Category Archives: Vet Topics

Professional topics, usually for my own benefit for later, but perhaps of some use to other veterinarians

What REALLY Kills Dogs? (Longevity threats)

What are the BIG Threats to Longevity in Dogs?

I’d like to do an article that describes “what really kills dogs“, or “What gets in the way of dog and cat longevity?”
There’s just so much stuff out there. With the advent of the Interwebs, veryone can sell advertising! 15 or 20 years ago it was just the major networks that could make money from a Nabisco ad. But now, anyone with Internet access, and enough of an audience can make money from advertisements running on their channel or web site. I’m fine with that.
The problem is that you have to have people (traffic) in your channel or website for those ads to make any difference, and so what you see is a lot of embellishment and hysteria and headline-grabbing and sensationalism; basically, which has been going on since the start of mankind.
Since EVERYTHING with dogs and cats is an overwhelming crisis, nowadays, how do you know what’s real?
I publish my longevity articles understanding that nobody’s really going to look at my stuff, and this has been borne out over and over again, because I don’t know how to trick Google into putting me at the top of the rankings and I’m not going to use headlines like “The president is dead“ to get people to click on my channel.

Don’t you think it’s funny that when Google started it was their job to be the best search engine there is. But now, instead of doing a good job of finding good information, they sit back and let the content provider come to THEM. It’s not about finding good content for them. It’s about content providers “toeing the line” and creating pages that Google “likes” whether there’s actually good content or not.

So what I’m going to do is write a quiet little article on pet longevity, what’s really killing cats and dogs based on experience in a suburban small animal practice.

Because it’s not dog food. And it’s not spay and neuter. And it’s not shots. Not hardly!

First, I’m going to brainstorm all the reasons dogs and cats died this last year.

  1. Extreme age and infirmity 75
  2. Cancer 35
  3. Complications from obesity 30
  4. Kidney failure 15
  5. Complications from Oral infections 7
  6. Biting and safety 6
  7. Hit by car and accident 6
  8. Heart disease 5
  9. Unexpected unexplained 3

There’s some overlap but not much. #2 is sometimes part of #1 and #4 and #8 find their root in #5.

Keep in mind that this is simply the number of cases that are subjectively assigned to a particular cause of death, from one little small animal practice in Marietta Georgia.
I think it sheds a lot of light on the reason people leave my clinic without a dog or cat (aka: pet expires or is put down).

What are the BIG Threats to Longevity in Dogs?

I noticed that a preponderance of animals face the end of life simply because they wear out. Their overall condition becomes so aged and infirm that quality-of-life is robbed from them.
As a distant second, lots of pets cross the rainbow bridge because of cancer, and a LOT of them have shortened longevity from  complications from malignant obesity.

Many a day I will be putting asleep putting an animal to sleep that is considerably overweight and can’t get up. These dogs have carried the weight most of their lives, and into old age and then as their joints stiffen and their muscles weaken, they get down and cannot get up.
They pee on themselves, and in the house, and there is no dignity, and we put them down.

That is a commentary on overweight in dogs as they move into their twilight years. “Overweight past eight” – just doesn’t go well for them.

Longevity in dogs
Besides YEARS, “down in the back legs” and “peeing himself” would be a second place.

On the other hand, it’s never too late to start, putting them on Atkins diet which is essentially Paleo. Ultra low-carb feeding getting the carbohydrate fraction down to 10% or less eating eggs and non-starch vegetables with a little pumpkin stirred in for soluble fiber.

And, administering DHEA to these pets to shave her weight off of them. This can add as many as three years to the longevity of some of the larger patients, as their physical abilities deteriorate with age.

DHEA
This is a pseudo-hormone that can restore many of the metabolic benefits of the sex hormones like testosterone and estrogen to the dog, increasing resistance to cancer, and aiding in the metabolic acceleration of weight loss.

Establishing thyroid status
Many older animals are hypo thyroid and when that is corrected, they get a new lease on their metabolism, a big boost to longevity  and weight loss is remarkable.

Feeding ultra low-carb, once known as Atkins, achieved amazing weight loss, suppression of the ravenous appetite after several months, and extraordinary benefits to overall health.
I will never mention feeding dogs Atkin’s style, without simultaneously mentioning that when people feed their dog Atkin’s style, but also give carbohydrate treats and table food on the side, that will kill the dog! Atkins style feeding is high protein and significant amounts of fat, and if given with carbohydrates, the fat is deposited and the animals become PONDEROUS.

longevity compromised by weight?
Is it his AGE or his weight? He gets put down because it’s so sad to watch him struggle with his arthritis.

It is difficult to contemplate the extension of life through weight loss if pain remains. Who wants to extend a painful life?

Allow me to take a moment to describe an “arthritis diagnostic” regimen that I am very fond of.

We take an animal in reasonable health, we put them on three medications to ameliorate arthritis in order to see how much of an impact arthritis is actually having on the dog.

Let me explain that:

If you put a dog on medicines for

  • pain
  • inflammation
  • nerve pinching
  • bone-on-bone grinding

…and you don’t see any difference in the dog, it suggests that these issues don’t manifest in the dog. That he doesn’t need those medicines.

