Howdy Partner, Welcome to the Buckaroo

Howdy Partner, Welcome to the Buckaroo

The other day I stumbled upon this picture of my nephew James who treasured his season pass to "cowboy country," Tweetsie Railroad in Blowing Rock, NC. It made me think of my first real customer service job working at the Buckaroo in Cary. My introductory title is the way I was instructed to greet each guest. For those of you familiar with downtown Cary, it was located on East Chatham at the current location of the U-Haul rental facility.  It would tickle me when a customer would step up to the counter ordering ½ of a fried chicken, large fries, apple pie and then ask about a diet drink. The hamburgers were the quintessential mystery meat as to this day I am not sure what they contained. Thus it was challenging when friends stepped to the counter and asked “What’s good”?

Surprises (although some are good) many times are not what we expected.

What is the surprise behind fleas in carrying diseases such as Feline Infectious Anemia in cats?

Although most clients do not want to see fleas on their pets, the more sinister, hidden aspect of these blood sucking pests is their  ability to carry infections such as Mycoplasma Haemofelis (Hemobartonella felis). This mycoplasma (bacteria without an outer cell wall) is carried by fleas (also lice and ticks) and transferred in the saliva of flea bites, attaching to red blood cells and taking advantage of the kitty host.  It is hoped that the body of a cat will mount an immune response to destroy the organism. However, left untreated or in an animal with a compromised immune system, (cats with feline leukemia virus), it can lead to anemia, pale gums, yellowish tinge to skin (jaundiced) and even death.  Many cats can become permanent carriers.

How is Mycoplasma Haemofelis diagnosed? Is it a disease only in cats?

Diagnosis is not simple as there is no cell wall so regular cultures as one would use for a urinary tract infection are not applicable. Most times detection is a scan of a red blood cell slide to detect the organisms on the surface of red blood cells. However, since they are transiently present, a better method is a PCR test to amplify the DNA of the organism within a blood sample of an anemic cat. It is estimated that up to 10% of cats are carriers. This particular organism does not infect dogs.

Which cat population is most at risk?

Cats with exposure to the outdoors and male cats are more likely to have infections. A positive Feline Leukemia Virus test increases the vulnerability of their compromised immune system to  becoming susceptible to feline infectious anemia. In rare cases, this co-infection increases the risk of bone marrow cancers. Also positive queens (cats who are bearing kittens) can transmit infections to their kittens.

Is there a treatment?

The newest treatment is combining a quinolone antibiotic, Veraflox, along with a good, comprehensive flea control of all pets in the household and the environment. Year round use of products such as Advantage multi, Activyl, and Frontline Plus is recommended. Many infectious disease experts are skeptical that cats can truly be cleared of this disease.

Switching topics, as we are talking about surprises in cats, is it possible a spayed cat (removal of both the ovaries and uterus) can show signs of being in heat?

Yes, there are a couple of scenarios when spayed (Ovariohysterectomy) cats can show signs of estrus: vocalization, behaving differently, urine marking, totally affectionate, and often sticking rear end up to be rubbed.  Cats demonstrate no vaginal discharge when they are cycling.  One cause is Ovarian Remnant Syndrome with part of the ovarian tissue is remaining (incomplete removal) thus producing estrogen.

The second cause is being seen more frequently in the last 5 years is due to cats licking the skin or being held close by owners using estrogen creams. In other cases, the human estrogen creams were applied without gloves and then a family pet was touched.

Here is a funny cat video to cheer your day!

http://www.youtube.com/watch?v=KIePsbJSS04 

Celebrating the joy pets bring to our lives every day!

Dr. Betsy Sigmon, Hospital Director, Creature Comforts Animal Hospital

Photo of the week from the Bryan Reddersen family

What’s New Pussycat?

After tending to the front door flower pots (blooming in their full glory), it is time to devote attention in this session to our under-served cat friends. 

Being a baby boomer with 4 channels on the TV, I grew up on “I Love Lucy” television reruns. As a token of my fond memories of this series, my cats have been named for characters in the series: Lucy & Fred. 

