Fish medicine

I guess this is a kind of follow up to the water blog.

Most people don't know that there are actually veterinarians that specialize in fish medicine. NC State has the two big guns in this field.

Why, you ask, would someone take their 50 cent guppy to the veterinarian? Usually they don't. But they could.

The most common work in the field has to do with koi, goldfish, and farm-raised fish. Some show koi fetch prices upwards of $20,000. Seriously. 20K. For a fish. But not just any fish. A beautiful, well bred, perfect color, history of reliable breeding, sexy kind of fish. So if your twenty thousand dollar koi has a tumor in his abdomen, you'd better believe that those people would pay for anesthesia and tumor removal.

Yes, anesthesia. The fish is maintained out of water with water and anesthetic combination flowing through the gills. Surgery is completed, wound closed up, fish back in water. I've actually done this in one of my fish and yes, the fish survived. It was REALLY COOL. Fish medicine, not unlike zoo medicine, was a field I could have really enjoyed getting into. But, understandably there aren't too many jobs in this field. Maybe some day.

Fluid therapy in a fish does NOT mean flushing them down the toilet.

AMH

Water - the Miracle Drug

Water is the blood in our veins.
-Levi Eshkol, Israeli Prime Minister, 1962

And Allah has created from water every living creature: so of them is that which walks upon its belly, and of them is that which walks upon two feet, and of them is that which walks upon four; Allah creates what He pleases; surely Allah has power over all things.
-Qur'an 24.45, M. H. Shakir's translation

Be praised, My Lord, through Sister Water; she is very useful, and humble, and precious, and pure.
-Francis of Assisi (1181-1226) Canticle of the Sun circa 1225


Water is one of the coolest substances on the planet. It's also a fantastic medicine. You shoot it out of a water hose onto a wound and it's hydrotherapy. Warm it up, soak a washcloth in it and it becomes a warm compress. Make ice cubes out of it and you can ice down a painful knee. Sterilize it and give it intravenously and it can resuscitate life.

I have a little patient in hospital today with a condition called hemorrhagic gastroenteritis (HGE - I'll post on that sometime). 90% of her therapy at this time is water. IV fluids make or brake HGE patients. The antibiotics are pretty important, too. But just getting the fluid volume back under control is the miracle cure.

One of the main reasons a patient dies from anaphylaxis (aside from the not being able to breathe thing, which is also considered a bad, bad thing) is that histamine causes all of the blood vessels to open up at once. The body can't handle that. There's not enough fluid to go around and everything collapses. The heart stops from lack of blood to move around. Treatment? WATER. ( Well, water and epinephrine and fancy medications and a crack team of health professionals, but you get my point) Giant doses of WATER are the first line treatment for shock.


How cool is that? Water ain't just water, is it?



AMH

E-mail notification

If you are a follower, there may be a setting on your end that will have an e-mail generated to notify you of new posts. I haven't looked yet.

Blogger will let me have 10 e-mail address that have an automatic e-mail generated anytime I post. But only 10.

If you want an e-mail or know a way around this, let me know. Just click on the contact me window and it'll fire an e-mail off to me.

AMH

Annual Physical exams

A reader just asked me a question that reminded me of something.

I don't mean to suggest in my vaccine discussion that if vaccines aren't due every year, you shouldn't see your veterinarian every year. Absolutely not.

The physical exam is by FAR the most important thing and that SHOULD be done at least once a year. Pets age quickly. Annual physical exams (or even bi-annual) are very valuable and your doctor will check:

• Teeth - time for cleaning? Problem spots?
• Heart and lungs - murmurs, abnormal sounds
• Skin - infections, hair loss, changes in quality that may suggest a systemic problem or a problem with the body hormones
• Palpate the abdomen - feeling for masses, etc
• Weight - are we gaining? Loosing? Do we need to talk about diet changes?
• Annual blood work - see if everything is working as well on the inside as it is on the outside. Many chronic conditions can be found FIRST on blood work. Things like early kidney disease, diabetes, thyroid problems. Not to mention the importance of heartworm testing.
• Bones and joints - arthritis?
• Dozens of other little items like neurologic problems, urinary problems.

The vaccines should take an "oh by the way" place in the annual physical exam.

AMH

MRSA update

Much to my surprise, I arrived at work this morning to find a fax from our local reference lab. It is entitled "IDEXX Continues to Identify Methicillin-Resistant Staphylococci on Routine Cultures and Offers MRSA Screen for Healthy Pets."

Now, I think that screening on healthy pets is more a marketing issue based on a suspicion, but I can't argue their reasons. Here's a couple of excerpts that are interesting:

"...a recent study in a tertiary referral center revealed that 35% of S. aureus isolates, 17% of S. intermedius isolates and 40% of S. schleiferi isolates in dogs and cats were methicillin resistant..."

"A follow-up study collected cultures from 50 healthy dogs and 59 dogs with inflammatory skin disease. MR staphylococci were isolated from 4% of clinically healthy dogs and 10% with inflammatory skin disease."

"Symptomatic MRSA infections in veterinary patients are rare and, in most cases, suspected to be the result of reverse zoonosis from infected humans."

In other words, MRSA is becoming more common in veterinary patients, ESPECIALLY those treated for chronic wounds, lung infections, bone infectious, and chronic skin disease. Most importantly, this means that all of these infections are going to be resistant to about two thirds of the drugs I have on the shelf.

This also means that I need to be much more careful handling my patients with suspicious infections. Veterinarians are REALLY bad about not wearing gloves and protecting ourselves. I wash my hands all the time, but don't usually wear gloves. YUCK. Guess I should buy a box of gloves before some poor dog infects me with the funk their owner gave them.

