Standard of Care

Standard of Care

Most people visit their physicians at least once yearly for routine checkups. These visits usually include an exam by the doctor and bloodwork that screens for hidden problems. Yearly bloodwork aids the physician in identifying potential problems the patient may have, but unable to see on physical exam. It has always been more beneficial to treat problems early in the disease course as opposed to the advanced disease state. The outcome for the patient as well as their quality life is more favorable with early intervention.
Veterinarians have always practiced preventative medicine with vaccines, heartworm and flea/tick medications etc. Overall as a profession however, we have been reluctant, largely due to cost, to recommend routine bloodwork as part of preventative care until the patient presents with a problem. Throughout the country, experts are recommending screening bloodwork as part of a pets annual or semi-annual checkups. Pets who visit their veterinarian once yearly equate to a human visiting their physician once every 7 years. As you can imagine, alot can happen health wise to a person in 7 years, especially as we age. Anticipating an increase volume of bloodwork due to this changing philosophy, veterinary labs are making these tests more affordable for the veterinarian to recommend to pet owners.
For instance, 1 in 6 patients under 6 years of age and 1 in 5 over the age of 6 have a significant health issue diagnosable on screening bloodwork. In my experience, outcome is always more favorable and less expensive when the disease is diagnosed and treated early in its course. Several times monthly, I diagnose early kidney failure in a patient on routine screening tests. The importance of this particular test is that the patient can live 600 days with early intervention as opposed to 180 days if diagnosed later in the disease course. Therefore, in order to improve our standard of care for our patients, we will be recommending screening bloodwork at annual and semi-annual visits.
As always, if anyone has any questions related to the monthly health columns, please feel free to call the office.

Feline AIDS

Feline AIDS

Feline immunodeficiency virus or FIV (similar to HIV or Human AIDS) is an infection that attacks the immune system of the cat. Up to 1 in 12 cats tests positive for FIV nationally. In cats that are at risk or clinically ill, the infection rate rises to as high as 15%. This percentage is higher here in Florida as I diagnose this disease at least 3 to 4 times monthly.
FIV is a lentivirus that is transmitted primarily thru bite wounds, but also may be acquired from the mother while pregnant. Unlike Feline Leukemia, the virus is not transmitted thru intimate contact such as with grooming behaviors, because the enzymes in the mouth destroy the virus just as HIV is in humans.
Clinical signs usually begin 6-8 weeks after infection and include low white blood cell counts (wbc fight infection), neurologic signs (behavior changes, dizziness, seizures) and severe sickness in general. Cats with AIDS have poor immune systems and do not fight common illnesses as normal cats would. In other words, a simple cold can kill a FIV infected kitty! Many FIV infected cats will have no specific signs of illness and can live 4-5 years without any problems. This disease, however, will eventually kill the patient as does HIV in humans.
There is no treatment or drug cocktails in veterinary medicine as there is in human medicine. There is a new vaccine, however, that was introduced in July 2002. A patient must test negative for FIV before vaccinating. There is a series of 3 vaccines initially with 1 vaccine given each year thereafter.
Any kitty that goes outside at all in Florida is at risk for FIV infection. It is transmitted primarily thru a bite wound commonly occurring during a cat fight. This is a terminal illness, but the vaccine has tested almost 100% effective in preventing the disease. As always, if anyone has any questions, feel free to call the hospital for more information.

Ear Infections

Ear Infections

More than half of the patients I see daily have some form of ear disease (Otitis Externa). Most of these cases are preventable with some regular ear maintenance. This month’s article will review ear disease causes and some easy prevention techniques.
Signs of ear problems include itching leading to head shaking and scratching at the area. Soon to follow can be redness, a malodorous discharge from the ear or ears and possible a head tilt.
Common causes are flea allergy, food allergy, atopy (like hay fever), mites and others. Predisposing factors include pets with floppy ears, hot humid environments (Florida), narrowed ear canals in certain breeds, pets that swim, tumors as well as others. Secondary to these conditions, the patient will develop a bacterial and/or yeast infection.
Treatment involves identifying the primary cause of the infection. Whereas fleas and atopy are the number one underlying reason in Florida for otitis, recent research has shown that food allergy is very common as a cause of treatment failure. (See the monthly article archive for further information regarding Flea Allergy, Food Allergy and Atopy) Microscopic evaluation of the ear discharge is necessary for identification of the bacterial and/or yeast involved. Once identified, topical and if necessary, oral medication is prescribed for a week or longer to clear the infection. A recheck is usually required at this time to assess treatment success.
Prevention is the best treatment, especially when it comes to ears. Pets which are predisposed to these diseases will require more regular care than others. Simply using an approved veterinary ear cleaner weekly, after baths and swimming will prevent visits to the veterinarian for treatment. We use V.E.T. Ear Cleaner exclusively because of studies which show excellent yeast and bacterial kill as well as effective gentle cleansing. I do NOT recommend alcohol, vinegar/water or most over the counter ear cleaners which tend to be irritating.
As always, if you should have any questions or concerns regarding this months health article, please feel free to call the office.