My Freddie Mertz was an orphan kitten hand raised by veterinary staffers from 10 days of age (bottle fed). Baby kittens, like children, rely on the interactions of others around them to mold their personality and provide boundaries.  Unbeknownst to me at the time, without proper socialization between 2 and 7 weeks of age with queens (or foster queens) and/or siblings, solo orphan kitties grow into aggressive cats: adult biters, fearful behavior with strangers, new surroundings, or any other changes in their routine.  Although experienced in the early portion of my veterinary career, this hard lesion as a”newbie” in hand rearing was never cured: Fred’s interactions with others, including visits to the veterinary hospital, were always stressful. For me, ownership of Freddie became a lifetime relationship of supervising and mediating both fearful & aggressive behavior, sucking on odd objects, and deficient social skills.

How does this Segway into the discussion below? Why are fewer cats being seen at the veterinarian?

There is an estimated 74 to 86 million cats (70 million estimated dogs) in the USA (averaging 2.2 cats per household).  During the last 5 years, the percentage of households owning cats declined 6.2 percent (dogs decreased 1.9 percent). 40 to 45 % of USA cats have NOT been to the veterinarian in their lifetime for preventative care. New guidelines by shelter and adoption agencies have changed the social experience of many of these cats, especially the indoor ones.

With so many new preventative treatments in cats for fleas and heartworms, including better nutrition, are related infections rising?  Is there more Diabetes Mellitus in cats now than in the past?

Yes, even though they are far more expensive to treat than to prevent (there is no treatment for heartworms in cats as there is in dogs).  For cats, in the last 8 years, flea infestations were up 12 percent, diabetes mellitus increased 16 percent, and internal parasite hookworm infections were up 3.5 percent in cats.

 Flea bites make cats itch in reaction to flea saliva, carry diseases (feline infectious anemia, cat scratch disease, tapeworms, & plague for example), drain blood, and increase risks of flea bite allergies. Fleas can also spread disease to people within the household (think children crawling on the carpeting). Obviously, if cats had a choice they'd clearly pick prevention over crazily itching from flea allergies or suffering the effects, even succumbing, to heartworm disease. Once a household has a flea infestation, it can take at least 3 months to get the situation under control.

My cat hates a car ride and I dread the veterinary visits. Could that be a contributing factor to a decline in veterinary visits?

Of course! Unpleasant experiences make pet owners avoid such episodes.  25% of cats in the USA had no regular preventative care in the last year alone. This is in large part because the cats themselves resist so vehemently being put in a carrier (remembering my own experience with Freddie Mertz), improper socialization/conditioning, and negative veterinary experiences. It’s stressful to the cats, and often more so to the cat owner.

With house calls for cats being an option at Creature Comforts, are there other reasons beside the economy to explain a downturn in veterinary visits for preventative care ?

Many indoor cat owners feel lack of exposure to other cats or the outdoors significantly lowers the risk of parasitic infections. Yet raccoons and opossums drop hundreds of fleas and eggs at entrances to pet homes. (Note squirrels and rabbit fleas are not of risk to cats). Pet owners and indoor/outdoor pets provide the mechanical vehicle for the fleas to ride into the house searching for a blood meal from vulnerable indoor cats. Mosquitoes fly through an opening door carrying heartworm disease through a bite to your cat resulting sadly in an untimely death for this totally preventable illness.  

I would know my cat is sick, wouldn’t I?

Not always as this is often false. Cats are masters at hiding illness as a protective behavior. Owners need to be aware of grooming, feeding, activity, interaction, sleeping, gum color, water consumption, breath, vocalization, and elimination habits of their beloved feline friends. Weighing of cats at home on a food scale is helpful on a monthly basis.  However, in a recent survey, 15 percent of cat owners feel they can "Google" anything their veterinarian can do (forget hands- on physical exam, blood work, and radiographs).

What is the take home message on socialization & acquisition of kittens?

Although isolating a kitten may seem like a good thought from the health perspective of infectious diseases, it’s the worst thing than can be done to a kitten emotionally. The key develop period socially for a kitten is between two and seven weeks of age in observation and interaction with queen mother, fosters, and surrounding siblings/kittens. During this sensitive time a young cat learns what to fear and what is safe. If a kitten is missing exposure to different animals, people or experiences during this key development period, it will probably retain a life- long fear of novel people, places, car rides, and sadly the veterinary experience. Eventually they often become dominating and controlling cats with both claws and teeth to demonstrate their discontentment. Perhaps this is why healthy, barn cats often are well socialized pets?

What about preventative care visits for cats?

