When national surveys are done, pharmacists continually rank high when it comes to trust, honesty and ethics. Whether it’s your pharmacy professional at the locally owned corner store or the one at the corporate big box store, this profession consistently out ranks doctors, engineers and even the clergy! Like veterinarians, pharmacists are viewed as compassionate and caring by the general public.
However, increasing numbers of news reports detailing mistakes made by human pharmacies dispensing pet medications has both professions concerned. In some cases, there was no noticeable effect and the pets were fine, but serious illnesses, severe complications and even deaths have occurred. How widespread is this issue?
Thankfully, in the vast majority of prescriptions sent to pharmacists from veterinarians, the dosage and medication is delivered as expected and the pet gets exactly what is needed. It’s only when drugs are changed, generics substituted or dosing altered that problems occur.
In a recent survey completed by the Oregon Veterinary Medical Association (OVMA), more than 1/3 of the veterinarians surveyed reported incidents of pharmacists from either retail or online pharmacies changing the prescription. In a highly publicized case from Los Angeles, an 8 year old Labrador was euthanized after the drug store altered the dose of a veterinarian’s prescription, changing the “cubic centimeters” (or “cc”) to teaspoons. This pet ended up receiving almost 4 times the amount of medication needed which compounded his other, already serious health issues.
In the Oregon survey, veterinarians also reported that insulin brands were changed, dosages for anti-seizure medications were altered and antibiotics substituted for chemotherapy drugs. Other news reports have shown that pet owners were told to give human pain relievers, such as Tylenol® or Ibuprofen®, to their pets. This seemingly harmless advice can lead to serious liver damage in dogs or even death in cats.
Executive Director of the OVMA, Mr. Glenn Kolb said that ““Together, veterinarians and pharmacists work hand in hand to meet the needs of the client and the best interests of the patient. The bad news is the rare occurrence when a pharmacy steps out of its scope of practice by making determinations and adjustments.”
Even the Food and Drug Administration (FDA) has taken notice. In a 2012 Consumer Update, the FDA mentions how veterinarians and pharmacists are taught different systems of medication dosing abbreviations, leading to confusion. In addition, transcription errors and product selection mistakes can lead to the wrong drug or the incorrect amount being given to your pet.
Both professions and the FDA are taking these reports very seriously. Carmen Catizone of the National Association Boards of Pharmacy says that pet owners “”primary concern should always be whether or not the pharmacist is knowledgeable in the area of veterinary medications” and cautions that price should be a secondary consideration when looking for pet or human drugs.
In the FDA alert, consumers are urged to ask questions of both the pharmacist and the veterinarian if your pet’s prescription is filled at an online or retail pharmacy. Glenn Kolb takes it one step further and flatly states that “veterinarians need to raise awareness among pet owners by telling them, “If a pharmacist suggests changing to a different drug or different dosage, please contact me right away.’”
Be familiar with your pet’s regular medications and take time to review any written prescription. If what you receive doesn’t match your expectations, do not give the drug and contact your veterinarian.
Veterinary experts also recommend that pet owners shopping for the best price on pet medications have an open conversation with their primary veterinarian. In many cases, the veterinary hospital will have the right medication available at a price that matches or is close to the online costs once you figure shipping and convenience. Plus, you get the added peace of mind that your veterinary team understands your pet’s unique needs.
Just like in human medicine, prescription errors happen with our pets too. The important thing to remember is that both your veterinarian and your local pharmacist are interested in what’s best for your four legged friend. More
Dental disease is the most common diagnosis veterinarians will make on any dog or cat over the age of one year. Despite a Pet Dental Health Month each February and constant reminders from veterinarians, some owners simply overlook or are unaware of what’s happening inside their pet’s mouth. But it is a real problem. Left untreated dental disease can lead to serious problems like heart or kidney disease, not to mention the horrible bad breath!
Even pet owners who do routinely try to brush their pets’ teeth or look at the mouth can be fooled. A study in the American Journal of Veterinary Research found that almost 30% of dogs and more than 40% of cats whose mouths were clinically normal actually had significant problems under the gumline. In addition, if the pet had visible dental problems, veterinary dentists found additional pathology more than 50% of the time using dental X-rays.
Some very serious problems can be found under the gumline. Root abscesses, fractures, jaw bone loss and even cancer often aren’t apparent with a visual examination. Dental x-rays (radiographs) are needed to find and successfully treat these painful and significant issues.
The use of radiology for veterinary patients is not new. Just like human dentists, veterinary dentists have long had the ability to use x-ray film and dental radiographic machines. However, long delays in getting the right shot and developing the film meant that dogs and cats were under anesthesia for long periods of time.
Fast forward to today and we see a great leap in technology. New digital sensors are replacing dental x-ray film and hand-held dental x-ray units are being used instead of large, wall mounted or floor units. Images are captured by computer using very special software instead of saving and filing lots of film.
