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The Distemper Vaccine for Dogs

distemperWe’ve all received the reminder in the mail that our pet is due for a vaccine that we don’t really know how to pronounce, much less know what it does. It doesn’t help that vet clinics may use the abbreviations or lingo that differs from clinic to clinic. In this article, we aim to discuss the “distemper” vaccine and the diseases it protects against. (In a separate article, the feline “distemper” vaccine will be explained).

For dogs, the “distemper” vaccine usually refers to a combination vaccine including vaccines against several common viral canine diseases. Sometimes separate vaccines are used for each of these diseases, but most practices are using the combination for puppies and dogs 8 weeks and older. You may see a variety of different vaccine combinations referred to as the “distemper” vaccine, such as:

DAPP – Distemper/Adenovirus/Parainfluenza/Parvovirus

DA2PP – Distemper/Adenovirus (type 1 and 2)/Parainfluenza/Parvovirus

DA2PPC – Distemper/Adenovirus (type 1 and 2)/Parainfluenza/Parvovirus/Coronavirus

DHPP – Distemper/Hepatitis virus (same as adenovirus)/Parainfluenza/Parvovirus

DHPPL – Distemper/Hepatitis virus/Parainfluenza/Parvovirus/Leptospirosis

*** The “A”, “A2” and “H” all refer to the same thing – typically a modified live canine adenovirus type 2 vaccine, which does protect against type 1 as well.

FAQs: Canine distemper virus

  • Who does it affect?
    It is primarily seen in young dogs (3 – 6 months old). The virus can also infect other canids (foxes, coyotes, etc.), cats, ferrets, and raccoons, and skunks. It does not affect humans.
  • How is it transmitted?
    It is shed through the respiratory secretions of infected animals, and most commonly transmitted by aerosol exposure. Direct contact with contaminated urine, feces, or skin may also transmit the infection. It can also be passed from mother to fetus through the placenta.
  • What are the signs?
    Distemper may cause a range of signs or even no signs at all, and it has a variable mortality rate depending on the severity of the clinical signs. There can be conjunctivitis (eye inflammation), eye or nasal discharge, lethargy, coughing, difficulty breathing, diarrhea, vomiting, dehydration, and fever. It can also cause neurologic disease, so there can be seizures, balance and coordination problems, paresis (weakness), hypersensitivity to touch, or involuntary twitching.
  • Is there a treatment?
    There is no specific antiviral treatment available for distemper virus. Secondary bacterial infections are managed with antibiotics, and other signs are treated supportively (e.g. intravenous fluid therapy for dehydration secondary to vomiting and diarrhea).

FAQs: Canine Adenovirus

  • Who does it affect?
    It primarily infects young dogs (less than 1 year old), but can occur in any unvaccinated dog. It also can infect foxes, coyotes, and bears.
  • How is it transmitted?
    It is passed dog-to-dog from contact with contaminated secretions (urine, feces) through the oronasal mucous membranes. It can also be transmitted via contact with fomites (inanimate objects) and ectoparasites (e.g. fleas).
  • What are the signs?
    There are two well-known canine adenoviruses, type 1 and 2. Type 1 causes infectious canine hepatitis, and may manifest as fever, lymph node swelling, increased heart and respiratory rate, abdominal tenderness (with an enlarged liver), and icterus (jaundice). The eyes can also be affected, and have a blue-ish hazy appearance. Sometimes secondary to the liver disease, there can be neurologic signs (depression, seizures, disorientation, coma) or blood clotting disorders (bruising, nose bleeds). Canine adenovirus type 2 can cause a cough, and is one of the potential causes of kennel cough.
  • Is there a treatment?
    Treatment is primarily supportive, including fluid therapy, correction of coagulation abnormalities with blood product transfusion, liver antioxidants, and sometimes steroids for inflammation suppression.

FAQs: Canine Parvovirus

  • Who does it affect?
    It only affects dogs, typically (almost exclusively) less than 8 months old and unvaccinated adults. There may be a genetic predisposition towards the disease in Doberman pinschers, rottweilers, pit bills, German Shepherds and dachshunds.
  • How is it transmitted?
    It is highly contagious and passed from contaminated feces to the oral cavity.
  • What are the signs?
    There can be a wide range in severity of the disease. Signs include lethargy, dehydration, fluid filled intestines on abdominal palpation, diarrhea (often containing blood), vomiting or retching, fever, and even shock (due to sepsis or dehydration, signs including increased heart rate, hypoglycemia, and hypothermia).
  • Is there a treatment?
    Treatment includes supportive care, antibiotics for secondary bacterial infection control. Fluid therapy is of the greatest importance, as dehydration can be fatal. In addition to this, there may be need for antiemetics, pain control and nutritional support. Usually IV medications will be needed initially, especially if there is vomiting (where oral medications wouldn’t be tolerated). The diet should be high-protein and high-calorie foods in small volume.

FAQs: Canine Parainfluenza

  • Who does it affect?
    It primarily affects young dogs, and is more commonly found in dogs that have been kenneled or in close proximity to lots of other dogs.
  • How is it transmitted?
    Parainfluenza is spread by the inhalation of aerosolized secretions from the respiratory tract of infected dogs.
  • What are the signs?
    Parainfluenza virus causes rhinitis (nasal inflammation), conjunctivitis, and tracheobronchitis, usually a fairly short duration. Persistent cough may be the major problem. Bronchopneumonia may develop if the viral infection is compounded with a secondary bacterial infection (such as bordetella), which would show as lethargy, increased respiratory effort, potentially fever and loss of appetite. There is a variant of the parainfluenza virus that may cause neurologic signs such as ataxia and paresis.
  • Is there a treatment?
    Uncomplicated cases of parainfluenza may resolve on their own, but supportive care may be needed such as cough suppressants, bronchodilators, and fluid support to maintain hydration.

