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Thursday, April 28, 2011

Preparing For Disaster With Your Pets

Last night my family dodged a bullet.  Storm systems tore through the southern US over the last couple of days, spawning possibly a record number of tornadoes and so far causing almost 250 deaths (the count may rise as wrecked homes and buildings are searched).  They hit my area yesterday and killed a dozen people in Georgia alone.  Only a few miles north of my home there were houses that were blown down to their foundations, trees and power lines down, and the county just west of us is probably going to be declared a disaster area due to the damage.  I sincerly thank God that the only damage near us was one branch down in a neighbor's yard and my lawn swing blown over.  My family made it through unscathed, though unfortunately too many families were devistated.

Just a few hours north of us in Tennessee a friend of ours was going through the same storm system.  He prayed hard that his house would be safe, and God provided that safety.  But his two dogs escaped and were missing overnight.  He posted on Facebook that he'd rather be homeless and have his dogs than to have his home and be missing them.  Again, God's blessings were there, and this morning he found that his dogs had been picked up by an animal control agent and were safe.  They are back with him now.

This brings up an imporant point that many people may not think about.  We talk about preparing our own families during crises and disasters, but the pets are often forgotten.  There were countless pets that ended up as strays in New Orleans when Hurricane Katrina hit.  Pet owners need to think about their dogs, cats, and other critters when they deal with sudden evacuations or damage such as we've seen in the last few days.  In my own family one of the first things we did was to gather all of the pets, especially the cats, and kept them behind closed doors downstairs until the danger passed.  That way we weren't scrambling to find skittish cats when a tornado was bearing down on us.

The ASPCA has a wonderful Disaster Preparedness page that details how you should keep your pets in mind during these times, and should be ready before a crisis actually occurs.  I strongly encourage everyone to go to the link and read the details.  But here is a quick summary.

*  Arrange a safe haven and don't leave your pets behind to fend for themselves.  Pick a designated caregiveer, boarding facility, family member, veterinarian, etc. ahead of time.
*  Make a traveling kit with emergency supplies such as food, blankets, water, recent photos of your pets, veterinary medical records, spare leashes, and so on.
*  Make sure your pet has a collar or harness with an ID tag.  A microchip is even better (but should not be the only identification) because it won't come off.
*  Bring your pets inside at the first time of a potentially serious situation.

Other details can be found on the ASPCA's site above.  You can find the same basic information on FEMA's website here.  The most important consideration is to plan ahead!  Don't wait until you're minutes away from being hit by a tornado before thinking about these things.

My prayers go out to all of the families affected by these storms.

Wednesday, April 27, 2011

Clueless Helpers

Everyone in the veterinary field knows the following scenario.  A client comes in with their pet and you start asking them questions.  Maybe they're coming in for vaccines, or maybe they're coming in with a sick pet.  As soon as you talk to them they respond with "I don't know.  My husband/wife/significant other just told me to bring him in.  He/she keeps up with everything."

Really?  First, if you're the person sending someone else in with the pet, make sure they know everything there is to know as well as you do yourself.  We're going to ask questions about how long the problem is going on, what symptoms you're noticing, how often it's happened before, or even something really hard like "when did he last have his vaccines"  or "is she on heartworm prevention."  You might be surprised how many times the answer to any of these questions is a blank stare.  It's fine if you have someone else be the caretaker and bring the pet in, but please make sure they're well informed.  If they don't know answers to crucial questions it can prevent us from making the right diagnosis.

If you're the person bringing the pet in, make sure you get all of the information you can!  Be aware that YOU are the one we're going to be asking the questions to, so be ready to answer them.

This is all about communication between people.  For whatever reason, too many spouses/relatives/friends/etc seem to assume that the person they designate to transport the pet knows the situation well enough, and the reality is that this is rarely the case.  If possible, the person noticing the problem or keeping the records should be the one bringing the pet to the vet.  If that can't be done, please let your helper be well informed.  It will make the vet's job easier and will improve the quality of care for the pet.

Yes, this happened to me today!  Again!  For the umpteenmillionth time in my 14 years of practice!  Communication, folks.  It's not that hard.

Tuesday, April 26, 2011

Dismember My Dog, Please

I know I've already posted once today, but I was reading one of my favorite sites, Not Always Right, and came across the following exchange, reported from a vet clinic in Madison, Wisconsin.

Me: “Thank you for calling [pet clinic]. How may I help you today?”
Client: “My dog is due for it’s dismemberment shot.”
Me: “Distemper? We can set up an appointment for that.”
Client: “Yes, dismemberment. I need my dog to get his dismemberment shot.”
Me: “Distemper.”
Client: “How much is the dismemberment shot?”
Me: “The distemper vaccine is [vaccine]. Would you like to set up an appointment for your dog to receive the distemper vaccine?”
Client: “Yes, please. I would like you to dismember my dog.”

