Notes from Dr. Webb:
Pet Loss Support Information
11/15/2012: I apologize for not keeping this up to date. Since my last post, we have updated the Stop 11 Animal Hospital's anesthetic protocol to provide better post-operative pain control as based upon the recommendations from the International Academy of Pain Management. While we have been using local anesthesia in conjunction with dental extractions and cat declaw surgeries for several years, the newer protocol includes local anesthesia in conjunction with almost all surgeries, including routine spays and neuters. We are also continuing to utilize a narcotic pain medication as part of our pre-anesthetic protocol for all patients, and when appropriate, adding in a non-steroidal anti inflammatory medication (NSAID) pre- and post-operatively (including the new Onsior NSAID for cats) as well as the alpha-blocker dexdomitor pre-operatively to provide additional pain and anti-anxiety control. These additions, and some other protocol modifications, are allowing us to use less of the induction drug Propofol, which has made national headlines due to some of its uglier side effects (primarily focused on respiratory arrest).
One surprise for many individuals, veterinarians included, is that the newer anesthetic drugs (Propofol, Isoflurane, Sevoflurane), while being much safer than the older drugs, provide no pain control by themselves beyond rendering the patient unconscious. In studies, pain signals from the surgeries can be traced from the surgery site up to the level of the brain in pets under general anesthesia, resulting in a condition called pain "wind-up". After surgery, the pain pathway is so keyed in to conducting pain signals, that even the slightest trigger sends a massive pain signal to the brain. The older drugs, barbiturates, and gases like methoxyflurane provided some pain control in their own right. Today, patients need extra pain suppression before, during, and after surgery to keep these pain signals at bay. Narcotics, NSAIDs, alpha agonists, and local anesthetic agents all play a vital roll in controlling these pain signals.
Another change that has been made this year includes the hiring of two new assistants. Brittany and John both started last spring, after volunteering for several months (Brittany working on her certification as a Registered Veterinary Technician and John gaining experience to apply to Purdue's Veterinary School). John is continuing his basic education at IUPUI, and Brittany has finished her schooling, passed her exams, and is now our first "official" Registered Veterinary Technician.
We pray that you will all have a wonderful Thanksgiving, but don't feed your four-legged family members too much Turkey (or gravy, or stuffing, or pie, or....).
2/9/12: We have had a minor change of plans today. I was planning on attending the Hoosier Winter Classic dog show at the IN State Fairgrounds tomorrow (Friday), but instead will be attending the IN Veterinary Medical Association Meeting. I should be back in the clinic Saturday morning as planned.
1/27/2012: The New Year is starting off with a whimper. The warm weather has been keeping ticks, and to a much lesser degree, fleas active. We are still finding both with some regularity, not to mention mold and dust mite allergies.
The pharmaceutical world is also making things interesting. Novartis, one of our suppliers, has had some problems with production on their human drug side, which has spilled over and is now affecting our supplies of Interceptor heartworm tablets and Deramaxx arthritis NSAID pain medication. While we have most tablet sizes of Deramaxx in stock, we do not have all bottle count sizes. We are generally well stocked on a related NSAID drug Rimadyl (a Pfizer product). Regarding the Interceptor heartworm preventive, we recently received a shipment of Heartgard from Merial, which will allow us a little freedom in dispensing our remaining Interceptor. We will likely continue to stock Heartgard at least through this summer.
9/16/11: Highlights from the Illinois Fall Conference for Veterinarians:
1) Tularemia: A number of cats in Champaign County, IL have been found dead, and several more have been brought in very sick suffering from Tularemia, also known as rabbit fever. Symptoms include high fever, oral and skin ulcers, no appetite, and enlarged lymph nodes. Cats contract this illness by eating rabbits or rodents outdoors and may carry this infection in to infect members of the family. While no human cases had been reported as of the date of the meeting, this illness is occasionally fatal in humans too, so thorough workups by veterinarians are being recommended to alert the family to their exposure so that correct antibiotics can be started. Prevention is simple, and relies on keeping pets confined indoors.
