BATTERIES: Charging Up Your Awareness

By Loren W. Noblitt, MS, DVM


     In my Toxicology class in Veterinary school, we were taught much about everyday toxins that animals can and do get in to (i.e., chocolate, raisins/grapes, NSAIDs, ethylene glycol, rat poison, etc) and the proper remedies for them. We were also taught that many pets are too curious for their own good and occasionally will chew on an odd electrical cord/extension cord. I don’t recall, however, learning about chemical burns from battery acid from a chewed up battery—but, as I found out—it happens.

     I recently saw a young Black Labrador dog with a significantly irritated tongue that both the owner and I thought came from chewing too vigorously on a very thick rawhide. She had a history of “getting into things that she shouldn’t,” which is probably pretty common in these cases! Another thought that I had, after partially seeing the tongue only intermittently while the dog was excessively panting, was that she had developed a ruptured salivary gland (ranula) from some sort of blunt trauma to her mouth. She was very active in the exam room and required sedation to take a closer look in her mouth and figure out “what’s what.”

     Upon sedation, it was clear that her tongue had undergone pretty extensive chemical burns to the right side and the top of the tongue had already begun to slough. She was very painful during handling of her mouth and was very reluctant to chew her food. Saliva was pouring out of her mouth from the localized pain and probably also from nausea. Abdominal x-rays revealed a thin, wispy, wire-like entity in her stomach that I now believe to be the thin lining of the battery wrapper (see below). This same material was found interwoven with her teeth and gums adjacent to where the tongue had been burned.

(Photo courtesy of Zionsville Animal Hospital)

(Photo courtesy of Zionsville Animal Hospital)
     Earlier that same day, she had been observed intently investigating an inflatable mattress repair kit. Concerns had arisen over a small tube of glue that accompanied this kit. Could these mouth lesions be from exposure to glue? I didn’t want to discount it, but it didn’t seem likely based on the generalized nature of the wounds. Plus, there was thought to be only one tube of glue in the kit and it was accounted for and determined to be intact.

     It wasn’t until later that night that her owners discovered the partially destroyed battery back at their house—this made perfect sense!

     When a battery is punctured, battery acid (in this case it was an alkaline battery, so the caustic material is actually Potassium Hydroxide (KOH)—a chemical base) is released and is extremely irritating to oral mucus membranes leading to ulcers within minutes. When severe, this caustic KOH can eat through (and destroy) bone, necessitating debridement of wounds (often necrotic tissue) and significant oral surgery. Once swallowed, the acid wreaks havoc on the esophagus and stomach lining. It is also important to examine animal’s paws for chemical burns, because most animals use their front paws to hold items as they chew them.

     This dog was very lucky because she has owners that are very observant and that knew something was wrong—immediately. Had she been allowed to go untreated for several days, she may have sustained much more severe chemical burns possibly necessitating surgery or possibly may have died from stomach or intestinal perforation.

     Pain control is paramount in the recovery of these animals. Without that, they are very unlikely to eat or drink, and healing will be further impaired. In this particular case, this dog was able to swallow Tramadol (a morphine-type drug) and began eating (albeit reluctantly) later that night. She continued to improve every day with medications to help her body heal the ulcers in her mouth, and most likely in her esophagus and stomach, as well. This dog received Sucralfate and Pepcid A/C, as well as a short course of antibiotic (Flagyl in this case) for 7 days. The reasoning for the antibiotic was to help prevent bacteria (specifically bad, anaerobic bacteria) from gaining access to ulcers (and subsequently the systemic circulation) that were most likely present in her esophagus and stomach. It is important to note that, in animals that simply refuse to swallow medication or eat/drink, pain control can be achieved with a Fentanyl Patch, and feedings can be administered through a Nasoesophageal, Esophageal, or Stomach tubes. She was also given one dose of injectable Cerenia (a canine-specific potent anti-nausea drug), administered under her skin.

     Follow-up x-rays are scheduled for 7-10 days later, to make sure the [suspected] battery lining material shown below, has passed through her intestines, and out into her stool.

(X-ray taken by Zionsville Animal Hospital)
     So please take proper precautions with toys or other items that have batteries in them, taking care to make sure they are out of reach when you are not home or when pets are unsupervised. This is ESPECIALLY IMPORTANT if you have a very curious dog or cat at home!

If you have any questions or would like to set up an appointment with one of the veterinarians at Zionsville Animal Hospital, visit us at www.zvah.com or call 317-873-1833.

Zionsville Animal Hospital Affiliations:
Michigan Road Animal Hospital at Crooked Creek:  http://ccahvets.com/
Michigan Road Animal Hospital at 96th St.:  http://indyvets.com/

References:

Veterinary Information Network (www.vin.com)

Internet Pharmacies: BUYER BEWARE

By:  Loren W. Noblitt, D.V.M., M.S.
    
     In the past, veterinarians supplied prescriptive and non-prescriptive drugs and medications directly to clients. And while I believe that clinging to the past is no way to invest in the future, the advent of third party online pharmacies really complicates “best medicine” practices for veterinarians and, in many cases, could be putting your pet at risk. I write many prescriptions for clients on a daily basis to be used at “human pharmacies” and don’t think twice about it because I know who I am dealing with. Not so, when it comes to online pet pharmacies. There is much controversy regarding online pet pharmacies and whether they are a good choice for pet owners.
     The advantage to online pet pharmacy for the consumer has been pricing options and the convenience of home delivery, rather than having to visit their veterinarian’s office to fill or refill prescriptions. (By the way: Have you checked out our NEW ONLINE PHARMACY yet? Click Here to Do So!). The disadvantages, most of which are unknown to the consumer, are listed below. For these reasons, Zionsville Animal Hospital is hesitant to endorse their use:

     1.   Lawsuits against Internet pharmacies have been filed for multiple reasons, including selling counterfeit products.

     2.   Products purchased from a veterinarian are guaranteed. If your pet has an adverse reaction, the manufacturer will take responsibility for the cost of care – not true if purchased online or at a pet store.

     3.   Manufacturers sell only to veterinarians, therefore we know the product IS genuine. Online pharmacies buy from many sources (see below), including overseas. Storage temperatures, expiration dates, and the true manufacturer (though the package may look the same) are often UNKNOWN.

