Archive for the ‘Pet Health Issues’ Category

Medication administration: Doing it right

Saturday, June 18th, 2011

Medication administration: Doing it right


We often get prescriptions from our physicians or our veterinarian with directions for use. However, a big problem with both human and veterinary medicine is medication compliance. What is compliance?
It is the use of the medication as it was directed. This refers to using the right amount of the medication at the right time intervals. This article will focus on veterinary medication compliance, but some of the same questions can be asked of your physician when getting prescriptions filled.

Why is your pet being prescribed the drug?
One of the major reasons that medications are prescribed is to treat a disease or prevent disease by giving that medication. The biggest concern with compliance is correct prevention or treatment of that disease. One medication that if given correctly prevents disease by 99.9% is heartworm preventative. However, heartworm disease is very common in most states due to lack of compliance with medication. You may even want to ask what would happen if you did not use the medication and find out the cost of treatment if the disease is not prevented.

Before you buy or accept a medication, you should understand as best you are able, why your pet is on that specific medication. Get the veterinarian or a technical person in the office to explain to you why you are using this medication and how it relates to your pet’s condition. This may help you be motivated to make sure that your pet receives the medication as prescribed.

Dose the right amount and in the right way.
Carefully read the label and make sure that you understand the amount of the medication to give in number of pills or amount of fluid. If you need a measured amount for liquids, ask for a syringe for dosing oral liquid medications if the veterinarian does not give you one.

Before you take the prescription, make sure you understand the type of dosing: by mouth, in the eye or ear, or on the skin. Most oral medications (by mouth) will be given with food. This helps to prevent may of the side effects that may be seen. Vomiting is one of the most common.

Why do I need to give the medication every 8, 12 or 24 hours instead of when it is more convenient to give it when I normally feed my pet?
The most common problems with treating a disease is making sure that the dose of medication is given at the right time. Without the right dosing schedule, most medications will not work appropriately. This means that the medication may not treat the disease or that it may actually cause the pet to get ill if not dosed properly. If you cannot dose the medication as the veterinarian has prescribed, you should ask if another medication can be used.

Unfortunately, the best and most economical medication will be often prescribed for your pet at the time of diagnosis or the visit. It is better receive a slightly less effective medication or one that is more expensive than a medication that you will not be able to dose properly and consistently. This may result in a prescription for a more expensive medication. However, the cost of the medication (even if it is 2 or 3 times the cost of the original) is less than 2 or 3 additional office visits with diagnostic testing because of relapse due lack of compliance; i.e. not dosing the medication as directed.

When medications are not given as they are directed, treatment failure or lack of control of symptoms are common. If you cannot give the medication, hospitalization may also be another option to get things started and decrease the risk of relapse. If dosing is necessary very frequently (6 to 10 times a day), with a dangerous medication to humans or intravenously (I.V.), most veterinarians will hospitalize the patient to provide the best care. You can always ask about this option for the start of treatment if you cannot treat your pet easily at home.

My mantra with medication: the best medication is the one the patient will take!
Now that the medication and treatment has been set, what else can happen?

My cat or dog will not take pills or cannot take a liquid formulation.
If you know that your cat or dog cannot take a certain formulation or that sides effects were bad after a previous medication, then tell the veterinarian or a staff member during the visit. Often many drugs come in pill, capsule and/or liquid forms. If these are not available at the veterinary office, the veterinarian can call in a prescription for the pet at a pharmacy in the area where you can pick up the medication in a form that your pet can take. Although this is inconvenient to have to drive to the pharmacy, you normally have to do this for your own prescriptions.

Secondly, if a pet has had a previous reaction (vomiting, diarrhea or an allergic reaction) to a medication, that reaction may reoccur if the pet is put back on the medication. Tell the staff or veterinarian about the symptoms that have occurred before. If you are very concerned request a different medication.