2) Bordetella bronchiseptica/Kennel Cough: The most severe forms of kennel cough occur when dogs develop infection from more than one agent, generally the bacteria B. bronchiseptica, and either Parainfluenza virus or Canine Influenza virus. B. bronchiseptica alone generally results in a mild, "happy dog with cough" presentation, but throw a virus on top and we have a very sick puppy. Current evidence supports the intra-nasal vaccine as being the most effective preventive for both Parainfluenza and B. bronchiseptica. For most dogs, an annual booster is adequate, however for dogs with very high exposure (weekly trips to "doggy day care", or frequent trips to a boarding kennel), twice yearly is a good idea. Recent research shows that B. bronchiseptica is the parent strain that gave rise to the human pertussis agent, and the parent strain is still capable of infecting people, resulting in the deaths of one or two people a year (generally young pregnant women or children under 10 years of age). It was recommended that pregnant women not work in boarding/dog day care facilities, and children under 10 should not spend time in these facilities or be around dogs with kennel cough.
3) Feline Leukemia Virus: FeLV infections have declined significantly over the past 20 years, due in large part to the ease and speed of blood testing. An old theory is holding true though. In a significant percentage of cats infected with FeLV (up to 70 % of infected cats - less than 5 % of the total cat population though), the virus "disappears" after a month or two (these are cats that never show symptoms). The virus may be found by special tests on bone marrow or sometimes liver and spleen aspirates, so the virus is still present in the body. Months, or years later, when the cat is under a new stress (diabetes, some other major illness), the virus may resurface, or it may cause changes in the bone marrow resulting in the development of true leukemia or may trigger the development of lymphoma. The good news: it is very hard to infect adult cats (> 1 year old), when cats test negative on a routine FeLV test, they are not "actively" infected, that is, they are not capable of transmitting the disease. Recommendations from the meeting: test all cats regularly starting as kittens, retest all "healthy" kittens that test positive in three to four months, all older cats that test positive, consider an IFA confirmation test; consider FeLV vaccine a "CORE" (standard / routine) vaccine for all kittens up to 16 months old; continue the FeLV vaccine in adult high risk cats (cats with unsupervised outdoor access or in a household with a FeLV positive cat).
4) Hyperlipoproteinemia: Elevated Blood Fats in dogs and cats. This is a condition that has historically been considered just an "interesting observation" after blood draws, but is now recognized as true medical disease condition, responsible for a number of problems including eye, skin, seizure/brain, and gastro-intestinal disorders. Although commonly thought of as a "fat dog" problem, the most significant elevations tend to occur in normal to thin dogs. It also appears to be a genetic problem, primarily seen in certain breeds (Miniature Schnauzers and certain families of cats), but can also be brought on by hormonal diseases such as sugar diabetes, low thyroid levels, and Cushing's Disease (hyperadrenal corticism ). Diagnosis relies on fasting blood tests (8 to 12 hour fast), and either the direct observation of chylomicrons in the blood (large "fluffy" fat droplets that rise to the top of the test tube after the blood sets for 8 hours, or is centrifuged), or measurement of the smaller lipoproteins in a chemical assay (the largest lipoproteins are chylomicrons; then triglycerides; low density lipoprotein (LDL Cholesterol); and finally high density lipoprotein (HDL cholesterol)). Treatment is primarily aimed at providing a moderate to high calorie, low fat diet (most dogs are thin to normal weight), and in rare cases, carefully dosing with a "statin" drug or fish oil supplement. Dogs tolerance of statin drugs is much lower than human tolerance, so correct dosing is very critical.
9/8/11: Highlights from The Companion Animal Parasite Council Meeting (www.capcvet.org). The doctors from CAPC presented some alarming news regarding pet parasites and zoonotic infections.