     4.   At Zionsville Animal Hospital, we offer product education and oversee your pet’s health. We can address your questions and advise on product use. Our doctors are required by the AVMA to have examined your pet within 12 months prior to dispensing medications or prescriptions for medications, to minimize the risk inherent with any medication.

     At least once per week, I receive a request from an online pharmacy to fill a prescription for a client, such as1-800-PetMeds or Drs. Foster and Smith. Once we’ve determined that a particular pet can safely receive the medication in question, we, the doctors at Zionsville Animal Hospital, have adopted a policy where we literally send the hand-written prescription to the client’s home address for them to mail or fax into the online pharmacy.

     Many online pet pharmacies are NOT legally permitted to buy their merchandise directly from Veterinary Pharmaceutical Companies and therefore often rely on diverted merchandise from unscrupulous veterinary practitioners and/or other “back channels”—whatever that means. The expression, “one bad apple spoils the bunch” is very apropros because it is not illegal for veterinarians to sell their supplies to these companies; however, it IS violating their contracts with many Veterinary Pharmaceutical Companies to sell drugs to online pharmacies and should they be found out, those veterinary practices lose their ability to purchase products from that particular pharmaceutical company in the future.

     I have never personally been propositioned by one of these online pharmacy companies (yet!), but know veterinarians that have—usually under the guise of something like “this opportunity is a simple, confidential, and no-risk profitable exercise.” I found one such veterinarian’s (Dr. Georgina Marquez) comments very interesting, “All I need to do is make one or two phone calls and they will take care of the rest. And it will be done totally confidentially?  Really? This is the way legitimate companies operate?” She goes on to point out that most of these online pharmacies are based in Florida and it’s likely NOT a coincidence—it’s a lot easier to distribute counterfeit medications arriving from the Caribbean when you’re that close to the source.  While online pharmacies can be an inexpensive and convenient alternative to purchasing these drugs through a veterinary office, pet pharmacies are not regulated the same way human pharmacies are.  Dr. Marquez goes on to say, “if the FDA and the DEA have trouble keeping human pharmacies on the level, what do you think the level of control aimed at online veterinary pharmacies is? These online outlets know that the legal ramifications of your pet’s drug reactions can’t touch companies of their size. As long as counterfeits and questionable expiration dates abound in the online pet drug marketplace, its buyer beware all the way.” – Georgina Marquez, DVM

     Some of the Internet sites that sell pet drugs represent legitimate, reputable pharmacies, says Martine Hartogensis, D.V.M., deputy director of the Office of Surveillance and Compliance in FDA's Center for Veterinary Medicine (CVM). But others are fronts for shady businesses operating against the law. The CVM is the regulatory body within the FDA that oversees the manufacturing and distribution of animal drugs. Individual state pharmacy boards regulate the dispensing of prescription veterinary products.

     The CVM is especially concerned that pet owners are going online to buy two types of commonly used prescription veterinary drugs: 1) Non-steroidal anti-inflammatory drugs (NSAIDs) and 2) Heartworm preventives. Both drugs can be dangerous if there is no professional involvement. Veterinarians often prescribe NSAIDs to relieve pain in animals. NSAIDs should not be purchased on the Internet without a veterinarian's involvement because animals should undergo blood testing and a thorough physical examination before starting NSAIDs, they should be monitored by a veterinarian while they are taking NSAIDs, veterinarians should discuss possible side effects of NSAIDs with the owner, and the prescription should be accompanied by a Client Information Sheet that explains important safety information to the owner.

     Heartworm disease is a potentially fatal condition transmitted by the bite of a mosquito that is carrying infected larvae of the heartworm parasite. Dogs, cats (and ferrets) can get heartworm disease. Heartworm preventatives, given monthly, kill the larvae before they become adult worms. The American Heartworm Society recommends using heartworm medication for dogs year-round, no matter where you live in the United States and getting dogs tested yearly to make sure they're not infected with heartworms. "Testing is important even in dogs regularly treated with heartworm preventive products due to the occasional reports of product ineffectiveness," says Hartogensis. An online pharmacy veterinarian cannot draw blood from the animal to perform the test. If the test isn't done, a pet owner could be giving heartworm preventives to a dog that has heartworms, potentially leading to severe reactions such as anaphylactic shock.

     If you are determined to order from an online pharmacy, order from a web site that belongs to a Vet-VIPPS accredited pharmacy. Vet-VIPPS—the Veterinary-Verified Internet Pharmacy Practice Sites—is a voluntary accreditation program of the National Association of Boards of Pharmacy (NABP). NABP gives the Vet-VIPPS seal to online pharmacies that dispense prescription animal drugs and comply with NABP's strict criteria, including federal and state licensing and inspection requirements, protecting patient confidentiality, quality assurance, and validity of prescription orders. Look for the Vet-VIPPS seal displayed on a pharmacy's Web site or check with NABP5 (click on "Accreditation Programs") to find out if a pharmacy is Vet-VIPPS accredited. Because this is a newer program, a small number of pharmacies are currently Vet-VIPPS accredited.

     In summary, many pet owners are seeking lower prices for medications needed by their pets through the use of online pet pharmacies. The best way to assure yourself that the medication you purchase is safe, has been stored properly, is genuine, and has not been diverted—is to purchase the medication directly from your veterinarian. The products we sell on our veterinary website meet all of these criteria and are competitively priced for our clients, eliminating the need for them to search out and be scammed by the less than legitimate online pharmacies that are currently operating.

Sources:

1. The Veterinary Information Network: www.vin.com

2. Dr. Georgina Marquez’s blog article: The Dangers of Veterinary Internet Pharmacies. http://www.animalmedcenter.com/news-and-press/article/the-danger-of-veterinary-internet-pharmacies

3. The Food and Drug Administration’s website link to Buyer Beware: http://www.fda.gov/downloads/forconsumers/consumerupdates/ucm115432.pdf

4. The National Association of Boards of Pharmacy (NABP): http://www.nabp.net/

A Clean Mouth is a Healthy Mouth: February is National Pet Dental Health Month!

        By: Loren W. Noblitt, D.V.M., M.S.

