Giardia

Giardia
By Dr. Karen Burgess

giardia, parasites, feline

What exactly is Giardia?
Giardia is a parasite found in the intestine.   Unlike other intestinal worms, Giardia is a one celled organism better known as protozoa.  Animals coming from communal living situations (breeder, shelter, kennels)  are commonly diagnosed with giardia infection.

What are the signs of Giardia infection?
Animals that test positive for Giardia can range from having no symptoms to being critically ill, dehydrated and with profuse diarrhea.  Giardia found in adult animals showing no symptoms is not typically treated and is considered an insignificant finding.  Essentially the healthy immune system keeps Giardia numbers under control preventing illness.  It is often not even possible to clear Giardia from these pets.  Young animals or immunosuppressed pets testing positive for Giardia are an entirely different situation.  These pets are treated in an attempt to clear infection and avoid illness.

How do dogs and cats get Giardia?
Giardia is shed in fecal matter in the form of cysts.  When another dog swallows these cysts they travel to the intestine and after several stages of development become infective.

How is Giardia diagnosed?
A microscopic examination of fecal matter will typically demonstrate Giardia cysts.  Cell proteins of Giardia can also be tested for in the blood or feces via ELISA.  Giardia cysts are very small and can be difficult to visualize; submission of specimens to a reference laboratory is often the most reliable testing method.  Giardia cysts can be shed intermittently.  If diarrhea persists in a patient retesting for Giardia via ELISA of fecal may be recommended.

What is the treatment for Giardia?
Treatment for Giardia usually involves metronidazole, fenbendazole, or in more resistant situations a combination of the two.

How can Giardia be prevented?
Giardia is found frequently in the environment making prompt removal of fecal matter essential to control.  Cleaning surfaces with dilute bleach (one cup per gallon of water) and drying will also kill cysts that are highly resistant that can survive for years in cold moist environments.  Bathing at least once during treatment is also recommended to remove any cyst stuck to the fur.  Avoid taking an infected pet to swim or communal dog areas in an attempt to minimize exposure to others.

Can humans contract Giardia?
Humans do contract Giardia, but a different strain than animals.  There have been cases where pets have contracted human strain Giardia thus making it a zoonotic disease.  The risk of human infection from animal strain Giardia is considered rare if not impossible having never been reported.  This would be more of a risk for those that are immunocompromised.  Drinking contaminated water (fresh or tap) is a common source of exposure for people to human strain Giardia.  Care should be taken to avoid handling of fecal matter from infected pets.  Contact your physician with any specific questions regarding Giardia in humans.

 

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Muzzles

Muzzles
By Dr. Karen Burgess

 

What is the purpose of a muzzle?
Muzzles are typically used to protect people or objects from a dog or cat’s mouth, chewing, or biting.  While commonly associated with aggressive animals, muzzles are protective in nature, allowing a pet that might not normally be handled safely or into a particular environment more latitude.  Muzzles are particularly helpful when a pet is in a potentially painful or stressful situation and may unintentionally bite or harm a person.  In some jurisdictions certain dog breeds are required to be muzzled in public. 

Types of muzzles available
The two primary categories of muzzles are basket and nylon or tube type.  Several examples are shown below.  Things to consider when selecting a muzzle include

  • Sturdiness and security-it is essential for all involved that a muzzle stays in place and not slips off at an inopportune time.  An effective muzzle should also be able to withstand a pet pawing at it or trying to pull it over its head.
  • Ability to pant-dogs cool themselves off by panting.  If the mouth is held closed in particular for extended periods of time overheating can occur
  • Ability to see pet’s facial expression-visual cues clue us into our pet’s state of mind.  Some muzzles effectively block the ability to see a pet’s face.
  • Ability to drink or eat while muzzled-there is definite benefit to being able to still eat and drink while muzzled.  Treat rewards are often used to reward nervous pets and the ability to give these while wearing a muzzle is often beneficial

Specific styles/brands of muzzles

  • Baskerville Ultra Muzzle-basket style, rubber, third strap and collar loop, can feed treats through
  • Jafco Muzzle-basket style, clear version available, newer version can feed treats through, good for preventing licking wounds or eating foreign bodies
  • Wire or Cage Muzzles-can be more damaging if pet hits muzzle on objects or people
  • Leather Basket Muzzle-often used for security type work, more expensive, requires more maintenance to care for the leather
  • Tube type muzzles-leather preferable to nylon for restraint/protection, standard muzzle type used in veterinary medicine, safe and effective for short time periods only as mouth is held shut and panting prevented, care should be taken as some pets can still bite with tip of mouth that is not enclosed in the muzzle

How to properly fit a muzzle on your pet
Fit is often determined by the specific style of muzzle being used.  When fitting a muzzle ensure that a pet can open their mouth at least partially in a basket muzzle, that the complete nose is contained, and that the muzzle fits securely behind the neck.