However, if you use a comprehensive panel of medications for a week that address most causes of discomfort in elderly dogs and it’s “the best week of his life“ then you know you have a candidate for long-range arthritis management. You can’t tell a dog in back pain, it does NOT cause limping, right? How can you tell if they have a sore neck? They can’t tell you and it doesn’t cause a limp.
But when they respond to empirical arthritis / nerve pain medications “tried for a week” – these are exciting cases.

Quite often, it’s not necessary to use all three of those medications all the time once you know that arthritis is a factor and can be controlled, you can reduce the amounts and frequency of certain medications and still get excellent results.

The key is the initial diagnosis based on therapeutic response.

The initial cocktail does not include a painkiller. No narcotics, as I do not want to mask the pain, in this protocol I want to alleviate it.

We use Deramax, methocarbamol, and gabapentin. Depending on the pet, we may also use a stomach protectant like famotidine or omeprazole.

After the first week, if the Pet is doing very well we may continue to manage him or her using the following protocols:

Perpetual low-dose gabapentin, perpetual low dose methocarbamol, and “as needed“ Deramax. There is economy and safety in that message.

Some people are so crazy about the way their dog is feeling on the three medications given every day, that they decide to stay with that, and it is perfectly OK.

Most vets will bother you every six months for blood work to check to make sure nothing is happening with the kidneys and liver on the nonsteroidal anti-inflammatory.

Avoid The Spay or Neuter to Avoid Cancer?

Avoid The Spay or Neuter to Avoid Cancer?

Video at end of post

Interesting information has shown up (a little ‘fringe-y) that suggests that altering (spay, neuter) pets robs them of sex-hormones (testosterone, estrogens) that maintain their vitality into later years. Without those hormones, and after they pass the age of 9+ years, the odds of contracting cancer can increase up to four times. (Specific cancer, specific age range, specific gender, but still…)

Simplified: If you don’t spay or neuter your dog or cat, there’s a 8-12% chance of cancer in the reproductive / mammary tissues later in life. If you *DO* spay or neuter your dog or cat, there’s an 8-12% chance of cancer in the spleen or other organs. Sort of sounds like a dog has an 8-12% chance of cancer when they get old, right? Well, it’s just interesting that intact dogs don’t usually get spleen cancers.

Another study suggests that intact dogs are more ‘confident’ and less prone to anxiety*. This work was done as a Masters-thesis paper at Hunter College which is a decent college in New York, but the students were pretty much just dry-labbing a ‘paper’. No dogs were met, no exams were done. No experience was brought to bear, or gained. So I don’t hold a TON of stock in that paper.  The statistical work was good, but they didn’t qualify what “Aggression” or “Anxiety” were, or how that was elicited. The paper was accepted but not professionally reviewed.

*The down side to ‘intact-ness’ is that there’s a flip-side anxiety and prevailing ‘distractedness’ about ‘finding a mate’ that drives owners crazy so it’s a “no win” situation, right?

Following up on the belief that spay and neuter may potentiate cancer in older altered dogs, I dug up almost-ten studies that DO SHOW that spay or neuter increases the odds of the dogs getting cancer.

Other studies confound this. A study done in Michigan at a Veterinary College. (The influence of castration on the development of prostatic carcinoma in the dog. 43 cases (1978-1985). Obradovich J1, Walshaw R, Goullaud E.)

Avoid The Spay or Neuter to Avoid Cancer?

No study showed that de-sexing CAUSES cancer in any form –  but, (perhaps by weakening part of the immune system) some dogs (legitimately) were up to 4x more likely to get certain kinds of cancer than intact ones. (Spayed females and Hemangiosarcoma, for example)

Taking it “to the next level” I skimmed the abstracts and conclusions of about a hundred papers. While the statistics don’t speak to a national emergency or even a ‘prevalent’ problem, the papers are incontrovertible that even if you wanted to discount the research from one paper, you can’t discredit all of the data.

So, in some cases the results could be tabulated in “how you look at it.” and it depends on what you’re trying to convince people of.

HOWEVER, (and this is a BIG HOWEVER) the @ ten studies that DID relate to spay, neuter and cancer, and ACTUALLY showed increased risk of cancer in the de-sexed dogs!!

So what I’m saying is, that Snowflake Vets incriminating de-sexing surgery for cancer in later life, have a valid point. 

But here’s the thing: Let’s say the odds of cancer ARE increased in de-sexed dogs?

What then? Does ANYONE actually think a person would keep a male dog around that was peeing everywhere and squaring off with people and other dogs? Running off every time the neighbor dog went into heat?*

Does anyone actually believe an owner would keep a female around going through false pregnancies and bleeding on the furniture, struggling to get out the door when she’s in heat, and drawing dogs into the yard for blocks, and waxing all possessive-aggressive about bowls, closets and beds?*

*All of the above still happens, even with hormone-sparing sterilization procedures like vasectomy, hysterectomy and tubal ligations.

I don’t believe EVEN FOR ONE SECOND that aggression and anxiety are higher in de-sexed dogs. That part of the Hunter College study was done by inexperienced non-vets and didn’t even discuss what aggression and anxiety looked like. Nothing in that part of the study coincided with the reality we see in the exam room. And to me, that’s a BIG problem. I have to dismiss those findings out-of-hand because the common reality is wholly unmatched by their paper.

Still…

I am legitimately concerned that there are credible papers that support that spay and neuter are actually and palpably associated with an increase in vulnerability to cancer, and that seems to be borne out in the work done by Jeffrey Nyce, whom I hold in high regard. He is the researcher I talk about all the time, who suggests that hyper-supplementation of DHEA will replace the lost “anti-cancer” impacts of de-sexing dogs.