An obvious pattern has developed here – in these viral diseases, there isn’t usually a specific treatment but rather management focuses on supportive care. Preventive medicine is often the best choice. Vaccination helps us prevent the spread of these common diseases and protect our pets from serious illness. Many safety studies have gone into producing a reliable vaccine. There are several different vaccine manufacturers so there may be some differences in the exact mechanism of action between the different brands of vaccines (e.g. killed virus, recombinant virus, or modified/attenuated live virus), so if there are any specific questions about what your particular pet is receiving, don’t hesitate to ask your veterinarian! You should always feel confident and comfortable with what is being used, so be informed and not clueless regarding what all those vaccine reminders are all about!

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About Vaccines: Rabies

rabies2The rabies vaccine is probably one of the greatest successes in veterinary medicine and the public health field. It has saved countless lives and proves to be a very safe and effective vaccine, greatly reducing the number of cases seen in our pet populations. Rabies is rare these days in pets (the number of reported cases of rabies in the U.S. for 2012 was 81 dogs, 300 cats according to the Centers for Disease Control), but is still prevalent in wildlife and the disease is endemic in all states except Hawaii. A few countries are rabies-free, but all continents except Antarctica have rabies. Most U.S. states have laws requiring dogs and cats to receive regular rabies vaccination; some will also include regulations for ferret vaccination.

Rabies is caused by a number of different species of Lyssavirus, and can cause infection and clinical signs in any mammalian animal. (Experimentally it could infect birds but doesn’t seem to cause any clinical signs.) The virus is transmitted by exposure to the nerve tissue or saliva of an infected animal. The typical route of infection is by a bite from an infected animal, though there are other possible ways to be infected (e.g. organ transplant). After infection by a bite, the virus enters the peripheral nervous system and travels along the nerves to the central nervous system. Once the virus reaches the brain, it causes encephalitis and clinical signs begin to show.

In the first phase of clinical signs, called the “Prodromal phase,” behavioral changes like anxiety, withdrawal or isolation may be noted, fever can be present, and itching can occur at the site of the exposure (bite wound). The prodromal phase may last 2 – 3 days. The disease can then progress to a “paralytic” form or a “furious” form. A majority of dogs show the paralytic form, whereas the majority of cat cases show the furious form. In the paralytic form, animals are lethargic or even paralyzed, can have difficulty swallowing, drool excessively, can have a dropped jaw, and voice or bark changes may be noted. This may last 1 – 7 days, from onset of signs to death. In the furious form, animals may be aggressive and biting, seem hyper-sensitive to visual or auditory stimuli, and can also have altered voice, ataxia, paralysis or seizures. This phase may last 2 – 4 days.

Rabies vaccine is given to cats and dogs around 4 months of age. The vaccine is a killed virus vaccine, meaning that the virus is not infectious when injected into the patient. The vaccine also includes “adjuvants,” which are additives that will stimulate or enhance the immune response. The initial vaccine is followed by a repeat dose the following year, then repeated every 3 years unless using the feline non-adjuvanted rabies vaccine (e.g. the Merial Purevax feline rabies vaccine). The latter requires annual re-vaccination because it does not have the adjuvants that may produce a greater immune response, thus duration of immunity may be less.

Cat owners must decide whether they would like to use the non-adjuvanted rabies vaccine or not. In theory, the non-adjuvanted vaccine reduces the risk of chronic inflammation at the site of injection, which has been associated with soft tissue fibrosarcomas. These are often referred to as “vaccine-induced fibrosarcomas” but in some studies the link is not so certain. The adjuvants or even potentially just the action of puncturing the skin with hypodermic needles has been suggested as the inciting cause of these fibrosarcoma formations. In addition, some cats may be more predisposed to the formation of fibrosarcomas than others. Other studies show some strong statistical evidence in favor of the non-adjuvanted 1-year vaccine. These vaccine will hopefully soon get approved labeling for a 3-year duration, which may effectively end the debate… but for now, this is still a hotly debated topic within veterinary medicine, and when consulting your vet about which vaccine to choose you may get a myriad of answers. Both options are valid and the most important thing will be to follow the vaccine schedule closely for best results.

Rabies vaccine has very effectively reduced the number of rabies cases of domesticated animals in the past few decades, but the disease cannot be eradicated because of the “reservoir” of wild animal hosts. Public health efforts have extended to vaccination of wild animals through dropped oral vaccine in food bait. Though this is also very beneficial, there will probably always be rabies (just think about bats!). Because there is very little that can be done to treat rabies and survival is very rare, vaccination should still be a mainstay of preventive care. If your pet is unvaccinated or overdue for a re-vaccination, and is bitten by an unvaccinated animal, it should be quarantined for 6 months. This is due to how long the incubation period of the virus is before clinical signs develop. Testing for rabies is unfortunately only possible on brain tissue, therefore is only done post-mortem. During the quarantine, there should be minimal to no contact to reduce risk of transmission to others. If your pet is unvaccinated or overdue for re-vaccination and bites another animal or human, it should be quarantined for at least 10 days. This is because if no signs develop in 10 days, the animal was likely NOT shedding virus through its saliva at the time it bit the victim. However, the victim should be treated immediately (if a human victim, most likely will be treated with rabies immunoglobulin therapy and possibly given a vaccine; animals are typically just revaccinated). Any bite wound should be immediately decontaminated as best as possible by thorough flushing with cold water and antibacterial soap. Report any animal bite to a physician or the proper authorities.

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Puppy’s First Trip to the Vet Clinic

Getting a puppy is a fun and joyous occasion, but learning about all a puppy needs to be happy and healthy can be overwhelming and intimidating for those who have never raised a dog before. So much information is available now on the internet and so many conflicting opinions regarding pet care are voiced that it can be difficult even for the experienced to decide how to navigate the world of “puppy stuff”! Though everyone has quick access to websites, speaking to a veterinarian during check-ups will still provide the most reliable and relevant advice specific to your pet.

Being prepared and organized for your visit to the clinic can maximize the time you get to spend with your vet. It can be helpful to write down any questions you may have so you don’t forget them during the whirlwind of the first few days of having the puppy. There can be a lot of material to cover during the first appointment, so the list of questions can help keep the conversation focused. Prioritize the questions because there may not be time to ask all of them in one visit! If you have a lot of questions it may be worthwhile to ask the receptionist if you can have an hour long appointment, rather than a 15 – 30 minute allotment.

