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Monday, February 27, 2012

On The Radio

As any reading this blog regularly or paying attention to the US veterinary community will know, February is National Pet Dental Health month.  And I've been lucky enough to get to talk nationally about it!  Not long ago I started working with a national PR firm to start making more media appearances (besides the three local TV appearances I've had over the last year or so).  They booked me for several phone interviews with radio stations around the country!

Last Friday I was on a station in Virginia.  Today I was on stations in Minnesota, Ohio, Idaho, and Illinois (the Chicago market!).  One was live (the Minnesota one, which was also the longest) and the others were taped to be broadcast tomorrow.  It was a blast!  I said more or less the same things in each interview, but I've gotten used to that repetition with clients and when I was teaching.  I love doing TV and radio appearances as well as public speaking, so I get excited about things like this.  I may also have more radio interviews over the next couple of weeks, and then we can start on other topics.

I seriously wouldn't mind being a veterinary media personality, traveling around the country and being in articles, TV shows, and other outlets.  Once again, all part of my plan for world domination!

Update, Dental Contest Winner

Our final performance of Romeo & Juliet was this weekend, so now we can take a breather.  No plays in the immediate future, so no rehearsals and a more normal schedule.  I know our kids will be happy to see more of us.  My wife won't be doing so many costumes at one time, though her custom costume business ( is really taking off and she has about a dozen commissions to start working on.  And I go back to work tomorrow after having taken the last 12 days off to do the play and ConNooga.  This also means that I can get back to more regular blogging, as I haven't posted as much this month due to my other commitments.

Now for our winner! A few weeks ago I discussed pet dental care as part of National Pet Dental Health month here in the US.  There was a contest to win some dental care products provided by, and 20 people entered.  This morning I did a random drawing (via cool free site for generating random numbers and lists), and we have a winner.

Kerrie, who posted a comment on that blog entry, has won the Arm & Hammer wipes, tooth brush, and dental foam!  However, Kerrie doesn't have contact information on her Blogger profile, so I need her to email me ( so I can get the prizes to her.  If I don't hear from her by the end of the week, I'll do another drawing.

Everyone keep up with your pets' teeth!

Thursday, February 23, 2012

Guinea Pig Skin Issues

Ulrike sent me this email, and since I like exotic pets I thought I'd jump in with my opinion.... 

My oldest girl (6yo) started to lose fur on her behind, creeping up her back too. Looked like a typical mite infestation; skin flakes coming off, some scabby bits where she had scratched/bitten and made it bleed. So off to the vet we went.

He agreed that it looked like mites, but was a bit puzzled that he could not see any (took some hairs and flakes and put them under the microscope). Gave an injection just in case. Ten days were over, went to get the second shot, at this point there was no improvement yet. When almost a week later the shot had not shown any effect either, we went back.

Vet says it does not look like fungal as the hair loss is too irregular and he would expect patches or circles with fungal, however as it was not responding to the injections we should try something else.

Mabel is now (as of three days ago) on 0.4ml Septrin twice a day (he reckons as it tastes of banana piggies like it better than Baytril?) just in case it is something bacterial, and twice a week I bathe her with 1ml Imaverol diluted with 50ml warm water in case it is fungal. I really hope this will sort it out...

On another forum someone was putting up the query of hormonal issues, but I don't know... when pigs have lost hair in the past (for example my girl Milka who had a tumour on her kidney) the hair simply fell out as opposed to the whole flaky/scabby business.

In my experience the huge majority of skin issues in guinea pigs falls into two categories:  mites and fungal.  It's uncommon for me to see flaking skin and hair loss without it being one of these disorders.

Skin mites in these pets will always cause itching, sometimes severe enough to lead to seizures.  It's actually very common NOT to find the mites, as it only takes a few to cause a significant issue.  I also think that a light skin scraping should be done, not just plucking hairs (though this is not inappropriate).   Because of the nature of this disorder, I will find mites in probably only at most half of the cases that I test.  For this reason I often treat based on symptoms, using ivermectin injections spaced 10-14 days apart.  If it's mites you should see improvement (though not resolution) within the first week, then likely a cure after the second injection.  If it's not mites, then ivermectin won't do anything.  This is what we call "response to therapy" and is an appropriate diagnostic tool.