All cats in North Carolina -- indoor and outdoor -- need to be on preventative flea control/ heartworm preventative year round. Rabies immunization is required to be current and guidelines are established by local health departments, not your veterinarian. Working with the team at Creature Comforts, let’s work together to try to develop strategies to keep visits calm and healthy. This may involve food, positive re-enforcement, warm towels, hormonal Feliway spray, and yes, in some cases, medication for cats to lower their stress. 

In a coming blog I will discuss current recommendations of flea/heartworm/deworming preventative care such as ADVANTAGE MULTI, Heartgard, Frontline plus, and Revolution.

Next time I will venture into Feline infectious anemia (bacterial infection from flea bites) and estrus in spayed female cats (Ovarian remnant syndrome).

I am sure that Ricky Ricardo and Ethel Mertz (the kittens) are out there somewhere looking for their forever home with me. Let’s celebrate together the true love pets bring to our lives by updating the preventative care for all pets in our community/households. – Dr. Betsy Sigmon, Creature Comforts Animal Hospital

For more information on raising kittens

http://www.maddiesfund.org/Maddies_Institute/Articles/From_Helpless_Newborn.html

Taking illness to bed: the Influenza tale

As  CCAH many team members and pets are having acute illnesses this time of year, let's chat about infections such as Influenza. 

Did you know that pets, birds, and pigs share some infections in common? Bird flu, Spanish flu, canine influenza, and swine flu among others seem to frequent the news.  The influenza virus, especially, is constantly mutating, so new strain threats to our public health occur yearly. Here's some answers to a few questions I am asked frequently.

At times it seems like “alphabet soup!” What is the meaning of the multiple acronyms for “influenza”?

There are 3  main types of flu named after their core proteins: A, B, and C. The most common form that is a yearly presence is Type A. Influenza B is less frequent, occurring every 2 to 4 years. The remaining Type C is much milder and is not reported to be of an epidemic nature.

IF YOU DON'T WANT TO HEAR ALL THE SCIENCE BEHIND THE FLU, SKIP THIS NEXT PART. IF YOU ARE A SCIENCE GEEK LIKE ME, READ ON... 

There is a lot of the confusion about the different Influenza A  strains and their designation. The designation comes from the numbers tacked onto the surface proteins of the virus: HA (hemagglutinin) and NA (neuraminidase).  HA , a glycoprotein, binds the virus to cells in the upper respiratory tract and ultimately invades the cell, becoming part of its working function. NA, is an enzyme that enhances the flu virus to replicate within host cells and ultimately allows the virus to be released, thus spreading the virus to other cells in the body as it lowers host cell defenses.

The most common 3 types of HA (H1,H2,H3) and 2 types of NA(N1,N2) cause most of the annual influenza(flu) epidemics.  The 2009 infection, H1N1, infected 24% of the world population in a novel mix of human, bird, and swine flu virus particles  with over 200,000 people (mainly children age 5-19) dying.  In traditional seasonal flu, it is mainly the elderly people that succumb to the virus. Some new variants of H3N2v have been seen in children under that age of 10 often with exposure to pigs at state fairs.

Why does it seem most flu viruses originate in Southeast Asia?

One theory is that for many families, pigs, chickens, and people live in close quarters. The virus particles can more easily interchange and mutate. For example, in 2013 it is speculated that a mutation of bird (avian) influenza (H7N9) emerged outside of Shanghai, China. Of the known 101 people infected, 20% died.  This virus H7N9 can also infect songbirds ( a big passion in China) and migratory birds such as sparrows. Most bird flu (H5N1) spreads from birds to people, not person to person. Pigs (swine) are often a common denominator here as they can become infected by bird, human, and swine viruses. They then serve as a conduit to spread bird viruses to people.  The "virus stew” or new combinations of influenza develop when two different flu strains infect a body cell at the same time and reformulate.

Can influenza infect cats and dogs?  

 H9N2 virus is documented to infect dogs and cats (in China )  and it is speculated that pets that pets can further spread this form of the infection.  In 2009 there were 13 cats documented to be infected with the H1N1 virus from their sick owners. Although at this time it appears a low risk, further research is needed.

What is Canine influenza and how is it identified? Can it be prevented?