I just love the Orbit gum catch phrase, “Got a dirty mouth?  Clean it up!”  Unfortunately, dogs and cats don’t/can’t chew gum sooooooo – we need to talk about how to best “clean it up” when it comes to their mouths!  Once again, February is upon us, and as you may or may not know, February is National Dental Health Month, in both human beings and animals.  What does this mean for you and your pet(s)?  The benefits to your pet are numerous (and subsequently elaborated upon below) and the benefits to you are a more active, healthy pet and a pet that will, on average, live 2-4 years longer!  PLUS, if you schedule a full dental cleaning with us this month (February), you will receive a 15% discount, JUST BECAUSE IT’S FEBRUARY!  That’s pretty cool!  Keep reading on for more information regarding the many, many benefits your pet will experience from a full mouth dental cleaning…

Dental Disease:

Image courtesy of http://www.avma.org

            Periodontal disease is defined as disease of the periodontal ligaments, gums, and tooth sockets of the jaw that hold teeth in place.  It occurs from plaque that grows on the enamel surface of teeth which then anchors-in bad, anaerobic bacteria.  These bacteria secrete degradative toxins that destroy these supporting structures.  Dental disease is a progressive disease, but can be reversible if caught early enough.  Dogs and cats do not show pain the same ways that we do, and are unlikely to stop eating from mouth pain, even severe mouth pain.

 

Common signs of dental disease in small animals include halitosis (bad breath), crying when mouth or teeth are touched (or chattering in cats), and stained teeth.  Consequences of an infected mouth are not just isolated to the mouth, but can be far-reaching and can include downstream infection in virtually every organ in the body, most commonly the liver, kidneys, and heart.  For this reason, your pet, on average, will live 2-4 years longer with regular dental cleanings and good at-home preventative care.

 

The Dental Procedure:

           Although not mandatory, the staff at ZionsvilleAnimal Hospital prefer to have relatively recent blood work (routine CBC and Chemistry panels) performed to be reasonably sure that your pet is not a risk for anesthesia.  A physical exam is also important in making this decision.  While your pet is under general anesthesia, he/she will have an intravenous catheter placed and fluids hooked up to that catheter from start to finish, as well as a Veterinary Technician monitoring vital parameters such as blood pressure, heart rate, and oxygenation.  Your pet’s teeth are then cleaned with an ultrasonic scaler, focusing on removing not only the debris seen with the naked eye (supragingival calculus and tartar) but also that which lies underneath the gum-line (subgingival calculus and tartar).  Polish is then applied to all teeth.  Your veterinarian will be examining every nook and cranny of the oral cavity and making meticulous notes throughout the procedure.  This is also primetime to make sure that there are no infected, broken, or otherwise worrisome teeth that need extracted, root canal therapy, or some other form of T.L.C.  We also have the ability to take dental x-rays to allow us more incite into the severity (or lack thereof) of every tooth.  Sometimes we find growths in animals’ mouths (i.e., on the tongue or base of the tongue, inside cheeks, gingiva, etc.) that nobody knew about and there is no better time than the present to diagnose and treat these.

 

Preventative Care:

After your pet’s teeth have been professionally cleaned, the focus immediately shifts to preventative care by discussing things like at-home daily tooth brushing (the gold-standard), water additives, Kong toys, and Veterinary Oral HealthCommission (VOHC)-approved products (i.e., products scientifically proven to prevent plaque and tartar formation by 60-75%).  As a general rule, excessively hard toys should be avoided because they are prone to breaking teeth which leads to dental root canal exposure which leads to local and systemic infection.

 

Summary of Key Points regarding Dental Health in Pets:

It's not just about the teeth -- There is plenty of documentation not only in the veterinary field but in human dentistry proving that infection within the mouth will spread to other organs in the body, particularly the liver, kidneys and heart.

Periodontal Disease is more common than you think -- Periodontal disease which affects the gums and supporting structures of the teeth are present in 85% of all patients older than 4 years of age!

Your pet will live longer -- Cleaning your pets teeth and treating dental conditions can result in your pet living 2-4 years longer!

Dental disease is uncomfortable -- Remember, dogs and cats do not show pain the same way that we do. Very rarely, will an animal stop eating because of oral pain. What we do see is that after a dental cleaning/treatment, the pet may become more energetic and playful as the dental cleaning has removed all the harmful bacteria from the mouth and limiting its spread throughout the body.

 

If you’d like to schedule a full dental cleaning, or suspect that your pet may need a dental cleaning, call Zionsville Animal Hospital at 317-873-1833 to make an appointment or schedule a consultation.  If you do so before February is out, you’ll receive a 15% discount – but regardless of when you and your pet come in, he or she will likely be more energetic and systemically healthy as a result!

 

 

Sources:

1. The Veterinary Information Network: www.vin.com
2. The American Veterinary Medical Association (AVMA): https://www.avma.org/Events/pethealth/Pages/February-is-National-Pet-Dental-Health-Month.aspx

Food Allergy - My Pet has WHAT?

By Loren W. Noblitt, DVM, MS

What:  Food allergy is one of the itchiest conditions known to cats and dogs. Animals eat a variety of processed food proteins, fillers, and colorings that are further processed inside their bodies and changed into substances recognized by the immune system as foreign invaders.  A battle then ensues between the food and the immune system resulting in lots of inflammation.  Many organs can be affected but usually it’s the skin and the gastrointestinal (GI) tract (including the mouth) that suffer.

Interestingly, many people erroneously assume itching from food allergy requires a recent diet change of some sort. In fact, the opposite is true.  Food allergy requires time to develop; most animals have been eating the offending food for years with no trouble.  At some point, there appears to be a “straw that breaks the camel’s back” type of event that ignites severe itching +/- diarrhea/vomiting.

The most common offending agents in dogs and cats are:

1. Chicken
2. Beef
3. Corn
4. Wheat
5. Egg
6. Soy
7. Casein
8. Fish

Why: Pruritus (itchy skin) in the small animal is often more than just a minor annoyance.  Red, oozing bald patches, rashes, and large areas of hair loss (“hot spots”) are classic markers of discomfort.  The skin is the “organ” most affected in pets because the skin has the densest mast cell distribution than anywhere in dogs’ and cats’ bodies.  Mast cells are allergic type cells that secrete histamine, which promotes itching and inflammation.  Same as in our own bodies.  These mast cells degranulate (releasing histamine into the blood) when the offending agent binds to receptors on its surface, causing runny eyes and sneezing in human beings affected with hay fever.  So why the difference?  Location, Location, Location!  Our mast cells are largely distributed in our upper and lower respiratory system, thus the primary difference between humans and small animals when it comes to manifestations of allergic reactions. 