My pet is having side effects such as vomiting and cannot take the rest of the medication. We are midway through a prescription. What do I do?
If you find out part of the way through a course of antibiotics or other medication that you cannot treat your pet, call your veterinarian immediately and tell him/her. The veterinarian can likely prescribe an alternate medication that will help you treat the condition. If the symptoms do not improve, another medical condition may be causing the problem.

One thing I have noted is that clients often stop treatment when a side effect occurs. This is not a problem. The major problem is that they never call the veterinarian office to let us know. If you just stop treatment, the condition may reoccur or a more difficult treatment regimen may be necessary in the future. Let your veterinarian know as soon as possible when a problem arises. I have seen pets require hospitalization when the medication was stopped for a few days. This will cost a lot more than a new prescription or a quick office visit to chart the recovery process. If you notice illness, you should go ahead and schedule the appointment because the longer you wait the more expensive the treatment tends to be.

What is the big deal about stopping the treatment a few days early? My pet took half or more of the medication.
The problem with stopping the treatment early is dependent upon what the initial problem was.

If it is a small skin laceration, there is usually less risk than with an eye or ear infection that needs topical medication. With systemic medications (given by mouth), follow up visits are very important.

One common side effect of antibiotic treatment ended early is development of resistance to the antibiotic. This is a huge problem in medicine in general. Therefore, if an antibiotic is prescribed, give it until it is gone or until the follow up visit to make sure that the condition is improving. If a recurrence is seen, call back immediately, as an extension on the antibiotic or a switch of medication may be necessary.

If this is chronic condition, such as heart disease, stopping the treatment may result in the relapse of symptoms or fast progression of the disease. With chronic conditions, this is often a problem and can cause the full disease process to result more quickly. Many medications are used to both prevent and treat development of symptoms and slow the disease progression. Without the medications, the disease process will often occur much more quickly.

Why do I need a follow up visit?
Finally, there is often a follow up visit scheduled around the time that the medication runs out for simple treatments or after a few weeks for chronic problems to check on progress. This visit is important to make sure that things are going well with your pet. Other reasons for follow up visits are to monitor the medication levels or to check enzyme levels in the blood.

For chronic problems, this is a key visit as it is used to correct anything before the disease process has time to get out of hand from your initial visit. This follow up is essential for the following conditions that we see commonly: urinary tract infections, ear or eye infections, thyroid disease, whole body skin infections, and medications given for seizure disorders.

Finally some miscellaneous concerns on called in prescriptions and costs.
Unfortunately, veterinary costs are often based on disposable income and many problems seem to crop up when we can least afford them.

Use your best judgment, but here are my suggestions.

1. Be upfront about money.
I can tell you that I am not always happy with the limits, but I can better choose how to proceed and stay within the constraints placed upon the care. This also lets me decide what tests have to be run today and what can wait until later. It is better to know that I have only $200 to work with upfront than to spend $200 on diagnostics and the owner cannot purchase any medications that are needed.

2. If you cannot afford all of the medications at one time, tell the veterinarian and only get the most important one(s).
I believe that clients should be as educated about what is going on with their pets as possible. If your veterinarian educates you about medications and why, it is often easier to determine what to purchase and he/she should be upfront about this.

3. If prescriptions are called into a pharmacy, pick them up.
Sometimes medications are not available in the veterinary hospital. If the doctor bothers to prescribe the medication, you should try to get all of the medications. However, you should understand which medications are the most important because the one that was called in may be more important than any that you can purchase from the clinic.

4. If the pharmacy prescriptions are cheaper, have them called into the pharmacy.
If money is tight and we can call in a generic prescription to a pharmacy, assuming they carry the right size, most clinics are okay doing this. However, veterinarians do worry that you may not pick up the medication if you do not get it at the clinic.

S. Mason, DVM

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Pet Life Jackets Just Another Accessory or a Necessity?