Frankly, I can't think of any witty comment to follow that.  So there you go.

Scrubs Make The Tech

Most people who go into a veterinary practice probably don’t think a lot about the scrubs or uniforms.  But I can promise you that the practice owner does!  The first decision comes down to whether or not the practice wants to have a very uniform look with everyone wearing the same color and style, or whether they want the freedom to express their individuality with different scrub styles.  The second decision is exactly which styles to use!  Do you allow only animal prints, or do you give complete freedom, knowing that you may end up with people in Spider-Man or Spongebob scrubs?

As a professional veterinarian, it is important to me that my staff looks presentable for our clients. When a customer walks into a place of business, whether it is a doctor’s office, store, or restaurant, they expect the people who work there to be well-kempt, knowledgeable, and professionally dressed. Well-kempt and knowledgeable, those are easy. Simply be aware of who you are hiring, and whether or not they know their stuff. But professionally dressed can be a challenge and often requires some work in deciding exactly what is “professional”.  And then where do you get the look that you’ve decided upon?  Personally I like the look of a uniform in a clinic, with everyone wearing basically the same colors and styles.  But I know that many people like being able to wear whatever they want.

Now here’s something new to my blog, that I hope to continue in the future.  I’m going to try and find sites that I would recommend and use and direct my readers to them.

Recently I stumbled upon Medical Scrubs Mall, an online scrubs store. After searching through the site’s various brands of medical scrubs, I came across their Cherokee Scrubs department. I really liked the variety of styles they had, and I’ve know Cherokee to be quality scrubs.  This company has tons of different colors and styles to choose from, so whether you want a single look or you want your staff to pick whatever they want, it’s here.  It’s actually pretty cool to look through all of the different styles (I know my wife would love to have the Tinker Bell prints!).

The next time you go into your vet’s office, pay attention to how the staff is dressed and see if you can tell any sort of pattern. If you are in the medical profession in any capacity, or if you just love the comfort of wearing scrubs (yes, some people just like to wear them!), I recommend you visit Medical Scrubs Mall, and pick out a set of Cherokee Scrubs for yourself.

Monday, April 25, 2011

Shaking Hands

Rahul emailed me with this question...

Currently I am a second year undergraduate student and I'm leaning strongly towards going to veterinary school when I graduate.  But one practical issue is really concerning me: my hands are mildly shaky and I'm wondering if I could still do the surgeries that most general practitioners perform.  Would I be forced to specialize to get around this problem?

Steady hands are very important for a vet, and not just for surgery.  Obviously, being able to safely and accurately handle surgical instruments is crucial.  However, you need fairly steady hands regardless of which field of practicing medicine you end up in.  With internal medicine specialists there are needle aspirates, endoscopy, ultrasound and other diagnostic procedures that require good hand-eye coordination.  With dermatology you are doing scrapings of the skin with scalpel blades, injections, and so on. Any time you are working with a patient and doing exams, diagnostics, and treatment you need steady hands.

Now that doesn't mean that mild tremors will preclude you from practicing medicine.  Many times people can overcome such a mild disability.  Try doing some exercises at home before you apply to vet school.  Take a sharp knife and cut into a peach, making a straight line.  Sew a button onto a shirt.  Thread a needle.  Pick up a pin with a pair of tweezers.  If you can do these tasks, the chances are that your shaky hands won't be much of an issue. 

If you haven't already, I'd recommend spending time working with a veterinarian and seeing the things they commonly do to see if they fall within your abilities.  You'll need to know this going into vet school, because you will have REQUIRED rotations in surgery, and if you can't pass these you may not graduate.  Find out your abilities ahead of time, and good luck.

Friday, April 22, 2011

The Veterinary Blogosphere

When I started this blog in 2008 I honestly did not know how many veterinary blogs were out there.  I started it partially on a whim, and truthfully I'm a bit surprised at myself for having kept it going for 2 1/2 years.  As I have continued to do this I have learned of other vet blogs and made some connections with vets and veterinary students around the world.  I have several of these other blogs linked on the right-hand bar.

Recently I learned that my blog had been noticed and put on a list of the "50 Best Blogs For Veterinary Students".  I was surprised to see so many blogs dedicated to veterinary medicine, most of which I had never heard of!  It's probably a bit small-minded of me, but I had never imagined that so many vets and vet students would be writing blogs.  However, it seems that blogging is almost ubiquitous now, and with free templates and sites (such as the one I use) it's incredibly easy to start your own.  With so many people savvy in the ways of the Internet, it shouldn't be surprising that we have such a large veterinary "blogosphere".