 H3N8 equine influenza virus (documented for over 40 yrs.) was identified  in 2004 in Greyhounds  housed close to racetracks and is a probable mutation of the  equine virus particles. It can be a catastrophic respiratory problem in boarding kennels and difficult to control without effective hygiene.   Viral particle testing  (PCR of nasal swab) from the respiratory secretions at time of  onset of symptoms is recommended. Alternatively, antibody blood testing initially and then 3 weeks later are the standard for identification of an outbreak.

There is a canine influenza vaccine available. It does not prevent the infection; rather,  it lowers the severity of the disease once a dog is exposed. There is no documented  risk of spreading to people.

What are the current drugs available to fight back the influenza virus?

The current drug strategies are zanamivir (Relenza) and oseltamivir (Tamiflu). These medications and block the activity of NA (neuramidase) and thus hinder its essential role in viral release. Due to their extensive use for people, the cost and availability of these medications has led to limited use in pets. As a side note, for those familiar with canine parvo virus (a horrible intestinal infection of young dogs), Tamiflu has for some shortened the course of the illness in shelters. Antibiotics play no role in treating primary viral infections, but they are helpful in onset of secondary bacterial infections. 

Fishing for the Source of Suspected Toxicity

Sunday morning – I witness a beautiful sunrise even though it is late with Daylight Saving’s time. Taco Belle is exploring the hellebores, daffodils, and flowering quince that are projecting their subtle beauty to a world that has been previously encrusted with sleet, snow, and bone chilling rain for the past month.

In my morning quiet time I remembered a time long ago when my husband and I took Jason fishing. It was a glorious day, and I witnessed the delight of a child in discovering the mystery of what was on the other end of the fishing pole. When my husband, a fisherman for over 50 years, suggested he try the other side of the boat, he says, "My philosophy is to cast here.” Thus one day of fishing experience for a child superseded that of a half century by a parent.

At the start of each day I personally ask the Creator of this magnificent universe for wisdom in my approach to the day. It truly is a privilege to be entrusted with the care of your precious dogs and cats.

The humbling reality is, unlike humans, pets cannot tell us where they have been and what the cause might be of their illness. "Fishing" for a cause and appropriate treatment is at times quite a frustration. Dr. Mackie, my dear friend, NCSU cohort, and veterinary colleague for over 33 years ( the last 6 at Creature Comforts Animal Hospital), lamented the other day that we occasionally remember our successes but are forever haunted by our failures. And one of the most tormenting failures we encounter is when a pet is ill due to toxic ingestion of prescription and recreational drugs, plants, pesticides, and poisons. I thought I would take this moment to answer some common questions about this topic, and hopefully reduce the number of toxicity cases I see.  

What is one of the toxicities on the rise in the veterinary profession?

Marijuana (Cannabis sativa) ingestion is being noted nationwide, not just in states such as Colorado and Washington where “weed” is legalized.  NBC news reports the Animal Poison Control Center has reported a 30% rise. Since dogs weigh less than people, marijuana can sit in “stoned” pets for 3 to 4 days and cause dilated pupils, red eyes,  drooling,  urinary incontinence, low body temperature, disorientation/drunken appearance, slow heart rate, seizures, and in rare cases coma. The edible "pot" signs are related to amount of THC weed consumed versus the weight of the animal. 25% do not react in the same manner as people; rather they become agitated, distressed, and have rapid heart rates. Signs can develop within 30 to 60 minutes after ingestion as it targets the brain.  

How do pets consume such products?

 Ingestion comes from leaves, edible products, and Bong water. The edible versions are made the same as regular cookies or brownies with the cannabis oil added to the recipe. Although these contain high levels of the chief psychoactive substance, tetrahydrocannabinol, THC, they taste the same as the regular product. Tainted versions for sale also include beef jerky, chai mints, and chocolate truffles. People practice restraint and tend to eat one brownie; while dogs engorge on the “entire box” of tainted goodies. When there is a lot of chocolate in the product, this can enhance the toxicity signs. THC also seems to increase the “munchies” tendency.

Is there an antidote for ingestion of marijuana?

No, supportive care is given with warm fluids to help maintain normal body temperature, monitor blood pressure,  activated charcoal administered orally to lower the amount of absorption, and induction of vomiting if within a couple of hours of ingestion.  Many pets will require supervision for 3 to 4 days in a hospital setting necessary for those showing seizures or extreme intoxication. However, since marijuana is used for the medicinal purpose to lessen nausea associated with chemotherapy in people, it can be a challenge to induce vomiting after ingestion.