AMH

Vaccination situation #2

This post is long, but there's just no way around it. I can really talk when I get going, 'eh?



______________________________________

What vaccinations are we talking about?

In cats, the common vaccines are to Feline Viral Rhinotracheitis (FVR), calicivirus, panleukopenia (parvovirus), leukemia virus, and rabies. Many people are familiar with the term "FVRCP" or "Feline distemper" (distemper is a misnomer for feline vaccines, but it has stuck). The FVRCP vaccine is the common combination vaccine found in veterinary hospitals. Some hospitals add the chlamydia vaccine in the mix and then it is a FVRCCP.



There are also vaccines out there for Feline Infectious Peritonitis (FIP) and Feline Immunodeficiency Virus (FIV)


In dogs, the common vaccines are canine distemper virus (CDV), parvovirus, adenovirus (hepatitis). This combination is usually called the DHPP or "distemper combo". Corona virus, parainfluenza virus, leptospirosis, lyme, bordetella, and rabies are all vaccines that may be recommended.


The definition of core vaccines and the guidelines for their use were put forward by the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP). Together their findings comprise something like 70 pages of review and over 200 recommended readings. So they really gave this a lot of thought.



Based on these documents, the standard of care was recommended to become every three years on the core vaccines of DHP, FVRCP after completing a comprehensive vaccination series as a puppy or kitten.

Rabies is considered up to a three year vaccine, but actual duration allowed is determined by the state or local government. The vaccine is manufactured in a 1, 2, and 3yr form. So a patient could be required to get a "three year licensed" vaccine every year or two years if the local statutes require it. In the DFW metroplex, for instance, the same three year licensed vaccine is good for three years in Colleyille. However, if you walk across the street to Bedford, that same vaccine is only considered effective for ONE year. Kinda silly, ain't it.


These vaccines aren't considered "core" by the guidelines, so I'll mention them individually:


FIP vaccine - it sucks. I strongly discourage the vaccine. It has actually been shown to make disease worse in certain situations.

FIV vaccine - the jury is still out on this one. It might protect against the particular clade, or strain, of virus where you live, but it does not protect against all forms of FIV virus. The bigger problem is that once your cat is vaccinated, we can no longer tell the difference between a vaccinated cat and an infected cat. The vaccine may be appropriate for some cats, but it is not encouraged by the feline specialists.

Corona virus - probably important in very, very young dogs, but probably a waste of vaccine as an adult. This virus might cause transient diarrhea, but is not considered significant enough to warrant a vaccination for it.

Giardia vaccine - pretty much worthless. It will decrease number of organism shed by the dog, but does not prevent disease. Not much benefit to using this vaccine.

Lyme - Unless you live in an endemic area, don't even waste your time on this vaccine. If you do live in an endemic area (Michigan, New England, New Jersey), then talk to your veterinarian. I was a big proponent of the lyme vaccine when I lived in Connecticut. I really only liked one manufacturer's product. There are arguments against the vaccine. They are based on studies in humans and mice, and in this case dog lyme disease is just different enough to not necessarily translate between the species. I am a believer that we don't have Lyme in Texas. We don't have the right kind of ticks. Some might argue this one, but I'm not convinced at all.

Here are some other tidbits and facts:
--Vaccines for panleukopenia, distemper, and parvovirus may actually prove to provide life-long immunity.
--Vaccines for FVR, parainfluenza probably last three years.
--Vaccines for bordetella, leptospirosis, and FeLV are considered effective for one year maximum.
--Each of the major manufacturers of vaccines will support a three year re-vaccination protocol on the "core vaccines". These include the traditional DHPP and FVRCP.


If your veterinarian requires a vaccine every year, it is because they feel that it's the best medical decision for your pet. The arguments for giving the vaccines every year are 1) Owner compliance 2) Some animals may have such significant exposure (shelter animal) that they may do well with more frequent vaccination and 3) If we can't argue that you are doing harm, is it really a bad deal to do it every year and be SURE?

The last point here is about vaccine titers. This is a pretty lively debate. Cornell university pioneered the use of vaccine titers to see if the body still had enough immunity to determine if the vaccine was necessary that year, of if you could wait another year. These titers usually cost around $100 to run. They argue that the titers are an accurate measurement of the body's ability to resist infection.

I won't bore you with the details, but it's easy to debate this one. Antibody circulating in the blood stream (which is what they are testing) does NOT necessarily translate to protection. You may have no antibody, but plenty of protection. If you have a high titer, you PROBABLY have protection.

If you are absolutely trying to avoid giving any vaccine that is not absolutely required, then titers are appealing. In my humble opinion, however, they are hard to use in a way that actually helps me determine what vaccines need to be given. Not at this point. As our understanding increases, then...maybe. Others steadfastly disagree with me and feel that titers are an effective way to help determine if a pet needs a vaccine. I'm sure we'll find out in the end that the truth was somewhere in between.

I'm sure this will spark questions, so just send them to me and I'll post responses.

AMH

Vaccination Situation #1

Here's a subject that is likely to spark controversy. I'm only going to address vaccinations in adult animals in this post. Puppies and kittens require their own review. I'm going to split this one up into two parts. It's just too much information and it's too important to skip around.

Why does this matter? What's the hubub all about? Why do we care what vaccines are done every year, what vaccines are done every three years?