Now I'll have to admit that though I'm an avid blogger, I really don't go and read many blogs.  I periodically check some of the posts on people I've made a connection with through this blog, but I'm not out there comparing different vet blogs. Honestly, I probably spend too much time playing Facebook games to do that kind of reading!  

Still, I think this is a "win" for pet owners and veterinary students, as there are many sources of information easily accessible.  And it's nice to see that my little corner of the Internet is part of that!

Thursday, April 21, 2011

The Frustration Of Not Knowing

I wish that we as doctors knew everything and could figure everything out.  Unfortunately, we can't.  And it bugs us to no end!

Yesterday I saw a cat for the first time.  The cat wasn't eating, and over a month or two had gone from around 24lbs to 17lbs.  On physical exam he was purring and happy with no obvious physical abnormalities other than an abnormally unkempt coat and some mild dehydration.  We ran a full battery of tests:  blood chemistry panel, CBC, thyroid screen, heartworm test, leukeima test, and AIDS test.  I was expecting to find a leukemia infection, hyperthyroidism, or kidney problems.  When all of the test results were in, my jaw dropped a bit.  There really weren't any significant abnormalities!  The ONLY problem I found was a mild increase in the white blood cells and an analysis of these cells leaned me towards inflammation.  That's pretty non-specific.  So this cat was losing weight rapidly, wasn't eating, and the only thing we could find wrong was some signs of inflammation hiding somewhere inside the body.  All of my normal possibilities went right out the window!  And unfortunately I was left with a thought of "I really don't know what the heck is going on here."

Thankfully this doesn't happen very often.  But it's also not the first time I've been faced with this (in fact, I may have blogged about it previously).  And it never gets easier to deal with.  As doctors we like to be able to find a problem and therefore be able to either fix it or relieve the pet's suffering.  When we know a pet is sick but can't figure out why, it can drive us crazy!  I mean, we know there's SOMETHING wrong, but for the life of us we can't figure out where or why.  With all of our skills, knowledge, and fancy equipment, sometimes easy answers simply elude us.  Not only is this extremely frustrating to us personally and intellectually, but it's bad for the patient as we can't effectively discuss a treatment plan without having a decent idea of what the problem is.

In this particular case I'm worried about cancer hiding somewhere in the body, especially the digestive tract, and have sent the cat to an internal medicine specialist for ultrasound and consultation.  Hopefully they will be able to figure out what is wrong and give the client more specific advice.

Honeslty, this is one of the reasons I really like surgery.  In most surgical cases you have a pretty straightforward situation.  Sure, you can be surprised sometimes and the unexpected does happen when you're exploring the abdomen.  But in most cases you're either cutting something out, sewing something closed, or a combination of the two.  Rarely is there the ambiguity you'll find with internal medicine cases.  It's often said by surgeons, "A chance to cut is a chance to cure."

Any veterinary students reading this, take the lesson to heart.  You simply can't figure out and fix anything.  That WILL happen to you, and you have to learn how to handle it.  Once you learn how to deal with this frustration, be sure and let me know so I can learn from you!

Wednesday, April 20, 2011

The Big 1-0!

It can be amazing how time flies.  Today my son turns 10 years old.  Wow!  The first of our children to number age in double digits.  Last night my wife and I were looking at pictures from just a few years ago and it's pretty remarkable how much he's grown during that time.  I very clearly remember when he was born, after a long and hard labor, and how he had to be in the hospital for a week because of pneumonia.  They had whisked him out of the birthing room as soon as he was born and we didn't get to hold him until the next day.  I saw him before my wife did since I was able to get up and walk over to where he was.  Thankfully it wasn't too serious and he's had no complications since then.  But what a start!

The last 10 years have had their ups and downs just like with any child.  But I must say that Lucas is a great kid with a very kind and loving heart.  Yes, he has his selfish moments and is a typical kid in many regards, but we're all like that at times.  He's smart, creative, and loving and can be a lot of fun to be around.  Originally I wasn't too keen on the idea of having a son, as I wanted daughters.  Silly me!  He's so much easier for me to handle than our daughter, and it's great being able to share typical father-son interests:  comic books, sci-fi and adventure movies, etc.