When should my puppy go see the veterinarian?

It is a good idea to bring your new pet to the veterinarian for an examination within the first week of bringing it home. You may want to give a young puppy some time to settle down from the stress of moving to a new environment, but it is better not to wait too long so any problems can be identified and addressed quickly.

For puppies, the first trip to the vet usually occurs around 8 weeks of age. Most responsible breeders will not separate the puppy from his/her mother and littermates before then, and most will also have done some routine care already – deworming, vaccines, etc.

What should I bring?

Please remember to bring any adoption or breeder paperwork, including any medical/vaccine/deworming history to the first appointment. If your puppy is on any medication right now, please bring the medicine or write down what it is exactly, and what dose they are receiving.

It is useful to bring a stool sample from the puppy if you have one, since it is routine practice to test the stool for intestinal parasites. If you do not have one, the vet may choose to collect one rectally from the puppy during the visit, but it typically is easier on these little ones to bring in a sample if possible. The stool is often re-checked at subsequent visits as well, so it’s always helpful to bring a sample in. The fresher the sample the better, so try to bring in something from the same day. It doesn’t have to be refrigerated, but helpful to bring it in a small sealed container or plastic bag. The vet will only need about a gram, so it doesn’t have to be much.

If you know what the puppy was being fed before coming to you, it is good to make a note of it, as well as what he/she is being fed now, including treats.

Checklist for the first Appointment:

  1. The first exam – the vet will look at your puppy from nose to tail: he/she should look at the puppy’s eyes, ears, nose and mouth, checking for signs of infections and palate or dental defects. He/she will listen to the chest to make sure there are no signs of a heart murmur or respiratory problems. He/she will palpate the puppy’s abdomen and check the genitalia to make sure he or she is developing normally.
  2. Check vaccine history and update as needed – the “core” vaccines that the puppy should get are the rabies vaccine (at 16 weeks of age) and the DHPP (distemper/parvovirus) vaccine. Depending on region and risk factors, bordetella, lyme disease and leptospirosis vaccines may also be recommended. The vet will recommend these as needed and vaccinate the puppy if he is old enough and due for it.
  3. Talk about parasite control and de-worm; start flea/tick/hw prevention – puppies as young as 7 weeks old can start on flea/tick and heartworm prevention. The vet can provide you with these medications. Most puppies are prophylactically dewormed because it is very common to have parasites. The most common signs of intestinal parasites will be diarrhea, occasionally vomiting, a distended abdomen, and in some cases anemia, failure to gain weight, and an “unthrifty” (unkempt/unhealthy) appearance.
  4. Get a fecal test – bring that stool sample if you can!
  5. Talk about nutrition – there are countless varieties of dog foods these days and largely most of those available at reputable pet stores will be acceptable brands, but it is important for your puppy to be on a puppy-specific diet. Puppy diets will have a better nutritional balance for the growth life stage. The rest of the selection criteria may be determined by cost, availability, taste preference, or specific health needs. These issues your vet can help you sift through.
  6. Talk about training and socialization – typically, until a few boosters of vaccines are given, the vet will recommend limited interaction with other dogs to prevent your puppy from picking up contagious diseases. This doesn’t mean you can’t start training your puppy! You can start teaching basic commands like sit and stay, teaching good manners on a leash, and of course, working on house training.
  7. Talk about spaying/neutering – spaying and neutering pets is the standard recommendation for most pets in the United States. It is recommended for various health reasons, behavioral reasons, as well as population control (reducing unwanted litters and shelter overcrowding/euthanasia). There is a lot of controversy in this area because there are opposing philosophies about the ethics of elective surgery as well as some studies suggesting increased risk of specific diseases associated with earlier age spay and neuter. It is appropriate for you to have a discussion with the vet about all these pros and cons, as well as finding out about the surgical procedures and after-care. This discussion can be postponed, because typically dogs are spayed or neutered at 6 – 9 months of age.

Remember to relax and have fun! Take notes if you need to, but don’t worry… you don’t have to remember most of these things the first time. Your puppy will probably need a check-up every 3 – 4 weeks until he/she is about 5 months old, so there will be plenty more opportunities to learn/refresh your memory.

Tiffany Fu, VMD
Associate Veterinarian at Glenvilah Veterinary Clinic

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What’s Eating Me? Internal Edition

Parasites, those little bugs that infest your pet. We’re going to talk about the ones that attack from the inside. We’ll get to the ones on the outside next.

When your veterinarian asks you to bring in a fecal sample for testing I promise you it’s not because we like the smell. Fecal samples are most often used to perform a fecal floatation test. In this test the samples typically have specific fluid added to them, they are spun in a centrifuge then left to sit for some time allowing parasite eggs to collect at the top of the fluid. In this way we get the best chance to find eggs, cysts and sometimes the infective agents themselves. Fecal samples can also be used for direct smears and other testing if required.

Caveat to the following article. The information being given is basic in nature so that you have a basis to understand results given to you by your veterinarian. As in any case of disease (parasitic or otherwise) discuss test results and treatments with your doctor.

Let’s talk about the most common parasites found during this routine test.

Coccidia (protozoan parasite)

Infection of this little periodic troublemaker comes primarily from ingesting the oocytes (eggs) in infected feces. This typically occurs in environments that are not being cleaned properly. That said, the majority of coccidia infections are non-disease causing.

If disease is present there are typically other factors along with the coccidia themselves. These include stress, malnutrition, overcrowding and unhygienic conditions. Clinical signs start with diarrhea (watery, sometimes with blood). Other signs can include weight loss, energy level decreasing and possible vomiting. The majority of animals that show clinical signs are puppies as their immune systems are still immature.

Because coccidia can be found in asymptomatic animals (those not showing any signs of disease) treating just on the presence of it in a fecal floatation is not always warranted. Often these will be self-limiting infections. However, if there are multiple animals in the home treating can help reduce contamination in the environment.

There are many drug treatments for coccidia (the most common being sulfa containing antibiotics) and this should be discussed with your veterinarian.