The answer isn't straight-forward. To put it simply, we want to use vaccines to prevent disease, not cause disease. The current concern regarding vaccines is that vaccines in general may not be as absolutely safe as we once thought. There is the autism debate in human children, the hypothyroid debate in people and in dogs. The autoimmune debate over things like lupus being related to vaccines. We don't know for certain that vaccines cause any of these things, but it sure looks suspicious.


So if we don't know for certain if vaccines cause problems, what are we to do about it? The answer is that we should re-evaluate how we choose and use vaccines so that we are limiting our exposure to only those things that are necessary to try and prevent disease. Our goal should be to use just enough, and not too little or too much. If there isn't a compelling reason to use a vaccine - WHY DO IT? The real fight becomes when you try to identify a "compelling reason" since different people feel strongly in one direction or another.


In other words - we have to be smart about our vaccine choices. We can no longer just blindly go in to get our "shots" whenever we're told we need them. We need to treat the right patient with the right product taylored for them.

Tune in tomorrow for the next post of specific types of vaccines and specific recommendations.

AMH

Solicitation for questions and topics

I haven't had anyone send me any more questions from this blog site. If you have a question or know someone with a question - send it to me! It's always more fun to answer questions. Even if you don't have specific questions, send me any suggestions for topics.

AMH

Surprise breeds

I had a kid ask me an interesting question one day while coming through the clinic on tour with her Girl Scout troop. The question was: "What breeds have surprised you most since you graduated?" I thought it was a pretty interesting question coming from an eight year old.

My answer surprised me: Golden Retrievers and Pit Bulls (American pit bull terriers, pit bulls, stafforshire terriers - purists would argue that these are distinctly different breeds, but most of us would paint them with the same brush).

I've had more Golden Retrievers try to eat my lunch in the past 10 years than any other breed aside from German Shepherd dogs. They're also NUTS.

The opposite is try for Pitties. They're AWESOME dogs. Really great. High energy, but amazingly good dogs. They also wear their emotions on their sleeves. If they don't like you - they tell you and are honest up front. Goldens look sweet and act sweet and then suddenly turn and try to eat you alive. Same with a lot of German Shepherds.

Pitties are also very powerful, so when you get a bad apple, it really spoils it for the bunch. We don't hear about cities trying to outlaw chihuahas, even though they are by far more evil than pitties. Land Sharks. They like to eat little children. They look sweet, but then they're like that rabbit in the Holy Grail movie. (Ok, that's not fair, but you just can't trust the little buggars.)

Now - it's not fair to generalize. And I shouldn't. I've seen sweet and mean of just about every breed imaginable. But the girl asked what breeds surprised me. My preconceived notions were that the goldens would be sweet and the pitties evil. Nope. What a surprise!

AMH

Over the counter pain medications

I am frequently asked if a pet can take anything over the counter for pain. Typically, the answer is NO. In cats, the more specific answer is not just no, but NO!


Dogs and cats are so very, very physiologically close to us in many ways and yet worlds apart in others. One of the big differences has to do with the way their livers process certain toxins (or drugs). Because of this, drugs in the Non-Steroidal Anti-Inflammatory Drugs (NSAID) designed for humans are exceptionally bad for dogs and cats. Instead, drugs had to be developed that they could tolerate. These drugs are all prescription and there are no over the counter equivalents.


Ibuprofen is horribly unpredictable in dogs and can easily be toxic at a single dose. Some dogs tolerate fairly high doses before they get sick. Since you can't predict this, it's not safe to give at any dose. Acetaminophen (Tylenol) is rarely used in dogs, and then only if required because it is in a combination with a narcotic (like Vicodin). Dog livers tolerate it OK, but not well enough to comfortably use it any more than you have to. Do NOT give tylenol to your dog.


But to all rules, there are exceptions. Dogs can tolerate aspirin. Small doses, at least. Before we had canine specific drugs, aspirin was commonly used. The problem with aspirin is that the side effects all happen at doses lower than those required to provide pain relief. Tummy upset and disruption of clotting are the two biggest side effects we are concerned about. Aspirin is a potent inhibitor of platelet function. It's why people take tiny doses daily to help prevent heart attack or stroke. Because aspirin is associated with such potential for problems, I'm not even going to mention a specific dose. There is the occasional dog that can tolerate aspirin quite well and does well on it as a pain medication. This is the exception and those patients are at higher risk of bleeding.


In cats, however, there are no exceptions. DO NOT give your cat anything over the counter. Period. A single Tylenol is fatal. Aspirin has to be given with extreme caution. Ibuprofen is likely to be fatal. I repeat - DO NOT give your cat anything over the counter. Nothing. Nada.


There are some great prescription drugs designed to work well with dog and cat livers. This class of drugs still requires care when using, but the veterinary drugs like Rimadyl (carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and Previcox (firocoxib) are all fantastic in the right situations. Because they are SO safe relative to the over the counter options, it simply isn't worth the risk of giving anything else.


AMH

MRSA or "The Bad Staph"

MRSA or (MERSA) or resistant staph are all terms used to describe a particular form of a bacteria named Staphylococcus aureus. We are all covered in staph organism. It's common. It's usually harmless. However, the concern for these MRSA or methicillin-resistant Staphylococcus Aureus is that these particular bacteria appear to be fairly aggressive and highly resistant to antimicrobials. Every year this population of bacteria seem to become more adaptive and develop new resistance remarkably fast.

It is estimated that up to 25% of people have some kind of MRSA currently residing on their body. This isn't a big deal until the bacteria gains access through a wound or has an opportunity to grow in a sinus infection, at which time it can become a wicked problem to deal with. I have, in fact, had a MRSA cultured from my nose a couple of years ago. Ironically enough, it was resistant to the sexy antibiotics and sensitive to the really cheap, easy antibiotics and we appear to have cleared up up without any problems. Total cost of prescription: probably $0.50.

