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Friday, February 25, 2011

Do I Really Need to Spend My Money on Preventatives???

Flea control.  Heartworm control.  Tick control.  Can you just feel the dollars being sucked out of your pocket by this billion dollar a year industry?

The average client will spend about $200 a year on flea control, and probably another $125-150 on heartworm control a year.  That's if you're doing things right and doing it every month as directed.  Call it $350 for maintenance. 

Does that freak you out?  Maybe something you want to avoid putting your well earned dollars towards?

Now....Think of it a different way. 

Let's say you decide NOT to spend money on these preventatives.  Let's look at what could happen.  Let's take it on a case by case basis.

"Arthur" is a male, 5 year old, Labrador Retriever around 75#'s.  He presented for hair loss and severe itchy skin.  Our exam finds him loaded with fleas and his skin has pustules and collarettes because he has created a secondary skin infection because he has been so self traumatizing.  We give him a steroid shot to calm his itch, start him on 6 weeks of oral antibiotics, prescribe a medicated shampoo for him to be bathed 2-3 times a week and send him home with Comfortis or Trifexis for flea control (only 2 that allow for bathing as they are oral).  Recheck at 3 weeks.  Antibiotics don't seem to be working.  We run a culture on a pustule and switch him to something more broad spectrum for an antibiotic.  We recheck him at 6 weeks and finally he is showing progress but 3 more weeks of antibiotic will be needed.  Recheck at 9 weeks and he is finally better and off of medication (except flea control). 

Total bill:  $782

Pretty easy math here......routine preventative would have cost $200/yr for flea control.  That's $582 MORE for a preventable problem and God only knows what value one could place on the TIME required here (visits to vet, bathing dog, doing medications twice daily, etc...).  Avoidable.  Easy to prevent with proper preventative protocols.

Next case:
"Beau Geste" a 4 year old Pitbull male neutered doggy.  Presents for coughing and exercise intolerance.  Chest xrays show right sided heart enlargement and tortorous pulmonary arteries.  Heartworm test is run and is POSITIVE.  An echocardiogram shows evidence of right sided heart failure, visible heartworms in the right ventricle.  A procedure is required with the cardiologist to remove the heartworms that are in the heart (can't kill these with medicine yet, because they will stop up the heart and cause sudden death).  Beau survives the procedure and 2 weeks later is started on an arsenic based medication to begin killing the other worms in his lungs.  3 treatments 2 weeks apart are started.  Beau must be kept very quiet so that he does not embolize the worms.  He is fortunate enough to survive the treatment. 

TOTAL BILL- $5245.00.  ($2500-3000 for cardiologist and his special procedure.... $2000-$2500 for diagnostics and treatment at our hospital).

Heartworm preventative- $90/yr.

I wasn't very good at math.... but prevention seems like a no brainer in these cases. 

We all want to save money.  This economy still hasn't seen the light of day...but I would urge all of you to use caution at what you skip when it comes to the care and well-being of your pets.

Doing flea control and heartworm control is not only good medicine for your pet.... it's just plain cheaper than dealing with the very likely poor outcome of not doing what is best.

I've even got better news! 

Comfortis (our favorite flea product) is now available as TRIFEXIS- a combo of Spinosad (active ingredient of Comfortis) with Milbemycin (long trusted and safe monthly heartworm preventative medication) ALL IN ONE once a month pill.  EVEN BETTER NEWS- total cost is only a few bucks MORE per year.  People who have done both Comfortis and Heartgard for instance stand to SAVE $90/year!!

I know it's tough.... and I actually stand to lose money if everyone follows my advice here.... it's actually good for business when people don't put their pets on preventatives.... but we truly want what is best for your pets!  Don't skip these simple preventative steps!

FINAL NOTE:  All flea and heartworm preventatives are only guaranteed against side effects when purchased through a veterinary clinic or through our online distributor Proxy.  For instance:  If your dog has a problem on the medication, you will receive a full refund and coverage for medical costs if it can be traced to the medications if purchased through us.  THIS IS NOT THE CASE WITH THE "ONLINE PHARMACIES" out there.... distributors refuse to work with them because often their products are counterfeit.

Call us for further information 858-272-6255!

Wednesday, December 22, 2010

Health Care and Vaccines for Your New Puppy

I am constantly asked what a new puppy should receive for health care.  I have summarized our protocol below....but do not forget the importance of the veterinarian's examination.  Examining a new puppy every 3-4 weeks through 4-6 months of age is crucial.  Just doing vaccines at the pet store or a vaccine clinic is just plain being cheap and risking your new family member's health. 