Giardia (protozoa parasite)

Giardia are pear shaped protozoa that infect the small intestine leading to poor absorption and possible diarrhea. Animals are typically infected by consuming contaminated food or water. Again puppies are most commonly infected along with animals in groups that are kept in small areas.

Clinical signs are characterized by diarrhea which can be persistent, intermittent, start acutely or last chronically.

Giardia can be diagnosed with fecal floatation or, more commonly, by a test for the Giardia antigen.

Treatment is often with a combination of antibiotics and anti-parasitic agents. However, failure to respond to initial treatment is common. Animals will shed infective cysts and can recontaminate themselves and other animals in the house. Along with medical treatment the patient should be bathed frequently to help remove cysts from fur, clean environment often and well, discuss treating animals that are housed together. As always, discuss treatment with your vet.

A whole mess of worms

Roundworms

Or Ascarids. These are the most common type of intestinal parasite in dogs and cats. Typically seen in puppies or kittens. Infection can occur from ingestion of eggs, ingestion of an intermediate host or even infection via mother’s milk or through the placenta (depending on which species of worm).

They cause discomfort of the stomach, potbellied appearance, diarrhea and poor growth. On very rare occasions large numbers can cause an intestinal foreign body, intussusception (when the intestine telescopes in on itself) or intestinal perforation.

It is easily diagnosed by fecal examination.

Hookworms

Hookworms attach by mouthparts in the intestine to suck blood and other fluids. As they move along to eat they leave bleeding ulcers. Infection can occur similarly to the roundworms above. The eggs from the adult worms pass into the feces and are then ingested by another host.

Signs of hookworm infestation include anemia, lethargy, pale gums and dehydration.

Again, hookworms can be readily diagnosed by fecal floatation.

Bad news time: both ascarids and hookworms can be zoonotic (fancy word for a disease that can infect both animals and humans). Hooks cause a disease called Cutaneous Larva Migrans. Infection in humans is on the skin, very itchy, and usually treatable. This is one of the reasons that dogs are often banned from public places (beaches/parks etc.). The good news is, however, hookworm eggs do not last long in the environment (lasting only a few months) are do not survive freezing. Bleach will destroy the eggs outer coating leading them to dehydrate and die quicker.

Ascarid eggs if ingested by humans can lead to the larva migrating to the eyes, neurological tissue or other internal organs. The damage done can be permanent, the disease signs depending on which tissue is affected. Roundworms are much hardier in the environment so treatment/prevention is very important.

The good news is that both Ascarids and Hookworms are easily treated with de-worming agents and by your pets monthly heartworm pill (another good reason to give heartworm prevention). Also this is why puppies should be started on a broad deworming medication (one that treats for many species) starting at 2 weeks old. They should then be given a dose every 2 weeks until 8 weeks old when the owner should be bringing their new pups to the vet for a first time and have a fecal sample checked.

Whipworms 

As with other internal parasites, whipworms primarily cause diarrhea (sometimes with blood present). In very rare cases severe infestations can lead to electrolyte disturbances. 

Whipworm eggs are not infective when they are excreted, it takes 2-3 weeks for them to become and infective (larval) stage. When the dog or cat ingests the larval eggs they mature first in the small intestine, moving finally to the large intestine. Adults produce eggs for 70-90 days, intermittently. This means that whips cannot be ruled out as a cause of diarrhea even if the fecal sample is negative. It also means that careful cleaning of the environment is essential in preventing reinfection.

Diagnosis is via fecal floatation, the eggs are characteristically barrel shaped.

Treatment is via de-wormer (typically given for 3-5 days then repeated at 3 weeks and 3 months due to the long lifecycle). But in good news there is a heartworm product that treats whipworms too. Sentinel (from Novartis) has an active ingredient that treats for this worm. If your dog is on another heartworm prevention product and is positive for whipworms it is advisable to switch.

Tapeworms

 Tapeworms rarely cause severe disease if any signs are seen a slight loss is overall body condition is the most likely.

 Infection occurs from ingesting the intermediate host (most often fleas or lice) where the eggs have started to mature.

Identification of infection is most often brought to vets attention when the owner notices “rice segments” in the animal’s feces.

They are easily treated with deworming agents but the most important factor in preventing reinfection is good flea control.

One final species to mention is Strongyloides or threadworms. This is an uncommon disease in dogs and cats leading to no clinical signs in a light infection to diarrhea in heavy ones. It is important to mention because it is another zoonotic agent. It can be difficult to treat. If your animal is positive for this infection your vet will have more information in terms of treatment/environmental control and helping to prevent reinfection.

Last tip-and I’m hoping this did not need to be said but you never know. Due to the fact that some of these worms can affect you too ALWAYS follow good sanitary policies. In other words WASH YOUR HANDS after touching your dog’s rear end and/or feces. Especially with young puppies/kittens who are more likely to be harboring infections.

www.cdc.gov/parasites is a good source for more information.

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Dog and Lyme Disease: The Good, the Bad, and the Scary

lymeLyme disease, just the name alone is enough to give veterinarians a headache. It is a complicated combination of exposure, infection, clinical signs, prevention and treatment. All of this is wrapped up in multiple controversies: is my animal at risk? Should we vaccinate? Should we test on a regular basis? What should be done once an animal tests positive? This article is going to try and sort out these questions and give some advice. But always remember whether it is Lyme or any other disease process the best place to discuss information, testing and treatment options is going to be with your veterinarian.

The critters that cause this and how they pass it on.

The problem starts with the Ixodes species of tick (specifically the Ixodes scapularis, or deer tick, in the eastern United States). These critters carry the bacteria that cause Lyme: specifically a gram negative spirochete called Borrelia burgdorferi (Bb). This infectious agent multiplies within the tick and will enter the animal at the end of the tick’s feeding cycle (approximately 48-72 hours after attachment). The agent then replicates in the skin at the tick bite site followed by migration through the tissue. Lyme disease is endemic to the northeastern United States (Massachusetts to Maryland), north central states and northern California.

Lyme does not begin to show signs in a dog for weeks to months following infection. The most common signs are fever, lack of appetite and joint pain. The most serious possible consequence of infection with Lyme disease is glomerular disease leading to renal failure (more on this later).

Stop it before it starts.

