Vet Blog
06/22/08
My vet recently decided not to give out
prescriptions for online pet med services. He
claims they use “old” medications which can be
harmful. I wonder if he is more interested in
making a profit for himself off the meds than
giving a break to his patients. How can an online
supplier consciously sell old meds?
S H
Chicago, IL
My vet says that ordering from a well-known internet pharmacy is a
bad idea because you don’t know what you’re
getting. Is it really a bad source to order from,
or is the vet not wanting to lose money? Thanks so
much!!
Alison
Muscatine, IA
Veterinarians and online pharmacies have had a rocky relationship from the start.
When online pharmacies first started selling medicines, many vets were worried that their already slim profit margins (even though vet care is expensive, most of what you pay your vet ends up going to his suppliers, his landlord, his employees, utility companies, the IRS, and regulatory agencies) would be reduced by the loss of income-generating drug sales.
This concern has not panned out as expected. Well-managed veterinary hospitals do not derive much income from drug sales. In the hospitals where I have worked, medications were offered to clients more for their convenience than for our profit. And this makes sense. A veterinarian’s job is to manage the health of pets, not to sell drugs.
So why is there a lingering animosity between vets and online pharmacies?
To my knowledge, none of my patients has ever received an expired or ineffective medicine from an online pharmacy. But I have had conversations with representatives from drug manufacturing companies who assure me that this does happen. They also claim that some online pharmacies unwittingly distribute counterfeit medications that have no efficacy.
In my opinion, if you order from a reputable online pharmacy the odds of receiving expired or counterfeit medicines are low. Most of the drugs that I have seen dispensed from these pharmacies are perfectly fine.
However, I still have a bone or two to pick with many of the internet pharmacies. Working with them can be very frustrating.
For instance, one internet pharmacy habitually refuses to write instructions on the drugs it dispenses. If I send a prescription to the pharmacy and indicate that the medicine should be taken twice daily, they will dispense the medicine with instructions to “take as instructed by veterinarian”. In the best case, this wastes my time–clients call me to ask how often the medicine should be given, when I have already provided that information to the pharmacy. In the worst case, it puts my patients at risk of overdose (for instance, if the client for some reason believes the medicine should be given four times daily).
Another pharmacy routinely sends faxes to my office requesting authorization for prescriptions. I promptly fax back authorizations. The next day, I often receive faxes from the pharmacy, written in a somewhat threatening tone, stating that they have not received my authorization. This confusion on the part of the pharmacy is very annoying, and it also causes me to lose confidence in their business in general. If they can’t manage their fax system, how can I expect them to dispense drugs accurately?
To give the internet pharmacies credit, I have been experiencing these sorts of problems less often over the last year. Nonetheless, I still find working with some online pharmacies to be quite inconvenient.
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06/13/08
 The Iditarod dog sled race is an Alaskan and American institution, in which teams of dogs and people race over 1000 miles in the course of several days. It is considered a supreme challenge in endurance racing.
Most dogs I know love to work. Cattle dogs enjoy rounding up cattle. Shepherds enjoy herding sheep. My pal Buster enjoys playing fetch (which is the closest thing to work he experiences). I have always assumed that sled dogs involved in the Iditarod enjoy running the race. And perhaps most of them do.
However, two recent papers in the Journal of the American Veterinary Medical Association have made made it clear that some dogs are not benefiting from their participation in the race. The first paper discusses autopsy results of 23 dogs that died while running the race between 1994-2006.
Conclusions and Clinical Relevance–Unexpected death is a rare event among conditioned sled dogs during competition in endurance races. Potentially life-threatening conditions of dogs that are associated with periods of long-distance physical exertion include aspiration pneumonia, gastric mucosal lesions, and severe rhabdomyolysis. (J Am Vet Med Assoc 2008;232:564-573)
Translated into English, the last sentence implies that prolonged heavy breathing may cause dogs to inhale foreign matter and develop pneumonia; stress from endurance running leads to stomach ulcers; and extreme prolonged exercise may cause muscles to break down.