(More articles from Dr Nyce)

The Only Three Things I Know Absolutely, Without Exception:

  1. Intact male dogs are usually oppositional-defiant, prone to roam, and urine-markers.
  2. Intact male dogs smell unpleasant
  3. Intact female dogs are bi-annually messy, prone to roam and attract males, and many do eventually get malignant breast cancer. 
Skip the spay, this is just twice a year.
A cute Havanese dog in heat is wearing a specialty diaper to absorb the discharge.

I know from a TON of experience that when any “intact” male dog comes in, he’s 95% sure to tense up, and ‘square off’ with everyone in the waiting room, pee in 5-6 places around said waiting room, and get his hackles up, and get ‘stink-eye’ when I walk into the room. VERY rarely seen an exception to that one. Keep in mind, as a professional, I can deal with that. But on the ‘day-to-day’, can the owner?

I know for a fact that ALL intact male dogs I have ever seen have consequential amounts of ‘smegma‘ (mild, persistent balanoposthitis) and smell metallic, and ‘male’.

And I know that when someone comes in with an older female dog with lumps in the breast line, and it’s intact, those are going to be malignancies with a poor prognosis without exception.  And that spayed female dogs have never come in, not ever since 1991 with breastline malignancies (But they often have hyperplasia).

It’s true that pyometra can only happen in intact female dogs but that doesn’t make it COMMON. Fact is, I’ve often thought that pyometra wasn’t a compelling reason for spay. Breast cancer is, though. Regardless of the “studies”.

So, I said all of the above to say this:

I think that 99% of clients won’t avoid spay or neuter, because it will leave their pets ‘difficult’ and ‘smelly’ and bleeding on their furniture so that they can avoid a less-than-13% chance of certain cancers after the age of 9 or 10. 

I think that TONS of dogs are anxious and aggressive now, NOT because of de-sexing, but because our culture has abandoned ‘dominance’ as an owner quality and has adopted emotional ‘negotiation’ and ‘counseling’ and ‘therapy’ to accommodate dangerous or defiant pets.

Finally, to the concept of hysterectomy and vasectomy of the dogs in order to spare their hormonal integrity, which is increasingly popular among a variety of Veterinary “Snowflake”  – –  again, identically to Raw Diet  – which is another thing I endorse and have seen the merits of:

Clients don’t like BLOOD and mess. They’re not going to have dogs peeing and bleeding in their houses! 

The fact that normal clients don’t want to deal with raw chicken, or bloody diapers isn’t surprising. That America is still spaying and neutering despite these percentages is not even substantially a reflection on the veterinary profession, but instead a realistic expectation on the part of a prospective pet owner.

So, what’s the point in ALL of the mewling?

Doc Johnson

PS: To close this document, let me say that I’ve vasectomized companion animals before and it’s not hard at all. Same with tubal ligation and or hysterectomy. No worse than a regular spay or neuter. A bit more time consuming, but whatever. No big deal.

So if, after consideration of the above, a client is okay with intact-ness in a male or female dog around the house, I acknowledge the myriad minor but undeniable health advantages of NOT desexing the dogs and cats. And I’d be glad to perform those alternative, hormone-sparing procedures as long as the clients ‘get it’ that the pets will still act like distracted, overwrought teenagers, and pee and bleed on stuff.

I’ll take it a step further: So far, (My position is subject to change) I’ve decided NOT to Spay Luna Boona. And the only reason is, that I’ve seen too many elderly dogs “live too long” and get all crippled, blind and deaf.

That just doesn’t happen to un-spayed females. Un-spayed females tend to live healthier, but shorter lives.

I know from experience that if I don’t spay Luna, then (about three years before she’s crippled, blind and deaf), she’ll show up with malignant breast cancer, a pyometra or a blood dyscrasia, and I’ll be within my ethical rights to put her down. I think to myself: What will she (and her humans) have actually missed by her so-called “early” demise at 12 instead of 15?

So you can see that all of the above is uhhhhh…. sticky. I maintain that there is no need for anti-spay-neuter proponents to demonize the veterinary community for doing what’s been expected of them, asked of them by owners, and traditional for them to do for overpopulation-control advocates. And the fact that more owners aren’t suspending spay or neuter is LESS about ‘evil’ ‘ignorant’ or  ‘money-grubbing’ veterinarians*, than it is about what kind of mess-and-drama an owner is (understandably) UNWILLING to put up with at home!

*There are retired human dentists who say so.

The following are a smattering of references which require no ‘imagination’ to see that when we neuter male and female dogs we weaken them a little. We make them a little more vulnerable to cancer, we make their bones a little weaker, their joints a little weaker, their hormonal axes (balances) a little less stable.

Would I spay or neuter my dog? Yep. But it's a trade off.

In a nutshell, altered male and female dogs are a little LESS VIBRANT in most measurable parameters. It’s (metabolically) like we’ve aged them 3 to 4 years all at once. Interestingly, my clinical experience supports that 95+% of spayed and neutered dogs live JUST AS LONG as the intact ones. Only, they spend that time just “A Little Not-As-Strong” as intact ones.