There are two main parts to prevention of Lyme disease: vaccination and tick prevention. Let’s tackle the second first. If you live in an endemic area (and, let’s face it, even if you don’t) it is VERY important that your dog have good tick prevention. There are many different medications/medicated products out there including Frontline, Revolution, Advantix and the Preventic collar. You may live in an area where there is resistance to one, or more, of these products. Discuss this with your veterinarian, make the best choice for your pet and make sure you are applying the chosen product correctly.

Now for vaccination. If you live in an endemic area then vaccination for Lyme disease is a good idea. It is a course of 2 vaccines given 3-4 weeks apart and then an annual booster. It is important to note at this point that according to most studies only approximately 5% of all dogs infected will actually show signs of disease. Also approximately 1-2% of vaccinated dogs will still get the disease (nothing is 100% effective). The take home message about prevention is this: Good tick prevention will help more than vaccination when it comes to keeping your dog from being exposed.

The test you don’t want to pass.

Before talking about testing I want to take a moment to discuss how the body reacts to infection. When the body is attacked it forms antibodies in response to the part of the bacteria (or other attacker) known as the antigen. This is also how vaccines work; they stimulate the body’s immune system to produce antibodies to a specific disease. If the body becomes exposed to the disease again it will recognize, and fight it off, faster. All tests for Lyme disease test for the antibody and not the antigen. This becomes important soon.

The most common test performed by small animal veterinarians is either the Snap-3 or Snap-4 test by Idexx laboratories. These two tests also test for heartworm disease, Lyme disease and other tick borne diseases. Many vets use these combination tests as a screening tool. Both are C6 tests that are sensitive too, and specific for, antibodies that have been formed due to natural exposure to Bb. C6 is a peptide (a unique area of one of the surface antigens of Bb). This peptide remains constant and always detectable in a body infected by Bb. Dogs exposed to Bb will test C6 positive within 3-5 weeks and can stay positive for years. Vaccines, however, do not contain this particular peptide. In other words, these tests will not come up positive for Bb in vaccinated animals.

So what’s the problem (or why all the controversy surrounding Lyme tests)? It lies in the fact that there is no proven correlation to testing positive and whether or not your dog will become symptomatic for Lyme disease. In fact-as stated above-approximately 90-95% of all dogs that test positive will not come down with the disease. In some endemic areas up to 70-90% of all healthy dogs will come up positive.   Which leads to the question of whether or not testing on a regular basis is necessary and the diagnosis of Lyme disease?

So my dog is positive, now what?

The big question to ask yourself (or your vet will ask) is whether or not your dog is showing symptoms for Lyme. Do they have a fever? Are they eating? Are they limping? How’s their energy level? If the answers to all of these are good and normal then your dog is what we call an asymptomatic positive. And now the can of worms opens. I’m going to lay out what I’ve found in my research for this article. BUT this is where that disclaimer at the top bears repeating. This is my opinion and, as with any disease, you need to consult with your veterinarian before deciding on any treatment course.

Onward. Let’s hit the easy one first, your animal is positive for Lyme and has symptoms. They should, and will, be treated by your veterinarian. First choice antibiotics are doxycycline or amoxicillin. Typically dogs are treated for a month, though no one knows how long it takes to truly clear a dog of the carrier state (be clear of the disease). There is a second C6 test (called a Quant C6) that tests for the same antibodies as the SNAP test but it quantifies the level of antibody present. There is some use in using this test in dogs receiving treatment as you can test before and after to see if antibody levels falling which may give you an idea of if the treatment is working (more on that later-see below).

And the murky, scarier part.

Less easy one. Asymptomatic animals. First question, is it worth doing the Quant C6 test in these animals? Well, maybe. There is no evidence that antibody levels as measured by this test correlates to whether or not the dog will become symptomatic and, if so, the severity of the disease. Is it worth treating asymptomatic animals with a course of doxycycline? Well, maybe. There are arguments for this, primarily of the “if we don’t treat will my animal get worse later?” variety-no one knows the answer.

Arguments against include: overuse of antibiotics can lead to resistance (and no one wants doxycycline resistant Lyme disease), doxycycline can lead to unwanted side effects (typically vomiting, diarrhea and lowering of appetite) and, finally, back to most of these dogs will not get sick. So what’s the answer……that, for me, leads to the most concerning of all the potential consequences of Lyme disease.

A small percentage of dogs that get Lyme disease may get Lyme nephritis. This is a kidney disease thought (right now) to be caused by antibody/antigen immune complex formation that are deposited in the kidneys and lead to acute renal failure. These dogs have, unfortunately, a universally grave prognosis. They go downhill and die very quickly even with aggressive treatment. How can you tell if this rare consequence will occur in your dog? you can’t. BUT it does help answer whether or not you should treat asymptomatic dogs.

Back to my dog is an asymptomatic positive now what? First have their urine tested for protein. This should involve both a full urinalysis and a test called a urine protein/creatinine ratio. If these are both normal then these tests should be repeated every 6 or so months to make sure there are no changes. If either test is abnormal then full blood work should be performed (to include a chemistry profile and complete blood count). It is also a good idea to talk to your vet about testing for possible co-infectious agents (Anaplasmosis, Bartonella to name 2) as there is a reasonable chance the renal disease could have been caused by another infectious agent. If there is protein in the urine then, in my opinion, yes do a course of antibiotics. If there is no urine protein, no clinical signs of Lyme disease, you live in an endemic area where there is no way to know how long your dog has been positive, well, like I said, murky. Talk to your vet. You’ll get information, you’ll get confused (welcome to the club) and you’ll make the best decision for you and your pet.

One last thing, do you vaccinate an already positive dog? Most experts say no. Why? Vaccines are to help prevent infection in the first place, they’re infected now. The proverbial horse has left the barn. There is no evidence that vaccinating a positive animal will either help clear the disease faster and/or help prevent them being infected again.