I should emphasize that the vast majority of dogs that compete in the Iditarod do not suffer such serious consequences. (Although if 23 humans were to die in a dozen years during a similar sized sporting event, the event would certainly be banned.) However, the second paper points out that the stress of intense training may lead to stomach ulcers and reduced red blood cell counts in a much larger number of dogs.
[A]cute blood loss secondary to gastrointestinal tract bleeding was likely responsible for the decrease in [red blood cell count] associated with acute exercise. (J Am Vet Med Assoc 2008;232:873-878)
Some people believe that running dogs in the Iditarod constitutes cruelty. I am not ready to go that far. But these articles have certainly given me something to think about.
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06/10/08
The American Veterinary Medical Association (AVMA) is the leading veterinary organization in the United States. I have had my differences with the AVMA, particularly in the debate over horse slaughter. However, I owe it to the AVMA to acknowledge that they, in the long run, have done an incredible amount of work to advance the causes of animal health and welfare.
The AVMA publishes guidelines for veterinarians on a number of issues relating to animal welfare. Readers may be interested in a brochure that was recently released and targeted to veterinary students. It is a lengthy PDF document, but it gives insight into the guidance that the organization is offering to budding veterinarians.
Here is a link to the brochure (PDF format).
As you read it, remember that the leadership of the AVMA walks a tightrope when they publish such material. The AVMA does not merely represent dog and cat vets–its ranks include large numbers of dairy, swine, beef cattle, horse, and other livestock practitioners. Its membership is diverse and sometimes fractious. However, in my opinion the brochure does a good job of skirting controversy.
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06/06/08
Hi there,
Can you tell me the top reasons dogs and
cats have to visit the vet please?
Thanks.
Alison
Brighton, UK
As a veterinary family practitioner, I most commonly see patients for routine health checkups. That is a good thing, but I am guessing that you are interested in the most common health problems that trigger veterinary visits.
Although I don´t have personal quantitative data, I would say that for cats the most common medical problems I see are gastrointestinal upset/diarrhea, dental disease, urinary infections, respiratory infections, skin infections and allergies, kidney disease, thyroid disease and injuries from fighting with other cats.
For dogs (again, this is not quantitative), gastrointestinal upset and diarrhea are the leaders by a mile (that´s 1.6 kilometers if you live in the UK). These are followed by dental disease, urinary tract infections, ear infections, limping (usually caused by sprains and strains), skin infections and allergies, and minor trauma to the skin.
For those of you who prefer quantitative data, a major pet insurance company in the United States has published a list of the most common types of claims it receives for dogs and cats. A complete description of the findings can be found here. (Credit goes to Veterinary Pet Insurance, Inc.)
To summarize their findings, the top ten causes of claims for each species are listed below in order from one to ten.
Dogs: Ear infections, skin allergies, hot spots, stomach upset, intestinal inflammation/diarrhea, bladder disease, eye infections, arthritis, thyroid disease and sprains.
Cats: Urinary tract infections/disease, stomach upset, kidney disease, intestinal inflammation/diarrhea, skin allergies, diabetes, constipation, ear infections, respiratory infections and thyroid disease.
Here are my tips for preventing these problems. Feed a high quality diet. Practice home dental care (brush your pet´s teeth). Keep your pet free of parasites such as fleas and worms. Maintain your pet at a healthy weight. Do not allow your cat to go outside. And finally, take your pet to the vet for regular checkups to detect developing problems when they are at an early, treatable stage.
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06/01/08
You may be aware that the Supreme Court of the United States recently considered whether execution by lethal injection violates the constitution’s clause prohibiting cruel and unusual punishments (the court ruled that lethal injections are not unconstitutional). Veterinarians are notoriously apolitical and adverse to conflict, so it surprised me to find out that veterinary euthanasia guidelines had been cited in the arguments against lethal injection in humans.
A news story in the December 15, 2007 Journal of the American Veterinary Medical Association (JAVMA) brought the matter to the attention of veterinarians nationwide. The story sparked a frenzy of introspection among veterinarians, as well as a few letters to the editor of JAVMA. From the original article:
The high court agreed to hear the appeal of two Kentucky inmates suing the state over its three-drug lethal injection procedure, saying it causes unnecessary pain and suffering. Unwillingly caught up in the debate is the [American Veterinary Medical Association], whose Guidelines on Euthanasia are cited by lethal injection opponents arguing that even veterinarians won’t submit their animal patients to the same deadly cocktail used on condemned criminals.
