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

It’s a new Dawn for Dogs with Allergies

I am just back from a fascinating weekend at the Biltmore house in Asheville, NC where my sisters and I took the Butler’s tour. This basement tour took guests to the basement of this magnificent house to explore the staggering, innovative achievements of George Vanderbilt in 1895 (Otis elevator, coal-powered steam heat, indoor plumbing, and full electrical power which was both AC& DC wired due to suggestion of friend Thomas Edison.)  A surprisingly interesting  side note to our lesson in innovation was the medical recommendations for shock in the electrical room. A bit of a spoiler alert as it does not involve “mouth to mouth” but rather another orifice! 

As I witnessed the sunrise over the estate and took in all that I had learned, I reflected on new introductions in the veterinary world and at Creature Comforts in 2014. Probably the most significant new innovation available in 2014 for pet owners is allergy treatment. So for this week's blog I'd like to explore the topic of allergies allergies.

What are the most common signs & factors of allergies in pets?

These signs include chewing at the feet, rubbing at the face, inflamed/red ears, and licking of the rear end. Onset is under 3 years of age (unless moved to a new climate).This is due to environmental allergens and defects in the outer skin (epidermal) barrier. Pets living mostly indoors and are responsive to steroid use can be typically spared from itching. 

Although allergies to grasses and plants outdoors are often mentioned as causes of allergies & itching, why does my pet have skin issues year round?

Although in North Carolina allergies to grass, trees, and other plants are common sources of misery for pets, many dogs and cats are allergic to  house dust, mold spores, specific foods, and storage mites (mites found in pet food). Thus pets can itch year round, even in snowy weather. 

I have read bathing a normal pet too frequently could dry out the skin; yet, I was recently told to bathe my itchy pet weekly. Why?

The key words here are normal vs. itchy pets.  If a pet is itching it no longer is in the normal category. I advise clients that allergy pets are like giant “Swiffer mops” in the environment, thus maintaining a constant source of irritants on the paws, skin, and fur. By frequent bathing with non- irritating shampoos, owners are decontaminating the fur thus decreasing the cumulative irritant factors of allergens.

Besides bathing what are some of the traditional methods to deal with allergies in pets?

Once eliminating other causes of itching such as primary infections (mange mites, fleas, ticks, lice, ringworm, yeast, and bacteria), veterinarians start with supportive care such as anti-histamines (Benadryl, Zyrtec, & Chlortrimaton) and steroids (prednisone, prednisolone, Medrol, and triamcinolone) for specific, seasonal periods of the year. When pets are uncomfortable with prolonged itching, the self- trauma of scratching may lead to opportunistic skin & ear infections (yeast and bacteria).  Topical spot treatment steroids (Genesis spray) of non-infected areas such as the feet,  veterinary anti-bacterial  wipes (Preva & Malaket), and simply wiping off the feet, belly, and rectum with warm water wiping after being outside is helpful. Oral fish oil (wellactin) is another helpful product as well. Topical application of  a product to restore the lipid barrier  such as Douxo Seborrhea Spot-on  pipettes have added benefits.

What are some the concerns of prolonged use of steroids?

The increase in appetite leading to weight gain, urinary accidents as a result of increase in thirst, and silent urinary tract infections are the most frequent complaints.  Other concerns are changes in the behavior of pets that vary in the spectrum from depression to hyperactivity.  

With frequent bathing are there concerns that topical products for fleas & ticks could be washed off?

Yes, that is one of the reasons the new product, NexGard, was mentioned in the last blog.

What is a food allergy trial and how is it performed?

For pets showing specific signs of allergies, that are repetitive, a food trial that eliminates proteins that are in current or previous diets for 8 to 12 weeks is recommended.

What are some of the ingredients in these hypoallergenic diets?

For dogs that would typically be:  beef, chicken, soya, egg, and milk. 33 years ago, when I was first in practice, lamb was the typical main ingredient in these hypoallergenic diets.  For cats it is typically fish or chicken based diets. Currently, since lamb is in many pet foods, diets of rabbit, duck, and kangaroo are recommended. One new challenge is that specialty pet food companies are combining the multiple, innovative proteins in premium diets, thus finding a diet with novel proteins is often difficult. Working with veterinary nutritionists, some new possible food trials include such staples as fish, pinto beans and quinoa for dogs. In cat diets new proteins are often rabbit, pork, and venison. There are also available hydrolyzed diets with super small proteins the body cannot easily detect. The secret in these diets is lack of exposure  to  food allergens combined with similar avoidance in  chewable heartworm preventatives, treats, and edible toys.  The risk of pure food allergies  in pets are estimated to range from 12 to 33% in pets.

