Isoxazoline FDA Communication

On September 20, 2018, the FDA issued an Animal Drug Safety Communication to alert pet owners and veterinarians about the potential for neurologic adverse events in dogs and cats treated with drugs in the isoxazoline class. The FDA is working with the manufacturers of Bravecto, Nexgard, Simparica and Credelio, all flea and tick products within the isoxazoline class, to include new label information to highlight the potential for neurologic adverse events including muscle tremors, ataxia and seizures, because these events were consistently seen across the isoxazoline class. The FDA reports it “carefully reviewed studies and other data on Bravecto, Credelio, Nexgard and Simparica prior to approval, and these products continue to be safe and effective for the majority of animals”. The label changes to highlight the potential for neurologic adverse reactions are requested to allow pet owners and veterinarians to make treatment decisions for each pet on an individual basis. The potential for adverse neurologic reactions has been identified on package inserts from all companies since approval of the products by the FDA. Many current news articles and posts regarding this FDA communication are presenting these risks as new information or these products as dangerous. Please read the FDA announcement. The information is not new. The request is to highlight the risks. All products remain fully FDA approved and are considered by the FDA to be both safe and effective for the majority of pets. As with any product, if a particular pet has a medical condition rendering him or her more susceptible to an adverse reaction or if a pet simply has an adverse reaction, that pet should receive alternative options. Fleas and ticks are not simply nuisances. They are vectors of disease for both our patients and ourselves. Failure to adequately control fleas and ticks can have devastating health consequences for both ourselves and our pets. The takeaway from the FDA communication is highlighting a known and acknowledged risk, not abandonment of a class of drugs which has offered many of us a safe and effective way to protect our pets and ourselves.

The safety information below is copied verbatim from each company’s website homepage.

From the Bravecto website: [https://us.bravecto.com]
IMPORTANT SAFETY INFORMATION:
Bravecto has not been shown to be effective for 12-weeks’ duration in puppies or kittens less than 6 months of age. Bravecto Chew: The most common adverse reactions recorded in clinical trials were vomiting, decreased appetite, diarrhea, lethargy, polydipsia, and flatulence. Bravecto is not effective against lone star ticks beyond 8 weeks of dosing. Bravecto Topical Solution for Dogs: The most common adverse reactions recorded in clinical trials were vomiting, hair loss, diarrhea, lethargy, decreased appetite, and moist dermatitis/rash. Bravecto is not effective against lone star ticks beyond 8 weeks of dosing. For topical use only. Avoid oral ingestion. Use caution in dogs with a history of seizures. Seizures have been reported in dogs receiving fluralaner, even in dogs without a history of seizures. Bravecto Topical Solution for Cats: The most common adverse reactions recorded in clinical trials were vomiting, itching, diarrhea, hair loss, decreased appetite, lethargy, and scabs/ulcerated lesions. Bravecto is not effective against American dog ticks beyond 8 weeks of dosing. For topical use only. Avoid oral ingestion. The safety of Bravecto has not been established in breeding, pregnant and lactating cats. Use with caution in cats with a history of neurologic abnormalities. Neurologic abnormalities have been reported in cats receiving Bravecto, even in cats without a history of neurologic abnormalities.

From the Simparica website: [https://www.simparica.com]
IMPORTANT SAFETY INFORMATION:
Simparica is for use only in dogs, 6 months of age and older. Simparica may cause abnormal neurologic signs such as tremors, unsteadiness, and/or seizures. Simparica has not been evaluated in dogs that are pregnant, breeding or lactating. Simparica has been safely used in dogs treated with commonly prescribed vaccines, parasiticides and other medications. The most frequently reported adverse reactions were vomiting and diarrhea. See full Prescribing Information.

From the Credelio website: [https://www.credelio.com]
IMPORTANT SAFETY INFORMATION FOR CREDELIO
The safe use of Credelio in breeding, pregnant or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures. The most frequently reported adverse reactions are weight loss, elevated blood urea nitrogen, excessive urination, and diarrhea. See package insert for full safety information.

From the Nexgard website: [https://nexgardfordogs.com/Pages/About.aspx]
IMPORTANT SAFETY INFORMATION:
Reported side effects include vomiting, itching, diarrhea, lethargy and lack of appetite. The safe use of NexGard in pregnant, breeding or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures. See your veterinarian for more information.

