Sentinel and Comfortis Backorder

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Flea and Heartworm Prevention Backorder

Sentinel – and now Comfortis – have been on backorder for much of the year, causing flea and heartworm prevention to be a hot topic around our office. Our receptionists joke that they can now give an explanation of the industry situation and our doctors’ replacement recommendations in their sleep! While we were hopeful Sentinel would return in the next couple months, we recently learned that Novartis will not ship the product until some time in 2013. Respectively, Elanco is extending their backorder of big dog (40+ lbs) Comfortis for at least another month.

YOU’RE tired of this situation and WE’RE tired of this situation, so we’ve come up with an alternative solution. We will happily sell 6 or 12 months at a time of these new recommended products with equivalent ingredients so you do not have to continue to make a trip to our office every month – unless you want to! When Sentinel finally returns to the market, Dr. Flood will reassess our options and make a medical recommendation at that time to provide your pets the best protection against parasites. Thanks so much for hanging in there with us!

Our Current Best Recommendations

DOGS ON COMFORTIS

If your pet regularly gets Comfortis and Sentinel for flea and heartworm prevention; we are now recommending TRIFEXIS + PROGRAM.*

DOGS ON FRONTLINE

If your pet regularly gets Sentinel and Frontline for flea, heartworm, and tick prevention; we are now recommending HEARTGARD Plus + FRONTLINE Plus + PROGRAM.*

*Pets with conditions such as heartworm disease, food allergies, flea allergies, or medication intolerance should seek advice from our veterinarians before changing prescriptions.

CATS

We continue to recommend REVOLUTION for all cats. This product has not been affected by the recent backorders. 

What's the difference?

There are lots of flea and heartworm medications out there and new products are popping up on the market all of the time. We work hard to scour through all the options, researching efficacy, side effects, and safety. Just to give you an idea, some of the current popular drugs on the market include: ivemectin, milbemycin, moxidectin, imidacloprid, spinosad, fipronil, lufenuron, s-methoprene, cyphenothrin, pyrethrin…! We’re not expecting you to know the difference between all these medications (never mind pronouncing them); that’s our job! Our doctors research and recommend the best medications that keep your pet healthy and parasite free.

Buy local!

I could write an entire book on why purchasing medication directly from our hospital (as opposed to a national pharmacy) benefits all involved, but I’ll keep it simple. Purchasing medication directly from your veterinarian ensures your pet gets the right products, helps keep our fees for medical services affordable, and supports your local economy.  We TRULY appreciate your business!

Patient Care Plan while Under Construction

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You may have heard: we're expanding! We will begin knocking down walls between our hospital and the empty space next door (formerly Island Town Cafe) within the next couple weeks. We will remain fully operational during construction but will be doing things a little differently. The project will be completed this winter and we can't wait to show everyone around our new hospital!

Here's what you need to know when you visit our practice...

Checking In and Stopping By

  • Our receptionists will be in the building's shared lobby just to the right of our existing entrance. This is where you will drop by to pick up medication and food. (Please call ahead when food is needed, we will need a heads up to get it out of storage.)
  • Because this is a shared lobby, pets are not allowed in the space. When you arrive for an appointment or drop-off, a technician will meet you at the entrance and take your pet to our air conditioned mobile office across the parking lot. You can relax and talk to the doctor about your pet in our lobby.

Exams and Grooming

  • After you speak with the doctor, she will go to the mobile office to perform her exam. Unfortunately, clients are not allowed in the mobile office (zoning and liability) but we will make an extra effort to keep you up to date on what we are doing. You can chose to wait in the lobby or drop off and run some errands while we take care of your pet. 
  • Grooming appointments will meet at the entrance with Teri and Michelle. Teri will have her grooming table, wash tub (with heated water), and kennels set up in the mobile office just like she has in our hospital now!

Surgeries, Dentals, and X-Rays

  • We will continue to do anesthesia procedures and x-rays 4 days a week thanks to our friends at Veterinary Specialty Care and Charleston Veterinary Referral Center!
  • After you speak with your veterinarian and drop off for the day, the doctor and surgery technician will transport your pet (in our pet ambulance!) to one of our area specialty centers. Our medical team will be performing the procedures but we will be using the specialty center's space and equipment.
  • The doctor will give you a call mid-day with an update and time to pick-up back at our hospital.  