Ringworm is the other big concern, and is very common in guinea pigs (I see it several times each month).  Instead of being a worm, it's actually a skin fungus, and doesn't always have the classic "ring" shape.  It also may not look like it does in dogs and cats, often being irregular and causing thick scabs.  As I've mentioned in an older blog, using a blacklight (UV light or "Wood's lamp") is not diagnostic at all in guinea pigs because the species of ringworm they get doesn't fluoresce.  Even if they have it you won't get a "glow" (and honestly it's minimally diagnostic in dogs and cats so I don't normally use it in any species).  The only way to diagnose ringworm in guinea pigs is doing a fungal culture where you collect hairs and put them on a culture medium.  It can take 10-14 days to get a result, though most positives show up within the first week.  In any case where I have any doubts at all about it being mites, I will recommend a fungal culture since it's inexpensive and easy.

The most common hormonal problems leading to hair loss in guinea pigs are related to the ovaries.  In these cases you will see symmetrical hair loss over the flanks and sides with no itching, scabs, or flakes.  Spaying them fixes this particular problem, but it's also not really harmful.  Besides this cause, just about any metabolic disorder has the potential for causing bald areas.

I've never personally used Imaverol (enilconazole), though it is used for ringworm in dogs and horses.  I tend to use miconazole lotions myself.  Septrin is a sulfa antibiotic commonly used in exotic species and should be effective against most skin bacteria.  Either of these treatments can take 2-3 weeks to show significant results.

If the current treatment doesn't help, I would consider finding someone in your area that is very experienced with or specializes in exotic pets.  Though guinea pig skin cases are usually pretty straight-forward, you can get cases that stump even the best general practitioner.

Wednesday, February 22, 2012

Pleasing God

Last July I opened up and talked about my walk with God.  That post has received a lot of positive response and emails, as well as having led to an email pen-pal.  I know that religion and God are not important to all of my readers, but it is central in my life and I'm not going to hide this side of me.  Part of the reason for this blog has always been and will always be to show the human aspects of life as a vet.  And all of this brings us to an email I received a few weeks ago from Gina.

I just wanted to say Thank You! I read your blog on Rachel's email it has inspired me! I am glad there are true Christian vets out there I was beginning to feel like I was going into a faithless field. But I'm encouraged by your testimony. I too am wanting to become a veterinarian, it's a passion I know God has placed in my heart. I too am a new born in Christ. Now because of Christ I feel like I can actually accomplish the dream. Not sure where to start though, any suggestions? My question however is how do you feel being a Vet pleases God, as the true calling in your life?

Here's an interesting thing.  Personally I don't think that being a vet is my true calling from God.  Over the years I have gotten involved in various aspects of ministry and now help lead a ministry group (Fans For Christ), which is what I think God's real purpose for me is.  As I often say, being a vet is what I do, not who I am.  I certainly do believe that God has given me interests, talents, and other gifts related to veterinary medicine that allows me to be successful and well liked in my field.  Yes, I have worked hard to get where I am, but the doors have opened because of God, and my mind and personality were shaped by Him, so ultimately I give Him the thanks.  However, I think that my experience in this profession has lead me to be in the right places for God to use me in other ways.  For example, if I hadn't moved to Georgia because of my job I wouldn't be as involved in Fans For Christ as I currently am.  My training and experience as a practice manager has helped me in handling the challenges of leading a very diverse group of people.

But God wanted me to be a vet and lead me to this profession, so I'm sure that there is a reason for this.  When I'm at work I try to keep in mind that as a Christian I may be the only Bible that people read.  I need to conduct myself around staff and clients in a way that is pleasing to Christ, while also remembering humility.  I try to be a "servant leader" as Jesus has described, where I lead by trying to do things for others.  I pray for my patients, especially for very sick ones.  I ask God for help with difficult surgeries and thank Him afterwards.  And when it is appropriate, I bring God into conversations with clients.