I found a ½ empty baggy with a green, leafy substance in my child’s room and my pet is acting disoriented. How can I document this is marijuana exposure?

Take your pet and the substance to a veterinary facility. It is not a reportable issue to legal authorities. Rather the concern is the health and safety of your pet. Blood and urine tests to human laboratories such as Lab Corp are recommended. Although there are over the counter urine test kits, pets often test falsely negative. In people, these urine tests often cross react positive  with human medications such as antibiotics, anti-anxiety drugs, pain, and cold medications, so self-diagnosis is not recommended.

Can pets die from marijuana ingestion? Where can I obtain emergency information quickly?

Yes, but this is rare.  Please call the front desk during office hours at 919-387-3435 for emergency help. As an alternative, The Pet poison hotline is available at 1-800-213-6680 for emergency questions (iPhone app $1.99). There is a $39 fee charge. Be truthful in  these conversations concerning the risks of exposure including prescription & recreational drugs as well as possible indoor & outdoor poisons.  We are “fishing together, “not playing charades.

One, highlight of this blog I would like to add is searching the internet for new research that is helpful to all of us. Below is one such research proposal at Auburn University released this week concerning fibroids in women.

Why is this research proposal an interesting investigation for women’s health?

Auburn University reports that 70% of women in the USA will develop uterine fibroids by 50 years of age which can be painful and debilitating. The cause (and thus effective treatment) remains elusive. In utilizing a hens laying eggs model, investigators are researching over-nutrition and onset of early puberty. According to Dr. Wallace Berry, poultry scientist at Auburn, chickens have ovarian cells and hormonal cycles that are similar to women. In a controlled setting, researchers can manipulate the sexual development of hens through lighting and diet. One hypothesized factor is the rising insulin growth factor (IGF) factor which increases with over-nutrition, leading to an increased risk of fibroid tumors. In summary, this research project could help establish ways to lessen the severity of uterine fibroid tumors through nutritional recommendations. One third of the 600,000 hysterectomies performed in the USA are due to fibroid tumors.

Statically and fiscally speaking, besides the physical & mental toll on women and their families, the annual cost of lost work hours, surgeries, hospitalizations, lost work hours, and pregnancy complications due to uterine fibroid tumors is estimated by Auburn at $34.4 billion dollars annually.

On a personal note, my mother died from complications of uterine cancer when I was 25 years old. Having a sister that was recently diagnosed and treated for uterine cancer, it is personal as well.

http://blog.al.com/wire/2014/03/how_the_lowly_chicken_could_ho.html

Until next time,

Betsy Sigmon DVM , hospital director, Creature Comforts Animal Hospital, Cary, NC

HOME ALONE: The Pet Version

HOME  ALONE: The Pet Version

It is one of those glorious mornings that I do not have to be anywhere. As the Fresh Market Hazelnut Cream Coffee is brewing, I take Taco Belle out to gather the newspaper. It is my favorite time, as I admire the endless enthusiasm for life my precious dog discovers with each leaf and swaying daffodil. Aerobic exercise starts for her by chasing endless robins that choose to pick my carefully cultivated moss path between rock pavers. If I could bottle the inspirational zest for life my dog presents me with each day, it would be an “Amazon best seller”.

Back to the coffee and paper, my thoughts wander to when my son Jason was at the age when I could leave him alone, but the thought always questioned in my mind...should I? On one less than memorable occasion, I chose to have a TV baby sit him with a phone on speed-dial button in hand while I ran to the clinic to check on an emergency patient. The time passed quickly as I accessed the vitals of my patient and initiated emergency care. Suddenly the phone rang, and I got that parental "guilty as charged moment" call from my son saying, “Mommy when are you coming home?" The pet who is now long gone didn't have an appreciation of a veterinarian having to sometimes place patient above family; yet, to this day my son remembers that moment.

