You may have heard news stories in the past day or so about adverse reactions to oral flea and tick preventions for dogs and cats in the isoxazoline class of medications. This class of medication includes the medications Bravecto, Credelio, Nexgard, and Simparica. We routinely recommend using Nexgard and Simparica for our patients and continue to believe that the medications in this class of drugs are safe for the majority of pets so we wanted to go over a few things about these medications to hopefully address concerns you may have about using them.
All animal drugs that are approved by the FDA go through an extensive amount of safety testing prior to their approval. This includes testing safety of intentional overdoses of many times the labeled dose. In addition, manufacturers are required to report any potential or suspected adverse reactions after a product has been approved. The most frequently reported adverse reaction to this class of drugs is gastrointestinal upset (vomiting or diarrhea). As veterinarians, if we see a pet that we suspect may have had an adverse reaction to a drug, we report it to the manufacturer, who then reports it to the FDA. The FDA monitors these reports and if they feel a product is unsafe, they will revoke its approval. The FDA made this announcement to help pet owners and veterinarians be more aware of the potential side effects of this class of medications, not because they think the medication is unsafe. In fact, the potential for neurologic side effects is already listed as a known possible adverse reaction on the label.
We talked with Zoetis (the manufacturer of Simparica) after the FDA’s announcement to get some concrete numbers on the frequency of these adverse reactions. Currently, for Simparica, less than 0.01% of dogs taking this medication have experienced any neurologic side effects. The FDA considers this level to be “very rare”.
The isoxazoline class of drugs acts at receptors in the central nervous system of invertebrates like fleas and ticks. Dogs and cats have a barrier that protects these compounds from getting into their central nervous system (the blood-brain barrier). A very small percentage of dogs can have a mutation that allows some drug to cross this barrier, but even in those cases the receptor site that these drugs act on is rare to absent in most dogs. This mechanism has been known since prior to the approval of these products.
This announcement from the FDA also serves as a good reminder to obtain medications from your veterinarian or from a pharmacy associated with your veterinarian (such as Vets First Choice). Manufacturers do not sell to online pharmacies that are not associated with a veterinary practice. This means these online companies are not getting medications from the manufacturers but from another, unknown and unregulated source. The products you receive from an online pharmacy that is not associated with a veterinarian may be counterfeit, expired, or repackaged medications and are not backed by the manufacturers of these drugs in the event of an adverse reaction or disease (such as heartworm or lyme).
In summary, we continue to support the use of these medications to prevent fleas and ticks and their associated diseases. We all use this class of medication in our own dogs for flea and tick prevention. We are always happy to discuss any medications your pet is taking, including flea and tick preventatives.
To read the fact sheet published by the FDA for pet owners and veterinarians, please see the link below:
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The Doctors of Muddy Branch Veterinary Center
Many pets are stressed when they come to the veterinary clinic and it is understandable why they might feel this way. For most pets, the veterinary clinic is a strange place with weird smells, new people and unfamiliar sounds. Fear, anxiety, and stress affects all pets differently, but minimizing these three factors during veterinary visits results in a better experience for pets and their owners as well as faster healing time in sick or injured patients. It is not much fun for you or your pet to visit us if they are anxious while they are here and as animal lovers ourselves, we don’t like seeing pets frightened either.
This is why we are investing in Fear Free training for our staff. All of our doctors and several support staff members have completed certification as Fear Free Veterinary Professionals. This certification involves 9 hours of continuing education on recognizing, minimizing, and addressing fear, anxiety, and stress in our patients.
You may have noticed some of the changes we implemented already. We are utilizing treats more frequently to reward and distract patients during procedures that might otherwise be scary or uncomfortable. We are also adjusting our restraint techniques to help our patients be more comfortable during procedures while still keeping our staff safe. We installed pheromone diffusers in our exam rooms to help reduce stress in our patients. If your pet is very frightened during their visits, we may have discussed holding off on some procedures until the next visit or prescribing an anti-anxiety medication for your pet prior to their visit to help reduce their stress levels.
Some of the changes we are implementing are less obvious. We have started keeping track of what treats your pet enjoys in their medical record so we make sure we have them on hand during their visits. We are also recording the level of anxiety your pet has during their visit in their medical record so we can see if this level is changing over time. We are also recording what techniques for examining your pet work best – for example, some pets do much better being examined on the floor instead of the exam table.
We are excited to be working on making your pets’ visits to our clinic more enjoyable – please let us know if you have suggestions on changes that would make visits better for your pet!
Check out Fear Free Happy Homes to see what you can do to help your pet at home and prep for a stressful event!
Check out Fear Free Pets to learn more about Fear Free and what it can bring to the vet hospital. Hopefully it will give you an idea of why we are so excited to start this journey in growing our practice!