Expansion Details

  • The first phase of construction will be completed this fall and will allow us to move back into our operating room, radiology room, treatment area, and hospitalization ward.
  • The remainder of the project is scheduled to be completed this winter and include reception, exam rooms, grooming, and offices.
  • Our extra space will allow us to have...
    • An additional exam room (which will reduce wait times for appointments!) and be devoted specifically for cats.
    • A grooming area separate from our hospital ward.
    • A larger waiting area so everyone can spread out and cats can wait in peace!
    • A dental suite separate from our treatment area.
    • A quiet, private, comfortable area for consultations and euthanasias.
  • When finished, our entrances will be from the side courtyard and Seven Farms Drive. Parking will be available in the back of the building and street-side.
  • See pictures of our progress on our "News & Events" page!

We welcome any suggestions that you have and are happy to answer all of your questions! Stop by and see us this fall and look for an open house invitation when we're all finished!

Thanks to our construction partners Shook and Associates Architects, Suiter Construction, and First Citizens Bank!

The Skinny on Urinalysis

Many days in practice, I see clients with the following concern - “My cat is peeing everywhere” or “My dog has to go out 10 times a day!” Either the pet is urinating in the wrong place, urinating more than normal, or the urine looks abnormal.  These are symptoms of problems with the urinary tract, which includes the kidneys, ureters (tiny tubes that drain urine from the kidneys to the bladder), urinary bladder, and/or urethra.

Urinary problems are a big deal. Apart from skin and dental problems, urinary issues are one of the most common concerns of pet owners that come to our practice. Inappropriate urination is also a significant cause of surrender and/or euthanasia in pets. It can be an  incredibly difficult problem for people to manage – causing significant property damage and even worse, frustration with the issue can be very damaging to the human / animal bond.

There are 4 main reasons why pets urinate inappropriately:

  • Anatomic – young animals who inappropriately urinate may have developmental problems of the urinary tract that cause urine leakage (e.g. ectopic ureters)
  • Neurologic – damage to the nerves that control the process of urinating can lead to inappropriate urination for a number of different reasons (e.g. older female dogs with urinary sphincter mechanism incompetence or USME).
  • Disease- infectious, inflammatory, metabolic, endocrine and cancerous diseases can all affect the urinary system and cause inappropriate urination (e.g. bladder stones, diabetes, Cushing’s disease, transitional cell carcinoma, renal disease…)
  • Behavior – some pets may develop inappropriate urination habits secondary to poor early training (sometimes seenin older adopted dogs), territoriality, boredom, fear or even obsessive / compulsive types of problems.

An accurate diagnosis is critical to effective treatment when it comes to urine.  Remember, though tests may be a little costly, treating the wrong thing is ultimately even more expensive.  Imagine treating a behavior problem for several months when actually the problem was an infection that could have been treated with a single round of antibiotics!

For starters, ALL pets that present with inappropriate urination need to have a urinalysis. My vet school clinical pathology professor, Dr. George, used to call it a “liquid renal biopsy”.  There is a lot of information we can get from the urinalysis, which is comprised of three parts:

1) The test strip – this is a color based chemical test that looks for the presence of blood, white blood cells, glucose, protein, ketones, bilirubin (blood breakdown) and checks the pH.  Although not perfectly accurate, they are a good screening test for diseases such as urinary tract infections and diabetes mellitus, to name a couple.

2) The sediment exam – for this the urine is centrifuged, and the cells are examined under a microscope. This is a more sensitive test for the presence of blood, renal casts, fungal organisms and bacteria in the urine, and it also allows us to determine if there are urinary crystals, which can be an indicator of stone formation in the bladder.

3) The urinary specific gravity – This is a number, usually between 1.002 and 1.060, that essentially indicates the density of urine as compared to water. When there is an excess of water in the body, the kidney produces a diluted urine, and the specific gravity will be less than 1.008.  If not, then it produces a concentrated urine, which is indicated by a specific gravity of 1.025 or greater.  The specific gravity will change throughout the day depending on hydration. If the urine is in the middle range, neither concentrated nor dilute, it’s called isosthenuria. If the kidneys are only able to produce isosthenuric urine, it means that the kidneys have lost about 60 – 70% of their functional capability and the pet is in early renal failure. If we can detect renal failure early, before there are changes in the bloodwork, we have a much better chance of managing it successfully for a longer period of time.  If urine is isosthenuric the doctor will often ask you to submit a urine sample from the first morning urine, when it should be more concentrated.