Jesus was a healer, and I think that medical professionals of all sorts follow in Christ's footsteps, though obviously we cannot perform miracles.  But ultimately whether or not I please God has to do with my heart, actions, and words as opposed to my specific abilities as a doctor.  God wants me to do my best in my profession, but it doesn't matter to Him if someone is a better diagnostician or can do more complicated surgeries.  It is more important if I follow what is outlined in Matthew 22:37-40....Jesus replied: “‘Love the Lord your God with all your heart and with all your soul and with all your mind.’ This is the first and greatest commandment. And the second is like it: ‘Love your neighbor as yourself.’  All the Law and the Prophets hang on these two commandments.”  Basically love God and love others.  If I do this in the way that the Bible teaches, then I will please my Lord, even if I can't save every patient.

Tuesday, February 21, 2012

Generics Vs. Brand Names

Stefanie asked this question, and I'm surprised that I've not addressed this over the years.  

What is your take on generic meds for pets?  For instance - I just learned that Heartguard Plus has a generic version called "Tri-Heart Plus" or "Iverheart Plus". 

The savings is significant, but are these as effective for pets as the name brand? 

In general I'm very comfortable with generics, and use them quite a bit.  I know that there are some debates and controversies over quality control in some of these medications, but everything I've seen is for the most part safe and effective.

Let's talk a bit about how generics come about.  When a new medication/drug is first developed and produced, there is a patent on it.  I don't have any problems with these patents because developing things like this is a huge financial investment for the company and they need to be able to recoup the costs or they won't have a reason to develop new drugs.  Currently in the US the original company has a 12 year patent before generics can be developed.  Once the patent expires, other companies can manufacture the same product under different names.  The brand name of the product falls under copyright laws, which have a much longer duration, but the generics can market under new brand names or under the official chemical name.  So really these are the same basic products but with different names. 

The manufacturer of a generic medication has no research costs, so they can go straight into development, keeping the price down.  Many brand names also do extensive marketing, which costs money that must be passed along to the final consumer's price.  So Heartgard has ads and commercials in the public eye, granting brand recognition but costing more money.  Iverheart Plus advertises mainly in veterinary journals and didn't have any of the development costs, so the final price is lower.

The Food and Drug Administration in the US still governs generic medications, and these medications must still meet all of the safety and efficacy standards as the brand names.  For the most part the generics are essentially the same as the brand names, and we use them extensively.  As examples, my practice carries levothyroxine rather than the brand Soloxine, enalapril rather than Enacard, carprofen rather than Rimadyl, and so on.  And we carry one of the non-Heartgard brands or prevention.  Sometimes there are minor differences such as Rimadyl being a chewable flavored tablet and carprofen just a regular pill, or the taste and consistency of the heartworm pills. But as far as doing the right job, I'm comfortable with the generics.  I even use them in my human family (acetaminophen rather than Tylenol, loratadine rather than Claritin, and so on).

Here's some trivia for you.  Did you know that aspirin used to be a brand name by Bayer for acetylesalicilic acid?  Since Bayer originated in Germany, as part of the Treaty of Versailles in 1919 aspirin lost its trademark in several countries, becoming a generic name.  Bayer still maintains a trademark for Aspirin with a capital "A", but aspirin with a lowercase "a" is generic.

So Stefanie, feel free to use the cheaper generics.  In my opinion they are just as good as the brand names.

Monday, February 20, 2012

Meeting Draculaura

This past weekend my family attended ConNooga, a multi-genre sci-fi/fantasy/animation/comic/etc. convention in Chattanooga, TN.  My wife was in charge of the ConNooga Kidz track, about 16 events that were geeky and kid-friendly.  As part of her job she managed to contact and arrange for a celebrity guest, one of the biggest ones the con has had....Ms. Debi Derryberry.

Now I'm sure that the name doesn't ring a bell to most of you.  But you certainly know her work.  She is a mostly a voice actress, though she has done commercials and live acting as well.  She's most well known as the voice of Jimmy Neutron, and more recently as Draculaura on Monster High.  But she's been in dozens of movies, TV shows, and video games, such as Final Fantasy, Crash Bandicoot, iCarly, and even Toy Story (she was the voice of the three-eyed aliens).  Since my wife arranged for her to come, we ended up being her hosts through the weekend, making sure she got to and from the airport, taking her to the store, and making sure she got to all of her panels.  In other words, we spent a lot of time with her.

