Monthly Archives: December 2018

Colitis In Dogs

Colitis / Chronic Diarrhea in Dogs and Cats

Why does it take “a few tries” to get a bowel to “simmer down”?  Why isn’t it just “He’s got diarrhea” and “Here’s your medicine?”

Sometimes it is, often, it’s not. Here’s a thorough discussion of diarrhea / colitis  for folks who have a dog with chronic colitis. I guess if you’re going to have to live with it sometimes, you might as well know why and why not?

Chronic Diarrhea – Colitis in Dogs And Why It’s Not So Simple?

Phycox Glucosamine, Vitamin and Anti-inflammatory

What’s so great about Phycox?

Well I’ve gotten older and there’s some pain in aging and some creaking joints.

Nothing different for old dogs. They creak and groan a little, too. Here’s where “Phycox” comes in. Phycox is a chewable ‘treat’ that you can give your dog to help with several aspects of aging.

Phycox has

  1. Three natural antioxidants
  2. A potent multivitamin
  3. Glucosamine/Chondroitin and MSM

For less than Dasequin or Cosequin

Phycox is the answer to supplementing arthritis with glucosamine but there’s SO much more to it. In this document I explain how Phycox provides the benefits of five other arthritis modalities but ALSO where it falls short.

What’s So Great About Phycox? PDF read online or download

Oravet Chews and When They’re The Best

Not needing another dental saves you dollars, and saves the dog the aggravation.

The short read:

  • There’s a treat (we have them) that coats the teeth and makes them impervious to re-accumulation of tartar. Seriously, stop laughing I am not making this up.
  • They are called Oravet Chews.

Sidebar: Oravet Chews are not usually recommended until after the teeth are optimized. There is no point in coating crappy teeth.

The longer read:

You can “coat” the freshly cleaned teeth super easily every day and literally never need a dental scaling again.

Oravet Chews are basically a “plastic” (huge oversimplification) coating for teeth that is applied via a simple chewy treat. I wish I had invented it.

The dog chews up this teal-colored, chew enzyme-rich treat and it sticks to their teeth…..deliciously.

By the time they get it chewed and swallowed, the teeth have been enzymatically “cleaned” and coated with the bioactive ‘wax’ for the day. I mean, I don’t know, maybe days but Ajax has one a day after his morning walk.

Is this salesy? You know I hate being “salesy” because it’s just not my style but this is something that honestly, a person would be more-within-their-rights to speculate that the reason we did not recommend this after the dental was so we could line up another dental, and nothing could be further from the truth.

Your dog’s dental was done to topple infection and pain in their mouth. No one cares how the teeth LOOK. In that vein, keeping the teeth germ free and the gum line protected is the “thing” entirely.

Oravet Chews Especially After a Dental Scaling (download or read PDF)

VIPPS Online Pharmacies

NABP + VIPPS Certification

Download this article

See also: Sorry! We won’t prescribe through a non VIPPS Internet Pharmacy

 Petmeds is not VIPPS compliant/eligible. It matters a LOT to prescribers.

Every state has a “Board of Pharmacy” that monitors their state’s pharmacies. These boards provide standards of record keeping, supply-chain integrity, and compliance with state and federal law.

“I’m going to turn you in to the Board!!’  Yeah, THAT Board.

Anyway. These Boards of Pharmacy operated together and independently, then, one day, they decided to band together and create uniformity in the administration of standards and applicable laws. So that the Georgia pharmacy-law looked like the Mississippi pharmacy-law.

The National Association of Boards of Pharmacy was formed (1904).   NABP.pharmacy

Further, (much more recently) they founded a .pharmacy TLD.

Let me explain that: Some businesses have .COM and .NET after their name.

If you’re a “real” pharmacy you can get .PHARMACY after your business name.  Being a ‘real’ pharmacy eligible for a dot-pharmacy TLD means you have a license to operate in a particular region, and the State acknowledges you.

But that doesn’t mean you’re in compliance with state and federal law.

What proves that your business is compliant with state and federal laws? VIPPS certification.

VIPPS Verified Internet Pharmacy Practice Sites (1999)

NABP started this certification program in 1999 as Internet pharmacies started popping up.