Here is our vaccine protocol for new puppies:

First question?  Was Mommy vaccinated?  If yes, puppy doesn't need to start vaccine until 8 weeks of age.  Maternal immunity should be fine until then AND often maternal immunity received from nursing will actually interfere with vaccines making them about as useful as an injection of saline.

Puppies with NO known history from mommy we will start as early as 6 weeks of age.

However, MOST puppies should start vaccines at 8 weeks of age. 

By vaccines, we mean the core vaccines.  The first, is the combination vaccine that is given to most puppies.  DHPP- Distemper, Hepatitis, Parainfluence and Parvo combo vaccine.  Bordetella and Rabies are the other CORE VACCINES.

The DHPP vaccine is given at 8 weeks and repeated every 3-4 weeks until the puppy reaches 16 weeks of age.  Some breeds such as Rottweilers and Dobies should receive vaccines through 18 weeks of age.  DHPP is then boostered at 1 year.

Next:  Bordetella, the vaccine for kennel cough.  We give the first one at 10-12 weeks.  Usually we give the intranasal version as the first version and then repeat the injectable 6 months later.  This vaccine does not last very long, so our recommendation is for it to be repeated every 6 months in San Diego.  ALSO- dogs can still get "kennel cough" even though they have had this vaccine.  The idea though, is to prevent a SEVERE CASE.  Most dogs who get kennel cough when having had the vaccine have a mild dry cough for a few days and don't spread the disease as readily.

The last of our CORE vaccines is rabies.  Rabies is given once anytime after 4 months of age.  The County of San Diego is pretty strict about this vaccine being given after 4 calendar months of age.  It is then boostered at 1 year.

OPTIONAL VACCINES:
CIV- Canine Influenca vaccine- we only recommend this vaccine for dogs who go to boarding facilities.  It is given once then repeated 3-4 weeks later as a booster, then annually.  We have not seen any cases in SD outside shelters or boarding facilities.....YET.  If something changes, we'll let you know. 

Leptospirosis- This used to be part of any standard vaccine protocol...it used to be part of the combination vaccine.  However, since the incidence is very low in San Diego and since it has a higher rate of vaccine reaction, we have stopped using it unless people need or want it.  Travel to Mexico warrants coverage.  It could re-emerge as a necessary thing to vaccinate against....but currently few cases are seen.  It is a zoonosis (meaning you can get it too!).

Lyme disease vaccine- Only recommended for dogs who see tons of outdoor hiking time and are constantly getting ticks.  Very low to zero incidence in San Diego.  Travelers to Appalachian regions should consider.

Corona- Unnecessary vaccine.  All puppies likely are exposed to corona virus at 2-3 weeks of age and create all the immunity they need on their own.  Don't let someone sell you on that one.  Just not necessary in our opinion.

Giardia vaccine- Unnecessary vaccine.  Off the market.  At one point, there was a paper that came out that showed it was lousy as a preventative but worked as a treatment.  I have used it as a treatment for bad giardia cases....but not for prevention.  Now that you can't get the vaccine....not even much to discuss.

Other stuff:
Fecal testing 2-3 times during the first 16 weeks of age.  Treatment for parasites as needed.
Starting flea control and heartworm control, done as early as 8-10 weeks of age!
Neuter and/or Spay at 4-6 months depending on breed.  Smaller dogs I recommend waiting until 6 months because they often don't lose all their baby teeth.  If they are still there at 6 months, we can do some simple extractions while they are out!

Best wishes on that new puppy!!!!  We're available at Pacific Beach Veterinary Clinic if you have questions!

Cheers!

Dr. Hooli

Friday, December 10, 2010

Wine and Musicals

Ok...so I have to add some personal stuff too!

My daughter Emily is performing for one more weekend this weekend at the JCC in La Jolla in the Musical "13" as the mean girl Lucy.  Check out the review!  Future Broadway star here folks!!!!  Hope you can see her....she rocks!  http://lajolla.patch.com/articles/bullies-and-bar-mitzvahs

I will be performing at the Star Theatre in Oceanside next week as Miss Hannigan in the musical "ANNIE"!  Yup...full drag kids!!!  I make her hot and sexy!  Come check it out.... hee hee....  Info:  http://www.startheatre.biz/.

Wines of the WEEK:
-2006 Coho, Cabernet Sauvignion.  Great price for what tastes like a more expensive wine (mid $30's at San Diego Wine Company).  Bargain for this fruit basket.  Buy some....yummy!
-ALSO:  Caymus 2008 is absolutely a huge fruitbomb.  It got a 93 in WS....but it is so much better than previous 93's over the last few years.  It is as good or better than some of the 95 WS ratings I've had lately....AND at $55 at SDWC....there has never been a better time to buy it!  $100 wines rarely taste this good.  Ruth Chris sizzling fillet, swirl it with this bad boy.... yeah baby!!!