Assuming the food trial makes no improvement in a pet itching, what is the next step?

 Blood testing for offending allergens after being off oral anti-histamines for 7 to 10 days, and steroids for at least a month is recommended. This may be combined with a skin patch test as well. There is no conclusive blood or patch testing for food allergies at this time. Then a vaccine will be formulated based on the test results. It may take up to 6 months to prove that the immunotherapy works.

What if the blood testing fails to make a conclusive diagnosis, or the allergy vaccine fails, what are the next options?

Besides long term use of bathing, anti-histamines, and steroids along with good flea/tick control, up until this point immune-suppressive therapy with cyclosporine (Atopica) has been suggested. Atopica (first came to the veterinary market in 2003) is administered daily for up to 45 days, then alternate day dosing (on an empty stomach) is recommended to find the lowest dose that works. Atopica may take up to a month to work and can result in vomiting ( try freezing capsule and give with a small amount of food), skin warts (viral), swollen gums, reddish ear flaps, and thickened foot pads. By suppressing the immune system this may allow hidden infections to develop and in rare cases, some cancers.  Another drawback is the cost.

What is the new medication for controlling allergies, Apoquel? 

It is an oral medication for dogs over 6 lbs, at least 12 months of age, that may be administered with or without food. It has not been approved for breeding dogs or those nursing puppies. It starts working within 1 to 2 days, a distinct advantage over Atopica. It may be administered with vaccines, antibiotics, and other medications.  It does suppress the itch response, but in a manner different from Atopica. It is also cheaper than Atopica but more expensive that steroids/anti-histamines.  It is administered orally twice a day for 14 days, then once a day. Supplies currently are limited as the manufacturer cannot keep up with demand. Note as in any veterinary product, the FDA advises washing of the hands after administration.  It is not recommended to pre-split tablets at the office.

Dr. Betsy Sigmon

Veterinary News

It’s a Snow day, My Wedding anniversary tomorrow and Valentine’s Day. So what’s news in Veterinary Products?

As a child growing up in Wake County, snow days meant no school, sledding, test rides on my parent’s old skis, plywood jumps, sitting by the warm fire, TV marathons selecting from (gasp!) only 4 channels, and plenty of junk food. As a small business owner, it means the re-scheduling of appointments & staffing hours, walks in the snow,  sitting by the warm fire, TV marathons selecting from 600 channels ( my son and I picked House of Cards), and plenty of my Sister Joanie’s Coffee Cake.

For those recently at the clinic, she is the one that makes the dog biscuit samplers, including now a gluten free variety at the front desk.  Taco Belle only comes out from under the blanket twice a day, settling in for the duration lying beside my son Jason, back from Hong Kong for the week.

So since we all have some time on our hands, let's chat about an exciting new product coming soon to Creature Comforts. 

What is the news about a new oral flea/tick control product, NexGard by Merial? Are there any cautions?  

NexGard is the first oral veterinary product labeled for adult flea and tick control in dogs at 8 weeks of age or older.  It is NOT labeled for use in cats nor in pregnant, breeding, or lactating (nursing) dogs.  It is administered once a month, with or without food, year round.  I would use it with caution in dogs with a history of seizures. It is for dogs 4 lbs and up and does not contain heartworm preventative at this time.

Why is oral prevention such a revolutionary approach for control?

In the south, frequent water exposure through weekly bathing or swimming has the potential to dilute out topical flea/tick control concentrated in surface oil glands and thus lose its efficacy. By administrating orally, and concentration of the product in the bloodstream, not the oil glands, it remains effective even in water exposure.  For parents with children and the concern of topical product exposure, NexGard offers protection against the diseases carried by fleas and ticks without concerns of children touching pets after recent administration.

How quickly may I switch to this product if I recently applied a topical flea & tick control product and am still noting fleas?

Since it is a totally different method of action, there should be no adverse interaction to switching products within a week of each other.

In other products, insect growth regulators are important to control hatching of flea eggs? What makes this product different?