For better or for worse he won't be following in his father's chosen profession.  This kid has the most sensitive nose and weakest stomach I think I've ever seen.  On Monday I stained a new dresser for him and had it sitting outside for most of the afternoon.  We put it in his room and when he went to bed that night he had to run out almost throwing up because of the smell of the stain.  I could hardly notice anything.  He also doesn't like blood, feces, urine, or any of the other gross things that a vet has to deal with.  So I'm not sure what he'll end up doing, but I'm confident that it won't be in veterinary medicine.

So happy birthday to my son!  I'm so blessed to have him in my life!

Monday, April 18, 2011

Artificial Paw For Pets

I think many people are surprised at what veterinarians have the capability of doing.  I try to tell people that vets have just as much medical and surgical skill as human doctors, but because we work on animals I'm not sure how many people really understand our capabilities.  In fact, did you know that pets can get implanted artificial limbs?

North Carolina State University's College of Veterinary Medicine has been doing implants for pets since 2005, and have performed them in both dogs and cats.  The most recent surgery happened just a couple of weeks ago!  Check out this article in the local Raleigh, NC newspaper.  This latest surgery was done for the first time on a front paw, with all previous surgeries performed on hind legs.  What I personally think is especially cool about this procedure is that the implants are custom-made with computer models and analysis of the pet's leg!  And apparently NCSU is the only place in the world doing this procedure.

Now I know there are people thinking "Hey, it's just a dog!  I can't believe someone would spend that kind of money to give them a prosthetic paw!"  And though I don't know how much the procedure costs, I'm sure it's quite expensive and out of reach for many pet owners. But for those who can afford it and want to spend the money, it's nice to know that this capability is out there.  Really, we are limited only by people's ability to afford the services, and this is understandably difficult when the costs come out-of-pocket for most pet owners.  Since most people have insurance for themselves but few have insurance for their pets, things that we take for granted in human medicine are uncommon with animals.

Is a prosthetic paw taking things a bit too far?  Not in my opinion.  An artificial paw isn't completely necessary, but does replace a normal anatomical feature and improves a pet's quality of life.  To me this is much more worthwhile than a completely cosmetic procedure such as ear cropping.

I also have to talk with some pride about this issue, as I graduated from this vet school and Dr. Marcellin-Little was one of my professors!

Thursday, April 14, 2011

Rotting Mouth

In 13 years of practice I've seen some really bad dental infections.  But today I saw one of the worst in my career.  He's a dachshund around 12 years old and when my associate saw him a few days ago she knew that he would need some teeth pulled.  But none of us knew just how bad it would really be when he came in today.

We got him under anesthesia and before my assistant started doing any cleaning I figured that I'd see how many teeth would be left to actually clean.  Within a matter of a couple of minutes I had pulled almost every tooth on the right side of his mouth!  The odor was unbelievable and even made me have to breathe shallowly.  Most of the teeth were literally held in the mouth by extensive dental calculus.  The tartar went to the bottoms of many roots and the gums were rotting away due to the extent of the infection.  When I extracted the upper canine teeth (those long teeth, sometimes called "eyeteeth" in people), I quickly noticed that there was a direct hole into the nasal passages (an oronasal fistula if you want the medical term) and blood started coming from the nose.  This isn't uncommon when you have extensive periodontal disease, as the roots of these teeth pass just under the sinuses and when infection is this bad the bone is eroded, thus allowing a connection between the nose and the mouth.

The pattern continued with no tooth unaffected.  By the time I was finished I had extracted EVERY tooth in this dog's mouth due to the severe infection and bone loss.  The front of the lower jaw was unstable due to the degree of bone infection, though this will hopefully heal.  The dog went home on antibiotics and pain medications and will need to eat soft food for the rest of his life.

The sad thing is that this was preventable and didn't need to reach this point.  Seeing the vet regularly would have led to this being noticed in the early stages when a routine cleaning could have been done without waiting for infection.  And there are many ways to do preventative dental care, such as dental-specific diets, treats, toys, rinses, and tooth brushing.  I would recommend everyone check out the Veterinary Oral Health Council's web site to see more information on periodontal disease as well as dental care products they have endorsed.

Want to see what the teeth looked like?  I'm going to be talking about this on my webshow on tonight and showing some of the teeth I extracted.  Join me live at 9:15EDT/6:15PDT, or check it out afterwards in the archived section of the Pet channel.

Monday, April 11, 2011


Several weeks ago I was contacted by someone from a new web site,  They had come across my blog and were looking for a veterinarian to host a regular live webcast on their site.  I said I was interested, but didn't put much stock in it as it's not infrequent for me to be contacted about various "opportunities" related to this blog, most of which aren't worth my time or effort.  However, this one was different, as within a week I was on the phone with the CEO discussing what they were looking for.  Long story short, and after some negotiations, I am now one of the hosts on their site!

