Compounding (the problem?)

Dear Fellow Pet Lovers,

You probably know that most veterinary drugs tend to also be human drugs and that veterinarians (DVM’s) have the authority to prescribe any human drug the veterinarian feels is appropriate for any animal that is his/her patient.

In some cases, needed drugs are not available from a regular pharmacy or the concentration or form of the drug makes it unusable on animals. In such cases, a compounding pharmacy (a pharmacy which has the skills and equipment to create different forms or concentrations of drugs) can be useful to the patient.

For example, if a needed drug for a cat came only in a tablet that the cat would not take, the compounding pharmacist could make it into, say, a liquid. Pharmacies such as this are valuable for both veterinary medicine and for human medicine.

Of course, it is necesary that the compounding pharmacist be very skilled and meticulous. In a case several years ago, numerous horses died after being given a compounded injectable product. This tragedy resulted in tightening of the regulations concerning compounding. These tighter rules caused several compounding pharmacies to elect to not compound injectables rather than comply with the newer, stricter, rules.

Compounding pharmacies are another weapon that DVMs may use in the war against pet disease. And, like any weapon, it must be used skillfully and cautiously.

See? Something can be done about keeping pets healthy!

That is all.

Dr. John Emerson, Pet Emergency Clinic

Human Drugs

Dear Fellow Pet Lovers,

Though I take this up every so often, I would like to again remind you to be very careful giving “safe” human drugs to your pet for whatever reason.

Recently, I treated a dog who was  hit by a car, and the owners had already given him a certain amount of Tylenol. The owner just sort of gave an amount that seemed reasonable to him, without really knowing a dose or even whether the drug was ok. Luckliy, the dose used was not toxic and I was still able to use effective drugs on this dog despite the Tyleonol in its system.

I have on many occasions had possibly toxic doses of various drugs given by sincere owners just trying to help their pet. In most of these cases, I can deal with the toxic drug, but I am then limited on what effective drug I can use due to the toxic drug being present.

So, best bet is to avoid giving your pet any med not ordered by a DVM for this particular incident.

Remember that, even if the drug used is an OK drug in the correct dose, it may not be the one that best suits your pet’s condition, and it may then prevent use of a better drug due to drug interactions.

Remember too that many drugs used safely in people are toxic or have wildly different dosing in pets.

So, as regards drug use in your pet, avoid the do-it-yourself spirit. Since the stakes are so high, this is a time when a DVM should prescribe the correct med at the correct dose to best help your pet.

See? Something can be done about keeping pets healthy!

That is all.

Dr. John Emerson, Pet Emergency Clinic

Compounding (the problem?)

Dear Fellow Pet Lovers,

You probably know that most veterinary drugs tend to also be human drugs and that veterinarians (DVM’s) have the authority to prescribe any human drug the veterinarian feels is appropriate for any animal that is his/her patient.

In some cases, needed drugs are not available from a regular pharmacy or the concentration or form of the drug makes it unusable on animals. In such cases, a compounding pharmacy (a pharmacy which has the skills and equipment to create different forms or concentrations of drugs) can be useful to the patient.

For example, if a needed drug for a cat came only in a tablet that the cat would not take, the compounding pharmacist could make it into, say, a liquid. Pharmacies, such as this, are valuable for both veterinary medicine and for human medicine.

Of course, it is necesary that the compounding pharmacist be very skilled and meticulous. In a case several years ago, numerous horses died after being given a compounded injectable product. This tragedy resulted in tightening of the regulations concerning compounding. These tighter rules caused several compounding pharmacies to elect to not compound injectables rather than comply with the newer, stricter, rules.

Compounding pharmacies are another weapon that DVMs may use in the war against pet disease. And, like any weapon, it must be used skillfully and cautiously.

See? Something can be done about keeping pets healthy!

That is all.

Dr. John Emerson, Pet Emergency Clinic

Doc. It’s OK. He Doesn’t Bite

Dear Fellow Pet Lovers,

Whenever people find out that I am a veterinarian, many of them ask whether I have ever been bitten. I always answer in the affirmative, as almost any veterinarian would. Though that particular question can become monotonous to me, it is a good topic for today.

Aggressive dogs can be difficult and, I believe, unhappy. Recently, I had a dog that the person was “home schooling” as a police dog come in to the ER. This dog was so vicious that it was almost impossible to even inject him to sedate him. [FYI- Actual Police dogs are rarely truly vicious and are always under control]

Of course, few dogs are ever that aggressive. Usually, the bites we receive are the result of the poor dog panicing and biting in what he considers “self-defense.”