Have a great weekend!

Dr. Hooli

Heartworm Disease in San Diego

Heartworm disease- Myth or Reality for dogs in San Diego?  Well folks, unfortunately it is a reality now....

Here's a little history on this issue in San Diego....

For years San Diego County was blessed to be Heartworm Disease FREE. 

In the 1980's, I was a teenager working in a practice in North Park, and we rarely recommended heartworm prevention except for dogs that traveled to certain parts of the country or to military family dogs who were frequently moving to other parts of the country and world.  Those were the good old days.

Returning to San Diego in 1999, I was at first shocked to see how many veterinarians were recommending Heartworm Preventative.  My cardiology mentor from UC Davis was vehement that heartworm disease was too rare in Southern CA to merit preventative.  Very few cases, most INCORRECTLY diagnosed by mistaking the microfilaria of heartworm with a similar non pathogenic larvae produced in the blood stream by fleas, were truly being diagnosed. 

So were veterinarians who recommended heartworm preventative at that time doing the right thing or just looking for further income production for their practice?  My response at the time?  I was ok recommending Preventative because it also helped prevent other issues....

Look at what else Heartworm Preventative does...kills heartworm larvae (duh!)... but it also kills other larvae from the common roundworm, hookworm and whipworm.  Those diseases are actually zoonotic!!  That fancy words means that YOU can get it from the animal.  Most adult dogs are commonly exposed and can shed the L3-4 stages in their spit, even if they generally never get adult worms.  Wanna big wet kiss from your dog now?   THAT was a good enough reason for me to recommend preventative....especially to people with little kids.

Fast forward to 2010- what changed?  Why do we now need Heartworm Preventative for our dogs?  No one is completely sure why heartworm disease is now appearing in San Diego sporadically but at a HIGHER INCIDENCE.  Mosquitos, the vector for heartworm larva spreading, are more prevalent in our area now than 20 years ago.  We all keep hearing about West Nile Virus....well, guess how that bugger gets transmitted.  Yup, Mr. Buzzing Suckmeister.  Some authorities have speculated that the El Nino with wetter weather over the last few years is to blame for the 'squiters.  Others blame the economy and increase in foreclosures....standing water in pots, swimming pools in houses without occupants.  I think we can blame our friends in Louisiana just a bit as well.  Following Hurricane Katrina, over 300 dogs from Hurricane ravaged areas made their way to California.  Heartworm disease is like the common cold in Louisiana!  I'm convinced not every one of those dogs was free of larvae, even if they tested negative for adult heartworm.  (BTW- the Heartworm Antigen Test only detects pregnant females heartworms....use that on Trivial Pursuit!).

Bing bang boom....not matter what is to blame....we've NOW got an issue....

The final straw for us here at Pacific Beach Veterinary Clinic?  Reports that the County Veterinary Office of San Diego has seen adult heartworm in necropsied/autopsied coyotoes.  Ugh....no one is giving the coyotes preventative!

So friends, the long answer opinion from this particular veterinary BLOGGER is that YES, your doggie should be on heartworm preventative here in San Diego.  It is cheap to prevent.  It is easy.  All you do is give them a once a month preventative treat nearly every dog loves to get.  Problem solved.

Did I mention it costs about $1200-1500 to treat a heartworm positive dog?  Did I mention many of their clinical signs are irreversible (pulmonary vessels NEVER are completely normal again after heartworm infestation!).  Did I mention we rarely diagnose it until they are sick? 

Veterinarians get it... prevention is best.  Not sure why those human insurance companies don't get that....another topic for another day!

More on which heartworm brands do what in a future posting!!!!

Take care my friends-

Yours in Blogging,

Dr. Hooli

Thursday, December 9, 2010

Dr. Hooli's New Blog!

Hi Everyone!

This is my NEW blog!

My name is Chris Hoolihan.  I am the owner of Pacific Beach Veterinary Clinic.  Please check out our PBVC website for further biographical info!!!  http://www.pbvetclinic.com/.

I'm hoping to provide cool veterinary info for our wonderful Pacific Beach Veterinary Clinic clientele as well as anyone peaking in!

Check it out regularly for fascinating tidbits.... most will be related to veterinary medicine...I especially love cardiology.  I'm a want to be cardiologist....so I'll probably be going on and on about doggy and kitty heart stuff.  BUT, I'll probably also add some real life/non-veterinary stuff in here as well.  I happen to LOVE good red wine....so regular wine reviews may appear.  I also love the theatre....so expect theatrical reviews.

UPCOMING BLOGS:  Heath and Wellness for Your Cat/Dog, Heartworm Disease- Myth or Must Do?, Wine Recommendations for December!

See you soon!

Chris