I believe 100% that we don’t have to replace bio-identical hormones to conserve a dog’s health into later years. Affordable dosing with DHEA from Amazon is sufficient according to some of the most advanced thinkers in that area. (Dr Jeffrey Nyce)

One GOOD thing from the studies that show spay and neuter may have a weakening effect on dogs against various aging factors – is the rate of later-age surrender of dogs drops DRAMATICALLY in altered pets. In other words, people aren’t euthanizing or giving away altered pets, but they dump plenty of the intact ones. And that makes sense. Intact pets are eventually intolerable, just speaking for myself.

To wit:

Ajax required neuter at 6 months, to remain a viable companion. But my former Labrador “Bailey” went to TWO YEARS of age before masculine behaviors mandated neuter or ‘giving him away’.

Here are some of the studies that support an increase in vulnerability to cancer in older, de-sexed dogs. 

  • Teske E, Naan EC, van Dijk EM, van Garderen E, Schalken JA. Canine prostate carcinoma: epidemiological evidence of an increased risk in castrated dogs. Mol Cell Endocrinol. 2002 Nov 29;197(1-2)251-5.
  • Sorenmo KU, Goldschmidt M, Shofer F, Ferrocone J. Immunohistochemical characterization of canine prostatic carcinoma and correlation with castration status and ca
  • Ru G, Terracini B, Glickman LT. (1998) Host-related risk factors for canine osteosarcoma. Vet J 1998 Jul;156(1):31-9
  • Cooley DM, Beranek BC, Schlittler DL, Glickman NW, Glickman LT, Waters DJ. Endogenous gonadal hormone exposure and bone sarcoma risk. Cancer Epidemiol Biomarkers Prev. 2002 Nov;11(11):1434-40
  • Prymak C, McKee LJ, Goldschmidt MH, Glickman LT. Epidemiologic, clinical, pathologic, and prognostic characteristics of splenic hemangiosarcoma and splenic hematoma in dogs: 217 cases (1985). J Am Vet Med Assoc 1988 Sep; 193(6):706-12
  • Ware WA, Hopper, DL. Cardiac Tumors in Dogs: 1982-1995. J Vet Intern Med 1999;13:95–103.
  • Torres de la Riva G, Hart BL, Farver TB, Oberbauer AM, Messam LLM, Willits N, et al. (2013) Neutering Dogs: Effects on Joint Disorders and Cancers in Golden Retrievers. PLoS ONE 8(2): e55937. doi:10.1371/journal.pone.0055937
  • J. Armando Villamil, Carolyn J. Henry, Allen W. Hahn, Jeffrey N. Bryan, Jeff W. Tyler, and Charles W. Caldwell. Hormonal and Sex Impact on the Epidemiology of Canine Lymphoma Journal of Cancer Epidemiology. Volume 2009 (2009), Article ID 591753, 7 pages.

Avoid The Spay or Neuter to Avoid Cancer?

Fish Veterinarian in California – Full Time Practice!

I found a vet in California who treats fish all day long! Not only that, she’s really smart and went to Tufts!

Check out her web site, and information. This is a fish health veterinarian who is in practice in California you should be aware of.

fish veterinarian dr sanders
cafishvet.com

I can’t introduce the doctor(s) there any better than they can, so I cut and paste this about Dr Sanders:

Owner/Chief Veterinarian: Dr. Jessie Sanders

Aquatic Veterinary Services is owned and operated by Dr. Jessie M. Sanders. The practice offers both ambulatory and in-hospital services specializing in aquatic pet medicine. Our mission is to take the stress out of keeping your fish healthy!

Dr. Sanders specializes in fish surgery and has logged extensive hours honing her surgical skills. Our veterinary practice is proud to offer a broad range of surgical services, extending from a simple wen trim to a fully-invasive abdominal exploratory.

Dr. Sanders received her B.S. in Marine Biology from the University of Rhode Island and DVM from Tufts University. Dr. Sanders is one of the first Certified Aquatic Veterinarian through the World Aquatic Veterinary Medical Association, and a member of the American Association of Fish Veterinarians, the International Association of Aquatic Animal Medicine and the American Veterinary Medical Association.

Learn more about Dr. Sanders on her website: Click Here

You Must Be Rich! (Shareholder Medicine Strikes Again)

Did you know that there’s a program that takes your address off your veterinary record and runs it through Zillow (Radian?) and finds out what you paid for your house, plus the comparable home values around you? Yep. They just want to know how much you can spend on your animal. What could possibly go wrong? You should ask next time you go to the shareholder Vet if you’ve been profiled like that.

wealth-checking-software-shareholder-veterinary-medicine
wealth-checking-software-shareholder-veterinary-medicine

KHV Koi Herpes Virus Versus Spring Viremia of Carp

Overview:
Koi are generally hardy fish. They’re descended from the common carp and are tough, essentially omnivorous fish with the ability to withstand a range of living conditions.
As an ornamental specimen, the Koi is beautiful, and sought after for it’s highly strained color varieties.
Koi health and disease is essentially a balancing act or “equilibrium” created between stocking density, water-and-environmental conditions, parasites, and the fish itself.
It was once said that “if you take care of the environment, the fish will take care of themselves”. This was true until some of these viruses started showing up with increasing regularity.

Introduction to the Viruses:

There are (at least) two known viruses of importance to Koi. There are other viruses but these are important from the perspective that they can quickly kill the fish and are both highly contagious.