Debi is simply a sweetheart!  She was very down-to-earth and fun to be around.  We had contacted her in large part because my daughter loves Monster High and Draculaura is one of her favorite characters.  So for the first day or so my little girl was star-struck and could do nothing more than grin and giggle.  Debi has a 10 year old son of her own, so she was comfortable being around our kids (and even enlisted my son to help pick out a gift to take back to her boy).  She also has a line of music CDs for children, and has focused a lot in this area.

Debi amazed me with not only her talent and overall "niceness", but how open she was to expand the experience.  My daughter's other favorite character is Clawdeen, the daughter of the werewolf. When we were out at the store, Debi called the actress who voices Clawdeen and got her on the phone just to talk to my daughter!  My little girl got to have a one-on-one conversation with her two favorite characters, speaking in the proper voices.  I don't think I've ever seen her grin so wide.  Then at the Monster High panel with many other kids, Debi managed to get in touch with another actress who voices three characters on the show, and had her talk to the audience in all three voices.  Additionally, she was texting with the show's producer, taking questions from the audience.

This was an amazing experience for my family, as we've never spent this much time with a celebrity.  I'm grateful to Debi for treating us so well, especially our children, and hope to meet up with her again in the future.

Tuesday, February 14, 2012

Fifty Different Directions

A couple of weeks ago I received this email from Alissa and am just now getting to it...

I am very interested in veterinary medicine. Helping animals has been a passion of mine since I was very young. I have been really researching the requirements and commitments being a veterinarian entails. One thing that is very important to me is having a family one day. I really would like to be involved in my child's life. Do you feel that is is very difficult to have a good family life while being a veterinarian?

I think this is relevant to what is going on in my life right now.  My wife and I are acting in Romeo & Juliet, with my wife also the costume designer and seamstress.  This coming weekend we are at a multi-genre geek convention, ConNooga, with me running things for a ministry group, Fans For Christ, and my wife directing the kids' track of about 17 events.  In my professional life I am having to both be a doctor and help manage my practice, and we are in the middle of annual performance reviews.  Also I am going to be teaching a lecture on pet behavioral issues next week and have to prepare my slide show and notes for that.  Oh, and yes, we have two children who are home-schooled and deserve our attention as well.  As you can see, we have fingers in many different pies, and to mix metaphors we are certainly trying to go in fifty different directions at the same time.

What helps is that my wife stays at home.  She has a small custom costuming business, but mostly is a homemaker and mother.  We wouldn't be able to do much with our kids if she had a full-time job also.  I normally work 10 hour days four days per week, getting home around 7:30-8:00 at night.  Lately I've been spending two of those days going straight from work to play rehearsal, not getting home until 10:00 or later.  Now admittedly these after-work activities have nothing to do with my professional life and are things I chose to do, but these are things we have to balance. 

Alissa, go back and search the archives of this blog for work-life balance topics, as I've discussed it before.  A vet's life is difficult, and you often work very long days.  You also can't always leave work right at closing, as you may have cases to finish, notes to write up, or a particularly sick pet that you have to take care of.  Let's say that you're the only doctor on duty and you have to leave RIGHT at 6:00 in order to make it to your son's piano recital.  At 4:30 the "bus unloads" and your lobby is filled with sick pets.  At 6:00 you still have two sick pets in the hospital and you can't simply say "bye" and leave.  That's part of the sacrifice of this life.  We don't have a 9-5 kind of job where you leave at quitting time.  Because lives are often at stake, you may have to stay later to stabilize a patient.  I've been late to some of my rehearsals because I have last-minute patients.  And if you work for a practice that does its own after-hours calls, you may have to go in during the middle of the night.

Balancing work and life is a real challenge.  And though this may be a controversial statement, I whole-heartedly believe that you can be 100% dedicated to your job AND 100% dedicated as a parent.  There are some times when the job trumps being with the kids and vice-versa.  You may want to do both and have every great intention, but you simply can't be in two places at once.  Because my wife is home with the kids I can be completely focused on my job, and then when I get home I can focus on my family.  I have had to miss school events and field trips because I had to work, but I wasn't as worried because my wife was there for them. 