The other test that can be very important in determining the cause of urinary problems is called a urine culture and antibiotic sensitivity. This is where we collect urine in a sterile manner, usually with a needle directly in to the bladder wall (cystocentesis). We then submit it to our reference laboratory, whose technicians apply the urine to a bacterial culture medium. Urine should normally be sterile, so if any bacteria grow, then that is a positive test for a bacterial urinary tract infection.  The lab then tests the bacteria against a number of commonly used antibiotics to determine which ones it is sensitive to so that we know the best antibiotic to use. False negatives can sometimes occur if the pet has been on antibiotics.

Once we have information from the preliminary urine tests, we may move on to secondary testing. For example, if test results indicate the possibility of stones in the bladder, urethra or kidneys, we may do an x-ray or ultrasound to look more closely.  Many other tests exist for following up on urinalysis and culture results that can help us make sure we make the right diagnosis and get the right treatment started for your pet.

I hope this helps give you an idea of how we look at the world of inappropriate urination in dogs and cats. If you have a pet that you suspect of a urinary problem, please bring him or her in for evaluation as soon as possible. If you can bring us some urine that is great, but our veterinary technicians and assistants are pro’s at obtaining urine, so if you can’t, don’t worry, we’ll catch it!

Keeping Our Pets Safe

We had a recent request for a blog about keeping pets safe on Daniel Island. This question is important because of the natural predator population on the island. The following hunting species are part of the natural beauty of our community:
— Alligator, Bobcat, Coyote, Eagle, Hawk

    We also have abundant raccoon, opossum and feral cats who would fight a cat for territory.  In 2009, a case of rabies in a raccoon from Daniel Island was confirmed; proof that the virus is present here. View the SC DHEC annual rabies report here.

    Other diseases carried by wildlife which can affect our pets are heartworms, intestinal parasites and Leptospirosis. The best way to avoid exposure to these diseases is to keep cats indoors and keep dogs on a leash and out of wildlife habitat areas. For more on the "Indoor Pet Initiative", check out The Ohio State University College of Veterinary Medicine website.

    This question is also timely with the recent Post and Courier news story about a pet cat on Daniel Island being trapped and moved off the island because a neighbor found the cat to be a nuisance.  Our neighbors may not be pet loving people, and it is in our pets’ best interest for us to prevent them coming into contact with people who do not appreciate their unselfish, loving companionship.

    On Daniel Island, we are in the city limits of Charleston proper.  Chapter 5 of the city’s municipal code states:

    “Every person owning or having possession, charge, care, custody, or control of any animal shall keep such animal exclusively upon his own premises; provided, however, that, any such animal may be off such premises if the animal is restrained by a chain or leash or other means of adequate physical control, provided, however, that, when any animal destroys or damages any property, attacks, threatens to attack, or interferes with any person in any manner, becomes a nuisance, or strays onto the private property of another, there shall be a presumption of law that the animal was not restrained by a chain or leash or other means of adequate physical control.”

    If a neighbor’s cat is a nuisance, and you wish to keep them off your property, I recommend a motion-activated sprinkler by Contech called the ScareCrow.  The sudden noise, movement and spray of water are humane ways of teaching animals of all types to avoid your landscaped areas.

     

    Behind the Scenes: Bailey's Day at the Dentist (video)

    One of our wonderful Golden Retriever patients, Bailey, stars in this montage to show you exactly what goes on behind the scenes at our hospital during your pet's routine dental cleaning under anesthesia.

    From start to finish you get to see it all! This includes intubation, a tooth extraction, and a little blood. Fair warning for those who get squeamish!

    Starring

    Bailey the Dog; Dr. Allison Chappell; Mara Acevedo, LVT; Erin Waldrop, Technician's Assistant; and Bailey's Mom!

