Category Archives: Treatments

Treatments used, recommended, or described as part of Veterinary care

The Epic “Arthritis Triad” Approach to Canine Arthritis

I’m no genius but these three medicines work wonders on Arthritis in canines. I’m sure it’s because it intercepts three out of five of the common factors in canine arthritic symptoms. (I’ll pick all that in another article)

  • Here’s the three medicines
  • How they’re used
  • What we want to achieve
  • What we do with those results

Best regards

Doc Johnson

The Arthritis Triad

Claro

A duplicate of the other Claro article for clients who type in drjohnson.com/claro

Claro One Time Ear Treatment for Canine Otitis Externa

Outer ear infections can be treated with a one-time application of a medicine called “Claro” which contains three medications to combat fungi, bacteria and inflammation. The owner doesn’t have to apply anything, and in fact, should avoid getting anything in the ear which might dissolve or remove the Claro treatment Continue reading Claro

Assessment of Silybin / Which is Pretty Much “Denamarin” (Of Which I Hold a Low Opinion)

Denamarin was a “me too” veterinary preparation of Milk Thistle sold as a ‘proprietary’ answer to the far-more-effective “Urso” which is ‘ursodehydrocholic acid’ and had been working WELL for liver disease, cirrhotic, fibrotic, infectious….But Veterinarians didn’t ‘control’ the drug and there was a generic.

Milk Thistle contains minuscule amounts of UDCA and so it was a “me too” but didn’t work as well. So I stuck with Urso.

Denamarin contains SILYBIN as well, which is a ‘not-inconvenient’ delivery system for flavonoids. Those are ‘oils’ that can come from various thinks like Palmarosa oil, etc. Except Silybin contains SEVERAL Flavonoids.

So, I went out and found a decent study that performed to HUMAN-level stakes of research quality and reviews of thousands of pieces of literature. Thank god I didn’t have to do it LOLOLOL

Here’s the publication, in it’s entirety and not to decrease the economic value of the original document nor use it in a commercial measure. Fair use.

This document is a records review of numerous human studies on Silybin, the active in Denamarin.

Lantus (Glargine) for Cats Diabetes Mellitus

Lantus for cats

The use of glargine for the control of diabetes in cats

A lot of the following is irrelevant at this point, because Lantus has become quite expensive. I recall a day recently when it was as little as $100 – $110 a bottle. Manufacturers now are leveraging the absolute necessity of insulin and raising prices drastically. I am using very little if any Lantus with my patients, even though it is a superior insulin.

Here are some Lantus / Glargine notes from practice:

Firstly, I would not use Lantus and a cat that is being regulated from a condition of some instability. When they’re freshly diagnosed and only then being reigned in. It is not going to drastically or quickly lower the glucose levels and if the pet is a diabetic keto acidosis case, you probably should be using a faster insulin.

I have had good success mixing a regular and NPH insulin together for fast and slow effect during the initial phase of stabilizing the patient.
In pets that are not decompensated, their hydration status is decent and their blood sugars are under 400, I don’t feel an urgent need for instant control and I will happily use Lantus in those cats. Twice a day dosing.

What I like about Glargine, or Lantus and cats is that it’s onset of action is mild and it seems to stay up a bit longer than other insulins, in other words the blood sugars have a tendency to be more stable for a longer period of time.
It is interesting to note that almost 30% of cats being given Lantus will convert to non-diabetic status if only temporarily, requiring less and less insulin until they are in no need of insulin at all.

In practice, I have seen that to be extremely rare in cats that are getting a Humulin or NPH insulin.
It is not enough of a “selling point“ to recommend Lantus at its considerable expense. I mean the “outside chance“ that the cat will convert to non-diabetic status.
I have seen approximately the same incidence of insulin resistance develop against Lantus as I have the other available insulins.

I am prone to a deviation from the normal recommendation as far as insulin: It is commonly recommended that you would give your insulin shot and then feed. That way the insulin is in the system as the blood glucose comes up postprandially. I’m not crazy about this because if the cat decides not to eat after you’ve given the shot, you’ve made quite a commitment haven’t you?