  1. SVC / Spring Viremia of Carp (Rhabdovirus carpio)
  2. KHV / Koi Herpes Virus

These viruses are similar and dissimilar. Some of their differences and similarities are important.

Koi Herpes Virus – Spring Viremia of Carp – What You Should Know*

Recently Discovered?

No. This virus was described in the literature more than forty years ago.

No. KHV was reported in Japan fully ten years before it’s first outbreak or discovery in Israel. The earliest documentation I can find is from the 1980’s

Kills Fish?

SVC has recently been shown to kill groups of fish when experimentally injected with the virus, earlier researchers maintained that the SVC only allows opportunistic bacterial infections which then can kill the fish. Mortalities may be 20-30% if supportive care is given and the environment is optimized.

KHV kills upwards of 70%-90% of exposed fish which have not been previously exposed to KHV.

Seasonal

SVC Yes – Spring

KHV Yes – Spring and Fall

Endemic (native) to the USA?

Yes and No: The ‘party line’ is that the virus had not formerly been found in North America but there is emerging evidence that the virus was indeed being encountered in fish kills in Wisconsin almost a decade ago.
Reported “absence” of SVC from American waters may have been due to a lack of testing. I personally (ELJ) think that SVC is an endemic, and highly morbid contributor to many of the Springtime die-offs and illnesses we’ve seen every year for the past two decades.
The problem is that testing for SVC can result in quarantine or worse. Retailers are unlikely to “step up to the plate” and endeavor to discover this virus and limit its distribution.
Doubtful.

Koi Herpes Virus

This KHV virus seems to be infecting “groups” of exposed fish which go on to infect others, or simply die off en masse. It’s own virulence (aggressiveness) is probably limiting it’s morbidity.
Lesions: Pale white lesions may result due to the co-infection by bacteria. Fish may develop a pink or red color in the skin as infection progresses. Yes. Pale white lesions may appear in the gills of affected fish. Excess slime, especially on the head and nape of the fish seems common. Body-color of the fish may become blotchy and the internal organs may be damaged or even liquefied.

Diagnostic Challenges

People don’t want to submit for, nor do some labs want to test for; SVC because of the maelstrom it causes. SVC is an RNA virus and requires an extra step when using PCR technology to diagnose it. When the virus is not in a vulnerable host or is not in its ideal temperature range for replication, it’s diagnosis is essentially impossible. The PCR test and the other culture and swabbing techniques available are quite accurate for infected fish but false negatives can occur. When the virus is not in a vulnerable host or is not in its ideal temperature range for replication, it’s diagnosis is essentially impossible. Diagnosing “occult” (hidden) carrier-states of KHV may be impossible with current technology.

Immune Carrier States?

Fish usually survive SVC; but their carrier state is unconfirmed.

Survivors of KHV are said to be clear of the virus and cannot be re infected with KHV.
The lack of virus in post-infection specimens is probably due to the difficulty in detecting virus in asymptomatic fish or fish outside the viruses’ ideal range.

Kind of Virus

SVC: RNA virus, rhabdo (bullet) shaped.

KHV: DNA virus. (Herpes virus)

Testing

Can be cultured, there is a reverse PCR test for this virus. Can be cultured, can be detected via novel nucleic acid tests (swabs), can be detected by PCR testing.

Reportability

This morbid SVC virus is reportable by law.

This KHV highly virulent virus is ALSO legally reportable but is as yet unregulated.

Prevention

SVC Prevent exposure to the virus.

KHV Prevent exposure to the virus.

Control – Treatment

SVC: If fish are supported in ideal environments and secondary infections are controlled through aggressive antimicrobial therapy, including antimicrobial food and injections, 70+ percent survival is possible.

KHV Koi Herpes Virus Versus Spring Viremia of Carp
KHV Koi Herpes Virus Versus Spring Viremia of Carp

KHV: Mortalities may be kept below 70% if the fish are rapidly warmed to above 80 Degrees Fahrenheit.
To put the brakes on a late-summer outbreak, you can let the temperature sail down into the forties instead of heating, and the losses will slow down as the virus is deprived of it’s ideal temperature range. Fish may still die from prior damage done by the virus.
Sooner or later, the fish will have to be warmed up.
During an outbreak; if possible you can move the fish as quickly as possible to temperatures higher than 80 oF, or lower than the seventies (in Fo)

Spring Viremia:

The real issues concerning SVC are it’s status as a reportable virus. It’s very possible that many breeder and wholesale facilities (as well as many residential ponds) have fish which harbor this virus. Testing is currently possible, but is not being undertaken on a widespread basis, because of the cost, the lack of centralized and unified regulation, and a reluctance of civilians, and researchers to open that “can of worms”. Retailers concerned that their stocks could harbor this virus would put themselves out of business by soliciting SVC testing by a laboratory and receiving a positive result *.

Fortunately, SVC isn’t a terribly efficient killer of fish and could be considered ‘mild’ at least compared to KHV. Well-cared-for fish can often survive the virus not unlike the way healthy people survive the Influenza virus, and optimally housed fish may not even break out with signs of infection.
I for one do not spend much time worrying about the SVC condition because I would neither subject my customers to diagnosis (and potential persecution caused by an SVC diagnosis), nor would it change my treatment, which is antimicrobial support “past” the ravages of the virus . I am, as a healthcare provider to fish, almost alone with this opinion *.

