We veterinarians have been facing some availability issues with certain medications.   One article I read recently referring to shortages within human medicine reports that 267 new drug shortages were reported in 2011, with most remaining unresolved.  I suspect the veterinary pharmaceutical roulette wheel is spinning even more out of control.

The situation has gone from mildly annoying temporary shortages to being totally ridiculous.

Way back in the 80′s when I entered the profession, most drugs and medications were available almost all the time.  Occasionally, something would be back-ordered for a few days.  Rarely, a product would be taken off the market.  Often, it was because a better medication had come along–something superior or stronger or with fewer side effects.  A true improvement for our patients and our profession.

Unfortunately, in the last three or four years, the drug availability problem has escalated.  Drugs and other essential products seem to disappear from U.S. suppliers in the blink of an eye.  Sometimes things our patients depend upon are back-ordered for weeks or months.  Some medications are back-ordered indefinitely.  And some are taken off the market outright.

Right now, the majority of ophthalmic ointments–the mainstay of primary veterinary eye care–are unavailable in regular U.S. markets.  You can’t imagine how frustrating it is for me to unable to get a moderately priced eye ointment for pets, something that about 70% of young kittens need during their first months of life.

The only thing more annoying than this is going into a feed and seed store and finding the same product retailed there for less than I would pay for it wholesale IF I could find some to buy.

One of our important anesthetics is currently back-ordered, supposedly “for months.”  It is also used as a muscle relaxer, an appetite stimulant and for epileptic seizures.  A common cancer chemotherapy drug has been sporadic in availability for over a year.  It’s frustrating for me and could be a life and death matter for the patient that needs it.  And believe it or not, there have been times when I have been unable to get euthanasia solution.  Even something as simple as helping to end a life in a pain-free and dignified matter is sometimes complicated.

The  drug recommended for treatment of adult heartworm infections is off the market and has been for months. The American Heartworm Society has changed its recommendations to accommodate this temporary inconvenience and I have adapted my protocols.  Recently the manufacturer has been granted permission from the FDA to temporarily import some from European suppliers.

And now that I can actually get my hands on something with which to treat heartworms, my mainstay heartworm preventative is unavailable.  It’s enough to make me want to pull my hair out!

What is the cause of all of these shortages?

Raw Material Availability

Industry insiders indicate that some availability problems relate to raw material shortages.  In fact, when a very good pet insulin product was recently taken off the market, the industry blamed it on a shortage of beef and pork pancreas used in its manufacture.  Oh, really?  Right, like slaughterhouses aren’t turning out a few hundred thousand of those by-products a day?  Give me a break.

Quality Control Issues at Factories

Another common cause of product supply chain interruption is factory shut- down either by the FDA or “voluntarily” due to quality control issues.  For example, it is rumored that a quality control issue with a human over-the-counter analgesic is the reason why I can’t get a certain dog drug right now.  The products are manufactured in the same factory.  If the plant is shut down for quality control with one product, other products made in the plant also go offline.

Sometimes the quality-control issue is unrelated to product integrity.  It may be related to the packaging or even the labeling.  Last year a popular flea product was taken off the market because of an issue with the sprayer nozzles.

Economic Factors

Let us also place blame on the almighty dollar.

Whereas pharmaceutical companies are willing to invest billions on researching and marketing drugs for erectile dysfunction in human males and cholesterol lowering drugs for fast-food fueled Americans, they are not going out of their way to keep a production line open for generic kitty eye ointment.   While it is important to me and important to the cats that have eye infections, that share of the market is financially insignificant.

I sense that the situation with medication availability is only going to get worse.  If it feels like we–your primary care veterinarians–are juggling products in order to provide what your pet needs, it is true.  We can’t help it.  We’re trying to do the best we can.

~Jackie H. Burns, DVM

My office has been a busy place of late.  Besides going to various elementary schools for career day, we’ve hosted an entire school’s kindergarten (a big round of applause for about sixty well-behaved 5 year olds!) and VIPs from the local humane organization.

During one of these visits, I noticed a woman staring oddly at the side of the medications refrigerator.