    Litter Box 101 (pt 1)

    Here are some tips for setting up that all-important litter box and making it the place your cat wants to go:

    1. Provide a type of litter that your cat loves, preferably unscented. There are many litter choices, but most cats prefer clumping clay litter. To figure out your cat’s litter preference, offer different options in various litter boxes and retain the one that gets used the most.
    2. Scoop at least once a day — twice is better. Cats don’t appreciate dirty toilets. At least once a month (or weekly if it’s not a clumping-type litter), dump all the litter and wash the entire box with soap and water.
    3. Even if you have just one cat, you will need two boxes. Ideally, there should be one more box per household than the number of cats.
    4. It may be best to skip a litter box liner, as some cats don’t like the feel of the plastic and sharp cat claws can puncture the liner. Also, liners have a tendency to hinder box scooping with clumping litters.
    5. While some cats prefer covered litter boxes, most do not.
    6. Location matters. For example, litter boxes up or down a set of stairs might be a problem for older cats. Litter boxes near a loud appliance might be scary. Ideally, litter boxes should offer cats a view of what’s going on as they do their business, yet still provide some seclusion. Litter boxes should not be placed where children play, as there can be too much commotion for some cats. And when possible, keeping dogs away from the box is a good idea.
    7. Supersize the boxes. Big and overweight cats just don’t have enough elbow room in many of today’s boxes. Try a plastic storage container instead (the kind used to store sweaters under the bed). If the cat  is standing in the box but the urine ends up outside, try a plastic storage box with high sides. Just remember to cut out an opening (that isn’t sharp) so the cat can easily get in and out.
    8. Anxiety can play a role in cats missing the box. More than anything else, cats dislike change. The death of a pet, the addition of a new pet, or the owners going away on vacation can prompt a cat to miss the box. Give the offender a chance to blow off that stress by offering more interactive play and providing environmental enrichment. Another cause for anxiety may be the relationships in multi-pet homes. Cats can be surprisingly subtle about their disagreements. You may not see any overt catfights, but one cat may still be subtly preventing another from using the box in peace.

    How To: Brush Your Dog's Teeth (video)

    Dr. Rainwater and her dog, Zulie, demonstrate how to brush your pet's teeth. Just 1 minute, every day for healthy teeth and gums. You CAN do it!

    Tips

    1. Use a pet-specific, enzymatic toothpaste instead of a human toothpaste.
    2. Start with a fingerbrush and work your way up to a toothbrush.
    3. Create a routine to brush teeth before a meal or treat to reward the behavior.
    4. Start slow! Let your pet lick the toothpaste as a treat and brush a few front teeth.
    5. Brush each tooth and the gum line in a circular motion.
    6. Focus on the outsides of the teeth. (The tongue will clean the insides.)
    7. Make sure to brush all of the molars in the back of the mouth - they're easy to miss.

    From Your Pet’s Dentist

    An Introduction to the Canine and Feline Dental Treatment Process

    February is approaching, which the veterinary profession has designated “Dental Health Month” in primary care practices across the country.  Here at Daniel Island Animal Hospital, we want to put a special emphasis on the importance of dental care for your pets. In the next few blogs through the month of February, we will be addressing oral health and preventative care for dogs and cats.

    Like many of my clients, I grew up with many dogs and cats and we never paid much attention to their dental health. I couldn’t tell you whether they had dental tartar or not. If dental care came up, it was a reaction to horrible breath, not eating, or bleeding from the mouth. Since those days, the veterinary profession has come a long way in recognizing the importance of dental health to the well being of our canine and feline companions.

    What is dental disease?

    Dental disease in pets is no different from that found in people. It all starts with plaque bacteria that colonize the tooth surface just as they do in our mouths. Without regular bacterial removal by brushing or chewing, eventually the bacteria develop into a hard cement called calculus or tartar. This cement grows on itself, and eventually the constant presence of bacteria causes inflammation of the gums, known as gingivitis, also generally called periodontal disease.  If the inflammation and bacterial infection continue to progress, they cause the gums to pull away from the teeth, causing deep gingival pockets around the teeth. Eventually, the gums recede from the teeth and the infection proceeds to destruction of the bone that holds the teeth in place, eventually causing them to fall out. Gingivitis and periodontal disease are a significant source of discomfort for many pets, and there may be other potential health risks associated with a constant bacterial infection in the mouth.

    What’s involved in a “Dental”?