If you are not VIPPS certified, you have been found to be non-compliant with one or more of a state’s pharmacy laws. That’s a deal breaker for me.

You can do that without ‘technically’ breaking the law, but you are DEFINITELY bending laws. Sadly, with “they’re only dog drugs”, you can break the law and enforcement isn’t likely, because the government is overwhelmed with opiate regulation right now. That’s a fact. There are only about a hundred FDA field agents directly inspecting pharmacies for violations.

Let’s put that in perspective: There are approximately 67,000 pharmacies in the United States. Almost half (33,000) are located within drug stores, grocery stores, hospitals, department stores, medical clinics, surgery clinics, universities, nursing homes, prisons, and other facilities.100 Field agents. And they’re worrying about heartworm prevention. Uh huh.

Here are things you cannot do and still be Board/VIPPS compliant.

  • Wholesale (source) drugs or products from other distribution channels
  • Wholesale (source) drugs or products from other countries.
  • Neglect quality control and supply chain standards, allowing the business to sell counterfeit product whether knowingly or not.
  • Filling prescriptions without a documented, legitimate protocol for verifying prescriber information and licensure.
  • Filling prescriptions without documented prescriber authorization.

Sadly, the very first three misbehaviors knock most online pet pharmacies (In particular: PetCareRx and PetMeds) out of the running. The last two are variable between online pharmacies but is all too common.

So why don’t these online retailers seem to care about VIPPS? Because their television ads trump the marketing value of a VIPPS certification handily. Their business is not adversely affected by a lack of VIPPS certification because people are responding to the marketing. “There is NO WAY you can run television ads and be traded on the stock market and be shady-business!”    Right?  Enron. Haliburton. WorldCom, Bre-X, Union Carbide (Bhopal) and the list goes on. 

Price conscious shoppers aren’t the ones who lose their licenses if sensitive information about clients is pillaged by shoddy record-custody, or filled/refilled without a VCPR, or sued if a prescribed item is filled incorrectly resembling malpractice, or filled/refilled under my name/clinic name without my knowledge.

PetMeds Online Pharmacies

See Why I Won’t Prescribe To PetMed

What You Should Know About PetMed

http://news.vin.com/VINNews.aspx?articleId=12583

“PetMed Express is among a growing number of pharmacies and retailers trying to undercut DVMs on flea and tick killers, obtaining those products apparently via gray-market channels.”

“We only guarantee what is sold through licensed veterinarians with a Novartis account,” said Mickey McDermott, vice president of communications in North America for Novartis Animal Health, Inc.

The EPA said in a press release: “There has been a recent increase in the number of companies bringing unregistered pet products into the United States. Last year, EPA assessed a fine against a San Diego pet store for selling unregistered Advantage for Dogs and Advantage for Cats. Also, a Stop Sale Order was issued to a distributor for importing unregistered Advantage products from Mexico with Spanish labeling.”

On its Web site, the EPA warns consumers to beware of counterfeit Frontline Top Spot, Frontline Plus and Advantage. Clues to counterfeit product include: writing in a language other than English; product volumes expressed in milliliters rather than ounces; packages not child resistant; instructions missing; and lot numbers on the cartons not matching lot numbers on applicators.

During six months in 2003 and 2004, U.S. Customs and Border Protection seized nearly 60,000 pieces of counterfeit Frontline and Advantage from China, according to agency spokeswoman Erlinda Byrd. The seizures happened on nine different occasions but were traced to a single importer, who claimed to have purchased the product in the United States, shipped it to China for repackaging into smaller quantities and returned it to the United States for distribution.

Zymox Ear Management

Zymox Enzymatic “Cleaner” (Ear Remediation)

Downloadable or online-readable PDF about Zymox and why I am recommending it to you.

Especially after a successful Claro treatment.

Zymox

After Claro treatment there’s four realizations:

  1. Your dog is not like other dogs, for whatever reason, they’re (genetically/breed?) prone to ear infections.
  2. Your dog may have a lifestyle that contributes to ear infections, for example: Swimming. Tiny ear holes. Too much hair.
  3. For a LOT of dogs, ear infections come from #ATOPY and that’s chronic
    1. com/atopy
  4. Your dog’s ear “environment” has just been cannon-balled by strong medication to achieve ‘wellness’ and needs help restoring a proper pH and bacterial balance.