KHV:

KHV Koi Herpes Virus Versus Spring Viremia of Carp
KHV Koi Herpes Virus Versus Spring Viremia of Carp

The real issues concerning KHV is it’s predilection for a narrow temperature range for infection, and it’s ability to hide when it’s outside those temperatures in asymptomatic (not sick) fish. If you grind up a healthy-looking fish which you think might have or be carrying KHV looking for virus, you can easily miss the diagnosis unless the fish is actually viremic. When a fish is symptomatic and sick with a KHV infection, the virus can usually be cultured into certain cell lines, detected by enzyme linked PCR tests, or even detected by unique nucleic acids in it’s structure.

What it boils down to is this:
If you’re considering buying some nice new fish this Spring, how do you know the fish isn’t just sitting there; ready to explode with KHV as soon as it hits seventy degrees Fahrenheit?
You don’t have any security unless the fish has been through the following cycle of cold-then-warm, which are believed to be important triggering events for KHV infections:

  • Stress
  • Cold water,
  • Warming, to the viruses ideal range in the seventies (oF) allowing virus to replicate and damage the fish.

So, a fish which has endured, and survived, a temperate (North American) climate change from winter to summer could be regarded as the safest fish to buy but does not rule out that the fish could be carrying the virus. Some dealers are artificially inducing these cold-then-warm cyclic changes in their recent imports (unnecessarily, all it needs is 74 oF) to try and bring these cases out of the woodwork before sale by chilling and then warming the fish after importation, creating a “mini” cycle.

Testing for KHV can prove the fish to be without the virus and “not currently infected” but since the carrier state is a relative “unknown” at the present time, there is little security in a negative KHV test in a healthy fish. A negative KHV test in sick fish could be considered much more reliable as most fish with active infections have virus which is capable of detection by available means.

Quarantine will become a necessity, not an ideal, in 2003. This quarantine could arguably be 8-12 months to allow a complete “cold-warm-cold” cycle in order to reveal occult KHV or SVC infections.

An actual case:

KHV Strategy

The following was used on one of several cases of KHV which broke out in the Fall of 2002. The fish were being heated despite the onset of wintertime temperatures outside, to support the fight against what appeared to be a severe bacterial infection. Then an Arkansas laboratory indicated it was KHV. We had stopped the losses initially with Tricide Neo but the losses resumed a week after the Tricide dipping which made us even more suspicious that we were dealing with a virus. (In quotes, my customer communication)

“Your losses have not been on par with the others, most folks lose 70-90% of their fish in a week or two. This is not a cause for optimism. It may be because you used the Tricide-Neo it could also be because temps were falling as they broke….
However, now most of the fish *are* symptomatic and as the Arkansas specialist indicated, you COULD let the heat off and the virus COULD (should?) go dormant.

In the Spring, here’s the possibility: Since most of the fish are showing signs, it’s safe to say they are “viremic”. If they are chilled ***RIGHT NOW*** (today!) – could they not chill down, stop the virus / viremia / replication, and with warming in the Spring, perhaps mount an immune response???

Yes, it’s possible. Researchers I spoke to know that we cannot re infect KHV survivors. Did they survive the KHV with natural immunity or luck?; or do they develop specific immunity afterward, from incomplete (non-terminal) infection???

So, here’s my recommendations for Winter KHV Outbreaks:
1) STOP HEATING NOW if the fish have KHV.
2) STOP the water falls; to prevent the phenomena of “supercooling” from chilling them too fast.
3) Maintain mid-water circulation to maintain aeration and to de-gas the pond.
4) Remove dead as they show up.

5) In the Spring – when the Arkansas specialist , you, and I have talked, we should “accelerate” the heating process. *NOT* letting them warm up slowly, naturally.
We should do a sort of: “On your mark, get set, go!” and move them as quickly and safely as possible through the warming process, for example, when water naturally hits 45-47 oF we could suddenly take them “5-degrees-per-day” to a whopping, most “KHV-unfriendly” eighty oF Six day warm up. Window in the seventies: TWO

Crazy? Maybe. Kill all your fish? Not like the virus probably would if water temperatures were suspended in the seventies..
Finally, you *do* see the problem with complete disinfection, “depop-repop” plans. If you sacrifice all your remaining fish, to get new healthy ones; what on earth will prevent you from restocking with 49 healthy fish and ONE MORE KHV carrier? Nothing.

So I am not really in favor of a wholesale depopulation at this time.

Best regards

Erik Johnson DVM

Outcomes: When the pond was cooled, the losses basically stopped. The fish became lethargic and went to the bottom. A few of the worst fish which were about to die when the water was warmer continued to become sicker and died.
Some other fish were brought inside and rapidly warmed to 80 oF, and made remarkable recoveries. Spring 2003 is not here as of this writing but there is some encouragement that if rapidly warmed, these fish may recover.

Post Script:
It bears mentioning that it is the professional opinion of most researchers and ornamental fish health specialists in this field, that in the interest of the health of our nation’s Koi and carp livestock, all individuals and retailers suspecting that their fish might be infected with SVC or KHV should request testing for these infectious agents.
My (ELJ) position has been to recommend that retailers and wholesalers decline SVC testing and to destroy fish which might be infected. This represents irresponsible behavior on the part of the dealer and puts the hobby at risk because it will hamper attempts to detect and eliminate the SVC virus. However, the position is a result of the following:

Currently, if your fish are diagnosed with SVC you will be summarily bankrupted by the following processes currently in place:

There is (in fact) financial compensation for lost livestock which may be tested and slaughtered. Requests to operate under a new business name with new broodstock and new production ponds will probably be (and have been) denied.