The benefit to all of this is that skilled veterinary dentists and technicians are now able to get a set of full mouth radiographs in less than 15 minutes. That means less time under anesthesia for your pet and better imaging for diagnosis and treatment of problems in the mouth or around the teeth and roots. It also means that problems in your pet’s mouth can be found more easily and treatment started sooner.
Using sophisticated software, veterinarians can manipulate these images to look at a tooth or root in great detail or magnify a suspected lesion. If your veterinarian is using digital dental x-rays, areas of concern can be saved and even sent via email to a board certified veterinary dentist for review.
For some pet owners, the thought of having their four legged companion anesthetized for this is troublesome. But, it is important to remember that our pets will NOT hold still while someone tries to place a sensor in their mouth or position their head in exactly the correct position. Further, if a diseased tooth is found that needs extraction or a root canal, the pet is already for the procedure.
It is important to remember that most of the pet’s teeth and the problems they have are under the gumline where it can’t be seen in an awake animal. Mis-leading marketing campaigns try to tell you that non-anesthetic pet dental scaling is best. But experts and veterinary dentists highly discourage all pet owners from falling for these scams. Anesthesia is entirely necessary for proper evaluation of the pet’s mouth and for a a complete cleaning or even looking deeper should a serious problem be hidden.
Your veterinarian can help you understand that good oral care for your pets is more than scraping off tarter. Proper dental care is good imaging, complete cleanings and then treatment and correction of the underlying problems. And don’t forget, your help is then needed to provide the right type of at-home care, such as daily brushing. More
From simple heartworm tests to complex, multi-parameter chemistry profiles, blood screenings are a vital tool in your veterinarian’s arsenal for finding and treating many different diseases. Whether your pet is in the hospital because he is sick or because she needs surgery, many veterinary clinics can now decide what lab work is needed and run those tests immediately.
Not only is this type of diagnostic assessment helpful with sick pets, but our healthy animals are benefiting as well. Early signs of many different illnesses will first show up in a blood profile, long before any outward, clinical symptoms are seen.
Historically, veterinarians have used large reference laboratories to process their patients’ samples, but in recent years, counter top and “point of care” instruments have surged in popularity. One main reason is that veterinarians can now have answers to your pet’s problems in minutes, rather than hours. That, of course, helps the doctor make crucial medical decisions and possibly start treatment earlier.
Another reason for the success of in house blood analyzers is that the sophisticated automation and equipment have helped minimize errors that plagued early attempts. Companies like Heska, Abaxis, Idexx and others have developed compact devices that use patented technology and modern optical scanners to reliably provide results in urgent situations.
So, now that your veterinarian can do these tests in the clinic, what exactly is he or she looking for?
Whether your pet is sick, needs some sort of anesthetic procedure or maybe just a senior check up, the most common set of blood work will involve a complete blood count (CBC) and a chemistry profile. Depending on symptoms and the patient’s overall status, the chemistry panel may just cover a few key parameters or it may be all inclusive.
CBCs are a measure of the different types and numbers of cells in the blood. Patients who have too few red blood cells are considered anemic and may have difficulty delivering precious oxygen to the body’s tissues. White blood cells are the microbial defenders of the pet. These soldier cells patrol the body and attack invading bacteria, viruses and other foreign organisms. When a CBC shows a high white count, your veterinarian may be concerned about some sort of active infection. Conversely, low white blood cell counts could mean the cells are depleted from a chronic infection or, in the case of puppies and kittens, could be a sign of a parvovirus.
Chemistry panels will look at key enzymes and metabolic products to determine the health of internal organs. Everyone understands that a high glucose level on a chemistry panel probably indicates a diabetic animal, but less well known are indicators like Alkaline Phosphatase (ALP), Blood Urea Nitrogen (BUN), Creatinine and about two dozen others. Veterinarians can identify kidney disease, liver disease and many issues, including some cancers, from these key components of a pet’s blood work.
Combined with the pet’s symptoms, environment and other factors, your pet’s doctor will use the results of blood work run in their clinic to give you an accurate diagnosis. When you get the results, avoid the temptation to consult Dr.Google. It is possible to find some good information, however, without a complete picture, some well meaning, but un-informed individuals online may lead you to question your veterinarian’s findings.
It’s important to know that some specific or special testing will still need to be sent to reference laboratories. In either case, diagnostic blood work is a powerful tool to help your veterinarian take the best possible care of your pet. That gives you peace of mind and a better understanding of your pet’s health and provides vital information for any future medical needs. More
According to data from the IMS Institute for Healthcare Informatics, consumers in the US spent almost $4 billion on retail prescriptions in 2010 and a large portion of that business was in the form of generic medications. Generics now make up more than 80% of all prescriptions filled at human pharmacies. In addition, pet owners are now asking about generic alternatives for their animals.
So, what is a generic drug and are there concerns about using them for our four legged family members?
Drugs that contain the same active ingredient as a brand name medication are known as generics. These products become available after a pharmaceutical company loses their patent protection on the specific drug molecule. Since the necessary clinical testing that is so important for new drugs does not need to be repeated for generics, these medications are sold at a much lower cost. In addition, many consumers are already familiar with the drug and advertising costs can be greatly reduced.