The final word on Lyme: it is murky, it is confusing and one thing I can tell you for sure is if you get 5 vets in a room to talk about Lyme, especially about treatment of asymptomatic positive dogs, you will get at least 11 opinions at ever increasing volume levels. This is not a bad thing; in fact I think it’s a good one. The more questions means there are more people out there looking for answers. And maybe one day we’ll have them-but not today. Best advice I’ve got is Prevention First, with good prevention hopefully you won’t have to deal with decisions on treatment. But if you do discuss it with a veterinary professional and make the decision the suits you best. Good Luck.

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Leptospirosis: What’s Lurking in the Water

lepto-waterLeptospirosis is a disease that many dog owners are familiar with by name, as it is commonly included in their pet’s vaccine schedule and reminders. However, as a veterinarian I find that most pet parents are unfamiliar with what leptospirosis is or how it is spread. Here we will overview some basic information about leptospirosis so that we can understand the purpose and benefit of vaccination.

What is Leptospirosis?

Leptospirosis is the disease caused by spirochete bacteria of the genus Leptospira. There are at least 16 species of bacteria classified as Leptospira, with each species including potentially over one hundred serovars, or subgroups. This is significant because these different serovars of Leptospira bacteria have different antigens (surface proteins), so vaccines may need to be tailored to recognize these different antigens in order to be effective. In practical terms, the vaccine your pet may be receiving for protection against leptospirosis may include protection against several serovars, but will never be completely protective against all strains of leptospirosis. Dogs appear to be affected more commonly by the following serovars: grippotyphosa, braislava, canicola, icterohaemorrhagiae, and pomona.

How is Leptospirosis spread?

Leptospira bacteria thrive in warm, moist environments, commonly stagnant or slow moving water. They can survive for months in wet conditions without a host, and peak incidence of leptospirosis in dogs occurs between July and November, often after periods of rainfall or flooding. Leptospira bacteria are shed in the urine of infected animals, thus it tends to end up accumulating in still water from runoff. Animals become infected when the bacteria enters broken skin. Bite wounds, reproductive secretions, or consumption of infected tissue (eating an infected animal), and contact of broken skin with contaminated water all can transmit infection.

Who is affected by Leptospirosis?

It is common for veterinarians to recommend vaccination against leptospirosis based on lifestyle and exposure risks. In the past, it was often not recommended unless the pet was very active outdoors (e.g. roaming or working outdoor dogs, especially if swimming in natural bodies of water). Today this is not the case; Disease incidence appears to be increasing in suburban and urban environments due to spread by rodent and urban wildlife populations, and vaccination may now be recommended to all dogs – even the little Yorkshire terrier walking down the city street.

Leptospirosis is more prevalent in warm, tropical environments throughout the world. In the United States, dogs are affected in Hawaii, West coast states, the upper Midwest, the Northeast, and mid-Atlantic coastal regions.

Many different species of animals (e.g. dog, mouse, rat, raccoon, cow, pig, horses and humans) can be infected by leptospira bacteria, with certain serovars affecting different species of animals. Younger animals seem to be more severely affected than older animals, and there may be a genetic predisposition for infection in German Shepherd dogs.

Of note, leptospirosis is considered a zoonotic disease, as humans can contract the infection from contact with contaminated animal urine. Veterinarians, animal caretakers, sewer workers, and farmers may be at increased risk due to exposure.

How do Leptospira bacteria cause disease?

Once the bacteria enter the bloodstream, it spreads quickly and begins to replicate in the kidneys. This causes inflammation in the kidneys and can potentially cause acute renal failure. Some serovars of leptospire can cause other organ failure, most commonly the liver. The leptospires produce a toxin which can cause liver damage and acute or chronic hepatitis. Lung tissue can also be injured by the toxin, secondary to vasculitis (fluid leaking from blood vessels).

What are the signs of leptospirosis?

Leptospirosis can be marked by fever, joint pain, loss of appetite, nausea and lethargy. Excessive drinking and urination may be secondary to kidney damage, typically starting about a week after the fever. Jaundice and bleeding disorders may be caused secondary to liver damage, resulting in bruises, hemorrhaging, epistaxis (bleeding from the nose), bloody stool or vomit.

How is leptospirosis diagnosed?

Basic blood chemistry can be performed to support a clinical suspicion of leptospirosis before more advanced testing is ordered by the veterinarian. Increased kidney and liver enzymes will often be noted. Blood tests to detect antibodies against Leptospira can be performed. An initial titer of 1:800 or greater supports a positive diagnosis, a second antibody titer must be performed between 2 and 4 weeks later. If the second titer shows a four-fold increase, the diagnosis of leptospirosis is confirmed. Unfortunately, vaccination may affect test results since vaccines cause antibody production. If a dog was vaccinated within the past 3 months, testing may be difficult to interpret due to their high antibody level. If antibodies are detected against a leptospire serovar for which there is no vaccine, it must be a positive test result and the individual has leptospirosis. There is also a PCR test (polymerase chain reaction test), which detects Leptospire bacterial DNA, enabling the lab to detect even small amounts of bacteria present. The PCR test is an excellent choice for a diagnostic test, especially if there has been recent vaccination in an individual.

Urine testing can also be performed, but because the bacteria may be shed only intermittently, detecting the infection may be inconsistent. The bacteria can be seen using darkfield microscopy, which uses a dark background to highlight the paler leptospire organisms. Unfortunately, darkfield microscopy is not readily available to most animal hospitals and the typical urine culture tends not to be very successful.

Kidney biopsy may be also performed, but this is obviously a much more invasive procedure.

How is leptospirosis treated?

Patients with leptospirosis are treated with antibiotics, commonly penicillin and a tetracycline (such as doxycycline). They also need supportive care for their fever and other signs (e.g. blood transfusions if bleeding disorders occur, anti-emetics if vomiting), and require intravenous fluids to maintain good blood flow to the injured kidneys. With aggressive and appropriate treatment, 80 – 90% recovery rate in dogs is reported.

It is also very important to clean the patient’s environment and anywhere the contaminated urine may have touched. An iodine-based cleaner should be used anywhere the urine may have contacted, and gloves should be worn by anyone touching the patient and cleaning up after them.

Conclusions: Should I vaccinate my dog against leptospirosis?

