment is a valuable diagnostic test. Two diseases can be similar but respond to very different treatments, for instance.

Has the current illness caused changes in the way that your pet acts?  Are any of these things different since the illness became evident:  weight, activity level, appetite, general attitude (depressed, lethargic, etc), urination frequency, and stool consistency?

Are there other pets in the household?  It is best to consider all pets, not just dogs and cats, when answering this question.

Are there small children in the household?

Are you using a monthly flea control product, a medication for heartworm disease and/or any other  medications at the current time?

If you are giving your pet supplements of any kind it is a good idea to mention this to your vet. There are interactions between some supplements and prescription medications and in some cases supplements might mask symptoms of disease or affect laboratory testing, as well.

After reviewing this list it is probably immediately apparent to you that your veterinarian does not ask you all of these questions on every visit.  It is not necessary to know all of this information all the time but it should be apparent when bits of it are necessary for the problem your pet has.  You should probably be disappointed if your dog or cat has a digestive system problem and there are no questions about its diet or if your pet has a skin condition and it is treated without any questions about how long it has been present or when it first appeared. On the other hand, there are a fair number of disorders that don’t require a lot of history taking to diagnose so it is not always a bad thing when the history taking seems minimal.  If your vet is struggling with making a diagnosis or if response to treatment hasn’t been good, it is more important that many of these questions be answered.

Beyond these basic questions there is the separate issue of description clinical symptoms to your vet. It is obviously extremely helpful if your vet knows which leg your pet is limping on if you are bringing the pet in for that problem. You would be surprised how frequently owners know that a pet is walking three legged at times but have no idea which leg is being held up off the ground.  This sort of obvious question is fairly easy to avoid by simply writing down what you are seeing.  If you aren’t sure which leg is affected because it is hard to tell just let your vet know that. Sometimes taking a video of your pet is helpful in this kind of circumstance. A pictorial history can be worth a thousand words!

It can sometimes be a little more difficult to realize the importance of giving specific information rather than a general idea of a problem.   The following suggestions might be helpful in showing ways to do this.

If your main complaint is that your pet isn’t walking normally, can you be more specific than that? Is the problem that your pet lays down and then doesn’t want to get up or appears unable to get up?  Or is it that your pet is lame only when walking. If this is the case, which leg seems to be the problem?  If your pet appears to be uncoordinated this may be an entirely different problem than a lameness, so it is important to point out that the problem seems to be related to balance and coordination. If your pet just seems weak but is moving normally other than the weakness there is an entirely different set of problems related to weakness.

Lots of times people come in our clinic and say that their pet isn’t eating at all. Most of the time when we ask specific questions, we find out that isn’t the case.  For some reason, if a dog won’t eat its dog food but will eat treats, a large percentage of people will still say the dog isn’t eating at all.  Sometimes we find by asking that the cat ate yesterday but not the day before and perhaps missed a meal every now and then the week before, as well.  But the owner still says, “She isn’t eating at all”.   It is important to keep track of what your pet is eating and to be specific about when it is eating, how much it is eating and what it is eating rather than using a general description like “she’s not eating much these days.” It is also important to note if your pet is refusing its usual food but is willing to take treats or special foods.

People have a very hard time determining how much their pet is drinking. It is very helpful to us to know if a pet is drinking more or less than normal. I know that it can be hard to determine water intake accurately but it helps a lot to know that usually you have to fill the water bowl once a day but now you have to fill it three times a day. It is helpful in cats when they are willing to drink from a faucet or fountain but not from a water bowl to let the vet know this behavior is present, especially for a cat who is going to be hospitalized or boarded.  Measuring the amount of water that your pet is drinking is generally not that difficult to do and it truly is more helpful to know that a pet is drinking 1.5 gallons of water a day than that the pet is “drinking a lot”.

Veterinary clients often have problems accurately describing urinary problems.  It is not unusual for clients to confuse frequent urges to urinate with constipation. They see a cat straining in the litter pan and assume that the problem must be constipation. In some cases when the cat is straining to urinate small amounts of stool will be produced because of the straining, which does make defining the problem more confusing.  When it is clear that there is difficulty urinating it is important to note a number of things, in both dogs and cats.  Is the urine normal color or is it lighter, darker or does it contain blood? How frequently is the pet attempting to urinate?  For males it is very important to note whether any urine at all is being produced.  A male dog or cat who can’t urinate at all is an emergency patient.  Is your pet urinating small amounts frequently or is it urinating larger amounts than normal.  Is urine leaking when your pet is relaxed or asleep?  If you are not seeing the urination but are finding urine around the house is the urine found all in one spot or are there multiple spots?  Are there urine puddles on the floor or is the urine deposited on vertical surfaces?