Oh, goodness, I thought, there must be something naughty up there. Horrified that there might be an off-color cartoon posted on the ‘fridge, I leaned around the corner to see what she was looking at with such intensity.

 Thank goodness it wasn’t naughty at all.  She was looking at my Beware the Diagnostic Weenie poster.  I made it myself.  It features a brindle and white English bulldog caught red-handed with a strand of old-fashioned frankfurters in his mouth.    The dog looks sheepish, and I freely admit that I cut the picture out of a magazine and wrote “Beware the Diagnostic Weenie” in block letters underneath.

This one requires an explanation.

The weenie is so very important in Southern culture that it is revered for its veterinary value.  Pet owners always keep weenies on hand and use them as both a diagnostic and therapeutic tool when it comes to veterinary medical issues.  And I must note that my clients who use the wiener diagnostically and therapeutically often have difficulty pronouncing the word correctly.  More often than not, it comes out “winnie” instead of “weenie.”   I even had one client who honored this tradition by naming her dog Weenieman.

Dog owners who are unable to administer their pet’s capsules or tablets by pilling them very often use a weenie as a therapeutic tool.  In fact, I wish I had a dollar for every pet owner who has told me, “We don’t have no trouble getting Harley to take his medicine.  I just hide it in a weenie and he gobbles it right up.”

Then there is the diagnostic weenie, a pet owner’s divining rod or crystal ball.  This is when the pet owner uses the wiener to determine exactly how sick their pet is, much as the veterinarian might use a stethoscope, an x-ray machine, blood tests or an EKG.  A weenie, it seems, is a very accurate prognostic indicator.

A pet owner may say, “Dr. Burns, I give Puddles a weenie and she didn’t eat it, so I knowed I needed to bring her to you.

Or, “After Rambo got  run over by the UPS truck last week, I give him a weenie and he et it, so I knowed he was a-gonna be okay to wait ’til Monday to come see you.”

I’d almost bet my next paycheck that for every hotdog, corn dog or pig-in-a-blanket consumed by a human being in the United States, there are at least three wieners used to medicate or assess the severity of illness in dogs! My expert conclusion after twenty-one years in practice is that wieners might have a legitimate use in triaging pets.  The frankfurter industry might do well to do a marketing study on the use of their product in veterinary medicine.

Jack takes a ride on the lift table!

The first thing he brought is a new hydraulic lift exam table.  The patient is able to walk onto the table at floor level and take a quiet  ride up to the veterinarian’s desired working height.  This makes it possible for the veterinarian and staff to do excellent examinations and minor procedures without back injury or the stress of chasing exuberant pups around the floor.

When we are done, we simply lower the patient to the floor and he hops off.   While this doesn’t actually count as a new service, we think we will be able to do more thorough exams and treatments because of this table without the wear and tear on our bodies and frustration to go with it.

Our next new acquisition will allow for us to provide much improved dental services.   Our Midmark VetPro 1000 Dental Cart will allow the veterinarians and staff to expand our dentistry services.  It features an air/water jet, ultrasonic scaler, low speed (polishing) handpiece and a high speed drill.

Our new Midmark 1000 VetPro Dental Cart

So in addition to our old repertoire of non-surgical extractions, scaling, polishing and fluoride treatment, we will now be able to do surgical extractions of large multi-rooted teeth that have previously been impossible to budge.

This machine is low-maintenance, smooth and the compressor is nice and quiet.  We used it for the first time yesterday and it was like a dream come true.

We’re not sure if the Laurens area is ready yet for canine root canals and kitty orthodonture, but it sure will be great to be able to accomplish surgical extractions.  We expect to make a difference for the better in more patient’s lives.  So many pets suffer oral pain in silence.

Yes, even dogs feel holiday stress!

The hustle and bustle of the holiday season brings warm memories and pleasure for people, but we all know this time of year can be stressful as well.  Our own stress can impact our pets.  There are visitors, travel and sometimes novel foods.  And in South Carolina, you can count on lots of fireworks!