1) Data available from national veterinary laboratories and corporate veterinary clinics shows that in Marion County, IN. cats are at more than twice the risk of dogs to test positive for heartworms. 3 % of cats tested positive, slightly less than 1 % of dogs. This is no doubt due to our much better preventive protocols for dogs than cats. Dr. Webb has been recommending Revolution for flea control in cats for several years now, in part because it is a heartworm preventive medication as well as providing flea, tick, ear mite, and some intestinal parasite coverage.
2) Tick species are on the move, and with them tick transmitted diseases. Anaplasmosis, Ehrlichia, and Lyme disease are being found in areas that historically were considered "safe" from these diseases. In response to this, we have recently added Anaplasma, Ehrlichia and Lyme screening back into our routine heartworm testing in dogs (these diseases are very rare in cats, even in endemic areas).
Note: A positive result on a screening test does not mean your pet is actively infected.
If your pet tests positive, we hope that you will allow us to investigate the result in more depth by submitting a sample to our referral laboratory for a confirmation test and titer measurement, if confirmed, treating your pet for the necessary period of time (3 to 4 weeks for most of these diseases) with the appropriate antibiotic (doxycycline), then rechecking the titer after one to six months. If the titer is stable or falls, your pet does not have an active infection, but should be monitored regularly (many tick transmitted diseases are known to relapse from time to time).
6/21/11: HEARTWORM DISEASE ISSUES: Over the past few weeks, we have had a few phone calls asking what we know about published information concerning these two different issues related to heartworm infections.
1) New species of heartworm. This is generally related to published reports about Angiostrongylus vasorum, sometimes referred to as the "French" heartworm. This is not so much a new species, but a species that is getting new attention as more cases are showing up in domestic pets (primarily in Europe and eastern Canada). A. vasorum is a primary parasite of foxes, and has a very different life cycle than Dirofilaria immitis, the traditional "heartworm". A. vasorum sheds larva into the trachea, are coughed up, pass in the stool, then eaten by a gastropod (snail, slug) where they develop to an infectious stage, which completes its life cycle when the gastropod is eaten by a canine. Many of the traditional deworming agents appear to be effective against A. vasorum, although some may trigger a severe allergic reaction due to the sudden death of all the parasites at one time. It also appears that Interceptor/Sentinel/Trifexis should be effective as a preventive, although keeping pets away from areas that ingestion of slugs and snails is possible is the most effective preventive. Diagnosis of active infections can be challenging since special fecal parasite concentration methods must be used to detect the larva (it will not show up on either the standard "flotation" test used for intestinal parasites, nor the blood test for D. immitis heartworm infections), however, suspicion can be raised based upon radiographs of the chest, and bronchoscopy can be diagnostic as well.
2) Heartworms resistant to current preventive medications. Yes, there have been a small number of cases (mostly in the south, and mostly along the Mississippi river) were dogs apparently have become infected with heartworms despite being on preventive medication year round. One problem that has been cited is that all current heartworm medications belong to the same drug class (although we have approximately five different HW preventives on the market: oral, topical, and injectable; all are closely related chemically). A second problem has been the concern that, for economic reasons, more and more veterinarians are treating heartworm cases with the "slow kill" treatment: opting to use preventive medications in HW positive dogs to prevent the progression of the infection and not to use of the more expensive arsenic derivatives to kill off the adult worms; thereby allowing the adult worms more exposure to the preventive drugs and more chances for larva to be produced that have resistance. While one rather limited laboratory study suggested that one particular topical heartworm preventive was more effective against these resistant cases than the traditional oral drugs, that study was very limited (involving only a single dose of drug, on only one strain of "resistant" larva). We are not recommending any changes in our preventive protocol at the moment. We do recommend that all dogs and cats be on a preventive year around (milbemycin (Interceptor/Sentinel/Trifexis) for dogs, selamectin (Revolution) for cats) which should reduce the risk of infection as much as possible and which should also, with documentation of year around use and prior negative tests, activate the manufacturers guarantee to pay for treatment should a pet develop an infection while on preventive. If you have any questions about the manufacturer's guarantee, please ask.
Ed Webb DVM