Zymox is scarcely more than an (ear-appropriate) oil-base which lifts excess wax off the walls of the ear canals and restores the proper pH and bacterial colonies which actually belong in the ear.

  • It’s squalene, and that’s water repellent making it awesome for swimmers.
  • Squalene makes the ear canal too slickery to hold onto dark wax.
  • It has enzymes which digest organics, break down wax, and inhibit/outcompete yeast organisms and untoward germs.
  • It has compounds to down-regulate the acidity in the ear.

All you do is just apply a little (like oiling a clock or oil on a whetstone, just a bit) Zymox to both ears on days of the week containing a “T” for example Tuesday, Thursday and Saturday. Or of course, any three days a week you can remember.

You don’t have to wipe, rub or anything. Just a few drops to create a slight glisten, and you’re good.

Is It Time? Euthanasia in Dogs and Cats

Is It Time?

A document that (based on 22 years experience) provides a stone-cold, objective assessment of your dog or cat’s health and condition to illuminate whether it’s time to consider putting him/her to sleep. This is the best I’ve ever written.

Euthanasia – Is It Time? A downloadable, or online-readable document to sort out the hardest decision that a pet-owner makes.

Rabies

Rabies Shots for Dogs and Cats

Why Is A Rabies Shot Important For ALL Pets?

I don’t ACTUALLY believe your 17 year old indoor Pomeranian is going to go all Rabid like Ol’ Yeller.

Nope. Most old timers and indoor pets would not even survive the type of “wilderness encounter” that transmits Rabies. (Attacked by a rabid animal or Coyote)  There’d be nothing to even clean up. (But other times they’ll just pick up a Rabid bat, kitten or squirrel).

HOWEVER, (and this is what’s common)

  1. A perfectly normal dog or cat takes a nip of the neighbor kid.  Rabies immunization status comes to the forefront in everyone’s minds. And it goes VERY badly for you and the offending pet when there’s no rabies shot on board..
  2. You’re giving the cat or dog a pill and it’s hangs a tooth (even accidentally) in your finger. And it gets infected sending you to MedFirst. Human doctors have (significant) fiduciary responsibility for ascertaining the rabies status of the dog or cat. Rabies immunization status comes to the forefront in everyone’s minds. And it goes VERY badly for you and the offending pet when there’s no rabies shot on board..
  3. You get scratched and it gets infected, sending you to MedFirst.

If your non-vaccinated pet is accused of, or actually bites someone and is non-vaccinated for Rabies, here’s what happens:

  1. The pet gets quarantined at your considerable expense.
  2. And/or the pet’s brain may have to be sent to the GA State Diagnostic Lab for Rabies testing.
  3. The bitten party has to get Rabies shots in the belly at YOUR expense.
  4. You will probably get a citation and fine from the County.

Doc Johnson

PS: Recap:  So most people think I’m actually worried about a pet getting rabies and that IS part of it. But the most common problem is the above, where a dog gets indicted for a ‘crime’ and pays the price for being illegal.

Proin – Phenylpropanolamine For Leakers

PPA, Phenylpropanolamine

We use this for “leakers” which are dogs with relaxed (too relaxed) urethral muscles allowing them to leak urine especially when sleeping. Dogs get up from a urine/wet spot.

Used to control that with hormone replacement and it worked. And worked to cause other problems. Now we use THIS medicine and it works, too.

And yes, (little did I know) very occasionally a cat can have this. With the same presentation  as dog “leakers” —> Getting up from urine puddles.

Phenylpropanolamine Proin PPA for urinary issues. Downloadable / Readable PDF

I am not the author of the article. It’s annotated to the authors. I curated the two articles for this document.

Bradycardia

Bradycardia with PVC’s

Doc: I am not the author of these notes. I take no credit for these nor do I link to these notes. They are for me future reference and while they are in my website, they are principally put here for my consumption.

Bradycardia with compensatory sVPC

For bradycardia:
Propantheline bromide, albuterol, terbutaline, or theophylline

Dosing Albuterol (Proventil, Ventolin)

Summary
Albuterol, a bronchodilator, is available by prescription in multiple forms. Contact your veterinarian if your pet experiences fever, vomiting, excitement, dilated pupils, or abnormal heart rates while taking albuterol.