For dogs that are mildly to moderately stressed by holiday events, Dr. Burns recommends the DAP pheromone line of products.  DAP stands for Dog Appeasing Pheromone.   This pheromone is a hormone-like compound that dogs can sense (but we can’t).   DAP is a synthetic version of a pheromone that nursing mothers give off to calm their puppies.

DAP products come in several forms:

• DAP Collars are like flea collars.  They are odorless and go wherever your dogs goes.  For a dog on the go, these are an ideal choice
• DAP Spray may be sprayed on bedding in a pet-taxi or on your dog’s clothes or on a bandana that your dog wears.   Another good choice if you travel with your dog
• DAP Diffusers plug into the wall.  If there are specific places your dog gets stressed out, a diffuser keeps that location covered with calming pheromone.   For instance, if your dog is stressed out by having to stay in the laundry room when company comes, plug a diffuser in that area.

DAP products help with stress from various anxiety-inducing situations and also with separation anxiety and noise phobias, but for dogs with moderate to severe anxiety, whether it is general anxiety, separation anxiety or noise phobia, Dr. Burns recommends medications that alter serotonin levels in your dog’s brain.

“Anxiety is an uncontrollable irrational fear,” she says.  “Why let your dog suffer when there is ‘better living through chemistry’?”

Her drug of choice for dogs is clomipramine, a non-drowsy once-a-day medication.  But she warns that clomipramine may take 2 to 4 weeks to get into your dog’s system and begin to modify fearful behavior.

Another important component to canine anxiety is how we react to our dog when he is anxious.

“Often people unconsciously ‘reward’ anxious behavior by trying to pet, hold or soothe the dog.  In effect, they are giving the dog positive reinforcement for behaving in an anxious manner.  We have to retrain ourselves not to do this,” Dr. Burns says.  “There are also ways to build your dog’s confidence and retrain her to be less anxious.”

For more information, or to schedule a consultation with Dr. Burns, call (864) 984-2365.

Outdoor dogs need shelter in winter.  An ideal dog house does not have to be fancy.  But it should not drafty and should have a door that faces away from the prevailing wind direction.

The size of the dog house should fit the size of the dog that uses it.

The ideal dog house has enough room for its occupant to walk in turn around and lie down comfortably.   The dog house retains the pet’s body heat to keep the pet warm.  A small dog in a big dog house cannot stay warm because the dog’s body does not release sufficient heat to warm all of the air in the dog house.   I do know of small short-haired dogs that have died of exposure while sleeping in a nice dog house that was simply too big.

Dog houses may be bedded with cedar shavings or straw.  For dogs with sensitive skin or skin allergies, I recommend oat straw.  A deep loose layer of straw provides more insulation that a blanket.

People often ask me when to bring their pets in on very cold nights.  Generally, a healthy adult medium or large breed dog that has been acclimated to sleeping outside will do fine outdoors in his dog house unless the temperature gets below 20 degrees.

Small dogs, puppies and senior dogs or any dog unaccustomed to sleeping outside should be brought inside if the temperature is below freezing.

Food

Dogs may need to consume extra calories in winter to stay warm, so be prepared to feed your dog 10 to 20 % more calories during winter.

Water

Check to make sure your dog or cat has unfrozen drinking water during cold snaps.  When the mercury drops and stays below freezing for days, be prepared to provide drinking water several times daily.

Parasite Control

We have fleas in winter.  Really.  They can live on a nice warm dog all year ’round, though sometimes people forget this.   Warm days in winter can bring out mosquitoes, too, so don’t be tempted to slack off on your heartworm preventative.

For example, chronic kidney failure in cats and dogs is often addressed with a variety of treatments aimed at keeping toxins flushed out of the blood stream and binding excess toxins/electrolytes in the gut.  By keeping toxin levels lower, our patients feel better and have a better quality of life.

A dog or cat under management for kidney failure often takes:

• Azodyl to reduce uremic waste products by processing them in the gut
• Epakitin to bind phosphorous in the gut
• A kidney diet with reduced protein and reduced phosphorous
• Subcutaneous fluids, often several times a week
• Additional drugs may be prescribed to manage nausea and vomiting

Most pet owners can learn to administer the subcutaneous fluids at home, since this is something that is usually continued for the life of the pet.