On the flip side, MRSA kills thousands every year. Why the difference? Individual quirks in a patient's immune system, regional strains of bacteria, or types of wounds for one reason. Some individuals end up spending thousands of dollars on cool, sexy antibiotics compared to my rather plain $0.50 treatment.

I bring these bacteria up, because I have been asked if a dog or cat can either 1) get or 2) give a MRSA to the human in the household. Interestingly enough, the answer is YES to number one and maybe to number two.

There have been a few studies looking a cultures submitted to veterinary labs where a staph aureus has been cultured. The type of staph cultured from dogs and cats is usually staph intermedius. They are usually easy to kill, but not always. As it turns out, there have been S. aureus cultured and when those were checked, some were actually MRSA. This was a pretty scary finding.

You can actually check the genetics and determine that the MRSAs cultured were probably of human origin. When multiple people in a household continue to culture positive for a MRSA, it might be appropriate to screen the pets in the household as well. The current guidelines from the CDC do not recommend routine screening of pets or people unless there are households with severely immunocompromised (Chemotherapy, AIDS, transplant patients, etc) and there have been problems with MRSA. In those cases, every mammal in the household should be screened (people, dogs, cats, rabbits, etc).

Short version - Dogs and cats can apparently grow MRSA organism as part of their normal flora. These probably came from the people in the house. They might be able to pass it back and forth between pets and people. Don't worry about this unless you have a situation where your physician is trying to locate a potential source of re-infection or if you are immunosuppressed.

WHEN YOU ARE PRESCRIBED AN ANTIBIOTIC FOR YOU OR YOUR PET - FINISH THE ENTIRE TREATMENT. DO NOT STOP EARLY. Appropriate treatment with the right antibiotic at the right dose and for the RIGHT LENGTH of time is the main way to fight development of resistance in bacteria. Both human physicians and veterinarians are to blame on this one. Please, please, please follow the instructions on the label.

AMH

Allergies #2

If you are the proud owner of one of these unfortunate souls, you can approach their allergies much like you would your own. First line treatments are usually antihistamines. Benadryl (diphenhydramine) is typically the first choice. Given at about 1mg per pound of body weight every 8-12 hours. (25mg capsule to a 25lb dog). Chlorpheneramine can also be used - most dogs get a 4mg tablet every 6-8 hours unless they are very small (<10lb) or very large (<80lb) in which case they may get 1/2 or 2 tablets respectively.

Second line treatments include medications like steroids or cyclosporine. Steroids (like prednisone) aren't all that bad. They can be excellent for short-term use at a modest dose. The problem with allergy dogs is that these guys are rarely being treated for just a couple of weeks. They are usually itchy for an entire summer and you really shouldn't keep a pet on steroids that long.

Cyclosporine (Atopica) is a very cool drug that basically gives you the same benefits of steroids but without the side effects for long-term use. That's an oversimplification, but basically the idea. Atopica isn't perfect, it makes some animals puke, but it can be an awesome alternative to prednisone. Biggest downside is that it's expensive. It's worth the money if you can afford it. Prednisone is very, very cheap, so it's not a fair comparison.

Regular bathing with a hypoallergenic shampoo once a week or so during the bad season can also help. This rinses the pollens off the skin and can be very useful. You must use an appropriate shampoo - it must be mild, made for pets, and not contain any pesticides. I'll post more on shampoos later. Because the skin is inflamed and abnormal during an allergy outbreak many patients end up developing secondary skin infections or overgrowth with yeast or bacteria. These infections may require special shampoos or oral medications to treat them. The allergy may be part of the itch, but the secondary infection may be what causes the itch to be severe.

In some breeds, specifically hounds like bassets or coon hounds, they are likely to have an allergy to the yeast or bacteria growing on their skin. This means that as the yeast that normally live there start to grow, the poor dogs are actually allergic to them and develop a significant itch. Many atopic dogs are allergic to "staph" bacteria and the overgrowth of bacteria can actually make a little itch suddenly turn into a huge, horrible itch.

Last thing to mention is that the only way to truly treat the immune response of the allergy is to see a veterinary dermatologist. Testing can be done to determine what your pet is allergic to. We can then give your pet injections of that compound and hopefully get the itch to stop. This is precisely how it is handled in people.

The veterinary dermatologist can be your pet's best friend if they are suffering from chronic allergy, skin, ear, infection problems. The testing may seem expensive, but the savings in the long run from not having to treat as many infections or spend as much on anti-itch medications can be substantial.

AMH

Allergy Season

This will be my first post on allergies. There's lots of information to be said and even more bunk out on the internet.

When people "get allergies" to thinks like pollen, grass, dust, etc, we typically think of the runny nose, eyes, and asthma. When dogs have inhalant allergies, they tend to have skin symptoms of itching, redness, and then secondary infection. There's plenty of crossover - some people get eczema, some dogs get runny eyes.

So the typical "allergy" dog is a foot licker, armpit scratcher, and face rubber. They also tend to have ear problems (itching, secondary infection). Some individuals only have ear problems or only lick their feet. Some have the whole list of symptoms and are miserable.

"Allergies" are caused when the body's immune system sees something like a pollen and reacts to it instead of ignoring it. The cells in the body that are responsible for reacting to antigen (antigen meaning anything, usually a protein, that the immune system reacts to with an antibody) are full of all kinds of fun chemicals designed to spread havoc. Histamine is the major player. Histamine causes blood vessels to dilate, causes itch, and swelling. Histamine is what makes that mosquito bite swell into a little bump.