And then there's the whole issue of whether or not you can decrease your work schedule to have a family and still justify the cost of veterinary education and training.  I blogged on that at length back in December and you can find that entry at this link.  Personally I think that female vets have it harder than men because us guys can't carry the babies or nurse.  This simple biological fact puts a lot more pressure and responsibility on the women, and may take them away from work more than a male vet.  Honeslty, the women vets out there can talk more accurately on this topic than I can.

Alissa, if you want family as your main focus, I would be cautious about a career in veterinary medicine.  Even for the fathers it's difficult to balance work and life, and this is something vets have been finding a challenge for as long as I can remember.  With changes in the profession it is becoming easier as the standard is no longer working 60-80 hours per week.  But there are still difficulties to overcome, and you have to balance daycare versus being home with the kids.  Having an involved husband who has more flexibility in his schedule is a huge help.  And I really feel for the single mothers out there, as I don't know how you gals do it.

As for my schedule, once I get through the end of next week I can finally breathe for a while!

Sunday, February 12, 2012

Surgical Dilemmas....For The Vet

I think it's pretty obvious to most people that surgery isn't easy, otherwise anyone could do it.  Believe me, it takes a long time to go from a three-hour spay (the length of my first one) to a 20-minute spay (my current average).   You also have the difficulties with certain vessels, organs, and other structures that can make a surgery a challenge, as well as unexpected events such as slowing heart rates, dropping blood pressure, and burst vessel, slipped sutures, and so on.  

But I don't want to talk about that today.  I want to talk about problems the surgeon has that most people don't think about.

First, have you ever considered what happens when we get an itch?  We are scrubbed up with disinfectant and are wearing surgical gloves, caps, masks, and gowns.  Our hands, arms, and a bit of our front is sterile, but the rest of us isn't.  What do we do when our ear itches?  Because you darn well know that is going to happen in the middle of a lengthy surgery!  We can't just reach up and scratch it because we'd break sterility and risk contaminating the patient with bacteria.  So what do we do?  I asked one of my professors this during vet school and he replied "If it's somewhere you would scratch in public or in front of your grandmother, you can ask an assistant to do it.  Otherwise you just have to learn to ignore it."  Good advice, and I've had assistants scratch a bad itch on my back or nose before.  But I've also had to learn how to deal with those intense itches on places like the inner thigh.  You seriously can't do anything about it, and have to go with the flow!  It's not always easy, but it's possible.

Sweating is another problem, though you can usually get someone to mop your brow.  After all, they do that all of the time on medical TV shows, right?  But sweat running under your cap and through your hair is just tough noogies, and even though it feels strange, you have to suck it up.

Before I started wearing contacts a couple of years ago I would sometimes have problems with my glasses fogging up or slipping down my nose.  There were some points where I felt that the glasses would fall off and fall into the abdomen, but thankfully I can get an assistant to push them back up.  Fogging can be prevented with a well-fitted surgical mask, but even so sometimes you get breath coming up around it.  Again, learn to deal.

But the absolute worst happens with a cold or allergies.  Imagine this....there you are with a loop of intestines between your fingers, trying to find that rock you saw on the x-rays.  All of a sudden you start feeling the all-too-familiar tingling in your nose.  You know it's coming and you try to wish it away, but it keeps building.  You can't step out of the room because you're in the middle of surgery.  Then it hits, and you sneeze....right into your surgical mask!  Well, that's certainly no fun, but then picture me...with a beard.  Yes, that has happened many times to me. I have a big sneeze right into my mask, and sometimes those sneezes are rather...ummm...."juicy".  There it is dripping down the mask, oozing from my nose, clinging to my beard and mustache.  And there ain't a *@#!*& thing I can do about it.  I have to feel that for however long the rest of the surgery takes before I can take my mask off and clean up.

So as you can see, surgical situations can be rather challenging at times. 

Friday, February 10, 2012

Dental Care How-To.....And A CONTEST

In my last post I talked about why dental care is important to your pets.  Today I want to talk about what you can do to help.