Feline Leukemia

Feline Leukemia

Feline Leukemia(FeLv) is one of two diseases we routinely screen for in new kittens and outdoor cats, with the other disease being Feline Immunodeficiency Virus(Fiv)or Aids. Thankfully, we are not seeing this disease too often due to diligent vaccinating and routine screening.
FeLv is caused by a C-type retrovirus or oncornavirus that has a propensity to cause cancer of lymphoid cells and bone marrow stem cells. FeLv is spread by carriers in the saliva (richest source), urine and feces. Thus biting and intimate contact (mutual grooming/oral contact) is a very common mode of transmission. FeLv may also be passed in utero (transplacental) from mother to fetus, however most kittens die at birth. Survivors may mount an immune response and overthrow the virus resulting in a cure, become a carrier (10%) or have active disease.
The primary stage of illness has varying severity and may last several weeks. One may see enlarged lymph nodes and low grade fever. Two to four weeks after infection, anemia and low platelets may be seen. In 70-90%, the patient’s immune system will overthrow the virus and fully recover. Others will become carriers and continue to worsen. In carriers, the virus will cause cancer (lymphoma, blood related cancer etc), anemia (1/3 to 1/2 of patients develop severe anemia) and immunodeficiency (simple infections can cause severe disease and/or death). The average lifespan of a FeLv carriers is 1/2 to 1 year. Cats with active disease will usually die from a common respiratory infection or “cold” due to a poor immune system caused by the virus.
Diagnosis is accurate, simple and takes 10 minutes. Currently we use the Idexx Snap test which utilizes a few drops of blood. It also screens for Fiv or Aids.
Prevention is always better than treatment. Several commercially available vaccines are available and are very effective. Two vaccines are required initially 3 weeks apart and then once yearly thereafter.
This is a very serious and lethal disease. Some pets can live fairly normal lives, but will eventually die from the virus or illness caused by the virus. Early testing and proper vaccinating is key to hopefully someday eradicating this disease.
As always, please feel free to contact the clinic if you need further information regarding Feline Leukemia.

Skin Disease: Flea Allergy Dermatitis

Skin Disease: Flea Allergy Dermatitis

This is the most common presenting problem in patients I see at Olive Branch. Florida ranks number one in the country for Heartworm Disease, Flea Allergy Dermatitis and Atopic Dermatitis. Florida’s tropical climate is a haven for mosquitoes which cause Heartworm Disease, fleas which cause an Allergic Dermatitis and various grasses, pollen, trees and dust mites which cause Atopy. In addition to Flea Allergy Dermatitis and Atopy is Food Allergy Dermatitis which also causes skin disease either alone or in combination with the other two syndromes. So, basically 3 things cause skin disease I see daily in my practice:
  • Flea Allergy
  • Atopy
  • Food Allergy
  • In this article we will discuss Flea Allergy Dermatitis.
Some pets are allergic to the saliva in the flea’s bite. If allergic, 1 bite can cause itching for up to 2 weeks in these pets. A study published a few years ago, when the topical flea preventions (Advantage, Frontline Top Spot) were initially being tested, showed up to an 80% reduction of allergic symptoms not only from fleas, but also from Atopy. Therefore, this is the first line of treatment for generalized skin disease…monthly flea prevention. Treating the home and enviroment help, but topical treatment on the pet is by far the most effective prevention. Some clients will say however their pet doesn’t have fleas. They may not see fleas on their pet, but a flea will bite their friend when they go outside, then jump off the pet. Fleas have been around for centuries and have a knack for survival. Remember, we are the number one state for fleas in this country. Companies who make flea prevention come to Florida to test their products.
In the next article, we will discuss Atopy which is the second most common cause of skin disease.