Not everything is known about why this happens in certain individuals. Genetics is involved. Offspring of an allergic individual are more likely to have allergies, but it's not a guarantee. We now know that there are some really cool changes in the way the skin of an allergic individual is put together. As it turns out, the "cement" that holds all of the "bricks" of the skin cells together isn't quite right in these people and pets. As a result, the skin isn't as effective a barrier as it's supposed to be. This allows the body to absorb some antigens that you wouldn't normally absorb (like pollen) and the immune system gets all upset and you develop "allergies."

Allergies are also something that develop over time. The typical atopic dog shows signs during their 2nd or 3rd year of life. Sometimes earlier, but usually it's not their first summer. They also get worse over time, so the 8th summer is usually worse than the 2nd summer.

I'll post again with a discussion on treatments. There's TONS of stuff to talk about, so I'll break it up.

AMH

You don't get to do something this cool every day, so I couldn't resist publishing these. I really wanted to go into zoo medicine, but it's terribly hard to get into. This girl had a tooth problem and I had to fix it. Hopefully she'll continue to do well. She's part of a group of breeding animals that are used to supply individuals for zoos.

Pretty nifty, I think.

AMH

Animal Poison Control information - a MUST have for pet owners

This is the URL for the ASPCA Animal Poison Control Center:

http://www.aspca.org/pet-care/poison-control/

(888) 426-4435

There are many good articles and general information on this site. There are lists of toxic plants, foods, etc. I'll post again on toxic plants to give some more specifics.

Keep their phone number handy. If your pet ever ingests something and you're not sure if it's toxic, you can first call your veterinarian, but if there's any question - call APCC right away and they can save you a lot of time and money. They'll help you by 1) telling you if it's even a big deal and 2) if it is a big deal, they can tell your veterinarian how to effectively treat the issue and that will help save you lots of money in the long run.

There is a $60 fee charged to your credit card, but it's worth every penny!

They will give you a case number to take to your veterinarinan, so keep the number handy.

AMH

Melatonin for Thunderstorms

Dear Dr. Herndon

I read in a letter in the paper that said giving 1 1/2 Melatonin tablets per 24 hour time period might calm a dog that is afraid of thunder storms. The owner said they gave the dog, a lab, the Melatonin tablets when she "went into listening mode" (the dog could hear approaching storms before her owners could hear them). Melatonin would be safer and more readily available than, say, Xanax. Thought you might want to comment.



Melatonin is a hormone that the brain uses to help regulate circadian rhythms. These are things like when to sleep, when to wake, when the hair should grow, when a female should cycle into heat. Melatonin does have a sedative effect on the brain when taken in larger quantities. Many people have used it to help adjust to time changes when traveling, for instance. Melatonin may help your dog get through the storm if all they need is a little sedation.

In the case of thunderstorm anxiety the problem is one of intense fear and anxiety. The deep, booming sound, flashes of light, and all that extra energy in the air is too much for some pets to tolerate. It may only take a little sedation to make it through the event in mild cases. For others, they need something more.

I compare it to people who are afraid of flying. Some folks just have a vodka tonic before bording the plane and then drink another once they're in the air. The sedation effect is all it takes to get them through. True anxiety is typically worse. Sedation may not help that person and instead all you end up with is a drunk anxious that's so nervous they vomit in the seat next to them and end up finishing the flight in the toilet.

Thunderstorms are the same. If sedation is all that's requred, Benadryl might help (1mg/pound body weight diphenhydramine) or maybe your veterinarian will suggest a prescription sedative like acepromazine. These drugs make the dog drunk, but they really don't do much for anxiety. Acepromazine also drops blood pressure quite a bit and may not be safe for some dogs.

I tend to treat these guys with drugs designed to break anxiety (anxiolytics). These are typically drugs in the vallium family (vallium = diazepam; klonopin = clonazepam; Xanax = alprazolam). These work great at breaking anxiety in the vast majority of dogs. The difference between them has more to do with duration of action. I like clonazepam in thunderstorm dogs. Seems to last long enough and break the anxiety well enough. Alprazolam is fantastic, too, but very short-lived.

Dogs require fairly large doses of these drugs compared to people. They are also controlled, which means they are very closely watched by the federal government because of the potential of abuse. Your veterinarian has to be careful how much they prescribe. These drugs will also tend to sedate, so you get the double whammy.

Occasionally, there is a dog that acutally gets hyper-excitable on these medications. That's unfortunate. Always give a test dose before you need it. Finding out the medication freaks your dog out during a thunderstorm would not be enjoyable.


Don't forget about non-pharmaceutical options, too. Keeping a light on, the television on, or keeping the pet in a dark room where they can't see the lightening may all help. Cesar Millan has some good thoughts on this one.

AMH

SlyDog Retractable Leash Recall

This leash was recently in the news locally here. I girl was injured when the thing broke. If you have one - don't use it or take it back.

http://www.reuters.com/article/pressRelease/idUS204612+05-Mar-2009+BW20090305

From the company Website:

SlyDog is voluntarily recalling 223,264 units of its Retractable Dog Leash as a precautionary response to isolated consumer reports of a component malfunction.
Reports indicate a possible hardware failure of the product's metal clasp, causing the leash to break free from the dog's collar. Minor injuries have occurred when the broken leash snapped back toward the person holding it.
Number of units affected: 223,264Dates produced: from 9/2007 to 1/2008Manufactured in: ChinaSold at: Dollar General stores MSRP: $5.00Sold from: 9/2007 to 8/2008

http://www.squareonesystem.com/recall.html

AMH

How much food should I feed my dog or cat?