Who & When:  Any age animal may be affected, but the majority of animals are older puppies/kittens (12-24 weeks) or in early adulthood.  Older animals (> 5 years old) that have no or little prior history of itching are good food allergy suspects. 

Where:  There is an old expression: “Ears and Rears (anal glands) and it (the itching) goes on all year.” Ear canals and anal glands are just extensions of the pet’s skin and are thus disproportionately affected with inflammation from a food allergy (based on mast cell distribution).  Other food allergic animals will present with “pseudoscabies,” meaning that they are itching all day long (“mad itch”) but either lack the classic hair loss pattern and skin irritation (redness) of animals with active scabies mite infestation OR they are still itching fiercely despite having been treated for sarcoptic mange already. 

Dogs with food allergies often have hair loss or redness around any or all of the following areas (see below):  chin, ears, belly, paws, around eyes and around the mouth.  Cats usually present with scabs on or around the head (mouth, neck, and ears).

Drawing borrowed from www.marvistavet.com

 

Other possibilities to explain the itching!:  Atopy (inhalant or environmental allergy), scabies mites, demodex mites, pyoderma (yeast/bacteria), flea bite allergy, or ringworm (fungus).  To complicate matters, some dogs and cats can have BOTH food and environmental allergies at the same time.  Dermatologic diligence needs to be performed to rule out the obvious (skin cytology, ringworm cultures, skin scrapes), thus, food allergy is often (not always) a diagnosis of exclusion.  It is sometimes a good idea to try a 7 day trial of low dose steroids, as most food allergic animals will have minimal response to steroids (vs. environmental allergies, where response should be drastic).

Diagnosis:  Unfortunately, there is no trustworthy blood test or intradermal skin test that can be run to diagnose a food allergy.  We have to perform strict food trials using 1 of 2 principles: Hydrolyzed protein and carbohydrate diet vs. Novel protein and carbohydrate diet.  Hydrolyzed protein is protein (often chicken or soy) that is broken down into small amino acid strands that shouldn’t trigger an immune response.  Novel protein is protein that your pet has never been fed before and, theoretically should be tolerated by the immune system and not elicit an allergic response.

Treatment:  The various options are Veterinary Prescription-only foods, however, if you are willing to cook homemade hypoallergenic foods for your pet (which can be prepared in bulk and frozen), there are many recipes available upon request.  The following are commercially available hydrolyzed and novel protein foods:

Hill’s Diets:
D/D canned/dry- salmon & potato/rice
D/D canned/dry- duck & potato/rice
D/D canned/dry-venison &potato/rice
D/D dry – egg & rice
D/D canned-lamb & rice

Low Antigen diets:
Z/D Ultra Allergen Free dry and canned-hydrolyzed chicken and refined starch
Z/D Low Antigen –dry and canned-hydrolyzed chicken and single source carbohydrate (potato)

Purina Diets:Low Antigen diets:
LA Limited Antigen dry-salmon and rice
HA hypoallergenic dry-hydrolyzed soy

Iams Diets:Prescription diets:
Response FP dry and canned-fish and potato
Response KO dry-kangaroo, canola meal, and oat flour

Royal Canin:Low Antigen diet:
Hypoallergenic HP 19 dry-hydrolyzed soy and rice

Potato and Duck dry and canned-duck protein and potato (also has light formula)
Potato and Rabbit dry and canned- rabbit protein and potato
Potato and Venison dry and canned- venison protein and potato (has large breed formula-dry)
Potato and Whitefish dry and canned-whitefish protein and potato

 

Regarding acceptable treats for food allergic dogs, I have consulted several Veterinary Dermatologists through the years and the consensus seems to be that the following items are OK to supplement your pet while on a strict food trial:

1. Marshmallows
2. Bananas
3. The wet form of your particular hypoallergenic food (meatballs as treats or meatballs baked in the oven)
4. Hill’s hypoallergenic treats (compatible with z/d, d/d, and i/d foods)

***Note:  All other treats have to be avoided, including rawhides, Greenies, carrots, green beans, etc.  Everyone in the household must be on the same page with a food trial!***

 Common Food Trial Pitfalls: 

     1.   The World Wide Web and Dr. Google

     2.   “PetStore Wisdom”
     3.   Grandma thinks its Ridiculous!!!

     4.   Dog or Cat is an escape artist

     5.   Not having other pets on the same food

     6.   Dog eats cat barf, or worse!

7. Neighbor kid(s) feed(s) the dog through the fence
8. Social Events:  How cute!  He is begging!
9. Oral Heartworm prevention – A recent study done at North Carolina State University (NCSU) found that giving Heartgard or other flavored once-a-month medications (these contain soy and beef) is enough to keep a soy or beef-allergic dog itchy despite appropriate dietary change.  Topical Revolution should be once monthly, or there is a non-chewable Heartgard option available through Merial. 

Long-term control and Re-challenging:  In the early stages of a food trial, once per month veterinary exams should be performed to make sure fleas are under control, the pet’s weight is maintaining and not considerably up or down, all is going well with the food trial (Q and A sessions about acceptable treats or other questions), and that there are no secondary bacterial or yeast infections present that will cause itching on their own. 

It is important to re-challenge (or at least discuss it) with old food for several reasons.  The first reason is to help confirm the diagnosis of food allergy.  It may be that when the food trial was started, the seasonal allergen picture was in flux or fleas may have been an issue and no longer are, etc.  Stranger things have happened!  The second reason to challenge is to help narrow down the offending agent so that a less expensive over-the-counter or home-cooked food can be used/prepared.  The re-challenge should be performed at a minimum of 8 weeks into the food trial and ideally after 2 weeks of being symptom (itch)-free.  The re-challenge should be done with a 50:50 mix of old food : new food.  Most pets will start itching within a few days, but some may take up to 2 weeks.  Steroid (either topical or oral, or both) and ear medication can be sent home to be used if needed to keep your pet comfortable during the re-challenge period.  It is important to cut out or write down the ingredient list of “the challenge food” or “old food” so that we can avoid all of the protein containing components listed, keeping in mind the most commonly implicated food allergens listed above.