So my advice to owners is to give the cat it’s food and almost as soon as it is done eating to go ahead and give the insulin shot. Under those circumstances there is always insulin on board for the food it has just eaten, but there is never insulin on board if the cat has not eaten. Problem solved.

If a cat does not eat, it gets half dose insulin. If the cat does not eat yet again (it’s evening meal for example), then it would get no insulin and the office should be consulted.

Dogs and Cats Shouldn’t Have Chicken Butts

Dogs and cats should never have chicken in their butt.

Trying to get your attention with that headline.

How does chicken end up in the butts of dogs and cats? (Alternative title: “Inflammatory bowel disease due to whole protein maldigestion in colon” much less provocative.)

The gastrointestinal tract could be broken into three segments. The teeth and stomach handle the initial preparation of food for digestion, small intestine mashes everything together with digestive enzymes and absorbs all of the vital nutrients, and then the large intestine / colon picks up the water that’s left over in the gooey waste that’s left behind.

Sometimes the process is incomplete, as often happens with dogs and cats as they get older. Their digestive system becomes flimsy because they don’t chew their food as well, or can’t chew their food as well and their stomach acid production tends to decline.

The result of this, is the arrival of whole proteins in that last segment of the G.I. tract

Pieces of whole pieces of chicken as far as the body concerned, but especially as far as the germs are concerned.

The body sees these proteins as foreign invaders (having never seen them in the previous 10 years of the dogs life), and they very definitely recognize them as “not native protein“ so there is an immune response to these proteins and worse, whole proteins that enter the colon simply rot.

They are not digested any further there, so you can see how “having chicken in your butt” so to speak, would create problems. Rotting chicken in a large bowel that is absorbent, not digestive.

There are two ways to fix this, one is to give proteins that are already fully broken down and those are called hydrolyzed proteins and the second method is to give supplemental digestive enzymes including amylase, lipase, and protease.

Supplemental digestive enzymes are inexpensive, they are mixed with food that has had broth or water added to it to get the enzymes going, ideally you would let the food sit for an hour to pre-digest and then you would give it to the dog or cat.
What happens at that point is that the dog no longer experiences whole protein in the colon. The inflammation immune response and bacterial overgrowth ceases to occur in the bowels, and things proceed more normally.

You can thank me later.

Overgrown Head Growth, Cap or Wen in Orandas

Overgrown Head Growth, Cap or Wen in Orandas

A peculiar disorder of goldfish is the overgrowth of the cap to the extent that the eyes are covered. In most instances, this does not matter to the fish. Blind fish can apprehend food as effectively as the sighted colleagues in the aquarium. However, it is true that sighted fish do ‘play’ and blind ones do not interact as profitably with tank mates.

The correction of the disorder is a surgical one. You should induce anesthesia with Oil of Cloves or Eugenol© and once the fish is still, you would lift the fish from the water. There are two pieces of equipment you could use for this procedure. One might choose a fine scalpel, which is what I use for a clean post-surgical look. A #10 scalpel blade is ideal for this procedure because it is big enough to manipulate effectively, and small enough to get near the eye. The blade is introduced adjacent to the eye and the cut is made at an angle to the eye, removing the tissue around the eye. Extreme care must be employed to avoid lacerating the globe. This is easier said than done because you cannot see where the tip of your blade is. Still, having handled a #10 scalpel more than several thousand times, I am fairly dexterous with it. I can complete the trimming within four to five minutes under the most arduous of circumstances.

oranda cap surgery
^Where to buy tenotomy scissors

There is a bone UNDER the eye which is essentially a ‘zygomatic process’ and can’t be cut. If you trim too aggressively you will leave no ‘socket’ for the eye. So be sparing around the eye.

One could also use a pair of Iris Tenotomy scissors. These scissors have a devilishly sharp set of points and could be used to pare away the excess growth over the eye.

oranda head growth can be trimmed with these iris tenotomy scissors
Oranda head growth can be trimmed with these iris tenotomy scissors

One conspicuous point about this surgery is that the head growth never attaches to the globe at any point. Indeed, it is possible cut away too much of the head growth and you may find the eyes protruding without support into the water.

oranda cap surgery
^Where to buy Oil of Cloves that’s pure

Overgrown Head Growth, Cap or Wen in Orandas

If the fish begins to struggle during the procedure, please place it again into the aerated oil of Cloves solution. If the fish is not struggling but has been out of the water for more than 90 seconds, please place the fish into well-aerated normal tank water for a ‘breather’. Then resume where you left off. In all instances, you should maintain the fish under a fairly deep plane of anesthesia where gill excursions are less than a flex per several seconds. During many of my surgeries, gill excursions occur at an interval of less than one per minute.