This video explains how to do it.

Choosing a breed

If you have narrowed it down to a few breeds, research them and find out what types of health or behavior problems could be anticipated.

What type of upkeep is required?  Some breeds are what I call “high-maintenance” and require more grooming and hygiene care than others.   Some breeds require more exercise than others.  And some require intensive socialization/handling/training.

Speak with a number of people about your breed of choice.

Your veterinarian can tell you a lot about the type of health and behavior problems you might find in that breed.  A dog trainer might be a good source to ask.  Pet groomers and boarding kennel operators have some insight on upkeep and behavior issues as well.

Each breed has its own set of positive and negative characteristics.  A breeder’s opinion or a book or website about the breed is quite unlikely to say anything negative about the breed.  They love their breed!  Of course they put a positive spin on their attributes.

Generally, avoid the rare breeds, which have a smaller gene pool and are more likely to have physical or behavioral problems.  Likewise, breeds undergoing a fad surge in popularity, because they are churned out willy-nilly to feed a rapidly growing market.

Choosing a Reputable Seller

We’ve all heard of puppy mills.

In my opinion, the number one way to avoid puppy mills is to purchase an AKC registered dog from an individual who owns the dog’s dam and raised the litter on their own premises.

AKC breeders are held to higher standards than other registries as far as pedigree.  And if they have breeding bitches in quantity, they are subject to periodic inspection of their facilities by the AKC.

Buy directly from the breeder, not from a pet store or middleman.  Check out the breeder/seller.  Ask for references and check them.

Do not buy from a breeder who won’t let you come and tour their facilities.  I often hear of people buying puppies after seeing a picture on the Internet.  The seller offers to meet them at a rest area, a gas station or a restaurant parking lot to deliver the puppy.  This is a huge red flag.  They have something to hide—often dirty and crowded facilities, sick or malnourished animals.

Do not buy from someone who doesn’t have the AKC registration papers in hand.  A responsible breeder has them.  Period.

Beware of buying on the Internet, particularly if the dogs are being shipped from Kansas, Missouri, Pennsylvania, Ohio. Beware of buying a dog from a local pet store or individual with registration papers originating in “puppy mill states. “

Many breeders administer their own dewormers and immunizations.  A really great breeder has the puppies examined by a veterinarian to screen for birth defects and illness before selling and can produce papers to prove this.  Most breeders offer guarantee provided you have the puppy examined by your vet within 2 or 3 days of purchase.  A good breeder will stand behind a puppy that develops an illness, especially something the pup was born with (which, by the way, may not show up for months).

Choosing a puppy

Meet the dam and sire.  Are they friendly, outgoing and well-behaved?  Behavior traits are very inheritable.  Avoid puppies with parents who are fearful, suspicious, cowering or growling.  Avoid puppies who hang back and are fearful.

Avoid being dazzled by pedigrees and show records.  Get a puppy because you like it, not because its family members have a list of accomplishments.

Avoid odd colors.  This sounds trivial, but in breeding selectively for rare colors and patterns, sometimes other qualities are lost or other negative health or behavior traits pop up.

Choose a puppy because you like it.  Observe the puppies at play with each other and with people.  Pick a puppy that is somewhat outgoing but maybe not the most dominant of the litter.  If the puppy has a minor flaw or health issue and you really like the puppy, consider it.  Something like a retained testicle or umbilical hernia can easily be addressed by your veterinarian at the time of neuter/spay.

Do:

• Buy AKC puppy
• See the facility, parents
• Check references
• Like the puppy you buy
• Ask the opinion of vets, trainers

Don’t:

• Buy from middleman or pet store
• Buy from Jockey Lot
• Buy from Someone who doesn’t invite you to see their dogs at their facility
• Buy non-AKC breed organizations or no AKC papers in hand
• Buy dogs with papers originating in puppy mill states
•  Be dazzled by pedigrees
• Buy from the Internet unless you physically go there and see the puppy

Avoid:

• Breeds with sudden popularity surge
• Rare Breeds
• Rare colors or patterns

Dogs and cats are adept at hiding signs of pain, and are often not vocal about it.  Signs of pain may include limping, stiffness upon getting up and down, decreased activity, decreased appetite, panting and shaking and less interest in everyday events.