That being said, many of our owners with food allergic pets find a special food that helps control the itching, and just keep their pets on this food for maintenance long-term control without re-challenging.  The “if aint broke, don’t fix it” principle.

Common Myths of Food Allergies:

There are many Misconceptions and Myths when it comes to considering food allergy for pets. The following excerpts are taken from VIN (Veterinary Information Network), and were originally posted by Veterinary Dermatologist, Carol Foil, DVM, DACVD.

MYTH:	“Food allergy ought to produce intestinal signs as it is the intestinal tract that is exposed to the allergen.”
FACT:	In pets, it is usually the skin that suffers with a food allergy. Food allergy is one of the itchiest conditions in veterinary dermatology. Making matters worse is the fact that food allergies tend to be resistant to cortisone therapies which makes itch control especially difficult.
MYTH:	“Food allergy is a less likely cause of my pet’s skin disease as we have been feeding the same food for years and the skin problem is a recent development.”
FACT:	It takes time to develop a food allergy, typically months to years. The immune system must be exposed and must develop enough antibodies to trigger an allergic reaction and this requires multiple exposures to the food in question. A reaction to a food that occurs on the first exposure to that food is not an allergic reaction. Such reactions are called “food intolerances” and involve toxins within the food but not an allergic reaction.
MYTH:	“Soy and corn are common food allergens and it is best to seek pet foods without these ingredients to avoid problems.”
FACT:	The most common food allergens for dogs are: beef, dairy, and wheat. These three ingredients account for 68% of canine food allergies. The most common food allergens in cats are: beef, dairy, and fish. These three ingredients account for 80% of feline food allergies.
MYTH:	“If it looks like my pet might have a food allergy, I should be able to manage the problem by switching to another diet.”
FACT:	Unfortunately for food allergic pets, most pet food diets contain some sort of mixture of beef, dairy, wheat, lamb, fish, and chicken. This means that simply changing foods is bound to lead to exposure to the same allergens. There are two ways to address food allergy: feeding a diet based on a truly novel protein source (this usually means an exotic diet like venison, duck, kangaroo, rabbit or even alligator) OR feeding a diet where the protein has been pre-digested into units too small to interest the immune system.
MYTH:	“My pet got only partly better after the food trial so that means it didn’t work.”
FACT:	Animals commonly have several allergies concurrently. A food allergy responding to a test diet at the same time an inhalant allergy is active will look like a partial response. On the other side of the coin, an inhalant allergy can become inactive should the weather change substantially during the diet trial. This would make a diet appear to be successful by coincidence. In order to determine if a response to a diet trial is real, at the end of the trial the patient is challenged with the original diet. If itching re-starts within feeding 2 weeks of the challenge, food allergy can be diagnosed.

Sources:

1.  Veterinary Information Network:  www.vin.com

2.  Veterinary Partner: http://www.veterinarypartner.com/Content.plx?S=0&C=0&A=652

3.  Veterinary Dermatology article on VIN: http://www.vin.com/Members/CMS/document/default.aspx?pid=38&catid=&objectid=7282&objecttypeid=10&redirectFromMiscDefault=1&calc

4.  Drawing of allergic dog and cat borrowed from:  http://www.marvistavet.com/html/body_food_allergies.html

 

 

 

Itch Much??? -- It Might be Mites!!!

By Loren W. Noblitt, D.V.M., M.S.

One of the most common reasons that a pet is brought in to the veterinary hospital is because of itching.  Allergies (environmental, flea, contact, bacteria/yeast, and food allergies) are probably the most common underlying problem in the majority of cases; however, this is not always the case.  

In addition to ear mites (which most people have heard of), there are two other types of mites that affect the skin of dogs and cats:  Demodex and Sarcoptes.  The lifecycles of these mites are very different, but the end result is often very similar:  A very itchy pet! 

Zionsville Animal Hospital has seen a definite increase in mites over the last several months, particularly in dogs diagnosed with Sarcoptic mange.  We have diagnosed it in 4 dogs and have had several other cases respond very favorably to the treatment without actual confirmation.  We think that this prevalence has to do, at least in part, to the increased number of foxes residing in Zionsville over the past year or so.  Foxes are a known reservoir of Sarcoptes scabei mites.



http://en.wikipedia.org/wiki/Dog_scabies

Sarcoptic Mange:These microscopic mites can invade the skin of healthy dogs or puppies and create a variety of skin problems, the most common of which is hair loss and severe itching (known as “Mad Itch”). While they will infect other animals and even humans, sarcoptic mites prefer to live their short lives on dogs and other members of the canid family (wolves, foxes, and coyotes).  Fortunately, there are several good treatments for sarcoptic mange and the disease can be easily controlled once diagnosed.  Canine scabies can infect all ages and breeds of dogs. While it prefers to live on dogs, this particular mite will also infect cats, ferrets, humans, and fox. Cats, fox, and humans all have their own particular species of mite within the Sarcoptes family.  Each species of mite prefers one specific kind of host, but may also infect others.  If your pet is suspected of having scabies or has been diagnosed with it, you should see a dermatologist if you have itchy skin or develop a skin rash abruptly.

Interestingly, the sarcoptic mites usually spend their entire life on a dog. The female mite burrows into the skin and lays eggs several times as she continues burrowing—this act is what is thought to incite the itch sensation. 

These mites “prefer” to live on the dog (or fox), but will live for several days off of the host in the environment.Because of the mite's ability to survive off of the host, dogs can become infected without ever coming into direct contact with an infected animal.Trees, decks, and other inanimate objects where foxes and coyotes may scratch themselves or have casual contact are thought to be the sources of infection for our unsuspecting pets.