The AVMA’s euthanasia guidelines were developed to help ensure that animals’ lives are ended in the kindest and most humane manner possible. And it is true that the drug cocktail used to execute criminals would, if used on a pet, violate the guidelines.
But I must confess that, like many veterinarians, I could live without the controversy. If I had wanted to get drawn into this debate, I would have become a lawyer.
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05/21/08
Most people are familiar with the massive pet food recall that occurred in 2007. The recall affected dozens of brands, and was linked to ingredients that were intentionally tainted with melamine (and unintentionally tainted with cyanuric acid due to shoddy melamine manufacturing) by human beings. The combination of ingredients sickened or killed a large number of pets.
Human-made chemicals aren’t the only contaminants that can be found in pet foods. In 2005-2006, a massive recall of Diamond brand dog food occurred due to contamination with a natural poison. That poison was aflatoxin.
Aflatoxin is created by fungus that grows on corn. Exposure to aflatoxin can lead to sudden liver failure.
A report in the May 1, 2008 issue of the Journal of the American Veterinary Medical Association discussed the symptoms, treatment, and outcome of dogs that ate contaminated food.
Different species have varying susceptiblity to aflatoxins, with dogs being highly susceptible . . . During late 2005, a serious foodborne aflatoxin contamination that was derived from moldy corn in manufactured dog food was recognized through collaborative efforts of regional New York State veterinarians and the College of Veterinary Medicine at Cornell University . . . Although product recall was rapidly announced, high rates of morbidity and mortality of dogs nevertheless was encountered in the United States.
The report goes into quite a bit of detail about the pathology that occurred in affected dogs. But the conclusion of the study was disheartening.
Despite aggressive treatment, many but not all severely affected dogs died.
For reference, the article cited in this entry is J Am Vet Med Assoc 2008;232:1329-1337.
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04/25/08
I believe B. F. Skinner was the first person to point out animals (including humans) respond more favorably to positive reinforcement than they do to punishment. In other words, if you want to train your dog, cat or spouse it is more effective to reward good behavior than to punish bad behavior.
A news item in the February 15, 2008 issue of the Journal of the American Veterinary Medical Association reinforces that notion. Here is an excerpt.
The American Veterinary Society of Animal Behavior has issued a position statement and guidelines on the use of punishment for dealing with behavior problems in animals.
The guidelines clarify that while punishment can be effective in specific contexts, it also has an association with many adverse effects.
The news item goes on to point out that punishment, as it is employed by most people, is ineffective. In fact, it can lead to increases in undesirable behaviors such as aggression. It can weaken the bond between the punisher and the punished, and it may cause animals to become generally fearful.
Many people punish their pets out of anger, do not use punishments consistently, or time punishments inappropriately. Unless you have training in animal behavior, it is unlikely that punishing your pet will bring about desirable behavior changes.
So there you have it. The next time you come home and find garbage strewn all over the house, resist the urge to yell at the dog. It might help you blow off steam, but it won’t keep your pet out of the trash in the future.
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04/14/08
A couple of years ago, Greenie chew treats inspired a great deal of controversy. Reports emerged that Greenies were lodging in the throats of dogs, sometimes with fatal consequences.
A recent report in the Journal of the American Veterinary Medical Association (JAVMA) studied 31 cases in which Greenies became lodged in dogs’ esophagi. Some of the findings of the study are outlined below.
Incidences of throat obstruction were rare. The manufacturer of Greenies reported sales of over 300 million units in 2005 alone. The researchers were able to identify 31 instances of esophageal obstruction between 2000 and 2006.
Small dogs were at dramatically increased risk of having Greenies lodge in their throats. They comprised approximately 84% of the cases.
The overall fatality rate among affected dogs was approximately 26%.
The authors also noted that removal of the chew treats, when possible, was often difficult and complicated.