Leptospirosis is a very serious disease and may be on the rise. Infected individuals may quickly develop signs of illness and have extensive organ damage in a short time. The vaccines available are against the species Leptospira interrogans, including only the serovars canicola, grippotyphosa, pomona and icterohaemorragiae (some vaccines have all four serovars, others only have two of the four available). Though there are other serovars that can cause infection, these are the more common serovars causing disease in dogs. Due to the use of the vaccine for many years, it is difficult to determine incidence of the disease in environment, but reported cases of leptospirosis caused by these four serovars have decreased (as opposed to those serovars for which no vaccine exist). The vaccines are associated with allergic reactions in some patients, causing signs like hives, facial swelling, and rarely life-threatening anaphylaxis. If a patient has a history of significant vaccine reaction, it may be recommended to avoid this particular vaccination. Otherwise, for most dogs it is a useful, relatively safe vaccine due to the seriousness of the disease and the potential zoonotic risk to human family members. As always, the pros and cons of vaccination should be discussed with your veterinarian about your specific pet, as every individual case may be unique.

References

Morgan, R., DVM, DACVIM, DACVO and Rothrock, K., DVM. Leptospirosis, from VIN libraries. January 2012

http://vetgirlontherun.com/leptospirosis-part-1-geographic-distribution-vetgirl-veterinary-ce-blog/; June 24, 2015.

Brooks, W. Leptospirosis: Client Education, from VIN libraries. August 2011

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Declawing your kitty? Are you serious?

It always amazes me how everyone became so glued to their phone. Seriously, people? Can we rewind a bit there, and be able to walk your dog, do your grocery shopping, or take your kid to the park WITHOUT TALKING ON YOUR DARN PHONE?

Anyway, I was grocery shopping while I heard a woman telling someone on the phone as well as all the patrons of the store that she had to pick up her cat soon after he got declawed. She just mentioned it like it was something as casual as a manicure!

Declawing has nothing to do with a manicure. What if your cat was taking you to get a declawing? Let me explain to you what it is. If declawing was performed on a human, it would mean to CUT OFF EACH FINGER AT THE LAST KNUCKLE. Want to be casual about it?

They suffer, they freaking suffer on top of the fact that by removing their nails, you remove their defense if one day they escape. They will be at the mercy of any predator.

This is exactly why humans are really pissing me off more and more! Humans don’t want to adjust to the environment or to their pets. Environment or pets have to adjust to them. Did I miss something somewhere? Is it part of an amendment I have not been aware of written by our Founding Fathers?

I live in the country side around DC, meaning that yes I was privileged being able to watch nature around instead of people. It just changed not long ago since someone built a monster house next door to me. You know with 2 kids and a dog you need a bare minimum of 7,000 square feet! So anyway, I will be moving soon, but I witnessed so many people around here, moving from the city to the suburbs and complaining about the wild critters. Breaking news: they were there before you. I still remember that woman complaining that she spent over half a million of dollars in her yard with bushes and trees, and the deer ate the bushes! No kidding, lady! If you can spend $500,000 in bushes, why don’t you spend a few more bucks to get a fence high enough for Bambi not to jump over?

Declawing is the same thing. You want a cat, but at the same time, you want to make him fit your environment. We could call him the “Stepford cat”! There are solutions to keep your furniture safe without going through that barbaric surgery which will also alter your cat’s personality forever.

Nail Trimming

You have to trim their nails. Have you looked at them? Those things are dangerous! Seriously! On top of it, I have dogs, and even though my cats and dogs are getting along, you can never know what one of my kitties could do since he has a perverted sense of humor! He loves to hide and catch the dogs’ tails with his nails to give you an example.

So, get ready to trim those claws!
Step 1: Don’t go straight at your cat with nails clippers the first time. It takes some taming here! When Kitty goes to your lap, let him get accustomed little by little at having his feet handled. Doing this every day for a while will make it less stressful for your cat and for you!

Step 2: You should have someone with you to handle Kitty when Trimming Day is here! Cats have a very good memory, and if it becomes a fight the first time, it would be Hell in the future! Don’t expect your cat to stay still for 10 or 15 minutes. No one has that kind of tolerance!

Step 2: Do it on a regular basis, so you will become good at it. Trust me on that one! The only thing you have to clip anyway is the sharpest part at the very end of the nail. This is not like for dogs, just a tiny part has to be removed. If you hit a quick (blood and nerves which provide feeling to the nails), have “Quick Stop” to apply to stop the bleeding. Most likely you won’t need it since the sharpest part of the nail is at the very end, so only a tiny bit needs to be removed anyway.

Cats Do Scratch

Scratching is a normal feline behavior, and every cat should have at least one scratch post.
You are going to tell me that you have 5 scratching posts in hour house but that your cat prefers your leather sofa!

Maybe they are not at the right place. Try to monitor your cat to see when he feels the most like scratching. Is it after meal time? After a nap? When he is stressed by someone coming? You have to put the post on his path.

Your kitty scratches a specific spot of your carpet or your sofa? You can find at PetSmart something called “Smart Cat Sticky Paws sheet.” They are applied and removed easily from carpet or furniture once your cat acquires good manners and it will prevent any scratching since they absolutely dislike the texture of those sheets.

Fake Nails

If despite of the nails trimming and the posts, your cat is still trying to kill your carpet or your furniture, there are cool fake nails that you can glue to his or her own nails. It comes in cool colors if you kitty is into fashion but clear ones are available as well.

As always there are solutions far less drastic and barbaric than surgery. You can let your kitty be a kitty without fearing for your kids, other pets or furniture! I would love to hear from all the kitties’ parents now and share pictures! No “Stepford Cat” please!

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A Visit to the Vet by Jackson

image003Like every morning, I go with my Mom to get Zoe. Zoe sleeps at Jessica’s place, but that silly girl has to come home every morning to do her business in our yard. I found this pretty gross if you want my opinion.

Mom loves to take me with her anywhere she goes but I do provide some help with Zoe. You see, as soon as Zoe gets into my truck, she starts whining, and whining, and then screaming because she needs to go. When I am with Mom, I just bark once and it does it: she shuts up! Seriously that girl needs a reality check! Hello, there is grass somewhere else than in “my” yard!