The symptoms of canine scabies usually include hair loss and severe itching especially on the elbows, ears, armpits, hocks, chest, and belly. The mites prefer to live on areas of the skin that have less hair. As the infection worsens it can spread over the entire body.  Because of the severe itching and self-trauma to the skin, bacterial and yeast infection are common.  Trying to make a diagnosis of canine scabies can be very frustrating.  The standard method is to perform a skin scraping and then identify the mite under the microscope.  Unfortunately, on average, only ~20% of the infected dogs will show Sarcoptes mites on any given scraping. Therefore, if a dog has a positive skin scraping, the diagnosis is confirmed but a negative scraping DOES NOT rule out sarcoptic mange. Therefore, most diagnoses are made based on history and response to treatment for scabies.

The preferred treatment for scabies is with Revolution, a topical heartworm and flea preventative.  The active ingredient is called Selamectin (a derivative of Ivermectin).  The key is to apply the Revolution every 2 weeks for at least 6 weeks, and usually 12 weeks is recommended with confirmed cases.  I like to give a dose of injectable Ivermectin on Day 1 of a confirmed case of scabies to “get the ball rolling” and start killing these little buggers ASAP.  Because of the damage to the skin in sarcoptic mange, many dogs also have bacterial and or yeast infections and these obviously need to be treated as well.  Skin cultures are preferred, especially in severe cases, to make sure that the correct antibiotic or antibiotics are given.

Because your dog does not have to come into direct contact with an infected dog to contract scabies, it is difficult to completely protect him. Places where large numbers of dogs congregate are obviously more likely to harbor the mange mite.  Since foxes and the environment in which foxes may spend a large amount of time can transmit the mite to dogs, keep dogs away from fox and these areas.

Is Sarcoptic mange contagious to me or my other pets?  Yes, although when humans get Sarcoptes scabei from animals, the disease is generally self-limiting, causing only temporary itching. There is a human species of Sarcoptes, which is transmitted from person to person. This human species of sarcoptic mite causes a rash on the wrists, elbows, or between the fingers. In infants, the rash may appear on the head, neck, or body.  Other dogs in the house need not be isolated from each other, but because the treatment of scabies is relatively straightforward, it is recommended, however, to treat all pets in the household when there is a confirmed case.

Demodectic Mange:
Demodectic mange, also called demodicosis or “Red Mange,” is caused by a microscopic mite of the Demodex genus.  These mites are transmitted by mothers to their young through cuddling and nursing during the first few days of life.  Most live in harmony with their mites, never suffering any consequences from being parasitized.  However, if conditions change to upset the natural equilibrium, such as some kind of suppression of the dog's immune system (stress or long term/chronic use of steroids), the Demodex mites may gain the upper hand. The mites proliferate and can cause serious skin disease.  The mites burrow into the actual hair follicles, causing itching and hair loss, as well as secondary bacterial/yeast infections.

http://en.wikipedia.org/wiki/Dog_demodex

Demodectic mange is NOT considered a contagious disease (to people nor to other dogs or cats) and isolation of affected dogs is generally not considered necessary.  While there are still assorted theories about dog to dog transmission of Demodex mites, there is no question that mites cannot be transmitted to humans or to cats. 







Demodicosis has Three (3) Forms:  Localized, Generalized, and on the Feet (Demodectic Pododermatitis):
1)   Localized demodicosis occurs as isolated scaly bald patches, usually on the dog's face, creating a polka-dot appearance.  Localized demodicosis is considered a common puppyhood ailment and approximately 90% of cases resolve with no treatment of any kind. 

2)  Generalized demodicosis the entire dog is affected with patchy fur, skin infections, and bald, scaly skin.  The entire body is typically affected, and the secondary bacterial infections make this an itchy and often smelly skin disease.  Treatment is needed to facilitate recovery.
 
3)  Demodectic Pododermatitis is confined to the paws.  Bacterial infectious usually accompany this condition. Often as generalized demodicosis is treated, the foot is the last stronghold of the mite.  Old English Sheepdogs and the Shar Pei tend to get severe forms of this condition. The infection can be so deep that biopsy is needed to find the mites and make the diagnosis.  It is one of the most resistant forms of demodicosis.

Treatment:  Ivermectin (Ivomec 1%) is a broad spectrum anti-parasite medication with a number of uses, including killing demodex mites.  Ivermectin is inexpensive and involves no labor-intensive bathing.  It DOES, however, taste terrible if given orally.  It requires daily treatment in most cases and should be continued for a minimum of 3 months, or 2 negative skin scrapes 1 month apart.  There is, unfortunately, an important occasional problem that keeps other treatment options listed: drug sensitivity.  Some individual dogs are sensitive to ivermectin and can die if subjected to a typical therapeutic dose for demodicosis.  Benzoyl Peroxide Shampoos (e.g., Pyoben) are great to use with affected animals because it penetrates and flushes out the hair follicles, deep where these mites live on the animal’s skin.  Amitraz dips on a weekly basis are effective, but labor-intensive, and are usually reserved for dogs that don’t tolerate the oral Ivermectin.

Relapse?
When relapse occurs it is often because the dog appeared to be normal and the owner did not return for the appropriate re-scrapings. Relapse is always a possibility with generalized demodicosis as there is no easy way to confirm that every mite has been killed, but most dogs that relapse do so within a 6 to 12 month period from the time they appear to have achieved cure.

Sources:

1.  Veterinary Partner (www.veterinarypartner.com)

2.  Wikipedia (http://en.wikipedia.org/wiki/Dog_scabies)

3.  Wikipedia  (http://en.wikipedia.org/wiki/Dog_demodex)

4.  Dr. Fosters and Smith (http://www.peteducation.com/article.cfm?c=2+2111&aid=764)

 

 

 

Why Do Dogs Eat Grass?

By:  Loren W. Noblitt, D.V.M, M.S.

 

A lot of dogs (and some cats) eat grass.  I am commonly asked, "Why does [ENTER PET'S NAME] eat grass?" - I file this question under my "if I knew the answer and how to stop it, I'd have a million dollars", category of questions.  There seems to be multiple acceptable answers to this question - no one knows for sure in all cases. There are some very interesting theories to help explain our pets' 'fondness for forage', and they are as follows:

 www.thepetcentral.com

• Boredom behavior
• Dietary deficiency
• To induce vomiting
• Biologic/Ancestral influence

Let’s take a look at each of these individually now.