FDA Communication:
Animal Drug Safety Communication: FDA Alerts Pet Owners and Veterinarians About Potential for Neurologic Adverse Events Associated with Certain Flea and Tick Products

Tick Season Is Upon Us

– 2018 Maine Tick Outlook –

Maine has become well known for it’s tick population. Every year we see an increase in the coastal areas and watch the number of cases of Lyme Disease rise. Dog ticks and Deer ticks are the most prevalent in our state. Dog ticks do not typically carry harmful pathogens but they are a nuisance and cause discomfort for us and our furry friends. The Deer tick is the main culprit in carrying diseases that harm. Marshlands like those in Scarborough, heavily wooded coastal areas like Bath/Brunswick and the lake regions like those in Casco and Fryeburg are the most common habitats. But don’t be fooled! Any cool, dry wooded area can be host to these creatures.

Many believe that the deep freeze we had in January would help control the tick population. Ticks will hide under blankets of snow to remain warm and overwinter. Since we had a nice blanket of snow before the deep freeze, most survived. We at Mosquito Squad of Southern Maine have already heard from many of our customers that they found ticks on their dogs after walking them during the thaw. This is a clear sign that spring will bring another year of tick issues.

In New England, watch out for Male & Female blacklegged (deer) ticks as temperatures rise. Tick activity will increase towards the end of March and especially in April.

It is best to treat for ticks in the spring and fall during their hatching period. We treat during April/May and September/October to achieve the greatest effectiveness. Mosquito Squad of Southern Maine treats with two different methods. We have a proven track record of controlling the tick population. Treatments must be designed to be effective for every life stage of the tick. Many treatments only kill the adult ticks. While effective in controlling numbers, many times doctors and the Center for Disease Control find that the nymph stage Deer tick is the most common culprit in the spread of Lyme Disease. It is a common misconception that the Deer tick needs to feed on deer. Most times, the nymph stage tick is carried on to the property by a mouse or squirrel. The Lyme spirochete is spread from the white field mouse to humans and animals.

As the old adage goes, an ounce of protection is worth more that a pound of cure.

Source: https://somaine.mosquitosquad.com/blogs/2018/3/13/2018-maine-tick-outlook/

Xylitol -The Sugar Substitute Which Can Kill Dogs

by John Gilpatrick

Dog owners know the dangers that foods like chocolate, garlic, onions, and grapes pose to their canine companions’ health; foods that are harmless to most people.

Another common substance that’s harmless to most humans but potentially life-threatening if consumed by dogs is xylitol—a sugar alcohol that is used as a sugar substitute in many human foods.

But for dogs, xylitol poisoning is a major problem, according to Ahna Brutlag, DVM, associate director of veterinary services at Pet Poison Helpline. Brutlag says ingesting xylitol causes a rapid and massive insulin release in dogs, which will manifest itself outwardly to a pet owner as acute weakness, staggering, and vomiting. “Within 15 to 20 minutes, they might even be comatose,” she adds, and depending on the amount consumed, a dog can also experience liver failure from ingesting xylitol.

According to the Poison Pet Helpline, cases involving xylitol ingestion are increasing rapidly. In 2009, they were consulted on approximately 300 cases, while in 2015, that number increased to 2,800. Read on for more about what foods xylitol is found in to learn why these cases are multiplying and what you can do to respond appropriately if it happens to your dog.

Xylitol in Gum

If a gum is labeled as sugar-free, that should be a warning sign for xylitol, though various gums can have vastly different amounts of xylitol. “One or two pieces of certain gums can cause serious problems, while ingesting ten pieces of another gum can be fine for your dog,” Brutlag says. “It all depends on the xylitol dosage.”

Some gums—like Spry—plainly advertise themselves as containing xylitol because it’s good for your teeth and for diabetics. Meghan Harmon, DVM, is a clinical instructor for emergency and critical care at the University of Missouri College of Veterinary Medicine. She co-authored a 2015 study in the Journal of Veterinary and Emergency Care that retroactively evaluated cases of xylitol ingestion in nearly 200 canines. She lists Stride, Trident, and Orbitz as other gums containing differing amounts of xylitol and echoes Brutlag, saying it’s critically important to know what kind of gum was ingested, how much your pet has ingested, and how long it’s been since he or she ingested it in order to appropriately treat the problem.