So, anyway, we went to grab Zoe. Mom took her out of the truck. Zoe is one of those that Mom has to carry because she never figured out how to get out of the truck, but hey, I have known my sister for so long that I am quite accustomed to her non sense.

Zoe went inside the house, and I was waiting in the truck. First time it ever happened! Mom…. Hello…. Mom? I am still here? Mommmmmm! What’s happening here? I am hungry! My stomach is growling…. Mommmmm?

It seemed like it took Mom forever to come get me. Gosh, by then, I was so hungry. I went straight to the kitchen. Nothing. The others were already taking naps and taking it easy. Where is MY breakfast? Mommmmmmm….. I am hungry! She was in her office, and I went there and tried to get her attention by grabbing her arm. She kissed me, but did not move. Mom? Seriously? It’s not funny anymore! I need my food!

I went back to the kitchen, checked out the counter which was totally clean for once. I am usually the one in charge of it. What was happening here? That started to freak me out, let me tell you! I thought I was going to faint! I went to check the trash can just in case: EMPTY! Starting to get really upset, I went straight to the recycling: EMPTY! I was starting to panic: what if she had totally forgotten that I did not have breakfast? I tried to open the fridge, but she had put a chair in front of it!

Suddenly, Mom arrives, all smiles, and she called me to go back to the truck! Okay, maybe she ran out of my food, and we are going there. I like to go to that shop. One time, I managed to get lose and Gosh, I had a ball! I swallowed everything I could find on my path. Now, Mom is careful when we go there. She always checked my collar first. Still, most of the time I get that duck patty as a treat. I love ducks! One of my favorite foods in the whole wild world.

We were in the truck, Mom driving and I was next to her making sure we were safe. I tried to grab her arm a few times. I kind of like to have my paw in her hand in the truck. It just feels good. I suddenly realized that we were on the way to the swimming pool! Gosh…. Ok Mom I forgive you to have forgotten my breakfast. Between food and swimming, I go for the swim. I was so excited. I started talking to her. Go faster…. Faster woman! Suddenly we were stuck, and the truck was not moving! I was getting impatient and started barking! Mom got impatient too, and starting honking! It was getting fun. We started to move again.

I knew we were getting there. I know the way; I could walk there, except that I would not really be able to do so since my paws are kind of fragile on hard stuff! I could not wait to get to that pool! I love to swim! Then that guy, Ross, plays with me and sends a bumper in the pool and I grab it, he takes it back, he throws it, I grab it back. I could play forever!

YES! We are there! I knew it! I started getting antsy and….. MOMMMMM you passed the pool! Mom! Are you kidding me? Are you blind or something this morning? Mom! And I did not stop screaming until she stopped the truck some time later.

It was a place I have never been before. There was some grass, and she told me to pee! Okay, that’s what she says each time we go swimming. If I don’t pee before going in, then when I see Ross, the guy I play with in the pool, I am always so happy that I kind of forget myself! Hey, nobody’s perfect around here! It just might be another place where I can swim! I can’t wait! So, as soon as I get out, I pulled Mom fast, and she screamed at me to stop!

As soon as we arrived there, so many smells, but funny, I could not smell the pool stuff. Where was she taking me? Sometimes humans are really hard to read!

We went to a small room. The first thing Mom did was to break a small flower pot! Who is clumsy? You wanna tell me? Mom told me to shut up. Gosh that woman has no manners!

We were waiting and suddenly the door opened and a woman came. She looked sweet. She kneeled down, and petted me. She started talking how handsome I was, that I was taller than George! How the heck did she know George? He never ever mentioned anything about that place, but true, he left us long ago now!

Mom and “the” woman started talking, then she got something out of a cabinet, and I shrieked in horror “NO! I am not sick! I do not want to have my temperature taken! This is violating my rights! Any laws in this country protecting my privacy?

Then, we all left the room, but Mom did not come with me. I went to another place without her, and I really did not want to go without her. Was she leaving me there? I started to panic and barked loud. I think I scared all the other dogs who were crated there, and they looked quite sick! What on earth was I doing here?

Another lady joined us, and here we went to another room again. How many rooms does that place have anyway? There, she made me lie down, and at that point, I was really scared. They started shaving my tummy? Hello? That thing is tickling me! Can’t you stop?

Those humans sometimes are making me speechless. After shaving my tummy, they put some kind of jelly on it, and it was cold! Then, they started massaging me with something. I was so lost. I just wanted to go see my Mom. Mom, whatever I did to deserve this, I swear, I’ll be good!

Then, they wanted me to pee again. I mean, make up your mind, people. First, Mom makes me pee and now those strangers want me to do the same thing? I am shy, Okay? When I do my business, I do it behind bushes! They were pretty insistent so at the end, I did it. Happy, now?

Then, we went back to the room where were first, and Mom was waiting for me. I ran to her so fast, the woman who was holding me kind of tripped, but I did not care. All I wanted was my Mom. I was so happy to see her that I jumped on her lap, and I am telling you, nobody will make me stay away from her now!

The woman talked to my mom, and was petting me and saying that she loved to see healthy dogs, and that she used to have a lab herself, and that I was so handsome, she could not get over it. I know. Very often, I have that effect on people. When they see me, they are just stunned how handsome and perfect I am.

We finally left. As soon as we got into the truck, Mom got from under the seat a bag with those duck patties I was telling you about a bit earlier. Okay woman, you are forgiven. I just gulped the whole thing down, but then I was a bit thirsty. Mom was laughing and pulled a bowl that she filled with water from a bottle. That’s my Mom! I know she loves me, but I haven’t figured out the meaning of this trip!

We did not go back home the same way. Instead we took kind of a weird stuff. Our truck was on a boat and we crossed a river. That was kind of cool. Mom opened my window, and there were so many smells. I decided I kind of liked it. I don’t like bridges. If I walk with my Mom, and there is a bridge, I brake with my four legs. By now Mom knows that I don’t do bridges!

We finally made it home. Just on time for our daily snack: carrots! Of course, as soon as I got into the house, all the others were all over me and asking me where I have been. I shook my head and told them “Don’t even ask!”

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