The problem with the financial remuneration policy is that there is NO MONEY allocated in ANY fiscal budget to make the promised payment.

No official process exists to formally determine the length of impound and quarantine. You may be under quarantine for an indefinite period of time.

There are no mechanisms to protect your identity and you may be informed of your SVC infection along with the rest of the industry, simultaneously.

There is no standard format, nor standard interval for testing of your peers or competitors, so you may be the only organization subjected to the penalties associated with reportable SVC infections.

*Errors or omissions in the above are possible but are unintentional. Some of the above is based on hearsay, opinion or verbal exchanges with researchers in the field. Newer information may be available.

What’s Next For Veterinary Medicine and Pet Insurance?

insurance claims for petsNot unlike the human side of things, veterinary health insurance is going to come on, and become a “thing” and that’s great. Clients secure services and get reimbursed by the insurance company, not unlike the old days of human medicine.

Then veterinary corporations will recognize that ‘filing for the client’ is an advantage they have over the independent. The independent Vet won’t have a central office / corporate structure that allows a full time insurance filer. By offering the convenience of “we’ll file for you” to their customers, more business will be pulled away from the independent. That’s the not the consumer’s problem.

The customers are suddenly having to get ‘approved’ for procedures and treatments.

The problem is that as soon as the Vets start filing for the customer, the relationship gets six-degrees-of-separation and the insurance company starts “allowing” payouts of a certain prescribed size, interval and frequency. Reimbursement limits that would be hotly contested by the client, but the Vets (like human physicians of yesteryear) will roll over on. Eventually, veterinarians (like human physicians and hospitals) will be supplicant to the whims of the insurance companies. As will the customers who are suddenly having to get ‘approved’ for procedures and treatments.

And that all begins when the Vets start filing claims on behalf of the clients. And that, dear souls, is as inevitable as every other gimmick that’s going to come out of Veterinary-shareholder medicine.

pet insurance

Doc Johnson

 

 

Urso – Ursodehydrocholic Acid for Hepatocellular Health in Dogs – Canine Liver Disease

Long ago, traditional Chinese medicine derived that Black Bear gall bladder contents was therapeutic for numerous diseases (link) and disorders. I wasn’t even born at that point and my exposure to TCM is limited. Fast forward to the Vietnam War when military personnel were exposed to large amounts of Agent Orange and suffered severe liver damage. When they came back from the conflict, one of the medicines they found effective in their treatment was Urso. At the time, called Actigall.

Urso – Ursodehydrocholic Acid for Hepatocellular Health in Dogs

Urso - Ursodehydrocholic Acid for Hepatocellular Health in DogsWhen you’re presented in clinics with a dog or cat with elevated ALK lab values it can be assessed that there’s some stress on the liver. Either acterial showers via the bloodstream from the teeth and, or, the presence of some chemical or medicine that’s taxing the liver. ALKPhosphatase is a ‘stress’ or ‘overexertion’ enzyme from the liver under most practical instances.

Another enzyme from the liver is ALT, (alanine amino-transferase) and I’ve seen this elevated more commonly in cases of actual liver DAMAGE. So when I see this, I interpret it in light of a CBC for infection, cirrhosis, inflammation, or other damaging process. If the exam, signalment, or more bloodwork doesn’t illuminate this, and the values are high –  an ultrasound of the liver is almost always rewarding.

Urso is ‘in play’ for me whenever I see elevations in ALKPhos because historically, Urso ameliorates these values to normal in 80+% of cases.

Urso causes gallbladder contraction, which drastically reduces sludge in the gall bladder and prevents the formation of stones (or more stones) and it boosts the enterohepatic cycle of pigments, nutrients and microbial ‘players’ in and out of the liver.

Other research says that ursodehydrocholic acid is actually trophic to liver cells. They can actually metabolize it? As a nutrient? I don’t know much about this.

But this relatively affordable medication is indicated (at least by me) for the normalization of the liver’s stress enzyme, AlkPhos with a recheck of that value in 2-3 weeks. I have found the compound less rewarding in elevations of ALT because it would seem, the pathophysiology of ALT elevations is different and tbh, more serious.

 

 

Why We’re Not Giving ProHeart 6 or 12* To Our Patients.

Why Won’t I Prescribe ProHeart 6/12?

It’s not because of money!

I’d *double* my preventative revenues recommending and giving that product!

It’s not because of effectiveness!

It works just fine! In fact, fully 1% (one percent) better than monthlies.

Not because of convenience!

What could be easier than a shot every year to prevent heartworms?

Nope.

It’s because nobody’s dog dies from heartworm pills. But people’s dogs die every year from ProHeart 6 and ProHeart 12 injections.

Liver disease: Once ProHeart’s in the dog, that’s “it” …there’s no ‘stopping it’ if it starts to ruin the liver. It’s a 12 month decline you can watch with your hand over your mouth. Oops.

And more: If the dog starts to mysteriously lose weight after the first injection, and nobody pays attention or remembers that’s “A Thing”, the second injection ^will^ kill it.