So, what’s the good news? First, the problems occurred at a very low rate. And, in August of 2006 the manufacturers of Greenies changed the formula of the product. The new formula is more readily soluble (digestible), and therefore less likely to cause harm.
The article cited in this entry is J Am Vet Med Assoc 2008;232:1021-1025.
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03/30/08
Most of us are acutely aware that millions of unwanted dogs and cats face euthanasia each year in the United States. I was surprised, however, to find out that unwanted horses are alarmingly common as well.
I first became aware of the problem in 2006 when a representative from the American Veterinary Medical Association (AVMA) sent me a preposterous e-mail. The message urged me to oppose legislation that would close horse slaughterhouses in the United States. The quote below is from the e-mail.
Rep. John Sweeney (R-NY) today will offer an amendment . . . that will drastically harm the welfare of horses . . . [t]hese changes will affectively [sic] shutdown [sic] the horse slaughter plants and will force the estimated 70,000 unwanted horses to find a new home.
I had to read that e-mail four or five times before I could believe it. The AVMA was claiming that, if you are a horse, it is better to be slaughtered than to find a new home. I was furious. To me it looked like a leading organization, with a mission to protect the interests of veterinarians and animals in the USA, was shilling to industry.
I still believe that the AVMA was pandering to the horse slaughter industry when its representative sent that e-mail. Despite the AVMA’s opposition, a ban on horse slaughter in the USA was enacted.
And, alarmingly, it turns out that horse welfare may have been adversely affected by the ban.
The AVMA reported on January 15, 2008, that horse slaughter is now being outsourced to Mexico. The number of horses sent to Mexico for slaughter each year has increased from approximately 11,000 before the US slaughterhouses were closed to approximately 44,500 after. And, it is suspected that many horses that are sent to Mexico for “breeding” or “recreation” are also ending up in slaughterhouses. The conditions inside the slaughterhouses are not known. Most of the meat is exported to Europe.
I suspect that the problem of unwanted horses will be as intractable as that of unwanted dogs and cats. But I am not convinced that re-opening the American slaughterhouses is the solution.
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03/27/08
Being bitten or scratched by patients is an occupational hazard for veterinarians. In the United States, a veterinarian who is injured by a patient can not sue the animal’s owner.
Laws state that veterinarians have special knowledge of animal behavior and should be able independently to assess whether a pet is a threat. We have the right to refuse to treat an animal that we decide is hazardous. However, if we are injured by an animal that we have elected to treat, we cannot hold the owner liable.
A court ruling last fall set a precedent that will expand the group of people who are not able to seek damages from animal owners.
A kennel worker was mauled by a dog. She sued the owner of the dog. The court ruled that kennel workers, like veterinarians, have special knowledge of animal behavior. They therefore cannot hold owners of animals liable for injuries sustained while working. The ruling likely applies to all staff members at boarding, grooming, and veterinary facilities.
At first glance, this sounds like good news for people who have nervous pets that lash out at vets or groomers. However, the ruling may have a dark side for these animals.
First, the ruling allows injured animal workers to sue owners who do not disclose their pet’s previous aggressive or nervous behavior. In other words, if a pet has ever bitten or scratched a person and its owner does not disclose that fact, the owner can be sued.
As well, there is no doubt that America is a sue-happy place. Some day, a kennel worker will be bitten by a dog. He will start looking for someone to sue. He won’t be able to sue the dog’s owner, but he will be able to go after his boss. And he will probably win. After all, employers have a legal obligation to provide a safe workplace.
What could happen next is frightening. A combination of workplace safety laws, insurance company policies, and litigation precedents could make it impossible for veterinarians to treat any pet that anyone in the facility feels may be dangerous. In the worst-case scenario, nervous or nippy animals may not be able to receive any form of veterinary care whatsoever.
I hope that this scenario does not play out. But in the crazy world of the US legal system, I fear that anything is possible.
Due to the controversy that surrounds the terminology, I try to avoid using the words owner and guardian. However, this post deals with legal matters and litigation. Courts unambiguously and consistently use the word owner. I have followed that precedent in this post.
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