My colleague Dr. Joe Soileau used to say that the number one cause of death in dogs is euthanasia due to behavior problems. I believe that is true. So, what to do?

1- Start with a breed that is generally docile. There are very few actual advantages to an aggressive breed. (And no. It is NOT just in how you raise them. Some breeds, raised among the most loving people and situation in the world, are still just aggressive.)

2- Socialize the puppy. This does not mean you must call him “comrade.” Rather, it means to expose the pet to other pets and lots of situations early in life. This will probably result in a confident, non-biting pet. The puppy should stay with its litter at least 6 weeks and up to 12 is even better.

3- Avoid hand-raised orphans. These pets often become very squirrelly due to their lack of other members of their species to emulate. And yes, there ARE exceptions.

3- Puppy classes. Some of the big box pet stores offer these, and they are good. Some private individuals offer “private lessons.” These can be very good if you get the right trainer.

4- Train yourself in how to interact with a puppy. Slap fights with a puppy? No. Tug-a-wars with your puppy? Probably no. How you interact with your puppy is key in his later confidence as an adult. Usually confident adults do not feel they must bite.

5- Have all vaccinations and licenses in place as early as possible in case something does happen, it is a huge hassle if your pet is not legal.

Pet owners are very compassionate and kind as a group. The above tips may help you avoid being one of those owners who has to make a difficult decision about a pet due to bad pet behavior.

See? Something can be done about keeping pets healthy!

That is all.

Dr. John Emerson, Pet Emergency Clinic

We Need Veterinarians!!

Dear Fellow Pet Lovers,

Every time a natural disaster occurs, usually a hurricane in this area, there will be displaced and injured pets who need help at the very time it’s the hardest to provide it. Of course, the same could be said for people.

When Hurricane Katrina so devastated the New Orleans area in 2005, this problem really showed itself in a big way. There were literally thousands of pet, dogs, cats, horses, and even livestock, that were alive but stranded and maybe injured.

There were also hundreds of veterinarians from all over and thousands of other animal-related volunteers willing to help. Some were local and many were licensed in other states. In order to practice a profession in a state, it is always necessary to have approval from that state’s licensing agency. This is to protect the public from unqualified people and possibly even charlatains.

The requirement to verify to the people offering assistance were actually qualified and legitimately and slowed the flow of help. As you can imagine, scammers love chaos and some use the chance to rip off hurricane victims, in such times. People wanting to help were in some cases delayed or even stopped.

At the time of Katrina/Rita, Louisiana had no workable system to handle such a situation, and red tape interfered with honest efforts to help. Additionally, many Louisiana veterinarians from unaffected areas, available to assist, were not even asked. So you can see how the needed help flow was not as smooth as it could have been.

After Katrina/Rita, agencies, such as: the Louisiana Board of Veterinary Medicine, the Louisiana Department of Agriculture, and others, created an emergency plan that activates upon a governor’s declaration of emergency. So now, when hurricanes or flooding occur or an emergency is declared, the plan activates and help needed for all animals can smoothly and quickly flow to the areas that need it.

I have been privileged to be a part of  this workable system, during a few recent events. It is good to know that our animals are now being considered along with the humans during disasters. When people are not as worried about their animals, they can care for other very important things, and at least SOME of their stress may be alleviated.

It is good to see effective people getting results in helping our animals.

See? Something can be done about keeping pets healthy!

That is all.

Dr. John Emerson, Pet Emergency Clinic

TOXIC PETS

Dear Fellow Pet Lovers,

What is a toxin? One definition is a “poisonous substance capable of causing disease when present at low concentration in the body.” This seems like a pretty good definition. I also always try to remember that ANYTHING in large enough amounts can be toxic.

If you think about a usually non-toxic human drug taken by a 200 pound man that is now ingested by a 20 pound Beagle, you can see that the dose of drug per pound body weight is 10X higher in the dog. And there is the problem. At that dose, it may kill.

I have seen cases in which a 10 pound Poodle was given an ounce of alcohol at a party just “for fun.” What the alcohol provider did not realize was that this 20X higher dose of alcohol may be enough to cause severe illness or even death in the dog.