“Most dogs we looked at were hospitalized, usually for about 18 hours,” she says. Dextrose is typically administered as quickly as possible in order to bring the canine’s blood sugar up. Harmon says that as long as liver health appears normal, once they regain the ability to regulate their blood sugar levels by themselves, dogs are weaned off the dextrose and eventually released.

Xylitol in Mouthwash and Toothpaste

While not usually containing the same levels of xylitol as gum, dental health products tend to use this sugar substitute because of its appealing, sweet taste and its teeth-strengthening, plaque-fighting properties.

The Pet Poison Helpline cites gum as the source of nearly 80% of cases involving xylitol. While gum manufacturers have the options of using other sugar substitutes, like erythritol and Stevia, xylitol is the only one experts know of that causes such adverse reactions in canines, according to both Brutlag and Harmon. Manufacturers of dental health products aren’t facing the same scrutiny as the food industry, meaning their share of xylitol cases may increase in the coming years.

Xylitol in Baked Goods

Because packaged xylitol can be bought in bulk at many food stores, baked foods are becoming a more common source of canine health emergencies. “It’s a good option for diabetics who like to bake,” she says. Similarly, you might find some already-made baked goods containing xylitol at bakeries and specialty stores. And because cupcakes and cookies have a lot more sweetener in them than mouthwash, a pet that consumes a baked good packed with xylitol is in danger of facing a life-threatening situation.

“You need to call your vet or the Pet Poison Helpline immediately,” Brutlag says. “Give them as much information as you can. Depending on the severity, they may suggest feeding [the dog] syrup or honey—something sweet to help keep their blood sugar up temporarily while you drive to seek emergency help.”

Xylitol in Sugar-free Groceries

Xylitol is found in trace amounts in many fruits and vegetables, but because it’s occurring naturally and in such small amounts in these cases, it’s hardly ever a problem for pets, Brutlag says.

On the other hand, many grocery stores have started carrying sugar-free foods like ketchup, peanut butter, protein bars, pudding, and more that contain xylitol as one of their primary ingredients. Harmon even says there is a brand called Zapp! that manufactures condiments, sauces, and other groceries that are marketed primarily on their being made with xylitol. “In this case, it’s very clearly labeled,” she says, “but in most other instances, you’ll need to check the ingredients list on the label to know if something sugar-free is made with xylitol or some other substitute.” And in some cases, products that are not labeled as sugar-free still contain xylitol. It is important to always carefully read the entire ingredient list of any food before giving it to your dog.

Xylitol in Medications

Brutlag says most medications that contain xylitol are of the “meltaway” variety. These accounted for 12 percent of xylitol cases referred to a veterinary emergency facility, according to the Pet Poison Helpline—the second most behind gum.

You also might see xylitol in some medications containing melatonin, liquid prescription products, and gummy vitamins.

Xylitol in Lotions, Gels, and Deodorants

You’re probably thinking, “Wait, why does my deodorant contain an artificial sweetener?” Fair question.

“Xylitol has humectant properties,” Brutlag explains. “This means it can help a product retain moisture, which makes it perfect for products like this.”

Brutlag says this is a relatively new development, meaning even many veterinarians aren’t aware of the dangers of dogs digesting deodorants—at least when it comes to xylitol. As with everything on this list, it’s best to keep such products in a cabinet or on a high shelf—completely out of reach of your four-legged friends.

This article was verified and edited for accuracy by Dr. Jennifer Coates, DVM

Source: https://www.petmd.com/dog/emergency/poisoning-toxicity/6-dangerous-and-surprising-items-contain-xylitol

LD 1646 – New State Prescription Requirements

LD 1646, An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program, will go into effect on January 1, 2017. Maine veterinarians will be required to check the the Prescription Monitoring Program (PMP) for all written or dispensed opiate and benzodiazepine prescriptions. To be in compliance with this law, this office will require a State driver’s license or State issued ID to be provided by the individual presenting a cat or dog for examination whose medical condition results in the issuance of a physical or written prescription for opiate or benzodiazepine medications. Refills of these medications will also require the presentation of identification by the individual picking up the written or physical prescription, even if that individual is not the designated owner of the patient. Without a State issued photo ID containing the presenter’s birth date, opiate and benzodiazepine prescriptions, written or physical, will not be able to be provided.

We ask for your cooperation and patience as we implement these changes to be in compliance with the emerging understanding of LD 1646.

Thank you.