The site just went live yesterday but is still very new and expanding, and we're not sure where all of this will go.  But there are some big names behind this, including former Disney CEO Michael Eisner as an adviser and network executive Fred Silverman as a co-founder, chairman, and financial backer.  There are some pretty big names behind this endeavor, so there must be a good feeling about it (go look at Fred's accomplishments, as there are some big-name shows that he's brought to TV).

How does all of this work and what does this mean for me?  This site is being set up to allow people to have their own webcast get-togethers that they can put on themselves.  There are several different "channels" on various topics, from dating, to health and fitness, shopping, teen issues, and pets.  That last one is where I come in!  There are videos that people can watch, and which I will be adding to weekly on various pet-related topics.  I will also be hosting a live 10 minute webcast about ten times per week (twice daily on some days) where people can chat with me and ask questions.  When there are no questions to answer I'll pick a topic to go over for the time period. Of course I'm really hoping that this will quickly pick up steam and develop a following that will get me plenty of people participating in the show!  I'm trying to schedule my own show at several different times so that people in different time zones can have a chance to join in.  

For now the site is free to register, and you can come on and see what's happening.  As I said this is all very, very new (less than 2 weeks old, and only officially since yesterday) so you may not see much quite yet.  But keep checking back and you'll see things take off quickly.

Now what does this mean for this blog?  I'm not giving up on it, as this was always intended to be as much about the personal life of a vet and what it means to be a practicing vet as it was a source of veterinary information.  But in order to make my webcast succeed I'll be spending more time there going over clinical information and advice.  There will at some point be an "Ask The Expert" paid service on GabCast, and once that is established I won't do direct case advice for free like I've done in the past (doing so would undermine my efforts at GabCast).  Until then I'll likely answer any emailed questions on my webshow rather than in this blog.  So you can see this blog getting back to more of the personal trials and tribulations of a small animal vet, and my GabCast shows and videos focusing on pet-related advice and information.

Will this really take off?  Who knows?!  But with some big names behind it, there is a real chance of success.  If nothing else, it's opening some opportunities that I never imagined happening.  

So come on over to and check me out live!

Sunday, April 10, 2011


Don't you just hate that feeling you get when you come home from a vacation and realize that you have to go back to the "real world"?  Yeah, me too.

Today my family and I just got back from Myrtle Beach, South Carolina, a favorite vacation spot for us.  Though my wife and I prefer the mountains, our kids really love the beach.  Besides the beach itself, there are lots of family-friendly activities in the area, so it's perfect for us.  Two events this week showed me just how incredibly fearless my little eight-year-old daughter is.

One of the places we visited was Alligator Adventure.  This is an animal park designed around alligators, crocodiles, and their cousins, as well as some birds and other animals.  Both kids like it but my daughter loves creepy-crawly animals and was fascinated by being in the snake house and looking at all of the various reptiles.  They have an interactive show where a keeper educates on various reptiles and gives kids the chance to touch some of them.  My little girl was so excited to get to touch a baby alligator!  No hesitation whatsoever.

But the big surprise was when we went to WonderWorks, an interactive museum with lots of kid-friendly activities.  One of the things they could do was a "skyline", walking dozens of feet in the sky on ropes and narrow beams, safely attached by a tether.  My son is developing a fear of heights, and couldn't be up there for more than a few minutes before having to go back down.  My daughter? We had to keep telling her to slow down so my wife and I could catch up!  It didn't matter how wobbly the walk was or how narrow the rope, she scurried across without any hesitation whatsoever!
This girl is daring and fearless!  And she's only eight!!!  My wife and I have decided that we're in for big trouble when she becomes a teenager.

It was a very nice, relaxing vacation.  The best part was that we had a limited agenda and concentrated on spending time with our family and not rushing.  For the first time in I don't know how long, my wife and I each read an entire book in one day.  We are realizing the benefit of simply taking it easy and not having to fill our days with activities.

Tomorrow....details on my new endeavor!

Tuesday, April 5, 2011

Wandering Vet

I've mentioned before that the practice I work for has multiple satellite locations in our area and I manage one of them.  Over the years I've worked at almost all of the locations and have developed a reputation as someone who can jump in and work in just about any situation.  Sometimes this is to my detriment.

For some reason or another we've had a lot of doctors go on vacation or suddenly take ill, leaving a clinic without a doctor to see patients.  This isn't good for business, as we can't do much revenue without seeing the pets.  It's also not good for the clients and pets as their illnesses can't be seen or treated by us.  So when we have a doctor deficit we look to some of the other locations to fill that gap.  And I seem to be one of the main go-to people!