Recently, I treated 2 cases on the same day in which a dog ingested an illegal stimulent drug. In the first case, nobody knew about any single thing that the dog could have received. As a result, I needed a good bit of blood testing that I may not have needed had I known, and I also had lots of stress as this dog that had “gotten nothing” tried to seizure itself to death.  I spent far more money and effort just because the owner would not help me.

In the second case, the innocent owner had figured it out and advised us at admit. As a result, I was able to specifically treat the problem more aggressively and without lots of extra possibly unneeded testing. Both dogs, eventually did well.

So it comes down to this. If you are aware of what may be “ailing” your pet, even if it may be illegal and you may not want to admit it, ADMIT IT. We at Pet ER are not police. We need the data to help your pet. And then, once all is well again, DON’T DO IT AGAIN!!!!

Also remember to never give your pet ANY meds unless a DVM has ordered it and you KNOW FOR A FACT that the drug is OK  and and the dose. I have had pharmacists innocently give pet owners potentially deadly “advice” to use a pet-harmful drug just due to lack of knowledge.

As they say on “Hill Street Blues,” let’s be careful out there.

See? Something can be done about keeping pets healthy!

That is all.

Dr. John Emerson, Pet Emergency Clinic

Accreditation

Dear Fellow Pet Lovers,

Did you know that veterinary facilities may be accredited by certain professional groups?

Many of you have probably heard of the American Animal Hospital Association, or AAHA, which is a group attempting to raise and improve the level at which veterinary hospitals are managed and practice. Practices that voluntarily choose to become accredited have met some pretty stringent standards and stand a chance of being a very good practice. (Many outstanding practices choose to NOT go through this process and are still great.)

In the Emergency Clinic world, the AAHA accreditation does not seem to fit as well, since it is focused on regular day practices. In the Emergency Clinic world, the organization that is similar to AAHA is called the Veterinary Emergency and Critical Care Society, or VECCS.

I learned several months ago that VECCS has an accreditation program for emergency clinics that is analgous to the AAHA accreditation for day clinics. The Pet Emergency clinic has been working on earning this accreditation for the past several months.

This is to let you know that the Pet Emergency Clinic is in the final stages of VECCS accreditation and will have this action completed before the end of the year. What do you get out of the deal?

An emergency clinic that has met stringent standards of operation on an international level. I am trying to say that your emergency clinic is definitely striving to be as good and competent as any similar one on the planet.

Earning this VECCS accreditation means that your pet gets treated at a clinic that has been evaluated and certified to high standards. And you still get our fine doctors and staff as always.

We will let you know when this is completed.

See? Something CAN be done about preventing pet illness.

That is all.

Dr. John Emerson, Pet Emergency Clinic

Other Professionals and Your Pet

Dear Fellow Pet Lovers,

There are situations sometimes, in which, a licensed professional working on humans may be of great value to a sick or injured veterinary patient (animal). Can this be done?

In some cases, yes.

I have heard of human anesthesiologists being used to assist with tricky anesthesias, with human opthalmologists assisting with surgery on a dog’s eyes, and with chiropractors, with some extra training, assisting dachschunds with back (disc) disease.

So, is this a perfect answer to all pet medical or surgical problems? Not exactly.

There have been many cases, in which, a physician was “treating” with incorrect therapy and occasionally with drugs that were either a very wrong dose or were even completely not ok for humans. This can be frustrating for the licensed DVM as well as for the helpful human practitioner.

Louisiana state law does allow another medical professional licensed by some state board to assist with treatment of animals, but only by referral of and under some supervision of a licensed veterinarian. In other words, a chiropractor may not just do animal adjustments “off the street”, but may do them when referred by a veterinarian.

So, what are my ideas on this topic?

1- I have, on many occasions, been able to get excellent assistance from these other professionals. So, used with care, they can be helpful.

2- I have also seen disasters created by these practitioners who wanted to help but who did not have the knowledge of animals to do well.

3- So, check with you veterinarian about the possible helpfulness of these practitioners when a difficult case occurs.

Under the right conditions, your pet could benefit from the additional expertise that these human-licensed practitioners may bring.

See? Something CAN be done about preventing pet illness.

That is all.