 It's funny the things we remember from our childhood! As a child, we had an outside dog, an Irish setter named Taffy. She would roam the neighborhood of Cary off of Cornwall Rd stealing what was left on back porches: dolls, shoes, and even a mop. At times we collected enough objects that our family could conduct a yard sale! Fortunately, there was plenty of stimulating  entertainment for her limited brain capacity . One other dog, a collie named  Aggie, tired from  lack of attention by our family and she moved to a higher class neighborhood than our own, Stoneybrook Estates where she took up new residence. She was missing for a month, then suddenly returned with her identifiable lacerated ear from a prior “social engagement." We rejoiced in her return, only to discover an ad for missing Collie with torn ear with a Stoneybrook Estates address and phone number in the Cary Newspaper. Shortly thereafter, Aggie disappeared and was discovered sitting on the porch of her new digs as we drove by. My third entertaining pet of note is the story of my cat, Lucy (as in the I love Lucy series) that accompanied me to Auburn University and onward to married life. When she was outdoors and tired of the accommodations she would climb a tree and jog up and down my trailer roof until I let her in the “aluminum box palace." Such is an entertaining life for outside pets.

With leash laws, more traffic, and a less than a collegiate atmosphere for roving pets, suburban pets are resigned to living indoors and in potential boredom. Over the last 33 years of practice, I wonder how many of our inside pets feel abandoned and anxious as a result. Here's some general rules on how to make sure your indoor pet is trained to live indoors properly and hopefully not bored with his or her environment.

It is an exciting time within a household to get a new dog. What is the basic timeline that a new puppy needs for outdoor potty breaks?

The rule is 1 hour per month of life plus one up to 6 months of age. So an 8 week old puppy needs to go out every 3 hours.  When that is not possible, a crate with the door opening to an enclosed area with a puppy pad  or dog litter training is recommended. Pets left in a crate for longer periods of time lose the desire to not soil their “den” and thus crate training becomes difficult.

What are the most common complaints/frustrations that are seen at Creature Comforts during this first 6 months of house training a dog?

One frequent complaint is lack of house training in a puppy that is crated 8 to 9 hours during the work week but going out every 1 to 2 hours during the weekends. Consistency in training 7 days a week is the key.  A second complaint is  after taking a puppy outside within 30 minutes the pet urinates/defecates in the house. It is recommended to not have a puppy off the lead in the house in the first 4 months until no accidents for a month. Until that time, keeping a young dog on a 7 to 8 foot rope attached to a human family member is recommended. Then when there is any sign of wanting to relieve itself, pull the rope, blow a panic whistle, fire a water gun, or shake a can of coins, to startle the puppy and immediately take outside.

My puppy is chewing on everything! How can I make it stop?

Chewing on things is akin to a child picking things up with their hands/thumbs as a means of exploring the environment. It is recommended to provide plenty of playtime activities and chew toys such as Greenies, the new Milk bone dental chews, supervised rawhides, and offer such objects when puppy is chewing on the wrong things.  In some cases, when substitution does not work, a temporary time out in a play restricted area (not the crate) is a “puppy time out” for 5 minutes.

When is it time for a dog to go to a training class?

I like to get my new patients in private training as soon as the trainer allows, otherwise by 4 months of age. The current benchmark for socializing puppies is to allow them to meet 100 people by 5 months of age.  In the Wake County area there is a lot more risk of surrender of pets for behavioral issues (fear biting, afraid of other dogs, afraid of children, accidents in the house) than illness such as the Parvo virus.

I am getting up in the middle of the night to take my puppy out to relieve itself; yet, it howls and cries all night. I am sleep deprived and need help!

This is a challenging one for which there is no fixed answer. Some clients allow their puppies in their bedroom in a crate so they can hear the owner’s breathing; others turn on Pandora's “Sleepytime Tunes for Kids”, “Ocean Waves”, or “Sleeping at Last”. One other suggestion is to take baby monitors and reverse it so that the monitor end is at the owner’s bedside to issue firm voice commands to a pet in remote location.

How can I better get my puppy to not bite on things including my hands and to walk on a leash?

Find a good natured play buddy dog for your puppy to learn about mouthing and biting on the ears. For leash training, attach an 8 to 12 inch rope to your puppy’s collar when in supervised play and let it feel the weight of the rope around its collar for short periods.

Besides house soiling and lack of proper socialization, what is the most common behavioral complaint you see in house dogs?

Separation anxiety. When dogs have panic attacks they begin to destroy furniture, howl, and chew up things in the owner’s absence or after long holidays.

Enjoy the journey of life! Until next time, celebrate the moment with your pet family. – Dr. Betsy Sigmon