As with pretty much anything in life, prevention is best.  If you wait until tartar and gingivitis are present the disease process may be harder to control.  Start your dogs and cats young, getting them used to having their teeth and gums touched while they are still puppies or kittens.  Many clients who start dental care later in their pet's life find that there is resistance to brushing or other preventive care.  When young, dogs and cats are still learning what is "normal".  Make dental care normal for them and it will be easier throughout their life.

So what can you do to help prevent dental tartar from forming, or reduce build-up between cleanings?
1.  Brushing.  This is the gold standard and the most effective method.  You can use most tooth brushes, even human ones, though ones designed for pets' mouths are shaped slightly differently and may work better.  Definitely use a pet toothpaste, as human toothpastes are not designed to be swallowed and are not as palatable to animals.  To be truly effective, brushing must be done at least five times per week.  Since that's most of the week, why not just go ahead and do it every day?  Put the brush and toothpaste somewhere you will see it daily, and make it a part of your routine.  Just don't get it mixed up with your own tooth care products!  You probably wouldn't like poultry-flavored toothpaste.

2.  Foods.  Several foods have been specifically designed to help with dental care, and many are quite effective.  Hills Science Diet, Purina, and Royal Canin all make dental-specific diets.  Though formulated to be the primary foods, Hills t/d is generally still effective when part of the diet (at least half).  Though foods are not quite as effective as brushing, they can still make a big difference.  The idea behind these foods is that they chemically bind with some of the minerals that make up calculus on the teeth, keeping them off the teeth, as well as mechanically scrape the teeth as the pet chews.

3.  Treats.  There are many treats on the market that say they help with tartar build-up, not all work well.  Greenies brand products are probably the leaders in this area, though I've seen good results with Pedigree Dentabones and several others.  The key with the treats is to treat them like brushing.  They must be given at least five times per week to be effective.

4. Sprays.  Recently I've seen several oral sprays come onto the market, and have greeted them with some skepticism.  However, some actually do work, such as the products made by HealthyMouth.  Some water additives can also be effective.

5.  Dental cleanings.  Eventually most pets will need to have their teeth professionally cleaned, even if the above steps are taken.  These cleanings need to be done under anesthesia by a veterinary professional.  The "cleaning" done by some groomers is actually just brushing the teeth.  It's not bad, but if you only do it every few months it really isn't helping any.  You should also not have teeth cleaned by someone not properly trained, as it can do more harm than good.  And if the pet is not anesthetized, most will move at some point during the procedure, potentially causing harm because of the sharp instruments, and likely resulting in a poor quality job.

I want to direct my readers to the web site of the Veterinary Oral Health Council.  This is a group of veterinary dentists (yes, they exist) who evaluate different products on the market and determine if they actually work.  On their site you can easily find a list of products that have been given their seal of approval, and I would recommend using these as a starting point, though I do think there are products not on the list that also work well. Above all, talk to your own veterinarian about what is best for your pet.

Okay, that's the info.  Now on to the contest!!!! is giving away a set of dental care products exclusively to readers of this blog!!!  The prize is a set of Arm & Hammer dental products for dogs:  Advanced Care Dental Finger Wipes, 3-Sided Toothbrush, and Gum Care Dental Foam.  One (and only one) lucky winner will receive the full set free, shipped to their address at no charge, and with no strings attached.

So how do you win?  Really simple.  Make a comment on this blog entry.  It can be something as simple as "pick me", or a real discussion, though keep things polite.  The deadline to post is 11:00pm EDT (GMT -5:00) on Sunday, February 26th, 2012.  Of the posts, one name will be chosen randomly and that person will win!  I will announce the winner on my blog and they will be contacted shortly afterwards to arrange shipping.

Good luck to all entrants! And keep your pets' mouths healthy!

Wednesday, February 8, 2012

Busting Dental Myths

Here in the US February is officially Pet Dental Health Month.  With this in mind, I'm going to post a few things about dental care this week.

Do you know what the most commonly diagosed disease is in pets?  Diabetes?  Heart murmurs?  Diarrhea?  Kennel cough?  Nope, none of those.  It's dental disease!  Tartar, gingivitis, and periodontal disease have a much higher incidence rate than any other disease or disorder.  Yet surprisingly many pet owners don't do much about it, resulting in health risks and discomfort for their pets.  There seems to be a perception among many clients that dental issues really aren't a big deal and are optional to treat.  Nothing could be further from the truth, and I want to spend some time debunking some myths surrounding dental disease.  Here are some common misunderstandings, in no particular order.