Thursday, February 10th, 2011

I have mentioned pet life jackets before on this site as they relate to overall safety in the summer and around water. This article examines pet life jackets more closely and will hopefully help pet owners decide if a life jacket is a good idea for their pet(s). I’ve decided that they are a great idea for my dog, Sophie.

All dogs know how to swim, don’t they?
No, they do not! This is a common misconception, probably helped along by the swim stroke referred to as the “dog paddle.” Some breeds do not enjoy being anywhere near water and some breeds that have low body fat (Greyhounds, Whippets, etc.) may have a much more difficult time staying afloat and regulating body temperature. Fear and anxiety in the water, as when a pet falls in unexpectedly, can hamper normal respiration and swimming ability as well. Waves, undertows, currents and fast-moving rivers can overtake even the strongest swimmer. Wearing a life vest may be the difference between life and death.

Of course, some breeds live to be in the water, such as the Retrievers and Labradors out there. However, even these “water dogs” can have trouble if they are elderly, sick, or overweight and out of shape. Fatigue can set in, and no matter how good of a swimmer they are, they may tire out and be unable to stay afloat. I am sure that many people can relate to occasionally overdoing it as far as exercise now and then. Some people have even experienced medical emergencies from being out of shape and doing too much. Like their human counterparts, many dogs (and cats) lead a much more sedentary life style these days, and gasping for breath while in water is not a good way to assess fitness levels.

Have dog, will travel!
Pets are part of the family, and more pets than ever are taking vacations with their families. For those that travel to lakes, rivers and the coastal areas with their pets, it is a good idea to stop and think about your pet being near water.

I have a mixed breed dog named Sophie who loves the water. She takes frequent dips in the pond, loves to swim in the lake and doesn’t even mind a nice cooling bath in the summer. So I didn’t really worry about this particular dog needing a life jacket. While at the lake last weekend, she eagerly jumped in our little boat from the beach. She is very athletic and in good shape. As she sailed around the docks with my husband to meet the rest of the family, she got very excited and anxious seeing the rest of “her people” on the dock.

Before anyone could think, she leaped from the boat to the dock. Normally this wouldn’t be a big problem, but… she missed. The combination of her pushing off from the boat, the boat heading for the dock, and the dock moving from waves meant that as she was underwater, and the dock and boat closed right over her submerged head!

We grabbed her quickly as she popped up out of the water, and everything was OK. But it was scary. I realized that while she loves swimming with her family nearby, she gets nervous when we are doing different things; some of us on the dock, some of us in the boat, or some of us swimming. This leads to unpredictable behavior from our excitable dog.

After this incident, on went the life jacket for Sophie. At first, we used a vest made for humans, but then purchased a dog-specific life vest. It offers a better fit and handles that make lifting her out of the water much easier. Sophie seems to appreciate the additional lift from the vest and I appreciate the piece of mind!

If you are considering a life vest for your pet, talk to other boaters and pet owners. The US Coast Guard, which regulates human life jackets, does not regulate vests for pets, so be sure to have your pet fitted for the vest that will work best. Dogs in particular come in every shape/size/weight, so be sure to get accurate measurements for a good fit. There are many jacket styles out there and the materials used have different levels of buoyancy in the water. I do not recommend leaving your pet unattended while wearing a life vest at any time — they can be quite hot to wear if not in the water and your pet may chew or become entangled in the vest if bored or wanting to escape.
By Janet Tobiassen Crosby, DVM

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Skin issues, Allergy and Diet

Thursday, January 6th, 2011

Skin issues, Allergy and Diet

It’s 2 a.m. you are awakened by scratching on the floor and soft whining.  Your dog is at it again – scratching, licking his feet and legs and whining every so often.  This has been going on for days now.  You yell at him to stop and lie back down, but within 10 minutes, he’s started up again.  What do you do?  You take him to the vet again, the third time in 6 months.  You are given a two week supply of antibiotics, steroids and an antibacterial/antifungal shampoo.