Initial response to a muzzle
It is best to first desensitize a pet to being muzzled.  Some pets will become very passive muzzled, others will paw relentlessly at their face.  In the end, safety and prevention of self-trauma are both important.

How to desensitize to wearing a muzzle
Optimally a pet is first introduced to a muzzle in a non-fearful  and comfortable situation.  Initially let the pet explore the muzzle, sniffing  and investigating it, while providing treats to create a positive association.  After this, put some treats in the muzzle and have your pet eat them out of the muzzle.  Gradually put the treats farther in the muzzle forcing your pet to put their nose farther forward into the muzzle.  Next, after having put treats at the end of the muzzle, put the muzzle on for a few minutes but do not fasten it, pulling it off immediately and giving treats and verbal praise.  Finally, put the muzzle on as above and fasten it, gradually increasing the wearing time.  If you pet becomes anxious or distressed while muzzled back up in the training process until they are again calm.  Ultimately getting your pet used to thirty minutes in a muzzle should be the goal.  Avoid removing the muzzle if your pet is pawing at it as this can lead to further objection in the future.  Instead try and redirect them with verbal commands or a soft tug on a leash.

 

More detailed descriptions of muzzle training can be found at

Acepromazine (Promace)

Acepromazine
Promace
(Tranquilizer)
By Dr. Karen Burgess

Brand name and formulations

  • Promace and generic
  • Tablets, Injectable

What is acepromazine used for?
Acepromazine is used as a tranquilizer for dogs and cats.  The effects can be variable causing excessive sedation in some and no sedation in others. Another concern is that acepromazine has minimal effect on anxiety.  This would be similar to being afraid of snakes and then being put in a room with snakes just sleepy.  Acepromazine can also assist with motion sickness by decreasing nausea.

How is acepromazine given and what if a dose is missed?
Acepromazine is typically prescribed to be used as needed.  The effects of acepromazine can last anywhere from six to twelve hours.  A very conservative initial dose is typically prescribed with instructions to repeat dosing.

What side effects are associated with acepromazine?
Acepromazine may cause excessive sedation, abnormal gait (walking as if drunk, unstable on feet), and decreased blood pressure.  Elevation of the third eyelid is a common and normal occurrence with the use of acepromazine.

What patients should not take acepromazine?
Pets with liver disease, geriatric patients, and debilitated animals should use acepromazine cautiously.  Pets with MDR1 mutations (more common in herding breeds) may have prolonged effect from acepromazine.  Giant breeds, greyhounds, sight hounds, and Boxers also may be more sensitive.  Aggressive patients may become uninhibited while taking acepromazine leading to spontaneous aggression despite the appearance of being sedate.  Pets with a history of seizures should not use acepromazine.

What drugs should not be given with acepromazine?
Care should be taken when using acepromazine with other anesthetics, sedatives, or potentially depressing agents.  Antacids may affect absorption of acepromazine.  Do not use acepromazine with organophosphate insecticides.

Alprazolam (Xanax)

Alprazolam
Xanax
(Anti-Anxiety, Tranquilizer)
By Dr. Karen Burgess

Brand name and formulations

  • Xanax and generic
  • Tablets, Oral solution

What is alprazolam used for?
Alprazolam is used for the treatment of anxiety disorders.  It can also be used to assist with sedation, as a muscle relaxant, and as a tranquilizer.  Alprazolam is often used in treating panic disorders in pets.

What is alprazolam?
Alprazolam is a benzodiazepine similar to diazepam (valium) that acts in the brain to cause relaxation, anti-anxiety, and at times sedating effects.  Dependency is not considered a major concern in pets with the use of alprazolam.  Care should be taken in storing alprazolam as there is human abuse potential.