GENERIC NAME
Albuterol

BRAND NAMES
Proventil, Ventolin

TYPE OF DRUG
Bronchodilator

FORM AND STORAGE
Oral: tablets, capsules, syrup Aerosol For inhalation: solution or capsules. Unless otherwise specified by the manufacturer, store at room temperature. Leave capsules for inhalation in original packaging until needed.

INDICATION FOR USE
Treatment of bronchospasm, asthma, or cough.

GENERAL INFORMATION
Not FDA approved for use in veterinary medicine. It is an accepted practice to use albuterol in specific cases, but it is not a common treatment. Available by prescription. This medication works by relaxing the bronchial smooth muscle and opening airways making it easier for the pet to breath. It is used orally and by inhalation.

USUAL DOSE AND ADMINISTRATION
Dogs and Cats: 0.01-0.03 mg/pound by mouth every 8-24 hours. Duration of treatment depends on reason for treatment and response to treatment. For inhaler doses contact your veterinarian.

SIDE EFFECTS
May see increased heart rate, tremors, excitement, restlessness, dizziness, or nervousness. These tend to be dose related and mild.

CONTRAINDICATIONS/WARNINGS
Not for use in patients hypersensitive (allergic) to it.

Use with caution in patients with diabetes mellitus, hyperthyroidism, high blood pressure, seizures, heart disease, or abnormal heart rhythms.

Monitor potassium levels in the blood, as supplementation may be needed.

Not for use in pregnant or nursing animals.

DRUG OR FOOD INTERACTIONS
Increase risk of heart/respiratory problems if used with other sympathomimetic drugs like phenylephrine or ephedrine.

May have decreased effect if used with propranolol and other beta blockers.

May have increased effect if used with tricyclic antidepressants or monoamine oxidase inhibitors (MAOIs).

Albuterol lowers digoxin levels.

May increase risk of abnormal heart rhythms if used with gas anesthetics like halothane or isoflorane.

No known food interactions.

OVERDOSE/TOXICITY
May see abnormal heart rhythms and rates, high blood pressure, high body temperature, vomiting, excitement, dilated pupils, or low blood potassium levels.

Article by: Veterinary & Aquatic Services Department, Drs. Foster & Smith <= Ridiculous.

About Beta Blockers for arrhythmias:

BETA BLOCKERS

Medications Commonly Used for Heart Failure

Enalapril (Enacard, Vasotec), Benazepril (Lotensin), Lisinopril (Prinivil, Zestril).

These drugs are angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors dilate blood vessels and moderate excess hormone activity that occurs with heart failure, resulting in less resistance in the blood vessels against which the heart must pump. These drugs have improved clinical signs of heart failure and prolonged survival in several studies. An ACE inhibitor may be the only drug needed early in the disease process.

The specific drug used and the individual pet’s disease influence the dose and frequency of administration recommended. Enalapril, Benazepril, and Lisinopril can be given either on an empty stomach or with food.

Adverse effects of ACE inhibitors could include vomiting or diarrhea, deterioration of kidney function, elevation of blood potassium levels, or low blood pressure (hypotension). Other adverse effects that have been reported in people taking the drug include skin rash or itchiness, taste impairment, and certain abnormalities in blood and urine tests.

Furosemide (Lasix, Disal, others)

Furosemide is the diuretic (“water pill”) most often used to promote the loss of excess fluid in patients with congestive heart failure. The dosage varies depending on the clinical situation and the patient’s response, but generally the lowest dose that controls signs of congestion is used for chronic therapy. Signs of heart failure decompensation and congestion such as a persistent increase in resting respiratory rate or recurrence of cough may respond to an (often temporary) increase in furosemide dose. In most cases (check with your veterinarian first), if your pet has been doing well on heart failure medication but subsequently develops signs of congestion again, you can increase the dose or add an extra dose of furosemide for a day or so. If this becomes necessary, be sure to discuss each event with your veterinarian – reevaluation additional tests, and/or other therapy adjustments may be necessary.

Adverse effects of furosemide are usually related to excessive fluid and/or electrolyte losses (especially potassium) resulting in dehydration and weakness.