1.  My parents never had their dog's teeth cleaned and he lived to a ripe old age.  This whole thing has been blown out of proportion.  In the veterinary profession there is a joke that about 20 years ago we discovered that dogs have teeth, and about 10 years ago we discovered that cats also have teeth.  Decades ago dental care wasn't emphasized and the risks were not appreciated.  Medical understanding evolves over time, and what we know now may not have been a generation ago.  Vets who practiced 40 years ago weren't taught much (if anything) about periodontal disease.  I graduated from vet school 15 years ago, and I had one lab and maybe a couple of lectures on dental disorders.  Over the last few decades our knowledge of disease processes in general has expanded, and this includes things in the mouth.  Just because something wasn't done in our parents' generation doesn't mean that there isn't valid reason to do it today.

2.  A little tartar really isn't a big deal and doesn't cause problems.  Think about this for a minute.  Do you think your dentist would be okay with you having "a little bit of tartar".  Certainly not.  We are supposed to have our own teeth cleaned every six months, even if we're brushing and flossing appropriately, in order to prevent periodontal disease.  Tartar of any amount is unwanted and begins the process that can lead to periodontal disease.  Additionally, much tartar is below the gum line where we can't easily see it on an exam, so "mild" tartar may actually be more of a problem than it initially appears.  We also don't want to go from tartar and gingivitis to periodontal disease because of more serious health risks (see the next point).

3.  Dental infection only causes bad breath.  Tartar causes gingivitis, which can lead to infection under the gums and in the bone of the jaw.  When the bone is severely infected it begins to deteriorate and causes teeth to loosen and fall out.  But bad teeth isn't the most serious consequence of periodontal disease.  When gingivitis and periodontal disease are present bacteria in the mouth have access to the blood stream and can spread to other parts of the body.  Dental disease is known to lead to liver and kidney infections, heart murmurs, diabetes, and other serious diseases.  Regular dental care and early dental cleanings (see point #2) can prevent the mouth from getting this severe.

4.  My old dog is just getting slow and the tartar doesn't cause her any problems. Many people think their pets are just getting old and slowing down because of age.  Yet periodontal disease may actually be the problem.  I have seen many cases where an old dog has severe infection in its mouth and gums, we do a dental cleaning, extract infected teeth, and put the pet on antibiotics.  It's very common for those owners to come back later and say that after the dog recovered they were playful and more active, acting much younger.  Periodontal disease is painful!  And because it's common in older pets owners may make the assumption that reduced energy is due to age when it is actually due to dental infection.  Clearing the infection makes them feel better. But preventing infection is even better!

5.  It's too dangerous to put my pet under anesthesia, especially at his age.  I often tell my clients that age is not a disease.  If a pet's heart, cardiovascular system, and organ functions are normal, anesthesia on a 15 year old dog or cat is not going to be at a significantly higher risk than on a one year old pet.  Safety with anesthesia is related to multiple factors, and only part of it is the patient's health.  The safest anesthesia involves pre-anesthetic blood testing (to screen for anemia, infection, and organ dysfunction), the right induction agent and gas anesthesia, IV fluids, and full monitoring equipment (ECG, pulse oximeter, and blood pressure).  Unfortunately, there is not only one anesthesia protocol that every veterinarian uses, so the particulars of a procedure will likely vary (sometimes considerably) between practices. If a pet has a medical condition it becomes a whole different ballgame, and the dental cleaning may be more risky.  However in the large majority of patients, the risks associated with dental disease are far greater than any risks of anesthesia, even in geriatric pet (see all of the above points!).  Talk to your vet about the type of anesthesia that they use, and if your pet is a good candidate.

As you can see, there are many good reasons to have a dental cleaning done on your pet and very few reasons not to.  Take this opportunity to have your pet's teeth evaluated and if your vet recommends a dental cleaning, take what they say seriously.  It could significantly improve your pet's health and life.