How is alprazolam given and what if a dose is missed?
Alprazolam is typically prescribed to be used on an as needed basis and is known for its ability to deal with immediate situations of anxiety (ex. Fourth of July, thunderstorms).  The maximum benefit from alprazolam is seen one to two hours after administration and the effects are short lived (four hours).

What side effects are associated with alprazolam?
Alprazolam may cause excessive sedation, abnormal gait (walking as if drunk, unstable on feet), and increased appetite.  Cats may become more irritable with the use of alprazolam.  Care should be taken using alprazolam in cats with liver value elevations.  Pets should be monitored initially as disinhibition may occur (alprazolam may allow for previously unseen aggression to demonstrate itself).

What drugs should not be given with alprazolam?
Do not give antacids within two hours of using alprazolam as absorption can be affected.  Use with caution in conjunction with other medications that cause central nervous system depression.  Drugs that are metabolized by the liver may delay alprazolam’s breakdown and lead to increased sedation.  Digoxin dosing may require adjustment while using alprazolam.

What follow up is necessary with alprazolam use?
Dosing may need to be adjusted based on results.

Gabapentin (Neurotin)

Gabapentin
Neurotin
(Pain medication)
By Dr. Karen Burgess 

Brand name and formulations

  • Neurontin and generic
  • Tablets, Capsules
  • DO NOT use human oral solution in pets as it contains xylitol (toxic in dogs)

What is gabapentin used for?
Gabapentin is used for the treatment of pain in dogs and cats.  While not good for sudden or acute pain, gabapentin is often prescribed to preempt pain or to treat general signs of chronic pain such as arthritis.  Gabapentin can also be used in the treatment of refractory seizures.

What is gabapentin?
Gabapentin’s method of action is not truly understood but it is believed to be related to blockage of pain directly at the nerve cell.

How is gabapentin given and what if a dose is missed?
Gabapentin is prescribed to be used typically every twelve hours but as often as every six hours.  Tolerance may develop over time necessitating dose increases.  The safe dose range is quite wide and therefore the latitude in dosing interval is wide.  If a dose is missed, go ahead and give the missed dose.  Use should not be abruptly stopped if gabapentin has been used for a long period.

What side effects are associated with gabapentin?
The most common side effect of gabapentin is drowsiness.  Some may notice ataxia similar to what is seen in inebriated individuals.  Often these signs will improve over time.  Urine testing for protein may be affected by gabapentin use.

What drugs should not be given with gabapentin?
Caution should be used when using gabapentin in conjunction morphine or hydrocodone.  Antacids may affect the absorption of gabapentin, allow two hours between use of these drugs simultaneously.

What pets should not take gabapentin?
Caution should be taken in using gabapentin in patients with kidney disease.

What follow up is necessary with gabapentin use?
Dosing is variable for gabapentin, if benefits are not observed at a particular dose, consult with Dr. Burgess for further recommendations.

Tramadol (Ultram)

Tramadol
Ultram
(Pain medication)
By Dr. Karen Burgess

 

Brand name and formulations

  • Ultram and generic
  • Tablets

What is tramadol used for?
Tramadol is used for the treatment of pain in dogs and cats.  It is also commonly prescribed after surgery and to treat general signs of arthritis.  Tramadol may also assist in cough management.

What is tramadol?
Tramadol is an opiate that blocks the sensation of pain centrally, or in the brain. Opiates are known for providing pain relief and euphoria but on the negative side, they can also lead to dependency, depression of the respiratory system and hallucinations.  Tramadol is more selective for receptors that tend to minimize these negative effects while still providing pain relief.  Similar to its close relative morphine, tramadol is a controlled substance and can have addictive tendencies in people.  This dependency issue is not considered a major issue in pets.  If children are in the household or any one with known addiction issues, extra care in the storing of tramadol location may be necessary (ex. locked safe).

How is tramadol given and what if a dose is missed?
Tramadol is prescribed to be used up to every six hours.  The safe dose range is quite wide and therefore the latitude in dosing interval.  If a dose is missed, go ahead and give the missed dose.  Use should not be abruptly stopped if tramadol has been used for a long period.