Treatment approaches to osteoarthritis are often multi-modal, with anti-inflammatories representing the main approach to treatment of most dogs.  In addition to treating pain, they address the cycle of inflammation that perpetuates itself and worsens with time.

Here are some of the medications and products we use to treat osteoarthritis at Holmes Veterinary Hospital:

1. NSAID’s  (non-steroidal anti-inflammatories) such as Novox/Rimadyl, Metacam, Previcox.  Dogs must have healthy liver and kidney function to be able to safely take these medications, so blood work is mandatory before prescribing them.
2. Joint Supplements that contain glucosomine and chondrotin.  Our principal supplement here is a pleasantly flavored soft chew called Phycox.  An alternative is to feed a joint diet such as Hill’s Prescription Diet JD.
3. Tramadol is used to treat pain.  Tramadol is not an anti-inflammatory but is similar to a narcotic pain reliever.  It lacks the usual negative side effects of narcotics.  Unfortunately, Tramadol is very bitter-tasting and difficult to administer to many dogs.  Often paired with Greenies Pill Pockets to make giving it easier, Tramadol is also available in flavored chews or liquids from compounding pharmacies.
4. Adequan is a series of injections of a drug used to promote healthier joint surfaces and joint fluid.  Usually done weekly for about a month and then every 3 to 4 weeks as maintenance.

Other treatment modalities that are not available here include acupuncture, therapy laser and physical therapies such as underwater treadmills.

Treatment is very individualized for each patient.  Some may respond better to one NSAID than another.  And some dogs may develop (over long periods of time) some tolerance to one drug or another, necessitating switching to another medication.

Osteoarthritis cannot be cured.  Our goals in treatment are to make your dog’s quality of life the best that it can be for as long as we can.

This year, as part of our 25th Anniversary Celebration, we’ll be doing a pet Halloween costume contest on Saturday, October 29 at 11:00 am here at Holmes Veterinary Hospital.

Show us how creative you can be!!  One year, someone brought in a live chicken in a pot surrounded by artificial vegetables.

Have fun and win prizes!

This is  due in part to the fact that people and pets enjoy outdoors activities more when the weather is cooler.  We typically see more injuries during this time.  More pets are out so there are more dog fights, lacerations and hit-by-car trauma.  We also see more intentional injuries and poisoning.

It is now white tailed deer hunting season in the Upstate of South Carolina.   Every year during hunting season, we see free-running dogs that have been shot by hunters.  

Even if you think no one is hunting near your property or think that your dog never leaves your property, we advise that you do not let your dog run loose during deer hunting season, which ends January 1, 2012.  We have even seen dogs shot while being exercised by their owners on their own property.

To allow them to be seen and immediately recognized as pets, your dog should wear a brightly-colored collar with tags.  However, the best means of preventing accidental injury remains keeping your dog within a fenced yard and leash walking for exercise.

Another fall hazard is radiator anti-freeze, which is extremely toxic to dogs and cats.

Anti-freeze is sweet in taste so dogs and cats will readily drink it.  Sometimes pets consume accidental spills or product left out when the weather turns cooler and people change their radiator fluid or add anti-freeze to their radiators.   We have also seen cases of pets and wildlife poisoned by antifreeze put into fountains and water features to prevent them from freezing, as well as intentional poisonings with anti-freeze.

Early signs of anti-freeze poisoning mimics intoxication.  Dogs may stagger and sway as though drunk and their reflexes may be altered.  Sometimes they seem barely able to walk.  Sometimes they have seizures.

If very quick treatment is not instituted, permanent kidney damage occurs that usually results in death.   If you suspect your pet has been poisoned with anti-freeze, you must see a veterinarian as soon as possible.  There is a very narrow window of time during which a pet may be successfully treated for anti-freeze poisoning.   If we are not open, it cannot wait until tomorrow.  You should take your pet immediately to one of the areas animal emergency clinics, such as the Animal Emergency Clinic in Greenville or C.A.R.E in Spartanburg.

Have a safe and happy fall!