    Unfortunately, many pets, ESPECIALLY pets that have sensitive or painful mouths due to dental disease, don’t really let us get a good look around in their mouths during a routine visit, much less allow us to do anything about a problem that we may see. This is why veterinary practices have developed the basic protocol for what is called a dental prophylaxis treatment, often referred to as a “Dental” for short.  Although preventative care is implied in the name, the process usually involves both the prevention AND treatment of dental disease.

    If you think back to the last visit made to your dentist, hopefully you experienced a comprehensive evaluation of each tooth, measuring the gingival pockets, scraping away tartar, taking dental x-rays, doing treatments as needed, followed by thorough cleaning and polishing.  Your dentist should have also evaluated your mouth as a whole, including the gums and tissue of the insides of the cheeks, lips, hard palate, throat and tongue. The veterinary dental prophylaxis is no different – we have 30 (adult cats) to 42 (adult dogs) individual little tooth patients that need to be thoroughly evaluated and treated appropriately.

    Why is it so expensive?

    Unfortunately, our pet’s reluctance to voluntarily submit to a tooth-by-tooth evaluation makes anesthesia necessary for effective dental prophylaxis treatment.  Which leads to the biggest obstacle to pet dental prophylaxis treatment for most people - the cost.   Inhalant anesthesia, done properly with pre-anesthetic blood screening, appropriate premedication, temperature, circulatory, and respiratory system monitoring throughout the procedure (including ECG, blood pressure, carbon dioxide and tissue oxygen levels), intravenous fluid support, and post-anesthetic monitoring, adds a significant cost. However, it also adds a significant value to the procedure.

    Removing calculus when pets are awake, or even performing“sedation” dentistry, where animals are placed in a mild version of anesthesia and tartar is removed by hand, is unequivocally rejected by the members of the American Veterinary Dental College as being inadequate (see http://www.avdc.org/dentalscaling.html).  Removing the tartar you can see only addresses the visible part of the problem for pets with dental disease, but it doesn’t deal with the bacteria under the gum line, which is what leads to painful periodontal disease.  Unfortunately we just cannot safely and effectively remove tartar above and below the gum line, check for and treat periodontal disease, get full dental radiographs and thoroughly examine the mouth for other oral problems with an animal in an unpredictable state of sedation.  It’s unsafe for the patient, personnel and equipment and it is not providing the level of medical care that your pet deserves.

    Now I will be the last person to ingnore or underplay the risks of anesthesia. It is ALWAYS a risk, for any person or pet, to undergo. However, when all the necessary precautions are taken and it is carefully monitored, anesthesia carries a fairly low risk for even older pets with other underlying medical conditions. When compared to the increase in welfare that can be achieved by removing a constant source of inflammation and infection that is present in the mouth of pet with dental disease, it is usually a risk well worth taking.

    How do you “treat” dental disease?

    In general private practice, we rely on removal of plaque bacteria and calculus and topical and/or systemic antibiotic therapy to resolve most of the dental disease we see.  In cases where the disease is severe, especially if there has been significant bone loss or there is an abscess at the tooth root (which we can see with our digital radiographs), then dental extraction may be necessary.  Since our dogs and cats aren’t out chewing up carcasses to survive, the loss of teeth is generally well tolerated and a much better alternative to continued pain and disease.  In some cases however, advanced techniques such as periodontal surgery, root canals, crowns and even orthodontic treatments may be the best option for your pet. At this time, we refer cases such as these to a board certified veterinary dental specialist on an individual basis. 

    How can I prevent dental disease? 

    Once the teeth and gums have been evaluated, cleaned and treated, we move on to the most important step – taking care of your pet’s teeth at home.  Home dental care, especially brushing to remove plaque accumulation, is the best way to extend the amount of time between necessary dental prophylaxis treatments under anesthesia. It is so very critical to your pet’s well being, that it has become one of my preventative care soapboxes, as my clients will attest to ;-)! In an upcoming blog I will go step by step through the process of brushing my own dog’s teeth, cat dental care and give tips on how to work on getting them to accept it.

    Your job between now and then is to email us with ANY questions you have about dental care in your pets. In our final dental blog I will address any questions that come up directly, so that we can help all of you better take care of your pet’s teeth at home.