What side effects are associated with tramadol?
The most common side effect of tramadol is lethargy or depression.  Gastrointestinal side effects including vomiting, diarrhea, constipation, and loss of appetite may also occur.  Dilated pupils may also be noted.  Often these signs will improve over time.

What drugs should not be given with tramadol?
Caution should be used when using tramadol in conjunction with other medications that may cause depression such as antidepressants.  L-Deprenyl, SAMe, and amitraz should not be used along with tramadol.

What pets should not take tramadol?
Dogs with a history of seizures should be cautious in their use of tramadol.  Pets with liver or kidney disease may require lower doses.

What follow up is necessary with tramadol use?
Dosing is variable for tramadol, if benefits are not observed at a particular dose, consult with Dr. Burgess for further recommendations.

 

Mirtazapine (Remeron)

Mirtazapine
Remeron
(Appetite stimulant, anti-emetic)
By Dr. Karen Burgess

 

 Brand name and formulations

  • Remeron
  • Tablet, dissolvable tablet

What is Mirtazapine used for?
Mirtazapine is used to stimulate the appetite and prevent vomiting.

What is Mirtazapine?
Mirtazapine is a human antidepressant that works in the brain to increase norepinephrine and serotonin activity stimulating appetite centers in the brain as a side effect.

How is Mirtazapine given and what if a dose is missed?
Mirtazapine is typically prescribed for once daily dosing in dogs and a twice weekly dosing in cats.  If a dose is missed and it is less than 12 hours late, go ahead and give missed dose.  If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose.  If using dissolvable tablet formulation, place it under the tongue and hold mouth shut for several seconds.  Follow with a swallow of water.

Are there any common adverse effects with the use of Mirtazapine?
Reported side effects include increased vocalization and affection in cats, drowsiness, and elevated heart rate.

Who should not take Mirtazapine?
Use with caution in patients that have heart disease.  Patients with liver or kidney disease may require a lower dose.

What drugs should not be given with Mirtazapine?
Mirtazapine should not be used in pets that have taken selegiline or amitraz in the last fourteen days.  Use with care in patients taking tramadol or fluoxetine.

What follow up is necessary with Mirtazapine use?
Withdrawal signs with discontinuation of mirtazapine can occur in humans after longterm use.

Probiotics (Proviable)

Probiotics
(Proviable, FortiFlora)
By Dr. Karen Burgess

Brand name and formulations

  • Proviable-DC, FortiFlora
  • Capsule, paste, powder

What are probiotics used for?
Probiotics are used in the treatment of acute diarrhea associated with stress, change in diet, travel, and antibiotic usage.   There have been promising results seen also with the use of probiotics in the treatment of conditions causing chronic diarrhea.

What are probiotics?
Probiotics are good live bacteria or microorganisms that provide a health benefit to an animal.  They are considered live bacteria similar to those found naturally in the intestinal tract.  In cases of diarrhea, imbalance in the intestine occur often causing bad bacteria to outnumber good bacteria.  When given orally to pets, probiotics can help restore intestinal and overall health.  Prebiotics are also included in products such as Proviable and serve as food for the probiotics.

What is the difference between a product like Proviable and yogurt?
The bacteria found in yogurt is often not life or in the numbers necessary to help with diarrhea.

Is there a difference between probiotic products?
Yes.  Because probiotics are a nuetraceutical and not a drug therefore they are not regulated by anyone including the FDA.  This means that manufacturers can sell an inferior product with little to no live bacteria or benefit to a patient.  Proviable and FortiFlora are both produced by reliable companies and contain appropriate strains and numbers of bacteria.

How are probiotics given and what if a dose is missed?
Probiotics are typically prescribed for once daily dosing.  If a dose is missed and it is less than 12 hours late, go ahead and give missed dose.  If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose.  Use is typically continued for several days beyond resolution of symptoms at a minimum.  Probiotics are often nice for owners to have on hand to administer at the first sign of diarrhea or prior to a known stressful situation in hopes of prevention.

Are there any common adverse effects with the use of Probiotics?
No.

Who should not take probiotics?
Avoid use of probiotics in patients that are vomiting, severely dehydrated, or immunocompromised.

What drugs should not be given with probiotics?
Antibiotic efficacy can be affected by probiotics; separate administration times by two hours to avoid this as a concern.