Medicines that are brought to market as generics must contain the same active ingredients, have the same route of administration, same dosage or strength and the same conditions of use. But, many people still have serious worries about how well these medications perform or their overall safety. News reports about poor manufacturing standards and contaminated ingredients have raised alarm in the minds of many individuals.
However, the FDA has an extensive overview process that not only creates a system for evaluating quality standards for manufacturing, but also significant testing to show that the drug performs just like the original product. This assessment of the generic’s performance is known as proving bioequivalence.
Still, it is important to remember that all people, and pets, are individuals and there is always the possibility that a unique response can occur to either the original drug or the generic equivalent. In addition, inert ingredients used in the manufacturing of the generic product may differ from the brand name. This could also lead to abnormal or adverse reactions to the medication.
Knowing all of this, does it make sense for pet owners to spend extra time at a retail pharmacy picking up pet medications or parasite preventives?
First and foremost, it is important to understand that your veterinarian is crucial to answering that question. A physical examination of the pet and a veterinarian/client/patient relationship are necessary in order for the veterinarian to write any prescription. In other words, don’t expect to get a prescription if your pet hasn’t seen their doctor in more than a year.
Next, lab work is often needed to keep your veterinarian up-to-date on your pet’s health status and to monitor any disease process. For medications like heartworm preventives, it is vital that your dog have a negative heartworm test before continuing the medicine.
Finally, with many brands and alternatives on the market, it’s easy to become confused about the exact product that your pet requires. Your veterinarian and his or her team can help you find the one that matches the medical needs of your pet as well as one that is safe and effective.
Be wary of online websites that promise absurdly low prices on pet medications. Far too often, these are simply scams designed to take your money.
Many veterinarians keep a well-stocked pharmacy right in their hospital or allow their clients to order drugs online. Getting the medications directly from your veterinarian could save you time and hassle. But, in either case, your veterinarian will want to help you get the right drugs at a price that fits in your budget. That is their commitment to you as their trusted client. More
Human athletes have long understood the benefits of physical therapy when trying to recuperate from an illness or surgery. After all, their goal is to get back in the game as soon as possible. Many pet owners want the same thing and have found that physical medicine and rehabilitation may provide the help they need.
Veterinarians can either offer physical medicine in their hospital, or can refer you to a facility that does, and the benefits are remarkable. Dr. Jacqueline Davidson, a veterinary surgeon at Texas A & M University’s College of Veterinary Medicine says “Animals that have had orthopedic or neurologic surgery are often seen for rehabilitation. But even pets who need to lose some weight, those who suffer from arthritis or who just need some conditioning can benefit from this sort of therapy.”
The goal of physical rehabilitation is not only to restore the natural function of the pet, but to attempt to bring the patient back to a pre-injury state.
Veterinarians and technicians who practice physical medicine use a wide variety of methods and technologies to help their patients. In many surgical cases, the pet needs to rebuild strength in muscles that have weakened from lack of use. In a case like this, carefully controlled exercises under the guidance of a trained professional can help the animal make great strides. Pets can learn to use a treadmill or even use balance balls and wobble boards to help strengthen those de-conditioned muscles.
By far one of the most popular therapies for pets is the underwater treadmill. These devices are especially helpful for overweight or older animals. The buoyancy of the water helps to lessen the weight bearing impact on the joints and make it easier for the pet to build up strength and endurance. Hydrotherapy and swimming are other popular rehabilitation options.
Other popular modalities use heat and cold carefully delivered to the tissues. Something as simple as heat packs can increase blood flow and help the joint’s range of motion in that area. After a therapy session cold packs, can be used to minimize inflammation.
Common therapies include coordination exercises, such as weaving through cones or walking over hurdles, strength building routines, like uphill or downhill walking (often on a treadmill) and even medical massage, trigger point release and passive range of motion exercises. A real benefit here is that many of these therapies can be learned by the pet’s owner and applied regularly at home.
There are also many high tech modalities that veterinarians are now trying in a variety of cases. Therapeutic ultrasound and low-level lasers both deliver heat deep in the tissues. Along with medications, electrical nerve stimulation can be used to block or ease pain.
Rehabilitation in animals is very specialized. There are certifications for dogs, cats and horses. An important thing to remember when searching for a rehabilitator is that any therapies applied should be performed or overseen by a licensed veterinarian. Physical rehabilitation done by someone who does not understand the subtle signs of animal pain or have a global view of veterinary medicine can actually do much more harm than good.
Many veterinary rehabilitators have undergone outstanding additional education and can become certified in the use of these treatments. Look for Certified Canine Rehabilitation Practitioners (CCRP), Certified Canine Rehabilitation Therapists (CCRT) or Certified Canine Rehabilitation Assistants (CCRA). For horses look for the Certified Equine Rehabilitation Practitioner (CERP). Ask your veterinarian for help finding a certified practitioner in your area. More