1)  Boredom behavior   
Some dogs flat out, just like to eat grass.  They like the taste and they like the texture.  Some particularly like certain types of grass, like fescue grass.  In these dogs there is no underlying pathology or illness causing them to eat grass.  This is not true of most dogs, and, for the most part eating grass is an inappropriate behavior and justifies some looking deeper to try to see why this habit is occurring.  Lack of stimulation during confinement in a particular environment, such as the back yard, can motivate a dog to eat grass or other various environmental substances. This condition, called pica is characterized by the consumption of non-nutritive material such as mulch, cat litter, grass, rocks, clothing, dirt, even feces.  Pica leads to vomiting, diarrhea, and intestinal obstruction or perforation.  Pica behavior can be reduced by providing your pet with stimulating and appropriate chew toys, more attention, and as a last resort: a basket muzzle. 

Try not to make it a “big production” if your pet puts an inappropriate item in their mouth, as this can eventually lead to attention-seeking behavior and can fuel a pica disorder.  Calmly walk over and remove the item from your pet’s mouth and replace it with an appropriate item, such as a Kong (available for both dogs and cats), Tartar Shield sticks, and Greenies.  Pica can be caused by underlying medical abnormalities, therefore veterinary examination, laboratory testing (blood/urine/fecal tests, radiographs, etc.) and dietary evaluation should be explored.  If your dog is eating his/her own feces (a subset of pica known as copraphagia) there are a wide array of anecdotal suggestions your veterinarian will likely have for you.  Contact the veterinarians at Zionsville Animal Hospital if your dog displays this unfortunate habit!

2) Dietary Deficiency

Veterinary behaviorists and nutritionists speculate that dogs eat grass to compensate for nutritional deficiencies, iron and fiber are among the most commonly sited suspected deficiencies.   A reduction in your dog’s grazing may be achieved by simply adding fresh greens and/or fibrous vegetables or fruits to their diets.  Leafy greens like kale, broccoli, and parsley and pineapple have all been reported to yield favorable results.  It should be noted that vegetables are most palatable (and digestible) when steamed and pureed or finely chopped before being incorporated into a dog’s meal.  Additionally, dogs that eat a diet based in whole foods (which requires owners to cook meals at home) instead of commercially available, processed, non whole-food based dry (kibble) or canned foods tend to exhibit less foraging behavior.

3)  To Induce Vomiting

Plant material is composed of insoluble fiber that is not readily digestible and irritates/inflames the stomach wall.  Dogs seem to “know” this instinctively.  Grass accumulates in the stomach instead of moving into the small intestine, like food normally would.  It also can pass through, undigested, and you'll see green blades in the feces (if you look carefully enough).  Underlying illnesses like Inflammatory Bowel Disease (IBD), stomach or intestinal parasite infestation, metabolic diseases of the kidneys, liver, or pancreas, and pica (discussed above) can stimulate the physiologic urge to vomit.  Therefore, dogs can eat grass as a means of facilitating their own vomiting and for reducing nausea.

4)  Biological/Ancestral Influence

Grass eating is a behavior exhibited by wolves.  An article in the Journal of Veterinary Behavior suggests that the grass eating traits of a nursing mother can influence similar behavior in her puppies. Your dog’s mother, grandmother, and so on may be partly responsible for imparting modern-day grass eating tendencies.   Conversely, another study looked at grass-eating dogs and no link was found to diet or history of gastrointestinal disease. Some dogs were reported to only eat grass if they already had an "upset stomach", and needed to vomit.  Most dogs seemed to eat grass because they liked it!

As a veterinarian, I see grass-eating dogs inadvertently ingesting toxins such as fertilizer, pesticide, and other unhealthy environmental debris (particularly rocks!).  Recently pesticides and some fertilizers have been linked to cancer in dogs and can cause temporary neurological problems (http://www.vet.purdue.edu/pcop/files/docs/CanineUrinaryBladderCancer.pdf). 

It's not surprising that the veterinarians at Zionsville Animal Hospital recommend dog owners take appropriate measures to deter grass munching, during all stages of life, and encourage owners to explore the possibility that there is an underlying reason for it.  However, there is a good possibility that the answer will be, “ Because he likes it," or, "Because the grass can't outrun him."

Nutraceuticals: The Good, The Bad, and the Worthless

        By:  Loren W. Noblitt, D.V.M., M.S.

     A question that I am asked very frequently (almost daily it seems), is, "Can I (safely) give my dog or cat the same over-the-counter (OTC) supplements that I take?" The answer is, "it's complicated." I mean, seriously -- EFAs, PUFAs, EFA, EPA, DHA, GLA, LPO -- What do all these letters and abbreviations mean? What do essential fatty acids do anyway? How should you use them? What dosage? What brands are available? Are they all the same? What about probiotics, cranberry extract, and appropriate liver support?

     Ok, Ok, Ok - it's REALLY complicated.
    
The term "nutraceutical" is defined as "a food or a part of a food that provides medical or health benefits."  Nutraceuticals and dietary supplements are commonly used in both veterinary and human medicine.
     
Since there is no regulatory body for the manufacturing of nutraceuticals, it becomes difficult to assess product quality.  Drugs regulated by the FDA must meet specific manufacturing standards. Nutraceuticals...not so much.  Studies have shown that nutraceuticals are commonly mislabeled; may contain impurities, such as heavy metals, toxins, bacteria, molds; may have variable quantities of active ingredients; may fail to dissolve (thereby remaining ineffective).  Though the label may say "X mg", it is possible that some capsules have less (even zero) and some may have more.

That's the clear advantage of Nutramax products:  What they say is in each capsule, really is. 

     Case in point:  Many of the OTC glucosamine and chondroitin products are made from shark cartilage or other hard-to-metabolize products.  They often pass through the gastrointestinal tract without reaching significant levels in the joints, largely because of stomach acid degradation.  Some of these products come from other countries (i.e., Mexico, China, Brazil, Malaysia, etc) and are not proven to be toxic free or even effective, at all.  It is for all of these reasons that the Veterinarians at Zionsville Animal Hospital consistently recommend products like Dasuquin, Cosequin, Proviable probiotics, Denosyl, and Welactin fish oils -- all of which are made by the Nutramax company.