Today that happened again, with a doctor having to go home because she started vomiting while at work.  I had another doctor working with me at my normal clinic and the afternoon wasn't busy so I agreed to drive over and see the rest of the day at the doctor-less location.  I've worked there before and know the staff so it wasn't a big deal.  But I know that my own regular staff were rolling their eyes and thinking "here we go again."  In the last month I don't think I've been able to have a full week in my own clinic.  Even if its just for part of a day I get asked to go from one place to another.

Really it's kind of a compliment, as I'm known to be efficient, reliable, fast, and very skilled.  Sometimes I get called to assist a less-experienced doctor with a complicated surgery, which I consider fun (I love surgery and love teaching).  But it's also a little frustrating at times as I sometimes don't know where I end up next.

I guess this fits with my life in general, as over the last 13 years I've lived in five different states, held licenses in six, and have lived in three of the four time zones in the continental US.  And there's a possibility that later this year I might be moving again!  My wife jokes that she has a little Gypsy blood in her because she has moved around a lot in her life and starts to get restless when she's in one place for too long.  Maybe she's rubbed off on me.

After today I'm taking a vacation to the beach to have some quiet time with my family, so I won't have internet access until Sunday. 

And then next week I'll have a somewhat big announcement that will mean a new opportunity for me and even a change to this blog.  Stay tuned!

Monday, April 4, 2011

It's NOT The Flea Product...Really! (Part 2)

Today we get a bonus entry, courtesy of Thomas!  He made a lengthy comment, but for some reason it won't show up in the comments section even though I am receiving the emails that tell me that a comment has been made.  Since he had some good points, I thought I'd post it myself, and address some of his ideas.  I'm going to break in and comment as we go along.

I can tell you're getting a little bit tired of repeating yourself on this. :) I also have no doubt that most of the "it's not working" cases are exactly what you describe, and that it must be extremely trying to deal with such unfounded claims on a daily basis. However ... :-)

Well, it's not so much that I'm tired of it, I just don't know what else I can add beyond what I've said.  However...:-)

To summarize on my earlier comment here and to add a few important points:

- I have used the product successfully for some time, which pretty much rules out "user error".

- My conclusion that there is something wrong is not based on expectations concerning the environment, but simply on the observation of large (!) amounts of flea feces and most notably eggs on the dog, in contrast to the excellent performance of the treatment at another location. By my understanding of the products workings, a treated dog should not carry significant amounts of eggs.

It's highly unusual that you are seeing eggs on your dog, and that may not be what you are actually seeing.  Flea eggs are not easily visible to the naked eye, being smaller than the feces ("flea dirt" or "fleaces").  They are smooth, shiny, and white in color.  The eggs are also designed to fall off the animal as quickly as possible, which is how the fleas are spread in an environment.  Once a flea lands on a suitable host it stays on that host for it's life and doesn't jump from animal to animal.  The fleas move around by the eggs falling off the animal where ever it goes.  So if you are seeing actual eggs, this is very unusual and something I don't even see on highly infested pets.  Here are what flea eggs look like, magnified many times.

- Frontline DOES work here, but only for a much shorter interval then the initial 30 days, which, when being able to rule out other factors, which I of course am not qualified to do, it *is* an indication of increased resistance.

- I have observed the problem over three treatments, all of which have happened after 14-20 days of the previous treatment, with the problem becoming painfully obvious after only two weeks, which means the product must have stopped working a bit before that.

- I do not claim this to be a general problem, but can only report this for a specific area of a specific city.

Actually, all of this can be explained without resistance.  In fact, this exact scenario is what Dr. Dryden looked at in Florida and what other researchers have investigated.  When you have an area (city, yard, neighborhood) with an excessive and overwhelming population of fleas, the sheer numbers can overcome the products.  Because it takes some time for the fleas to die, when you have high numbers they can keep jumping on (and yes, keep feeding) before they actually die.  Again, this type of situation has been looked at by independent scientists and in every case (so far) found not to be resistance.

Also, once a flea egg is laid it can take 3-6 months to become an adult.  That's why you have continued fleas emerging for months on end even with appropriate medication usage since some of the fleas you're seeing today may have actually been eggs laid last year.  Then you have wild animals and stray pets moving through an area regularly and you are getting constantly re-infested with new flea eggs. What this means is that in areas with high stray and wild animal populations environmental control is nearly impossible.