I get a lot of questions about skin problems including atopy (or dermatitis from allergies), skin infections, food allergy and hair loss.  The crux with almost all of these problems is that the body is not appropriately handling exposure to opportunistic pathogens, ingredients in food or the environment.  The question that I have is NOT how do we stop the itching, scratching and hair loss, but how do we actually stop this type of problem from recurring.

When I talk with owners, many of them just want to stop the problem, they don’t understand that fixing the cause of the problem will fix the reason they arrived at my office.  This crux seems to come down to a miscommunication or misunderstanding between the owner and the treating veterinarian.  For the most part, anytime a pet has repeated skin infections, hair loss or itching and scratching there is something else wrong systemically, not just on the outside of the pet.  However, if the pet is not on a topical or oral anti-ectoparasitic medication, we definitely need to check for fleas, ticks and mite exposure.  This is typically the first thing to do: examine the skin, take skin scrapings, send hair samples to a lab and take impression smears of the skin.  However, most owners who approach me about repeated skin problems are actually treating the pet with a topical antiparasitic medication (such as Frontline, K9 Advantix or Advantage, etc.)  In this case, we really need to figure out what is happening, because if the pet’s blood work is “normal”, the underlying problem is most likely the immune system.  This is often a sign of allergy.  Unlike hay fever in people, allergy in dogs is often seen on the skin.

Seeking help from your veterinarian to determine the exposure is extremely important.  There are various types of tests for this, including skin testing (which I prefer) and blood tests.  However, your pet may show a reaction to a substance on a test, but not exhibit an allergy when fed the allergen or exposed in a different manner.  Once your pet has been sensitized to a certain allergen, it is often difficult to stop the immune reactions that manifest as skin problems.  Whenever possible, determining the culpable allergen(s) (environmental, food, plants or tree pollens, etc) and eliminating them will help with the symptoms.  Stopping the exposure is a good start; however, the body will continue to have an aberrant response to these environmental exposures if the body’s overall inflammation is not decreased.

In my opinion, this problem is more than skin deep, which requires more than the topical and oral fixes of which we generally think.  For the most part, we as pet owners have to look at the diet as the first line of defense against these diseases.  Stress and exposure to pathogens seems to trigger these symptoms, but these allergic conditions appear to develop due to some underlying problem with the immune system.  Basically, the immune system is not responding properly.  This means, the immune system is not clearing yeast, bacteria or other opportunistic pathogens on the skin as it normally would and it may be irritating or attacking the skin inappropriately.  This is a bit simplistic, but overall, it explains what’s going on.  This is not to say that the pills or shots or oral antibiotics and shampoos will not alleviate the symptoms (the itching, scratching, hair loss, etc).  Rather I am pointing out what many owners find; these symptoms keep returning.

Because I think that the diet and overall body health is extremely important, I will give some general guidelines about what I find has worked for stable pets (without a lot of other health problems).  However, most of these guidelines can be applied to pets with other chronic illnesses, it is even more important to talk about it with your veterinarian and modify it as needed.  I am not advocating a specific diet because there are many ways to rectify the dietary problems. 

First of all, we are very busy and we do what is easy.  We feed our pets, usually, one specific diet out of a box, can, or bag.  However, we have to realize that the diets that have been processed and preserved in this way most often lack something that our pets probably need.  I liken these bag diets to me or you living off of frozen lean cuisine meals.  It is not as healthy as fresh foods and, often as animals’ age, they have a harder time extracting nutrients that they need from these diets.  There may be the added problem of some diets lacking adequate quantities of specific nutrients.  Therefore, when a pet shows up with even the hint of an allergy problem such as redden skin, mild hair loss, ear infections or increased licking, scratching or chewing, I try to have a discussion with the owner immediately concerning the diet.  This is client and pet dependent, but it usually results in me suggesting supplements or changing the food altogether.  I have seen pets improve dramatically, sometimes within a week or two, if the owner was feeding the pet a low quality brand and switched to a better quality food.  However, if a pet has developed the tendency for allergy, you should not stop there, as the “disease” process is already afoot.