Emily Cornwell, DVM, PhD, CertAqV
My husband Matt, our dog Anya and I love to go on hiking adventures together, and I like to make sure Anya is safe in the car when we travel to the trailhead. When I first went out to purchase a car harness for her, I was overwhelmed by all the choices. Fortunately, there is an awesome independent website that tests car harnesses, crates, and carriers for safety and effectiveness in the case of an accident. It’s definitely worth checking them out – there are a lot of differences between different brands of harnesses and carriers and some are not effective at all in an accident. Check out the crash test videos on the website below:
Center for Pet Safety website
Anya has the Sleepypod Click-It Sport harness and she loves it. She can sit up or lay down in the back seat of our car and I can attach her leash and walk her while she is wearing it if I need to. However, I think any of the harnesses or carriers that pass the Center for Pet Safety’s crash testing are a great idea for your dog. I also really like Sleepypod’s mobile pet bed for cats. Not only does it keep your cat safe in the car, but at home you can zip off the top and use it as a bed for your cat. This can go a long way toward helping your cat be less anxious and frightened when they come to visit us too because you are transporting them in a place where they feel comfortable.
Emily Cornwell, DVM, PhD, CertAqV
Lyme disease is becoming increasingly common in our region and as many of you know it can be frustrating to treat in our dogs. The toughest part for us and for many veterinarians is how best to treat a dog that tests positive for Lyme antibodies on our 4DX heartworm test but isn’t showing any clinical signs (symptoms). Because Lyme antibodies can last for a long time, detecting antibodies doesn’t mean that there is actually disease that needs to be treated. It’s not only a pain to give twice daily antibiotics to your dog for a month when they are not necessary, it is also a good way to spread antibiotic resistance. There are sessions on this conundrum at every continuing education conference we go to with lots of varying opinions over the years!
Fortunately, the American College of Veterinary Internal Medicine recently published a consensus statement from a panel of experts in the field summarizing our current knowledge and providing recommendations going forward.
Veterinary medicine is an ever-evolving field – that is why we love it! Because of this new consensus statement, we are changing what we recommend for follow-up if your dog tests positive for Lyme antibodies on their annual 4DX heartworm test. If this occurs, we now recommend sending out a urinalysis to look for any evidence of protein in your dog’s urine since this can be a hidden sign of Lyme disease. As long as your dog does not have any protein in their urine and is showing no other signs of Lyme disease, no treatment is needed.
If you are worried about your dog’s risk of Lyme disease, any of our doctors are happy to discuss your pet’s individual lifestyle and risk. For all pets in this area, we recommend being on year round oral flea and tick prevention to help reduce the chance of Lyme disease as well as other tick-borne diseases. I have found ticks on my dog, Anya, in the middle of winter after walking her on a paved path around our neighborhood! For dogs that are at a higher risk based on their lifestyle, we also recommend vaccinating for Lyme disease.
Written by Emily Cornwell, DVM, PhD, CertAqV
Map from the Companion Animal Parasite Council showing the percentage of dogs in Maryland that have tested positive for Lyme disease so far this year. Dogs in Montgomery County are considered at a high risk of infection with 6.31% of dogs in our county testing positive for Lyme disease so far this year.
Last winter my husband, John, and I took an incredible trip to Hawaii (the Big Island and Kauai). While on a hike through a beautiful canyon on the Big Island, we found an abandoned dog that was severely dehydrated and exhausted. We carried him to the top of the canyon, and after searching (to no avail) for his owner, we took him to a local veterinarian to get some basic treatment, and found him a home. We have stayed in contact with his wonderful new owner, and he is doing wonderfully!
Upon realization that this had been the highlight of our incredible trip, we decided to base our next trip around giving back. My husband and I are going to Otovalo, Ecuador, where we’ll be volunteering with an organization called World Vets (worldvets.org). It’s a bit of a trek to get to Ecuador, with pretty much a day of traveling on either end, but we’re super excited for a variety of reasons. We will be working to improve the health and welfare of animals, which is an issue near and dear to our hearts, we absolutely love to travel, and we both love experiencing new cultures, languages, FOODS, and animals/people. We have a particular affinity in our travels for places that are volcanically active, so Ecuador fits right in! After a week of work in a clinic in Otovalo, we plan to explore in and around Quito, with (hopefully) a day hike at one of the nearby volcanoes. We look forward to sharing stories and pictures about our adventures, so stay tuned…
Written by Lisa Challberg, DVM, cVMA
Below are a couple of pictures of Neville the pup when he was found in Hawaii.
Have you ever wondered what your dog is thinking? I certainly wonder that, on a daily basis! I have learned a ton about basic dog behavior from my dog, Violet. Violet gets picked up from our house most days for a few hours of play with Sam (a lovely and incredibly dog savvy human) and a number of other dogs—an awesome service offered by Dog’s Day Farm. I was particularly intrigued when Sam sent me a video of Violet’s first meeting with a new dog to the group, Cherry (please see the first video at the bottom of the post). She is not acting aggressively or doing anything wrong, but wow! Violet’s tail is straight up in the air, WAGGING though, her hackles are raised slightly, and she is standing face to face with the other dog. From her body language, you can see that Violet is reacting slightly, and nervous about the new dog. Once you’ve watched the video, now watch the second video—in this one, she is completely relaxed and just wants to play. This has been a reminder to me that wagging tails are absolutely not always signs of friendliness, and it’s important to keep an eye on your dog’s comfort level-you are your dog’s advocate, so if something makes them uncomfortable, it’s your job to work on helping them actually feel more comfortable in that situation, not necessarily to respond in a way that you expect. Thanks for reading, and have a wonderful day!
Written by Lisa Challberg, DVM, cVMA