- Resistances are more likely to develop, if a population is repeatedly exposed to small doses of a chemical. Untreated street dogs here are abundant, in addition to treated household dogs often spending most of their day on the street near their home. (Few people actually have a backyard here and literally no one walks their dog. They just let them out during the day and back in at night.)
Treated and untreated dogs constantly having close contact means the flea population on the untreated dogs is often exposed to very small concentrations of Frontline. It's pretty much the perfect example of accidental natural immunization. :)

- Frontline is the primary flea treatment used here. (I had to check three drug stores to get Advantix, and they just had one pack under a huge stack of Frontline.)

Now I do agree with the general principle here, and this makes logical sense.  In fact, the scenario you describe is normally how resistance develops in any species and to any product.  So you are thinking along the right lines and have a good understanding of the scientific principles involved.  However, even that being said there hasn't been documented resistance (I'll get back to that in a minute).

- The company producing the treatment is not a reliable source of information, because when isolated incidents of actual resistance become obvious, the information policy is all that decides the end of the products lifecycle. Meaning: even if they know about it, publishing it would be very expensive. It is far more likely that it would cause them to invest into the research for an efficient upgrade to the product and, when it's ready, market it to replace the current one without losing the general investment into the product line. (Yeah, I know evil corporate conspiracy theory, but I've worked for one long enough to know how they think. :)

I'll agree with you again here.  I've seeing data from every company about how their product has studies to show that they're faster, better, and work longer than any competing product.  Obviously they can't all be right, so there must be some bias involved in the study design or interpretation.  This bias is why I rely more heavily on university researchers and independent studies by people who aren't on a pharmaceutical company's payroll. 

- I agree that no reliable evidence against the products effectiveness exists, but as you said, resistances can happen, and I'd even go one step further: They are likely to happen sooner or later. If rare cases in isolated locations start to happen, it will take a while for them to spread and become generally know. I also know that to cross the borders with a dog here, flea treatment is mandatory, and the Andes to the east and the desert to the north make for pretty efficient natural borders.

Here's the point that I wanted to get back to and why I'm careful to state "documented" or "proven" resistance.  I agree that eventually resistance will likely happen.  In fact, I'm surprised that Advantage/Advantix hasn't seen any resistance over the years as much as it's been used.  Just because resistance hasn't happened doesn't mean that it won't.  A few years ago nobody was considering resistance of heartworms to common preventions.  Yet we now have documented populations of resistant heartworms in certain areas along the Mississippi River in the US, and it's becoming more of a concern as we worry about these parasites spreading beyond their current borders.  The situation you describe in Chile is certainly conducive to resistance, and we may see it develop there and in other areas.

Taking all this into account, I do conclude that my personal observations and the lack of another explanation are at least an indication towards an increased product resistance here. Advantix, which I am using now, working as expected would support this, since it is using a completely different active substance. I'll report back. :)

P.S.: If by not being convinced you mean that you will not accept observations from just some guy on the internet as evidence, then I can't really dispute this. Arguing with common sense is futile. :) 

As I said before, I don't completely discount the fact that resistance may be happening in your area.  But the situations that you describe (many fleas despite appropriate use) are also seen in parts of the US, have been investigated, and have been proven to not be due to resistance.  So there are other explanations that make complete sense to the parasitologists.

Great discussion, Thomas!  I enjoy these kinds of intellectual debates where everyone is bringing up logical points and can be polite and rational.

It's NOT The Flea Product...Really!

As we're warming up here in the US we're starting to see "flea season emerge".  So this brings up a good time to talk about flea prevention again. I thought to bring this up after a reader in Chile commented on an older post about Frontline, believing resitance to be taking place in his area.  But before addressing that, I want to remind everyone of previous discussions on flea control.  Go back and read these if you haven't before, as I don't plan on repeating the same information.
Bugged By Fleas?
Winter Prevention?
That Flea Medicine Isn't Working!
eBay Flea Prevention
Follow-up On Fleas & Frontline
Yes, You Really Are Doing It Wrong
Even Yet More Flea Problems
Best Heartworm/Flea Preventatives?

Here's the bottom line...Advantage/Advantix, Vectra/FirstShield, Frontline, and Comfortis are all very effective.  Study after study has shown this.  Bayer looks at resistance to their Advantage products every year with samples of fleas from around the world and has never documented any resistance to their products.  Dr. Mike Dryden, a world-renowned parasitology specialist, investigated cases on suspected Frontline resistance at homes in Florida where "it wasn't working", and in 100% of those cases found that the product worked great but the client had unrealistic expectations or there was some other problem in flea control in the household; in NONE of the 30+ cases did he find any resitance or failure of Frontline.