In cats, especially, urinary problems can be behavioral.  For this reason, it is important to keep track of more than just the symptoms associated with urination. Try to determine whether there are changes that might be affecting your cat’s behavior, such as new additions to the household (pets or children), nearby construction, loud noises not usually present, a neighboring tomcat or dog wandering through the yard frequently or anything else that might stress a cat or dog.  Also make sure you know what type of kitty litter you are using, whether the litter pans are open or enclosed, how many litter pans you have and whether or not you have changed litter types recently.

Respiratory problems are difficult for veterinarians and clients alike to describe accurately but it is important to try.  The most common respiratory complaint, by far, in our practice is “my dog is panting more than usual.”  It is important to note whether your dog exhibits any sign of distress while this panting is going on. There are a number of things that cause dogs to pant excessively but for most it is just a secondary sign and not life threatening.  A dog who is panting and is also in obvious distress is likely to be in real trouble, though.  Dogs often cough when they have respiratory problems or heart problems. The timing of the coughing can be helpful in determining what is causing the cough. It is also important to note whether the cough is soft or harsh and whether or not anything is coughed up.  Cats have a more limited number of causes of coughing but it can be hard to differentiate between coughing and retching in cats.  Make sure you know whether or not anything is coming up when “coughing” occurs in cats.  It is also important in cats to note if respiratory problems appear to be accompanied by stress.  A cat with deep or rapid breathing who is obviously lethargic or stressed is also an emergency patient.  Make sure that the staff at the veterinary hospital is aware that these problems are occurring concurrently when you initially call.

Giving the medical history for a trauma case requires a good deal of concentration and effort in order to give the pertinent details as quickly and as accurately as possible without causing confusion.  Try very hard to stick to facts that you know rather than speculation whenever possible.  It is much better to say that you don’t know what happened to your cat than to make a guess that she was hit by a car if you are unsure of that.  We see a great number of cases of trauma where the history we are given does not mesh well with the clinical appearance of the patient or else doesn’t match radiographic or laboratory results.  Guessing what happened to your pet and reporting it as fact can significantly slow the process of obtaining a correct diagnosis in some cases.  Just stick to what you know.  When you are sure what happened, try to present an accurate depiction of the events.  If your dog was hit by a car because you forgot to lock the Flexi-Lead ™ button and it ran out into the street, just tell your vet what happened. It might be embarrassing to admit that but it won’t be the first time your vet has heard of that situation and it does let your vet know that you do really know what happened.  Give the facts of the situation. Where is your pet bleeding from?  Did your pet walk after the traumatic incident? Are there obvious problems anywhere?  One thing that is important to remember is that you do usually have time to give some details to the veterinary staff when you call to ensure that a veterinarian is available to handle your emergency. It can be enormously helpful in preparing for the arrival of your pet and in ensuring that proper equipment is on hand if you have given an accurate history before bringing your pet to the vet.

Toxin exposure

If you use any toxins in the house to control pests such as mice or rats, your pet has the potential to be exposed to the toxins.  If your pet is allowed outside even for brief periods of time unsupervised, it is susceptible to being exposed to toxins.  Anytime that it is possible to bring the suspected toxin with you do so.  Try hard to ensure that you have the label on the box or bottle the product was in, if possible.  Whenever it is possible make sure you know the quantity of the toxin ingested.  There is a huge difference between a pet eating one of your blood pressure tablets and eating ten of them, for instance.

Intact Pets

If your pet is not spayed or neutered it is important that you remind your vet of this whenever he or she is seems to be ill.  It is very easy for veterinarians to forget that some of their patients are not spayed and neutered as the great majority of them are.  This is a serious oversight when thinking about the causes of some symptoms, such as drinking a lot and urinating a lot.  The list of conditions that causes these signs in a spayed female does not include uterine infections but it is an important part of the differential diagnosis in an intact female.  A female cat acting very strange is likely to be in heat but this doesn’t apply to a spayed cat unless a portion of an ovary was left intact during the surgical procedure.  

The Medical History

It is surprising how often it is possible to diagnose a pet’s condition based on the medical history alone – providing that it is given accurately.  In some cases the medical history from your pet’s previous visits can give important clues about the present condition.  It is important for your vet to keep good medical histories.  I really believe that most veterinary clients should ask for a copy of their pet’s medical records at least once. Look at the medical history carefully.  Can you tell from the history what you told your vet about the medical condition of your pet?  Is the information accurate in the record?   Can you tell from the record what your vet thought was wrong with your pet?  Are all laboratory tests that were done included in the record?  Would you be comfortable using these records to assess your pet’s past medical history or are they vague, illegible or incomplete?  You never know when good record keeping might be the difference between being able to figure out what is wrong with your pet and missing the diagnosis.  Knowing how seriously your vet takes record keeping is one of the ways you can evaluate him or her. The only way to know what type of records your vet keeps is to ask for a copy of the record now and then.  It is worth paying any copying fees your vet might charge for this.

Thank You For Your Support!

VetInfo Digest

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Copyright 2007