     To date, the Nutramax company has done virtually all of the available Veterinary studies in terms of effectiveness, batch variance, and bioavailability.  They have the research around their Cosequin product to prove it works, and better yet, the NEW! Dasuquin has added soybean and avocado extract, which has been found to reduce pain and inflammation, as well.  Does this mean that only their products are effective?  Likely not, but we can't say for sure.  The same holds true for the Omega 3's, probiotics, cranberry extract, and liver support (to name just a few). 

     Welactin has been extensively studied and remains the top additive of omega 3 essential fatty acid available to pets in the form of a supplement.  Of note here is the Hill's Pet food company and their j/d (Joint Diet) fortified with serious omega 3 fatty acids.  Hill's veterinary nutritionists say that you'd need to give ~two (2) dozen fish oil capsules to a large dog to approximate the omega 3's in a serving of Hill's j/d food.  These products are all promoted and sold at Zionsville Animal Hospital for these reasons.  Hill's j/d food is available upon request.

What's the BIG DEAL about Fish Oil (Omega-3 and 6 fatty acids) anyway?
Omega-3 and 6 fatty acids are classified as "essential"-- hence the term Essential Fatty Acids, or EFAs -- because humans and other animals are unable to synthesize them naturally.  Omega 3's have received much attention lately, and the important thing to know about them is they come in two varieties EPA and DHA, both are good!. 

Most EFAs are obtained from fish, crustaceans, and vegetables.  It was once thought that omega 3's were the better of the two because they were more anti-inflammatory than the omega-6's; however, this is no longer considered to be the case by Veterinary Dermatologists.  There is evidence that fish oil works to decrease the itching threshold, or "pruritic threshold", in dogs and cats with allergic skin disease (pollen allergy or atopy) and a recent clinical trial demonstrated a steroid-sparing effect of fatty acids due most likely in part to suppression of histamine and prostaglandin release.  Welactin fish oil is free of any proteins, which are the allergens in diets. Thus, theoretically, it should be safe to feed fish oils to animals with dietary allergies, so long as they're produced by reputable companies (i.e., Nutramax) that have repeatable quality control measures.  Your veterinarian may opt to withold fatty acids in the early stages of a dietary food trial (if a food allergy is suspected in your pet) in attempts to not "muddy the waters" in trying to arrive at a diagnosis. 

Fish oil is often used in cases of joint disease and osteoarthritis because of these inherent anti-inflammatory effects, and also a joint lubrication effect.

     When fatty acid supplementation is needed, it should be done at 180 - 200 mg of combined EPA and DHA fatty acids per 10 pounds of you pet's bodyweight.  The table below lists some of the preferred veterinary supplements on the market, and provides an omega-3 EFA dose per capsule or pump.  Zionsville Animal Hospital carries all 3 of these products and will be available via our online pharmacy coming soon:
            
        Product                                Omega-3 EFA Concentration/Dose         Amount per Pet
1)  Nutramaxlabs Wellactin                        270mg/capsule                             1 capsule per 20lbs
Omega3 Canine Gel-caps

2)  Nutramaxlabs Wellactin                        250mg/capsule                              1 capsule per cat
Omega3 Feline Gel-caps

3)  Nutramaxlabs Wellactin                      1300mg/5ml (1 tspn)                        5ml per 35kg
Omega3 Canine Liquid

     Ultimately, studies demonstrating the clinical benefits of a nutraceutical should be evaluated.  For example, several peer-reviewed studies exist documenting improvement in clinical signs with chronic osteoarthritis in dogs or horses given glucosamine or chondroitin sulfate (or combinations of these compounds). However, clinicians should examine how the studies were conducted, to determine their likely validity, because many studies are poorly designed or executed.
    
     In summary, neutraceuticals are not regulated by the FDA, as they are not considered to be "drugs." This means that they can be sold without scientific proof of effectiveness, without assuredness of safety and consistency from batch to batch, and without mandatory testing to determine the optimal dosage in target animals.  There are numerous anecdotal reports of these medications helping numerous individuals (both human and animal) but one should keep in mind that scientific investigation is continuing. 

     The best thing to do for your pet is to follow your veterinarian's advice and use reputable products when it comes to fish oil, glucosamine/chondroitin, or other supplementation, when possible.  If this cannot be done for whatever reason, try to keep the following suggestions in mind to help weed out inferior OTC nutraceutical products.

1.   Price.  Cheaper compounds are less likely to be of high quality. This has been the general observation with chondroitin sulfate.

2.   Pay attention to whether or not the product has a lot number and an expiration date.

3.  There is a general USP veterinary page (for veterinary drugs, requires free registration) and the USP Dietary Supplement Verification Program page, which provides a list of suppliers that have voluntarily submitted their products for USP verification and approval. These products carry the following mark:
                                                      
4. Claims of safety or efficacy.  If a nutraceutical claims a medical benefit on the label, there should be a New Animal Drug Application (NADA) number accompanying the product. While this is "mandated" by law, it is often ignored.  A NADA tends to suggest higher quality, because the manufacturer has bothered to abide by FDA regulations for drug manufacture.

5. Ingredient list. All ingredients should be listed by order of magnitude based on weight.

6. Scientific evidence supporting manufacturer's claims. Some manufacturers have begun providing data for their specific products through independent scientific studies. These studies should ideally be peer-reviewed and published. Importantly, they should be clinical studies, not in vitro studies. There are institutes, affiliated with universities and medical schools, who are beginning to investigate nutraceutical claims scientifically. These include The Nutraceuticals Institute, The Institute of Nutraceutical Research, and others.

7.   Testimonials in place of valid research.  Many companies provide testimonials from "satisfied clients".  These should be ignored, and companies that promote these instead of scientific research supporting their claims, should be viewed skeptically.

8.   Membership in National Animal Supplement Council (www.nasc.cc). This industry group has a close relationship with FDA and strict guidelines for member companies regarding quality control and adverse event recording. Member companies are likely to have better quality products.

Several websites exist that may help you investigate specific nutraceuticals:
1. www.quackwatch.com
2. www.herbalgram.org
3. http://nccam.nih.gov
4. www.navigator.tufts.edu/index.html
5. www.consumerlab.com
6. www.biovalidity.com

Photos coutesy of:  www.nutramaxlabs.com