After looking at the diet, one of the first things I suggest is an omega-3 fatty acid supplement.  I personally like Nutramax products but there are many other providers available.  The best advice on products is to do some research, talk to other pet owners and talk with your vet about these specifically.  I often suggest supplements that I know contain EPA and DHA, which are very important types of essential fatty acids.  Some of the quality food providers add these to the food, but the quantity of added nutrients may not be adequate for pets with deficiencies or who have chronic problems.

Secondly, pets may need additional B-vitamins.  These are water soluble vitamins that we need in our daily diet and usually get in whole grain foods.  However, some dogs may become deficient in specific B-vitamins, especially as they age.  There are various brands of vitamins, but one cheap option is adding brewer’s yeast to your dog’s food; however, you should make sure this is appropriate for your pet and discuss it with your veterinarian.

Exercise is the other major factor in your pet’s overall health.  With dogs, a walk once or twice a day for most breeds is adequate.  However, lack of exercise and resulting obesity appears to increase the risk of allergic disease.  Obesity is also becoming a major problem for many of our pets in the United States.  The extra fat does appear to have consequences that hinder good health in addition to the extra weight.  Research has also shown that the immune system behaves better and is “stronger” in people who exercise regularly.  This phenomenon also appears to impact our pets.

Finally, if you have noticed skin problems or they are recurring, the best way to assist with diagnosis and determine the cause is often by keeping a good record or diary of symptoms and when you notice them.  When you talk with your veterinarian about allergic conditions, you will likely be asked for changes in the diet, treats and the environment and approximately when they occurred.  Due to the chronic nature of these allergic skin problems, the veterinarian is very reliant on you for information as we see the patient often weeks or months apart.  Starting a diary and keeping track of outbreaks, improvements and making note of when food/treats change or other events occur will often help with determining potential culprits and help you to eliminate allergens from the environment to improve the course of treatment, remission and prevent relapse.

S. Mason, DVM

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Perianal Fistulas

Tuesday, July 13th, 2010

We received a question regarding a very serious health issue effecting a large number of dogs. Perianal Fistulas. Unfortunately, 84% of those dogs are German Shepherds.

Question:

I was sent an email a few weeks back on a product you were selling “SNP-G Wound Dressing Gell with Silver Sol”.

What I am wondering is if you know if it has been used to treat “Perianal Fistulas” in Dogs?

My German Shepherd has them and I have him on Cyclosporine but was wondering about this product when I read the description on it.  I also wrote to Dr. Rustom Roy of Penn State University and he said it could “most probably” work.

I also faxed the information from your site to my vet and her assistant just got back to me and said she has never heard of it so she really couldn’t say much either way about it but that it couldn’t hurt to try it.

Can you share your thoughts on this product and if it could or if you have had others use it for Perianal Fistualas in dogs with success or not?

Thank you for your time.

Response:

Based on the properties of the product it should be pretty effective in this case.  It should be able to help/prevent control infection at the site of the fistula, but it should be applied to a clean, dry area and checked daily for swelling, redness or reactions at the wound site which would prevent continued use.  One potential concern with this type of silver product is skin staining.  It is more common in light skinned animals/humans, but a blueish hue could potentially occur in as short a time as a few weeks of daily use.  This blue staining process seen with silver is due to the silver being absorbed into the skin at the application site and then “tarnishing” over time and is generally irreversible.  With animals, the hair typically covers such blemishes but it should be noted in case it were to occur.

Finally, I would suggest to this client that she let her veterinarian know how often, when and how she is using this product.  First of all it will maintain a good relationship with her veterinarian help to prevent potential drug interactions.  Interactions with this product and other prescribed products are very unlikely, but the veterinarian treating this patient should be able to advise appropriately.

S. Mason, DVM

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