Maropitant (Cerenia)

Maropitant
Cerenia
(Anti-nausea, motion sickness, anti-inflammatory)
By Dr. Karen Burgess 

cerenia, nausea, vomiting, grass eating

Brand name and formulations

  • Cerenia
  • Tablets and Injectable

What is Cerenia used for?
Cerenia is labeled for the treatment and prevention of vomiting and motion sickness.  Recently Cerenia has also been found to be effective in treating a variety of inflammatory diseases and in the management of pain.

What is Cerenia?
Cerenia works in the brain by blocking Substance P, a neurotransmitter involved in vomiting.  It also has some effect on small intestine contractions and inflammation peripherally.

How is Cerenia given and what if a dose is missed?
Cerenia is typically prescribed for once daily dosing.  If a dose is missed and it is less than 12 hours late, go ahead and give missed dose.  If it is within 12 hours of the next dose, skip a dose and resume regular schedule with next dose.  After use for five days a two day rest period is required before redosing Cerenia.  While giving with a small amount of food is recommended, avoid giving with treats that are fatty as this may affect efficacy.  Cerenia works on average within one hour of administration.

Are there any common adverse effects with the use of Cerenia?
Drooling, loss of appetite, diarrhea, and sedation may be seen at higher doses.   Pain at site of injection is seen in some patients.

Who should not take Cerenia?
Caution should be used in patients with liver disease or puppies younger than 11 weeks of age.

What drugs should not be given with Cerenia?
Side effects may be more common when used in conjunction with phenobarbital, thyroid hormone, and non-steroidal anti-inflammatories.

What follow up is necessary with Cerenia use?
No specific follow up is necessary with the use of Cerenia.

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Feliway (Cats Only)

Feliway  (Cats Only)
Synthetic Phermone
By Dr. Karen Burgess

Brand name and formulations

  • Feliway, Comfort Zone
  • Spray and electric diffuser (plug in device)

What is Feliway used for?
Feliway is used to help alleviate stress or tension and the resulting bad behavior that cats may experience in an environment.  Changes in the household, situations of inappropriate elimination, scratch marking, and addition of new pets or people are all acceptable uses for Feliway.  Many cat owners use Feliway to improve their cats overall attitude in particular with a multi-cat households.  An 86% success rate has been reported with the use of Feliway.

What is Feliway?
Cats produce a natural facial pheromone (chemical that relays a message, similar to a scent) that they use to mark their territory, in particular when they feel safe, calm, or “friendly”.  Feliway is a species specific synthetic version of this scent thereby only affecting cats.  By mimicking the cat’s natural scent it creates a sense of security or familiarity in what otherwise may be a novel, stressful, or uncomfortable situation.  As a side note, Feliway was developed by rubbing cotton balls on cat cheeks, thus no cats were harmed in the process.

How is Feliway spray used?
Clean any soiled areas in the case of inappropriate elimination with an appropriate pet stain eliminator avoiding overly strong smelling products (i.e. bleach, ammonia).  Test the Feliway spray on surfaces to ensure they will not be damaged.  Then spray affected areas daily for thirty days; do not stop even if improvement in behavior is seen.  Allow cats back into an environment fifteen minutes after application.  If trying to prevent damage to new furniture or items, apply daily to items for two weeks.  Application can also be discontinued if the cat is seen rubbing their head against the item.  If multiple cats are in the environment duration and frequency of application may need to be increased.  Never apply Feliway spray directly to a cat.

How is Feliway diffuser used?
The Feliway diffuser uses electrically produced warmth to dispense pheromone into an environment approximately 750 square feet in size.  Plug the diffuser into an outlet that is not obstructed vertically thus allowing appropriate circulation and avoiding damage to items such as furniture.  Use the diffuser in rooms being soiled or most commonly used by family cats.  Improvement in behavior may be noted quickly or take several weeks.  Use for a minimum of four weeks and keep plugged in twenty four hours daily.  The diffuser vial should be replaced when empty or at six weeks even if a small amount of liquid remains (normal for device even when “empty”).  The spray formulation should never be placed in the diffuser as it is alcohol based vs. the oil based diffuser formulation.  Replace the diffuser apparatus after 6 refills.

What other concerns may there be with Feliway?
Use of the diffuser in households with birds is discouraged.