Anaphylaxis: While a chewable is available, and that chewable literally can’t kill your dog, why would you use an injection that has been known to (rarely) kill dogs?

Forgetting a dose?

As long as you’ve got receipts for 12 doses a year of the chewable pills directly from your Vet, *IF* your dog contracts heartworms, the preventative manufacturer will pay for the diagnosis and adulticide treatment. So the fear of ‘missing a dose’ is just marketing.

So my position is: “Why risk it?”

You would KICK yourself if you killed your dog for nothing but convenience.

The monthly chewables are guaranteed*, taste like a tail wagging treat, cost considerably less, (especially with rebates), and they CAN’T jack up your dog like ProHeart can.

To close:

What dog *WOULD* you give ProHeart to?

Three types of dog should get ProHeart:

•Any dog that bites women and children without provocation.

•Any dog that routinely gets out and kills people’s cats.

•Any dog that just won’t get preventative any other way.

*ProHeart 6 and 12 are injections that form a small reservoir of preventative in the body which is absorbed over 6, or 12 months respectively.

Facts:  proheart-6-prescribing-information

Any Skin Case Can Be Fixed

It’s important that you know I’m not being sarcastic when I say I can fix (almost) any skin case.

I’m being serious; but I’m also discounting the fact that some of what I am saying may come at the expense of the pet, or at the expense of your wallet. Specifically, I’m talking about giving antibiotics and steroids to dogs with itchy, infected skins and they do well. For a month.

Or, sending you to a dermatologist who gives your pet four medications, a shampoo and a new food to eat: Limited antigen diets, antihistamines, antibiotics, Bravecto or similar, Apoquel, and a shampoo with antifungal and antibacterial properties. Which translates into, literally, treating for everything.

The dermatologist route (as listed above) flawlessly addresses:

  1. Ringworm
  2. Bacterial pyoderma
  3. Mange mites, dermal and intestinal parasites
  4. Allergies both topical and dietary
  5. Atopy

Besides skin cancer, nothing else happens that wouldn’t respond to the above.

Here’s the skinny on why we might be doing something “in between” with antibiotics, a cortisone and some Cytopoint.

ITCHY SKIN CRASH COURSE_drjohnson_com_simpleskin

 

 

Biological Assessment Forms – Koi Ponds and Goldfish – Not a Diagnosis

The practice of Veterinary Medicine “without a license” would have you diagnosing diseases and making prescriptions for fish*. To avoid doing that, you can make an assessment of the pond and fish and note ‘what you found’ without actually referring to a parasite or condition as a diagnosis.

Identifying the presence of a parasite isn’t a diagnosis. Identify a parasite or condition without making a diagnosis like a veterinarian. Here’s a document that steps you through the many assessments you would do well to annotate WITHOUT making an actual diagnosis.

https://drjohnson.com/wp-content/uploads/2019/10/BiologicalAssessementForm2007.pdf

 

*Because you can diagnose and give shots to dogs and cats without a license all day long and not get punished.

Veterinarians Working on Commission and Why It Matters

Why do you pick on veterinarians working on commission? How does that even matter to me?

Let me start by saying I was on commission for a while after I got out of school (1994) so I know something about it.

A recent market change has created the situation where any emergency clinic that you go to now, is owned by the same, national corporation, which is notoriously expensive and has the veterinarians on commission. In the event of an emergency, you will be directly impacted by what we are talking about in this document. (And this one)

A person might reasonably ask why I pick on veterinarian who work on commission or more accurately, why I pick on corporations who put their veterinarians on commission.

Commission seems to create a conflict of interest as far as what the on commission doctor will recommend as far as testing and procedures, to increase the amount generated by the inflated ticket.

Doesn’t the practice owner get the same improvement to his bottom line when he recommends unnecessary tests and excessive procedures? What is the difference between owning the practice, or being on commission as far as the profitability of practicing excessively?

First, let me observe that not every veterinarian on commission jacks up the client. My primary criticism is with corporations who put veterinarians in that position to have to guard themselves against that. And a degree of pity for the client, taking the risk that a commission veterinarian might practice excessively on their behalf.

Absolutely the only way a veterinarian-on-commission could possibly increase their paycheck or standard of living, is by increasing what they do. They can indulge the the luxury they have; of practicing excessively without worrying about the reputation of the practice.

On the other hand, the independent practice owner does not have to practice excessively. In fact, an independent OWNER is likely to do so much less than the commission veterinarian because word gets around that you practice excessively and it hurts business. That matters to the practice owner.

The practice owner has only to cut costs, and can raise the prices around the clinic to improve his financial bottom line without practicing excessively at all.

The practice owner can also increase his hours to generate increased income for himself. Commission veterinarians are limited to a scheduled week, and though they might have the luxury of taking a shift for someone else, that’s not guaranteed and it does not necessarily contribute to the bottom line besides allowing them to have more cases for greater commission revenue.

It’s important that you take away the fact that I am not condemning commission veterinarians because they do not have to practice excessively if they do not want to. For example: When I was working for Banfield veterinary hospital at a Petsmart location for nine months I earned absolutely no commissions. 

That clinic almost doubled in size but the “average invoice” did not go up and I did not upsell any of the bonus-incentivized products and services they wanted me to, unless it was actually necessary.

Related Post on Corporate Veterinary Medicine and How It Will Impact You In The Next Five Years.

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