Skin Disease: Food Allergy Dermatitis

Skin Disease: Food Allergy Dermatitis

This is the most common presenting problem in patients I see at Olive Road. Florida ranks number one in the country for Heartworm Disease, Flea Allergy Dermatitis and Atopic Dermatitis. Florida’s tropical climate is a haven for mosquitoes which cause Heartworm Disease, fleas which cause an Allergic Dermatitis and various grasses, pollen, trees and dust mites which cause Atopy. In addition to Flea Allergy Dermatitis and Atopy is Food Allergy Dermatitis which also causes skin disease either alone or in combination with the other two syndromes. So, basically 3 things cause skin disease I see daily in my practice:
  • Flea Allergy
  • Atopy
  • Food Allergy
  • In this article we will discuss Food Allergy Dermatitis.
Food Allergy Dermatitis is becoming a more common problem in the skin disease arena. In my experience, it is seen more commonly in dogs than in cats. The most typical presenting clinical sign is either the ears or generalized skin are slightly pink and itchy. The offending agent is the protein component of the food being fed. Most commercial over the counter foods contain chicken, beef or a combination thereof. Treatment involves feeding a hypo-allergenic diet for 8 to 10 weeks and sometimes longer. The two current diets are Hill’s Science Diet Z/D(dry formula only) or Innovative Veterinary Diet’s Venison/Potato, Fish/Potato, Kangaroo/Potato and others (dry and canned formulas). Hill’s Z/D protein molecule is formulated to be so small in size, it is not recognized by the patient’s immune system. Innovative Veterinary Diets provide a “novel” protein (proteins not available in over the counter foods) that the patient’s immune system has not been exposed to, thus the pet should not be allergic when consuming. The most important thing is the patient can only be fed the hypo-allergenic diet for the trial period. Any variance from the diet renders the results less than optimal. Results are sometimes seen immediately and other times later in the trial. Unlike Flea Allergy Dermatitis and Atopy, Food Allergy Dermatitis is not very responsive to steroids. After the trial period, it is recommended removing the hypo-allergenic food and returning to the patients original diet. Owners usually balk at this notion since the pet’s skin looks the best is has in years. It is acceptable to continue to feed the hypo-allergenic diet long term, although more expensive than over the counter foods. I have found in my practice that hypo-allergenic diets help pets improve more quickly and sustain their improvement regardless of the true allergy cause.
For more information on skin disease, see the previous 2 articles which cover the 2 most common forms of skin disease, Flea Allergy and Atopy.

Vaccinations

Vaccinations

“To vaccinate or not to vaccinate… That is the question!”

Recently, there has been much debate, fueled primarily by the media, regarding yearly vaccinations of pets. The media, as well as other non-veterinary groups, are asserting that veterinarians are over vaccinating pets in this country. This month’s article will look at this important issue and try to shed some light on this controversial subject.
It is uncertain why or when the veterinary experts at the time decided that yearly vaccinations were the best protocol. Maybe, 50 years ago when supposingly this began, veterinarians extrapolated from human vaccine protocols and continue their recommendations today. I recently attended a large vaccination symposium discussing these issues to determine are vaccinations necessary and do they pose a health hazard to the pet or human.
Major points of the meeting looked at current human protocols compared to veterinary medicine and detrimental health issues to pets and humans as a result of vaccinating or not vaccinating yearly.
I do not have any children, so I have no concept of what vaccines babies/kid/teenagers receive. Experts at the symposium presented a slide from the American Board of Pediatrics regarding their current vaccination protocol for babies in their first year or so of life. It was amazing! According to the protocol, vaccines are given every week for several months. This differs from veterinary medicine in that vaccines are started at 8 weeks of age and done every 3 weeks until 16 weeks of age, then recommended yearly. The program expert calculated a several fold increase in the number of diseases babies are vaccinated against in the first year compared to dogs/cats. Many diseases in children have not been seen in decades, but why do kids still receive vaccines for them? The answer to the question is with a question… would you rather your child get a potential deadly disease or would you rather have them vaccinated prophylacticaly? Most pediatricians have never seen some of the diseases they vaccinate for and would never see them unless visiting a third world country. The same holds true for our pet friends, except, I personally have seen all the diseases I vaccinate yearly for in the past 8 years. Some of these diseases I see every month such as Aids, Leukemia, Hepatitis. Recent research has shown that adverse effects attributed to vaccines themselves cannot be substantiated. Some people ask me to run a blood test on their pet instead of vaccinating to determine if their vaccine level is high enough to protect against disease. If every pet were exactly the same with the exact same immune status, blood tests may be useful. In other words, a flu shot may protect me, but not you since our bodies require different amounts of vaccine for protection.
Current recommendations by immunologists, veterinary colleges and vaccine researchers is to continue with yearly vaccines for Rabies/Distemper and twice yearly for Bordetella in dogs and once yearly vaccines in cats. I guess the old adage of “if it ain’t broke, don’t fix it” may apply to disease prevention and vaccine protocols.
As always, if you have any questions or concerns regarding this month’s health article, please feel free to call the office.