This is a question I answer nearly every day. The answer is: It depends.

Start with what the bag says. If you're feeding an appropriate food for your pet (puppy for puppies, senior for senior, etc) then look at what the bag suggests. The bag assumes normal patient with average metabolism. The number listed on the bag is in 8oz measuring cups.

Look at the cup you are using to measure. When in doubt - check how much the cup you are using holds. Typically, you can feed 25% above or below what the bag suggests. Anything outside of that, and the pet needs to be on a different formula food. For instance, if the bag suggests 1 cup of food per day, you could feed anything between 3/4 and 1 1/4 cups and be within an acceptable range.

Puppies - don't worry too much until they are around 4-5 months. If a puppy seems hungry and wants a little more - that's OK. Just keep it reasonable.

Remember, feed the pet, not the bag. If your pet needs more or needs less, feed more or less (within that 25% window). If you're having trouble getting your pet to loose weight and you're already feeding the smaller amount, you really need to have a talk with your veterinarian so you can discuss a veterinary diet that is designed for weight loss. Weight loss is a great topic for another post.


AMH

Cat vision question

Dear Dr. Herndon,

My cat Poppy doesn’t jump up on cabinets or over the wall around the back yard. In fact, she’s just not a jumper at all. She will stair step her way up to higher places such as the 5’ carpeted cat tower in the living room so its not heights that bother her. Do you think she could be nearsighted?

Cynthia

Dear Cynthia:

If her eyes are narrow set like a typical oriental breed or if she has vision problems in one eye, she may not have good depth perception. Is Poppy siamese?

Cats can have vision problems just like ours, so it is possible she's nearsighted. Unfortunately, we don't have any easy way to measure that. (I guess you could try to have her read a Cat Fancy from five paces, but that may not be very helpful either.)

Another possibility is that she has problems in her hips that make it too painful or impossible to jump up. In this case, she'd climb well, but it would hurt to jump. You'd have to take an x-ray to find out.

At least she's smart enough to know her limitations and not try to jump up where she can't see well enough to land.

AMH

Pop-top cans and hyperthyroidism in cats

This is interesting. I have to thank my Mother for bringing this to my attention. I thought it was total bunk, but there might be a little something to it.

There have been no studies that demonstrate that canned foods or pop-top cans cause hyperthyroidism. However, there have been two retrospective studies that looked at many, many different things in the life of a hyperthyroid cat to try and see if there were any statistically significant findings. There were. More hyperthyroid cats ate canned food compared to dry. (But there were several other statistics about lifestyle, sex, age at onset - that's all for another blog post). One study suggested that cats eating fish, giblet, and liver flavors were over represented.

These studies looked back as far as 1974. Canned foods at that time were not prepared using the same chemicals used now, but the link was still there.

So - is it the can, the lining, or something else? Iodine may be the culprit. It may be the plastic, it might be the teflon, it might be preservatives, it might be aluminum, it might be just plain bad nutrition.

The moral of the story is - we don't know. But it's awfully darned suspicious. Feline nutrition needs to be improved upon. We've let our cats down in this respect. Canned food is recommended for many cats, some experts suggest cats should ONLY eat canned food. (increased water intake is a good thing in cats - again, something for another post).

AMH

The short post on fleas

Fleas are easy to prevent and hard to eliminate. This is the time of year to consider this because as the weather warms up, the fleas are going to become more active.

Some Available products:
Frontline - excellent product, one of the best. Kills adult fleas and ticks.
Comfortis - new drug on the market. Spinosad. Known in organic circles as a new organic pesticide. Apparently it works very well.
Advantage - excellent against fleas, no tick control.
Advantix - Advantage with an added tick control. CAN'T USE ON CATS - IT COULD BE FATAL.
Sentinel - this is a heartworm preventative that has an added drug that inhibits fleas from reproducing. Does NOT kill adults.
Capstar - Kills adult fleas. REALLY quick. Very safe. Only lasts 24hrs.
Revolution - heartworm preventative that also kills fleas and is OK against ticks, but really not that good against ticks. Good product.
Promeris - New product that kills fleas and ticks. Supposed to be pretty good. Can control ticks well.
Flea shampoo - DON'T waste your time!
Biospot or other similar - I won't lie and say they don't work - but their safety margin sucks. Put dog Biospot on a cat and you'd better have money in the bank to treat the cat in the emergency room. It might just kill the cat. They also wash off quickly. They're cheap, but I can't tell you how many cat or dog toxicities I've treated from this product.

You can comb the fleas out, you can spray the yard, you can put those silly little light traps, but they won't get you far. 90% of the flea population is juvenille and lives off the dog/cat. You've got to either have 1) continuous control of the adults or 2) use a product that kills the juvenilles.

Frontline is rediculously safe (on anything but a rabbit) and is a great first choice. Flea prevention is so important it's one of those times that I don't mind using something that's technically a pesticide. There are no "organic" options that work as well. Garlic, orange oil, powders help - but they will not prevent an infestation. Frankly, if I can use Frontline every 1-3 months and avoid an infestation, I've used WAY less chemical than what is required to treat an infestation once started (organic or otherwise).

I'll post again sometime about flea control in the environment.

AMH

Pet Food Choices

"Let food be thy medicine." - Hippocrates


"Feed the dog, Not the bag." - I can't remember who, but they were smart




There are lots and lots of foods on the market now. Most are good. Some are very good. Some are absolute crap. I'm going to mention a few by name. I guess that's an endorsement, but just because I don't mention it doesn't mean it's not good.