Digoxin (Lanoxin, Cardoxin, Cardoxin LS)

Digoxin is a positive inotropic (refers to the ability to contract) agent that mildly strengthens heart muscle contraction. It also moderates the excess neurohormonal activity that occurs with heart failure and helps control certain heart rhythm abnormalities. Digoxin is not necessarily indicated in every case of heart failure.

Digoxin is best given on an empty stomach since food as well as antacids and kaolin-pectin compounds decrease drug absorption.

The toxic effects of digoxin can be serious and even life threatening so the drug must be carefully dosed. Monitoring of the drug concentration in the blood is recommended. This is often done 7 to 10 days after starting the drug or after making a dosage change. The blood sample is taken 8 to 10 hours after a dose of the drug has been given. Reduced kidney function, dehydration, loss of lean muscle mass, low blood potassium levels, and certain drugs increase the potential for digoxin toxicity.

Adverse/toxic effects can include heart rhythm disturbances, loss of appetite, vomiting, diarrhea, and depression. If you suspect digoxin toxicity, stop giving the digoxin and contact your veterinarian immediately.

Diltiazem (Cardizem, Cardizem CD, Dilacor XR)

Diltiazem is a calcium channel blocker that is used to help control certain heart rhythm disturbances and to promote heart muscle relaxation in hypertrophic cardiomyopathy (especially in cats). In dogs with atrial fibrillation (a rapid, irregular, abnormal heart rhythm) it may be used with digoxin to slow the rate of the heartbeat.

Adverse effects are uncommon at standard doses but can include decreased appetite, slow heart rate, and rarely, other stomach/intestinal or heart effects.

Atenolol (Tenormin) and Propranolol (Inderal)

These drugs, among others, are called beta-blockers. They antagonize the effects of the sympathetic nervous system, and thereby slow the heart rate, reduce the heart’s oxygen demand, and help control certain heart rhythm disturbances. A beta-blocker may be used with digoxin to slow the heartbeat in dogs with atrial fibrillation. A beta-blocker may be useful in cats with hypertrophic cardiomyopathy as well as animals with certain congenital heart malformations.

Adverse effects are usually related to excessive beta blockade and individual animals vary considerably in their response; thus, low doses are used initially and slowly increased to effect. Dosage and frequency of administration also depends on the drug used. Adverse effects can include excessively slow heart rate, worsening of heart failure, low blood pressure, bronchospasm (more likely with Propranolol), depressed attitude, and possibly masking early signs of low blood sugar (especially in diabetics).

Nitroglycerin (NitroBid, Nitrol) and Isosorbide dinitrate (Isordil, Sorbitrate)

These drugs are prescribed sometimes to dilate veins and help reduce congestion. Nitroglycerin ointment is applied to the animal’s skin, often in the groin or armpit area or inside the earflap.

Gloves or an application paper should be used to apply this medicine to your pet. Do not get this medicine on your skin because you will absorb it also.

Isosorbide comes in pill form.

Spironolactone (Aldactone)

Spironolactone is another diuretic that works by a different mechanism from furosemide. It is sometimes used in addition to furosemide in the treatment of chronic, refractory congestive heart failure. Adverse effects relate to excess potassium retention and stomach/intestinal upset. If used with an ACE inhibitor or oral potassium supplement, blood potassium must be monitored closely.

Chlorthiazide (Diuril) or Hydrochlorothiazide (Hydrodiuril)

These drugs are diuretics that are sometimes used with furosemide for refractory heart failure. Adverse effects are usually related to excessive fluid and/or electrolyte losses.

This Pet Health Topic was written by O. L. Nelson, DVM, MS, Diplomate ACVIM (Cardiology & Internal Medicine) Washington State University.

Washington State University assumes no liability for injury to you or your pet incurred by following these descriptions or procedures.

Interaction
(Making it impossible to manage bradycardia and VPC’s together with medicine. It boils down to needing a pacemaker.

Monitor closely
propranolol oral + albuterol sulfate oral
Significant interaction possible (monitoring by your doctor required)

Propranolol oral decreases effects of albuterol sulfate oral by opposing drug effects
Propranolol oral + albuterol sulfate oral
Potential for interaction

Propranolol oral increases and albuterol sulfate oral decreases potassium levels in the blood