Animal Rescue Importation Guidelines

SOURCE: The Maine Veterinarian, January 2014 Edition

Notice From State Veterinarian Michele Walsh

When considering the addition of a new pet to the brood, the Maine Department of Agriculture, Conservation and Forestry’s Division of Animal and Plant Health urges Mainers to take the time and care worthy of this significant and potentially joyful step. By doing some important but basic research ahead of time, and working with a local veterinarian, Mainers can help ensure the animal they are adopting is healthy, and the animal organization with which they are working is compliant with Maine law.

Fortunately, many groups — including local humane societies, shelters, rescue organizations and breeders – do wonderful work with animals and provide excellent opportunities to meet and learn about potential new pets prior to taking them home. Interacting with animals onsite prior to adoption gives families a chance to learn about any special behavioral or health requirements the animal might have, and to obtain a copy of the animal’s vaccination and health records. Reputable groups work closely with licensed veterinarians who assess the health of the animals in the facility, treat any medical issues, and quite possibly spay or neuter new arrivals before they are made available for adoption.

Obtaining a new pet off of the internet or from an animal organization based out of state can be more challenging. There are quality organizations to choose from in this sector, but all potential new pet owners should be aware of the state laws under which these organizations must transact businesses. Organizations selling animals to Maine or to Maine residents must register with the Department of Agriculture, Conservation and Forestry and obtain an importation permit for placing animals in Maine homes, regardless of where the new animal is first picked up. Additionally, any dog or cat that is imported into Maine for the purpose of sale, resale or adoption must be accompanied by a Certification of Veterinary Inspection (CVI) completed by a veterinarian licensed in the animal’s state of origin within 30 days of the import into Maine. The CVI is part of the animal’s medical history, and should be included in your copy of the pet’s records. Veterinary visits prior to and shortly after adoption are key to decreasing the likelihood that the new pet is carrying a contagious disease that could be dangerous to humans or other animals in the household.

“Healthy pets make happy owners. We want all Mainers to have a positive experience adopting a new family member,” notes Maine State Veterinarian, Dr. Michele Walsh. “Obtaining a pet is a significant emotional and economic commitment. “Taking a few additional steps up front to help ensure that a new pet is healthy and well-adjusted can help prevent disappointment down the road.”

Dr. Walsh recommends the following tips when adopting a new pet:

• Work with a reputable local humane society whenever possible

• Meet with the pet prior to adopting to ensure that its behavior and demeanor are a good match for your family

• Obtain a copy of the animal’s medical record, vaccination history, and Certificate of Veterinary Inspection

• Ensure that the dog or cat is vaccinated for rabies if it is three months of age or older

• If working with a rescue organization, ensure that the business is properly registered and licensed in the state of Maine and in the state where the business is based, and/or with USDA Animal Care.

Hunting, Tapeworms and Your Dog

SOURCE: The Maine Veterinarian, January 2014 Edition

Echinococcus granulosus canadensis (EG) in Maine Moose: Suggestions for Dog Owners

UMaine Veterinarian Dr. Anne Lichtenwalner Suggests that Veterinarians Be Aware of this Canine Health Issue

During a 2012 survey of Maine hunter-harvested moose, Echinococcus granulosus (EG) cysts were found in a number of moose lungs. EG is a very small tapeworm that has a two part life-cycle: one in canids (coyotes/foxes/domestic dogs) and the second in ruminant-type animals, such as moose or sheep. Although EG can infect humans, the form that is known to do so most often is the domestic, or sheep-dog, genotype. Genetic testing of the Maine tapeworms found that this EG is the northern, wild-type form. This form is unlikely to cause human disease. However, finding EG in moose suggests that likely wild canids (such as coyotes) in Maine are infected and that possibly domestic dogs are infected as well. If dogs are infected, then their owners could be exposed.

The risk to people is low, but breaking the tapeworm cycle is simple, and can reduce that risk even more.

1. Wear waterproof gloves when dressing out game.

2. Keep your dog away from game (moose/deer) viscera.

3. Thoroughly cook all game meat.

4. If your dog might contact dead game (or gut piles), use a wormer effective against tapeworms at least twice yearly.

5. Talk to your vet about a plan to minimize the risk of EG exposure.

How do moose get EG?
Moose may browse where infected wild or domestic canids have defecated. The eggs are in the canid feces, and these eggs are the form that infects the moose.