No sutures are needed. The fish will bleed very nominally after the procedure. It is remarkable to me how quickly the fish can clot up despite its aqueous recovery area.

Knowledgeable Chinese and Japanese breeders have told me that they would not perform this procedure because of genetic performance. Good head growth is a proud thing. Surgically concealing other defects is undesirable, as well. I do not question their motives but I must report that I’ve had great success and achieved very cosmetic results.

Robitussin DM For Dogs

Robitussin DM (Get it)

Has been recommended for your dog. (Printable version)

This is a poor choice for dogs with congestive heart failure. It’s a poor choice as monotherapy for respiratory infections. It’s a poor choice as monotherapy for pulmonary allergies without also addressing the inflammatory component of said allergies.

This has worked well for “real” kennel cough, and (surprisingly) for pulmonary hypertension and ‘hyperinflation’ in very old dogs where “nothing else worked”. I have only a vague idea why and how that works.  No matter, as long as it does.

The dose is 2cc per 20 pounds every 8 to 12 hours IF NEEDED (don’t give it if the dog doesn’t even need it)

You’ll see:

  1. Less coughing
  2. Less gacking
  3. Easier breathing.

It is CRITICAL that you do not ACCIDENTALLY buy

  1. Off-brand
  2. Something OTHER than the “DM” formula
  3. Anything with phenylephrine or phenylpropanolamine

Here’s the “finesse” of dosing, and the reason for this ‘article’

Dosing Robitussin DM For Dogs

Start with 1cc per ten pounds. You’ll need a dosing syringe from the office or Amazon.

If you “don’t see anything” (No effect of sedation OR control of cough / gack) then increase dose to 2cc per ten pounds.

A 10 pound dog starts out at 1cc every 8 to 12 hours “as needed” for cough / gack.

If you “don’t see anything” (good or bad) after a dose or three, double up to 2cc every 8 hours as needed. As the dog’s overall weight is higher and higher, the amount you give scrolls up a little bit, not even in a linear fashion, see chart.

Robitussin DM For Dogs
Robitussin DM For Dogs

Tooth Root Abscesses and Swelling Under the Eye in the Canine

Canine tooth root abscesses are common, and sometimes there’s more than meets the eye. What if it’s cancer from Apoquel? How can you tell? What should you do? How do you treat a tooth root abscess, antibiotics? Is it always ‘yanking the tooth’?

Canine tooth root abscess management

Management of a canine tooth root is usually associated with,

…or followed by the use of a non steroidal anti-inflammatory like Deramax, plus antibiotic therapy and my preference is a macrolide like Clindamycin which has decent bone penetration and can access and destroy the kind of gram negative germs that live anaerobically in pockets like abscesses and teeth roots.

canine tooth root abscess
canine tooth root abscess video

Cushing’s Disease Veterinary Notes

Cushing’s Disease Veterinary Notes

So, I put together 39 pages of information on Cushing’s Disease, which is overactive Adrenal Glands. The body produces way too much Cortisol and the impact is insulin antagonism, and hunger and thirst, weight gain, thinning skin, premature aging. And increased vulnerability to infections.

Cushings
There are two other resources on DrJohnson.com for HyperAdrenoCorticism

Actually, a lot of the same symptoms (besides thirst and elevated liver enzymes) of Hypo-Thyroidism.

And, so that I don’t look totally stupid when I walk into the exam room with my Cushing’s Cases, I put together THIS DOCUMENT to leaf through over my lunch.

There’s the diagnostic algorithm, and the numbers you want to see, and then treatments are discussed and my favorite (because it hedges itself against Addisonian Crisis) is the Utrecht Method of medicine.

Cushing’s Disease Veterinary Notes

Visit the Cushing’s Book