Stay tuned, as next I'll discuss things that you can do to help your pet's teeth.  Plus, a contest and giveaway!!!  Yes, you can actually get free stuff!

Thursday, February 2, 2012

Legalities Of Prescriptions

This post is brought on by a case I saw today.  A regular client recently bought a puppy from a pet store (a big rant that I'll save for another time).  The dog developed an upper respiratory infection that was quickly spread to her other two dogs.  Based on recommendations from the pet store, they returned the puppy so they could treat her.  Okay, fair enough.  But then they sent home two potent antibiotics (azithromycin and erythromycin) for her two dogs and two cats.  The big deal is that the pet store sent these antibiotics home with the client without the other pets ever being seen by anyone at the store, let alone a vet.  Additionally the labels only gave a little information, mostly just the medication and how often to give.

Wow.  That is wrong on so many levels, and I'll explain why.  Unfortunately I do see things like this happen from time to time, though normally from breeders and not pet stores.  Most clients don't realize why this is wrong, so let me take some time to illustrate.

Let's start with the legal aspects.  Since I'm here in the US and not aware of laws in other countries, any statements I make here are only related to my home country.  First, it is law in every state that in order to dispense prescription drugs the doctor must have a valid client/doctor/patient relationship.  This means that the doctor must have actually examined the pet in question in a relatively recent period of time.  Some states are more specific, requiring that the patient have been seen within the last 12 months or even more recently.  No doctor can legally send home a prescription drug without having seen the pet.  People who are not licensed doctors cannot legally send home prescription drugs at all.  And you have to be licensed for the right species!  This means that my physician cannot legally prescribe medications for his dogs and I cannot legally prescribe drugs for my kids.

Second, the label is very important and what is on it is mandated by law.  According to prescription laws a drug label must include the following information:  Prescribing doctor's name, clinic name, address, and phone number, patient's name, drug name, drug dosage (including milligrams or concentration), and expiration date.  The drug container or bottle must also be appropriate for medications and some states require child-proof closures.  If all of this information is not printed on the label they are in violation of the law.  I have many times seen a client bring in a new puppy with a small envelope of pills and simply "give one daily" (or something similar) hand-written on the envelope.  Usually this is an antibiotic such as metronidazole, and violates the above laws in many regards.

Okay, so sending home medications without seeing the pet and without proper labeling is illegal.  Are we clear on that?  Good.  But it's not just about the legalities.  There are practical reasons related to quality of medicine.

A growing problem in human medicine has been over-use of antibiotics, resulting in resistant bacteria.  Historically doctors have sent home antibiotics for simple things "just to be safe".  Any bacteria that aren't killed may have some resistance and as they reproduce you end up with the potential of a "super-bug" that common antibiotics won't affect.  This hasn't been as severe of a problem in veterinary medicine, but has caused controversy because of the common use of antibiotics in livestock feed.  Thankfully there has been increasing awareness of this problem in all fields of medicine, and physicians and veterinarians are less likely to send home such medications unless there is a real indication for it.  I've avoided antibiotics in many cases that I just didn't think would need it.  How do you know if a patient needs it unless you examine them?  Sending home random medications can increase the risk of antibiotic resistance.

We are also taught to not go straight for our "big guns".  Depending on the severity of the case, there are a few first-line antibiotics we will pick and then go to other things if that doesn't work.  Why?  Because if we have any bacteria that develop resistance to the potent drugs, we may not have other options.  In the case above, the pet store (apparently based on their vet's recommendation) went straight for some of the biggest "guns" we have, as well as using both at the same time.

In veterinary medicine drugs are dosed based on the patient's weight (unlike human medicine where a 120 pound person will likely receive the same dosage as a 200 pound person).  If you haven't seen the pet recently (or at all) you may have a problem with appropriate dosing.  In the case that prompted this discussion the pet store was under-dosing on one medication and almost over-dosing on the other.  Depending on the medication there is the potential for severe side-effects.

Obviously I have a big problem with breeders, pet stores, and even vets who send home prescription medications willy-nilly.   But there are legitimate reasons for my concerns.  People who do these things demean the profession, break the law, and potentially put pets at risk.