There is no food that is properly designed to be "good for all life stages."
Puppy food is designed for puppies. Senior food is designed for seniors. I encourage owners to feed an age appropriate food.


Here are a few general statements: Puppy foods are higher in fat and calcium. Adult foods are lower and fat, moderate in carbohydrates, and higher in protein. Senior foods are higher in fiber and carbohydrates, lower in fat, and moderate in protein.


Most puppies only need puppy food up until 6 or 9 months of age. Spaying and neutering doesn't make a pet fat. But their metabolism doesn't ramp up and so they just don't need the same calories as an intact dog or cat would. So from the time of their surgery, it's usually OK to go ahead and switch to an adult food.



Many adult foods are simply too many calories for the pet they are feeding. This is ESPECIALLY true in cats. Don't hesitate to switch to a lite or less active food. They don't have to be "fat" to switch. It's a preventative thing.


Senior pets must be careful what kind of proteins they eat. It's not that they need to be on a low protein diet. They need to be on a moderate protein diet. Older pet colons also benefit from a little extra fiber - just like you and I. Fiber is your friend!


Let's talk grain free.
This is a hot button issue. Many folks are ABSOLUTELY convinced that corn is the devil's fruit. Others see corn as an excellent carbohydrate source. I'm in-between those two extremes.


I disagree with the assertion that dogs and cats don't eat grains in the wild, therefore grains are bad. Dogs and cat's rarely eat a bowl of rice or some corn on the cob in the wild. What they do eat are the things that eat the rice and corn and have the corn in their bellies when they are killed and eaten. Therefore, the dog or cat do get the grains in an unprocessed/partially digested manner.


It's an effective argument to say that wild canids or felids don't eat processed grains and that processed grains are different from raw. Ok - I'll give you that one. But I have a hard time believing that grains are absolutely bad.


Rice and corn, for instance, can be outstandingly well digested by the body and are an excellent source of energy. Critics of grains in our pet foods argue that the processed grains used in pet foods are not an intended food for dogs and cats. Because of that, they are not appropriate for the overall health, energy, and immune state of the host system. Although these components don't cause direct damage, they still cause subtle disruptions in the body's energy and/or homeostasis. Therefore, your pets are "healthier" if you don't eat them.


There is big business in the specialty pet food market now. I find it immensely interesting that one company who markets a grain free diet uses potatoes as the carbohydrate source. Anybody ever seen a dingo eat a potato?

"We only use the part of the chicken you would eat." or "100% muscle."

Have you ever seen a wild dog or cat eat their kill? They leave tasty parts we would eat behind. Instead, a dog or cat eats from the butt hole forward. They need the guts, the liver, the heart, the lung, the kidneys, the blood. Sure, meat is tasty. But the good, balanced nutrition is in all the bits and pieces we won't touch with a 10 foot pole. Don't let this marketing trick fool you. "Animal digest" and "offal" are pretty disgusting to think about but they are really good for your pet.


Raw Diets:

I've seen some pretty amazing things happen when a pet with a poorly controlled, hopeless, chronic condition suddenly transforms when they are fed a raw diet. I've also seen some trainwrecks and death from people who don't know what they are doing. A proper raw diet is NOT JUST MEAT! It irks me when people think that some chicken meat constitutes a raw diet. If you feed your pet meat only, you will kill them. Just because it's not cooked, doesn't mean it's not balanced. If you are considering feeding raw - DO YOUR HOMEWORK! There's a right way and a wrong way. Some pets do fantastically on raw and it can be an excellent choice for someone dedicated enough to do it right.

Food safety is critical when feeding raw. Be aware of your source. Salmonella and E. coli can be just as lethal to your pets. Campylobacter and listeria as well. Quality sourcing of a quality product that is handled in a safe way is not easy to do. Nor is it cheap. If you aren't careful, you WILL make your pet sick. It is quite possible to kill your pet with raw food.

Therapeutic veterinary diets:
Each of the major food manufacturers has a line of therapeutic diets. Royal Canin, Purina, Iams Company, and Hills are the major players. Discussing therapeutic diets with veterinarians is sometimes like discussing politics or religion. People tend to have pretty strong feelings about it.

My opinion is that Royal Canin has far and away the best product line. I like them and encourage them to be fed. Your veterinary hospital may have two or three product lines that they carry. Some hospitals are exclusive to one company. I'm not a fan of Hills foods. Not at all, and that's all I'll say. They have one or two good diets, but they are the one that most folks recognize by name.

There is no such thing as a "prescription diet." Meaning no foods are considered legend drugs by the FDA and require a prescription. Prescription Diet is a trademarked marketing term used by Hills. If your veterinarian says they require a prescription to sell you a food - that's not technically correct.

Therapeutic diets are sold only through veterinarians because they are considered to be so specialized or restricted that they are not appropriate to sell over-the-counter to the public. Feeding a kitten or puppy a diet intended for a kidney failure patient could severely hurt the kitten's ability to develop and grow normally. Feeding a diet intended to prevent urinary crystals could be disastrous in certain dogs and cause them to become severely ill from pancreatitis. Although these foods are not technically a prescription product, your veterinarian may restrict to who and for what reasons they sell these foods in the interest of safety.

Specific foods:

When people ask me what foods I recommend I list the following:

Royal Canin
Wellness
Innova
Eukanuba
Iams
Purina Pro Plan


I have inconsistent results with Nutro. I have a strong dislike of Hills. Very strong dislike.

I'll add more to this later.