Dr. John Emerson, Pet Emergency Clinic

Cough Cough Cough

Dear Fellow Pet Lovers,

Many of us who have been in veterinary for many years remember plain old “kennel cough”, in which a dog coughs as if something is caught in his throat. The cough is noisy and bothersome and usually would run its course over about 7-10 days with the dog fully recovering afterwards. A “Kennel Cough” vaccine would prevent the problem in almost every case, and this was more of a nuisance than a severe threat to life.

In recent years, the cough situation has become more complicated. It started with Canine  Influenza (flu), a disease that possibly was a mutation of the Equine Influenza. This disease initially presents with symptoms similar to Canine Cough, fooling veterinarians. But then, the pet becomes more and more ill, with some dying and some having permament lung damage.

Once this disease became significant, tests to confirm it and vaccines to prevent became available. “Flu shot” for dogs is now commonly recommended by many veterinarians. Now, there is another deadly cough appearing in certain parts of the country. As I type, the actual ‘identity” of the new bug has not been learned.

While Canine Cough, or Kennel Cough, seemed to be found all over the country, Canine Influenza and the other new cough strain seem to appear in different  “bands” of disease in different regions of the country. We have also seen these strains spread slowly from region to region.

Louisiana was Influenza free for several years, but now is beginning to have cases appear. The new unknown strain has not yet appeared in Louisiana.

What is the point of all the above?

Simple. If your dog shows any type of coughing that lasts more than an day or of he is coughing at all and seems to fele bad, do not wait. Have him seen by a DVM ASAP, since the new coughs could be far worse than just a nuisance.

See? Something CAN be done about preventing pet illness.

That is all.

Dr. John Emerson, Pet Emergency Clinic

“He’s Allergic To……”

Dear Fellow Pet Lovers,

Allergies. It seems that nowadays, everybody is allergic to something, whether it is a vaccine, certain foods, bee stings, drugs, etc… etc…

What IS allergy? Allergy is a situation in which the body’s protective immune system OVER-reacts to particles it does not recognize it self, when that over-reaction is not appropriate or even helpful. The body’s over-response is usually far more dangerous that the “foreign” particle that it is trying to eliminate.

Allergies can vary in severity from runny nose and red eyes to anaphylaxis, clogged airways, and even death.

One interesting thing about allergy is that you cannot be allergic to something that your body has never been exposed to. For example, to be allergic to a wasp sting, you would need to have been exposed to wasp stings prior.

The classical allergic reaction we see at Pet Emergency Clinic is a swollen face and often some whelts on the body. This may be seen after vaccination on certain pets, after bee sting, or possibly after an unknown exposure to something. Usually, antihistamine and maybe a short-acting steroid injection handle this beautifully.

We occasionally see a totally collapsed pet maybe with bloody diarrhea with no known trigger. It is interesting that, in these cases, the history may involve a walk outside an hour or so before the collapse. What is even more interesting is that there is a sign that we see on ultrasound that can diagnose this problem with pretty high certainty. (And even more “interesting” is the fact that our own Dr. Scroggs is a part of the current research on this with a famous veterinary researcher and teacher.)

I am one who is cursed with allergies. These do vary from a runny nose to an attack that makes me miserable, though it has never been life-threatening.

So, what can you do about allergies in pets?

1- Keep your yard tidy and neat in order to make it less appealing to wasps and other stinging bugs.
2- Be aware of what if anything that your pet is allergic to and avoid. (Avoidance of allergens is the only certain way to never have a reaction)
3- If your pet is known to be allergic to vaccines, consider the importance of the particular vaccine compared to the risk of the disease the vaccine protects against. A discussion with your veterinarian is in order.
4- Try to ignore hype about food allergy that you receive from pet stores or on TV. Most of the data bandied about in those places is false. Again, your DVM can assist if food allergies are thought to be a problem.
5- A product that I hear promoted heavily on the radio is called Dinovite. In the promo, it seems as if using this stuff handles any and all skin problems in a dog, a cat, or maybe even in a person. From the ads, it sounds like the product is some essential fatty acids and a few other things that are sometimes helpful. Still, I doubt that this is as universally successful as they suggest.
6- If you think that your pet may be having an allergic reaction to anything, get the pet seen by a doctor ASAP, since it is always possible that your pet could have one of those really bad ones. (But most are probably not)

So there you have it. My opinion and a few facts bout allergies in pets. (And I apologize to Dr. Barta, my immunology professor, for the simplicity.)

See? Something CAN be done about preventing pet illness.

That is all.

Dr. John Emerson, Pet Emergency Clinic