So seriously, folks.  There is no documented resitance of fleas to these products that I've listed.  There is resistance noted to many over-the-counter flea preventions, so it can happen.  And the fact that there is no resistance now doesn't mean that there won't be in the future.  In 99+% of these products appearing to "fail" there is another problem besides the product itself:  overbathing, failure to treat all pets in the household, failure to treat the house and yard, large numbers of wild animals and/or strays carrying fleas into the environment, inconsistent use, expecting complete control in 1-2 months, etc.  The more I've looked into this over the years, the more I've heard the specialists discuss, and the more articles that I read the more I am convinced that any problems are NOT in the flea products (again, at least the ones I've listed and am familiar with).

Okay, I think I've just about exhausted the possible discussions on flea prevention.  Obviously, this is a very bothersome and frustrating issue to people, but there's also only so much to say.  Since I've talked about it numerous times over the last 2 1/2 years I probably won't say anything else unless new information comes out.  Hope there is enough information here for everyone!

Sunday, April 3, 2011

Scrimping On Heartworm Prevention?

Here's an interesting question I received...

With the economy the way it is I am trying to figure out ways to help our dollar go further.  I currently am trying Trifexis with our 2 1/2 yr old Golden Retriever.  We live on a lake and she swims daily.  The topical treatments were not working.  I heard via the internet that most heart worm medicines can last 45 days but the companies use 30 days for ease of remembering.  If she can go every 45 days,  it would be most helpful.  Thanks for your willingness to help.

First, let's briefly talk about how heartworm prevention works in general.  Most people don't realize that these medications don't stay in the body for a full month (with some exceptions, such as ProHeart).  Heartworm larvae go through several stages of development before reaching adulthood.  When you give an oral heartworm prevention it will kill any of the early larval stages that are in the body.  So basically we assume that a pet has become infected and are killing the larvae when they are young to keep them from developing to the point of causing a problem.  Depending on the ingredients, some preventions can kill larvae up to a couple of months old.  So theoretically, you could go beyond a month with some preventions. 

This is NOT recommended!

First, it's harder to remember odd dates.  Most clients have a hard enough time remembering once monthly preventions (as surveys have shown).  Trying to remember different dates on different months makes it much more likely that doses will be missed.

Second, all heartworm preventions carry a guarantee, promising to pay for treatment if your pet contracts the disease while on the medication.  However, this guarantee requires year-round prevention according to label directions, as well as annual testing.  So if you aren't giving a monthly prevention every month, the warranty is invalidated and doesn't apply.

Let's look at the potential costs and savings, and put it into real-world perspective.  My clinic doesn't carry Trifexis, so I did a quick internet search and a 6-month supply of prevention for a golden retriever is around $120, or about $20 per month.  If you give prevention every 45 days rather than ever 30, you will need eight doses during the year rather than 12.  This is a yearly savings of $80, or about $6.67 per month. If I eat at a fast food restaurant one time I normally spend about $6-7.  If I go to Starbucks it costs me around $5-6.   

Is your dog's health worth $7 per month to you?  Are you willing to gamble with your pet's life for this amount?  Heartworm disease can be deadly if untreated, and can cost $600-1000 to treat a large dog.  Here's an interesting statistic...A golden retriever's life span is around 12 years.  Divide the cost of treatment ($1000 for easy math) over the lifetime and you get a cost of $83 per year.  About the same savings over a lifetime as extending the interval between doses!  So if you look at it this way, there really isn't any significant savings if your dog contracts heartworm disease because of missed doses!!!!

If your personal budget needs an extra $7 per month that bad, I would challenge you to look at how many times you get coffee, eat out, play the lottery, and so on.  Al you have to do is cut out some other non-essential expenses and you can easily afford staying on schedule with the prevention.

Saturday, April 2, 2011

Best Hours Of Operation

My latest poll came from a discussion with one of my colleagues about what operating hours our clinics should be open.  Most of them are open from 9am to 7pm.  We try to have extended hours to accommodate client needs, but that the same time keeping in mind the quality of life for our staff.  So, I thought I'd ask my readers!

Interestingly, 10% opted for the existing hours, not preferring any extension of the time.  I suspect some of my veterinary readers didn't like the idea of getting in early or staying late.  Opening 1 hour early was preferred by 54% while staying open late was preferred by 34%.  I find the results interesting as conventional wisdom among my colleagues is that more clients would prefer being open later in the evening to help with the sick pets they discover when they come home from work.  I thought that more people might be interested in getting up a little earlier to have pets seen before they go to work.  Looks like I was right!

This doesn't mean that I'm going to extend our operating hours soon, as in our location I don't think that we'd pick up enough business to justify the change. But if we do grow to that point, I'll take the "advice" of the readers and open earlier.