AMH

Declaw

Since I'm doing two declaws today, I figured I'd make this my first entry.

I'm not a fan of declawing cats. That's not to say I won't do it when requested, but I do try to talk people out of it. Any readers in the UK will note that it's actually illegal to declaw a cat in the UK. Different states (California included) are considering outlawing declaw procedures as well.

Here's the thing - cats have claws. They're born with them. They use them. One thing you have to consider when you get a cat is how much you REALLY like your furniture. They may very well do some damage. But they're cats.

My personal decision is to just live with it. I still get grumpy and scold the cats when I see them damaging something, but I also accept that it's part of my life with my cats.

Others feel that they want to enjoy life with a cat and if the cat destroys something, they can no longer enjoy the cat and would have to "get rid" of it. Proponents of declawing argue that if a little surgery is required to keep a cat in a loving home, so be it.

Declawed cats should not be outdoor unsupervised. Period. Think long and hard about if you want your cat to be indoor only or indoor/outdoor. Declawed cats aren't helpless. They can still use those back claws to fight or climb, but they are at a significant disadvantage and it's not fair to them.

There are options to declawing:

Soft Paws - These are little kitty nail caps. They go on similarly to fake nails on people. You have to change them out every 6 weeks, but most cats don't mind them and you can get them in all kinds of fun colors. This way your cat can be color coordinated to the home! You can even give them special colors to be more festive during a holiday season. Some cats are personally offended at the idea of colors, so they might prefer clear nail caps.

Nail trimming - If you start working with them as a kitten, this is much easier. You'll probably have to trim the nails every 2-3 weeks. You can't use human nail clippers! Especially on big nails. Kitty nails are laminar and if you clip them with human clippers you'll just cause it to shatter. Use sharp kitty clippers instead.

Scratching posts/kitty furniture - you can find all kinds of devices geared to help distract your cat and get them to scratch on their own toy instead of your furniture. There are sissal pads you can hang, cardboard blocks, and even GIANT carpet covered kitty houses. (If anyone has a good experience with one type of scratching accessory over another - let us know!) I've even built one myself. Put it in a location the cat wants. You may have to move it from time to time in order to get the cat interested again. Cover the thing in kitty weed (catnip) if necessary. A stoned kitty is a happy kitty! The little sissal blocks are convenient because you can hang or set up those right next to the area the cat is scratching (i.e. hanging it on the couch arm).

Declaw procedure:

Declawing a cat involves amputation of the last bone in the toe. This bone is very small in a kitty and the nail grows from this bone. I'll try to find some pictures. There are several techniques to accomplish the declaw, but the end result is that the last bone is amputated and the resulting defect in the toe is closed with either glue or sutures.

I've had the opportunity to use a surgical laser on declaws over the past two years. I'll NEVER go back! If you need to declaw, definitely seek out someone using the laser for the procedure. It's dramatically better. Less pain, less bleeding. They do great! If it weren't for the laser, I think I would have sworn off declaws all together three years ago.

Let's talk pain - This procedure hurts. There's no way around that. The standard of care for these guys is to use local anesthesia so they do not feel the foot for several hours post-op. This only lasts 12 hours if the right drugs are used. Declaw cats MUST be on some kind of narcotic pain medication. Some hospitals use a patch that provides continuous doses of a narcotic called fentanyl. Others use a drug called buprenorphine. This is a very popular drug in kitties.

I also use a drug called Metacam. It's an NSAID (non-steroidal anti-inflammatory drug) and as such, you have to be careful with it in kitties. In europe, Rimadyl is also labeled for cats. This drug in combination with a narcotic is fabulous. Many practitioners are still very wary of NSAIDS in cats of any kind and will not use them for safety concerns. I use the drug in small doses and find it very safe.

When your kitty comes home from a declaw they MUST BE IN A RESTRICTED ENVIRONMENT. Many hospitals will keep them for several days post-op as well. If they are allowed to jump or run around they WILL cause problems. Make sure you give the pain medications are prescribed and don't stop early. This is an amputation, remember. They deserve the pain medications.

Occasionally some kitties have chronic pain associated with the procedure. Other complications include infection in the toe, bleeding, or refusing to use the litter box. You must change the litter to something like compressed paper or shredded paper. Clay, clumping, or dusty litter will only cause crud to get stuck up in the toe.

Once they heal most cats do just fine.

Talk at ya soon.

AMH

Welcome to my new blog! This is a new experience for me. For those that know me, though, it won't come as any surprise that I now have an online forum to keep talking and talking and talking...

My purpose here is to provide education. I want people to have a place they can come to and get reliable, current information regarding the health and healthcare of the small companion animals. I may also have a few words about goats, cows, birds, and reptiles. I'll try not to get too sidetracked :)

I've got a dozen or so topics ready to post, so check back often and see what I have. PLEASE ask questions - either by comment or e-mail. This lets me know what kind of information people want to hear!

I have a couple of rules, though:
1) No mean people. If you're mean - you're off. Pretty simple.
2) If you ask me a question about your pet - don't be surprised if I can't directly answer. Since I can't see your pet, I have to be very careful what I say or suggest. My hope is that this blog will be more topical and less specific, but we'll see what happens.
3) If it's an emergency - call your local veterinary ER.

And last, but not least, here's the legal disclaimer:
Above all else - the health of your pet is the most sacred. When in doubt - see your primary care veterinarian! I am not standing in front of your pet. I can't see, hear, smell, or interact with you and your pet. No advice, however well intentioned, from me can substitute for the face to face care of your primary care veterinarian!

This is going to be pretty fun. Keep in touch!

Dr. Herndon