What is a “canid”?
Canid is a term referring to a dog-like animal. For this form of echinococcus, canid hosts could include coyotes, wolves or domestic dogs.

What happens when the moose gets EG?
There will be cysts, or fluid pockets, in the moose’s lungs or liver. These cysts contain the scolex, which is the infective form for the canid host.

How does the canid host get EG?
The canid (wild or domestic) consumes the cysts from the moose lung or liver. These cysts are still infective after the organs are removed from the moose (“gutting”).

How could a human get EG?
The adult tapeworm lives in the intestines of the canid host, and eggs that are infective to the moose, or to humans, are passed in the canid’s feces. Humans may become infected by ingesting eggs of the parasite picked up by contact with canid feces; this could happen with poor hand-washing practices.

For more information, visit www.maine.gov/ifw.


For information about UMaine Extension programs and resources, visit extension.umaine.edu.

Find more of our publications and books at extensionpubs.umext.maine.edu.

Those frustrating vomiting cats!

How our search for the underlying cause of frequent hairballs and vomiting led to what should become a new protocol for all cats with this type of history.

Jan 1, 2014
By: Gary D. Norsworthy, DVM, DABVP (feline practice)Jen Olson, DVM
VETERINARY MEDICINE

 


(THINKSTOCK/EMRETOPDEMIR)

Like each of you, we have been frustrated with the seemingly healthy cat that vomits twice a month or twice a week or twice a day. And like you and our clients, we have accepted these explanations for chronic vomiting:
1. He eats too fast.
2. She has a sensitive stomach.
3. They’re just hairballs, and they are normal.
4. That’s just the way he is, or, as one of our clients put it, “He’s just a puker.”

While buying one or more of these excuses, we kept asking ourselves if one of our human family members were vomiting this often, would we accept it or would we seek a diagnosis and proper treatment?

No more excuses


Dr. Gary D.Norsworthy

In pursuit of the etiology of this problem, we performed endoscopy for several years. Convinced that it had to be a primary gastric problem, we scoped the stomach and took multiple mucosal biopsy samples. The pathologists would report “mild lymphoplasmacytic gastritis” or “Helicobacter gastritis” or something else not very meaningful, and we would find something creative to do to try to solve the problem. We often used a corticosteroid, an H2 blocker, an antiemetic drug, a hairball lubricant, and an easily digested diet under the umbrella diagnosis of inflammatory bowel disease (IBD). Sometimes there was limited but often short-term response; sometimes there was no response. It did not take long until we felt bad for spending clients’ money with little to show for it.

 


Dr. Jen Olson

As ultrasound became an integral part of our practice, we decided to take a different approach. Instead of using endoscopy, we performed an ultrasound examination of the stomach. Consistently, the walls were uniform with measurements well within the normal range. Therefore, we moved down to the small bowel. With ultrasound we could look at a great deal of the small bowel instead of the inch or so of the duodenum that we sometimes could reach with an endoscope. It did not take long until a definite finding emerged—virtually every one of these cats had thickened small bowel walls. Suddenly it clicked. Chronic vomiting in cats is a small bowel disease, not a stomach disorder. It became clear that our gastric examinations and biopsies did not find the answer because we were looking in the wrong place.

Proof positive

These findings led us to the only logical next diagnostic step: full-thickness biopsies of several places in the small bowel. It was not long until the clouds parted, and we began to see things much clearer than ever before. After 100 cases, we put our findings together into a paper that was recently published in the Journal of the American Veterinary Medical Association (JAVMA).1

These 100 cats, and about 200 that followed, have shown us conclusively that chronic small bowel disease presents as chronic vomiting, chronic diarrhea, weight loss, or a combination of these. Only one of the 100 cats in the study had normal biopsy findings, making this diagnostic approach a “must do.” In addition to the one normal cat, we had diagnoses of chronic enteritis (usually IBD) in 49%, lymphoma in 46%, mast cell disease in 3%, and adenocarcinoma in 1%. Therefore, we tell clients that the most common disease is IBD, but lymphoma is clearly the second-most likely differential. In addition, the only way to differentiate between them is with surgical biopsies.

A new hope

Understanding chronic small bowel disease is the most significant thing that has happened in our practice since the introduction of feline leukemia virus vaccine in 1985.

Gary D. Norsworthy, DVM, DABVP (feline) 
Jen Olson, DVM
Alamo Feline Health Center
San Antonio, Texas