NexGard kills fleas within 24 hours, before they have a chance to produce eggs, thus breaking the life cycle from a different manner of action.  This dramatically reduces repeat infestation in the environment. In homes with chronic flea issues in carpeting or bedding, it will reduce fleas by 98% within 3 months of monthly oral treatment.  A female flea can lay 40 to 50 eggs a day that morph into adult fleas within 3 weeks thus monthly treatment is critical to lower risk of environmental contamination by fleas.

I am disgusted by the appearance of fleas on my dog. Where do pets get fleas and what diseases do they carry?

 Fleas are not only gross in their blood sucking leading to anemia pets and subsequent “flea dirt, bloody poop found on pets”, they also carry a variety of illnesses: plague, cat scratch disease, and tapeworms among others. Feral cats and wildlife such as opossums, foxes, and raccoons, infest the environment around pet homes with fleas  that ride into the home on human clothing or pets themselves. In addition, any place dogs congregate can be a potential exposure site such as dog parks.

Why does the label indicate 98% control of only one variety of ticks for a month Dermacentor variabilis?

Stay tuned, the process to have labeling across all species is time consuming and expensive for product manufacturers.

For dogs that have food allergies, are there any concerns about the mentioned beef flavoring?

No, it is not a labeled concern.  In my dog Taco Belle, who is beef intolerant, I have witnessed no GI Signs.

May it be administered with other medications such as pain meds, steroids, dewormers, vaccines  and antibiotics?

There are no labeled contraindications.

When will it be available to Creature Comforts Patients?

I would like to use NexGard one more time in my own dog and then make it available after the first of March 2014.

I have no concerns with my current use of frontline for topical flea control. Do I need to switch?

No, if you are happy with your current product there is no need to change.

Enjoy the moments with your family,

-Dr. Betsy

Side note: Taco Belle reminds owners of indoor dogs , especially the small ones to make a tarp cover so "tush" does not contact snow during bio breaks. She also warns of toxic ice melts and to watch licking of paws and outdoor water on sidewalks after snows. When possible, use non-toxic ice melts on your own sidewalks such as  calcium magnesium acetate (CMA). This biodegradable  material is one of the safest deicing products because it has very low corrosive potential, meaning less damage to cars, vegetation, sidewalks etc. It costs more than salts such as sodium chloride (rock salt) or potassium chloride(potash), but you use less.  

Dr. Betsy, “What’s The Strangest Thing You’ve Seen As A Veterinarian?”

Dr. Betsy, “What’s The Strangest Thing You’ve Seen As A Veterinarian?”

When in casual social settings in the Cary community one of the most common statements made to me is, “I bet you see some unusual things in veterinary practice!” 

Of course it is true! I have enough stories of veterinary oddities to cover a five course meal and then some. Today, with Valentine’s Day right around the corner, I will share 2 particularly memorable ones. 

As usual at the first part of the business day at Creature Comforts, we check our after-hours messages and receive calls from clients with emergency pet concerns. On this particular day, a pet owner called concerned about breathing issues in her small dog. It didn’t sound good from her description, and I instructed her to come to the office right away. Upon arrival she rushed into the waiting room with her beloved pet clutched to her chest and was immediately instructed to go the exam room. When met by staff members, there was indeed a crisis, but it was not the pet in crisis! In removing the dog from the clutches of the owner’s arms it was glaringly evident she had forgotten to put on a shirt! The dog had no major issues.

The second episode was in my own household. It was Valentine’s Day and our first since adding Taco Belle, my dachshund-chihuahua mix, to our family. Although she was 10 months old and in our “puppy proofed” house, my teenage son had not “received the memo” about keeping his room puppy-proofed. I always get concerned when the house is too quiet with a puppy around. I decided to make a quick inspection. Sure enough, there was a trail of candy wrappers and candy coming out of my son’s room where a stash of Valentine’s candy had been casually left on the floor. And there she was – Taco Belle – standing in the middle of the collection with a guilty look. You know the look… the “I have been a bad dog” look. 

Of course dog behaviorists tell us they are simply reading their owner’s body language, but however you interpret it, Taco Belle definitely had the “guilty as charged” expression. It was evident something was in her mouth.  As the good dog she is, she immediately dropped the item on command. It was a candy heart that said “I love you.” I laughed and hugged her and all was forgiven.  No harm done, the amount of candy consumed was minimal, and my son had a lesson that was quickly forgotten on the risks of leaving things on the floor with pets around. 

I was fortunate that Taco Belle’s potentially toxic episode was minor. Bottom line: Keep candy away from your pets! But in practice, I see many more poisonings that are catastrophic and fatal. 

Several of my clients have questions about Melamine poisoning and Xylitol poisoning. Today I’ll touch on both. 

QUESTION: I thought melamine was a dinnerware. Why was it in the news in 2007 with pet food poisoning?

ANSWER: Melamine is a component in dinnerware, whiteboards, insulation, and laminate flooring.  In 2007, there were many unexpected death of pets due to kidney failure.  During the process of the investigation, it was discovered that many respected brands of pet food were contaminated with melamine.  China (the world’s largest exporter of melamine) some exporters of wheat, corn, and rice gluten illegally added melamine to cheaply elevate the detectable, nutritional protein levels (for which they were paid). Later investigations exposed contamination in fish, livestock feed, eggs, and baby formula. Recent discoveries of small amounts of melamine in food from animals and crops treated with the insecticide cyromazine, also warrant further study.

QUESTION: How many pet foods were recalled, and how many dogs and cats were actually poisoned?

There is no centralized government database of animal sickness or death in the United States as there is in people. The on-line self-reporting hotline reported 3600 sickened pets, while the US Food and Drug administration reported only 14 confirmed cases. A startling 180 pet food brands were recalled.

QUESTION: What was the outcome of the public outcry from such gross negligence by chemical manufacturers?

After the death of Chinese children in 2008 from melamine tainted baby formula, new standards of laboratory detection of melamine were developed. Melamine can be found in some food packaging & dinnerware where it may leach from such materials in storage, hot food use, and microwaving. This has led to recommendations to not microwave food or use foods with high acidity (ex. tomato sauce) in these containers.  There are ongoing investigations as to the amount of melamine that in cumulative exposure places pets and people at risk for bladder stones, behavioral changes, and certain cancers. Thus, always read recommended uses of plastic dinnerware before random use or switch to ceramic or metal products.

From a veterinarian’s standpoint, the melamine incident was when consumers started looking for grain free ingredients in their pet foods. Although this has evolved into a concern for food allergies (for which the risk is small, and low carbohydrate diets for cats to lower the risk of diabetes), the melamine catastrophe of 2007 was a tipping point.

While the 2 men responsible for the melamine scandal were executed in China, the whistle blower in the infant formula contamination, Jiang Weisuo from Shaanxi province, was stabbed and eventually died as a result of  the injuries in a suspected cover up by authorities.

And now about Xylitol...

QUESTION: What is Xylitol and why is so toxic to dogs and cats?

Xylitol is a naturally occurring sugar substitute in many gums, baked goods, and medications (prescription, vitamins, tooth paste, and mouth wash among others) that lower calories in products made for human consumption. Unfortunately, in dogs and cats  that inadvertently  consume such products, the body falsely recognizes the chemical as high sugar content. The pancreas then releases massive amounts of insulin based on the amount of xylitol consumed and the pet’s body weight. Subsequently seizures, liver failure, and death may occur. 1 piece of 1 gram Xylitol sweetened gum can cause significant low blood sugar in a 20 lb. dog within 1 hour of consuming the gum out of a purse. It is much more toxic to pets than chocolate.

QUESTION: I understand about the consumer goods when it comes to Xylitol, but, should I be concerned about human liquid medications prescribed by my veterinarian, especially generic ones?

Yes. You should talk to the pharmacist before giving a human medication to a pet. It is not always clearly labeled on a medication written for human usage that it contains Xylitol, and there may be no veterinary product substitute for the dosage needed. Take, for example, a nerve pain reliever “gabapentin” that is a 100 mg capsule for people. A 10 lb. dog may start with a ¼ capsule. That is difficult to score, so the liquid version of the medication maybe offered as a substitute. However, the sweetener in liquid gabapentin is xylitol, unless it is specifically compounded for pets. In addition, medications such at OTC children’s vitamins chosen by pet owners for senior pet supplementation may also contain xylitol.  Signs of Xylitol poisoning include weakness, vomiting, staggering, seizures, and depression. The poison pet hotline is 800-213-6680. There is no antidote, only supportive care. Thus prevention of exposure is critical.

Thank-you for any feedback and please let me know any topics of interest.

-Dr. Betsy