"Mind Controlling Parasite", Really? CNN and Fox Promote Panic in Cat Owners!

by Whitney M. 

My cat, "Biggs", attempting to use
mind control to get my husband to
do the laundry 

I recently received a panicked text from my husband after he read an article on Facebook put out by Fox6Now.com and originally CNN Wire Service  titled “Mind-controlling’ parasite that lives on cats may have infected 60 million people”.  After reading this article he was genuinely concerned about our mental health, seeing as we have three cats.  The reporter wrote about a “mind controlling parasite that can’t live without a cat, how it manipulates personality – and possibly suicide numbers.”

The article states that the parasite, Toxoplasma gondii, “has been shown to cause personality changes, correlating with mental health diseases like schizophrenia, autism and Alzheimer’s disease.” While the links between Toxoplasmosis and mental health disease are still being researched, I believe this article is inflammatory, misleading, and detrimental to cats.  While it’s true that cats can be a source of Toxoplasma infection, people are more likely to be infected by eating undercooked contaminated meat or gardening. 

Here is what we do know about Toxoplasmosis according to the Centers for Disease Control:

• Cats become infected by eating other infected animals, such as rodents and birds.
• Oocysts are shed in the stools for up to three weeks after infection which can then contaminate the litterbox of indoor cats.  Soil and water can also be a source of contamination for outdoor cats.
• Usually a cat will only shed oocysts after the first infection of Toxoplasma; a cat that has already had an infection will not continue to shed unless it is immunocompromised.
• It takes 24-48 hours for oocysts outside of the cat to grow into a form where they are infective to people.  This means that scooping your cats’ poop every day is a great way of reducing risk of infection.
• Cats themselves are not a source for oocysts; their feces are. 
• The CDC estimates that more than 60 million people may have been infected with the parasite, but of those, very few become sick.  A healthy immune system usually prevents the parasite from causing illness.

Basically you have little to worry about.  Though your cat may think he controls your mind, there is absolutely no scientific research that supports that he will do it through a mind-controlling, suicide-inducing parasite.  The best way to prevent Toxoplasma infection via felines is by cleaning the litterbox every day (hint hint, Husband of mine…), washing your hands, and wearing gloves while gardening.  If you have any questions or feel like your cat is getting inside your head, please feel free to call our office or check our website and search toxoplasma in our pet medical library.

Rabies Kills More People Than Ebola

by Michael Fagan, DVM

To follow up on our last blog, which discussed Ebola in dogs, we'll talk about another disease with an even higher mortality rate (virtually 100%), kills 5 times as many people every year (over 50,000)  than Ebola has in the past decade, and exists right here in the US.  Why hasn't this been in the news?

It's rabies.  And it's preventable.  Fortunately, here in the US and much of the developed world, cases of human rabies have been dramatically reduced, thanks to widespread vaccination of dogs, cats, and horses, as well as control of feral dog populations.  Our risk of rabies in the US is primarily from wildlife, especially bats. 

from: Centers for Disease Control

In 2010, about 6000 animals tested positive for rabies in the US, including approximately 2200 raccoons, 1400 skunks, 1400 bats, 400 foxes, 300 cats, 70 each of cattle and dogs.  

from: Centers for Disease Control

The 1400 bats represents about 1 in 6 that are submitted for testing.  All but four states had rabies positive bats.  Wisconsin had 27 bats that tested positive (we had a rabies-positive bat brought to Hallett Veterinary Hospital last month), as well as one skunk and one fatal human rabies case, which was transmitted by a bat. 

The third world, however, is a different story from the US. 
Tens of thousands of people die from rabies every year in Africa, India, and Southeast Asia.  Almost half of those are children.  Their exposure comes mainly from dogs, often stray or feral.  In South America, vampire bats are a common source of exposure.

Every year, more than 15 million people worldwide receive a post-exposure vaccination to prevent rabies.  The cost of treating a person bitten by a rabid animal in the third world is about $400, which is more than an entire year's income for most of the population.    Vaccination after exposure greatly reduces the chances of developing rabies infection, which likely prevents hundreds of thousands of deaths per year.

The cost to vaccinate dogs in these countries would be 10% of the cost to treat people who have been exposed.   Click here for more information on how you can help, and here for informational videos.

Ebola and Dogs?

Can Dogs Transmit Ebola Virus?

by John Hallett, DVM

According to the CDC, "There are no reports of dogs or cats becoming sick with Ebola or of being able to spread Ebola to people or other animals," even in Africa. But then again, the CDC also downplayed the risk to medical workers in this country because our health system is so much better than in Africa.

So why is a dog in Texas under quarantine?
It appears that they just want to be sure. If you are paying attention to the media recently, you know that Ebola is transmitted by direct contact with body fluids from a person sick with Ebola or from contact with a bat or monkey that is carrying the virus. In Spain an Ebola patient's dog was euthanized, which sounds a little extreme considering what is known about the virus. I'm glad that pets of Ebola patients are not being euthanized in this country. I suppose if a dog stepped in or rolled in bodily fluids from an infected person and then rubbed that stuff on another person, they could be implicated in transferring the virus but an object like a chair could do almost the same thing. The important thing is that so far, dogs have not developed disease after being exposed to the Ebola virus. 

The CDC info that is being distributed to veterinarians says "There is limited evidence that dogs become infected with Ebola virus." So I checked around a little more. In 2005 a study in Africa showed that dogs can develop antibodies against Ebola but no virus was found in those dogs (antibodies are produced by an animal to fight a disease). This suggests that dogs can develop an immune response (antibodies) if they are exposed, but the immune response is apparently effective at keeping the virus from staying alive in dogs. It is possible that dogs could develop antibodies to Ebola without ever being infected (by just being exposed to the virus) but it doesn't look like much research has been done on dogs. I'm sure someone will write a paper on the Texas dog. 

I suspect that someone will suggest that I shouldn't even be concerned about Ebola and that the media is promoting panic about Ebola while ignoring other things that kill many more people. For example, 51,000 people die of Rabies in India and Asia every year and in Baoshan, China, 5,000 dogs were killed because 5 people died from Rabies in July and August. That doesn't mean we should panic - about Rabies, or about Ebola, but we should learn all we can about new diseases to be prepared for things that are going to become more common.

Have mice? Some mouse poisons have no antidote!

Bromethalin has no antidote!

Quite often we are presented with a dog who has eaten rat or mouse poison and we have to sort out what brand of poison, when they ate it and how much they ate, so we can induce vomiting and give the antidote along with messy oral activated charcoal to stop absorption of the poison.  We also send home oral medication for two to four weeks and draw blood to check clotting times after finishing the medication. Sometimes, the owners don't know that poison has been ingested. They just know that their dog is bleeding. It could be bloody urine, blood in the stool or just bruising on the skin or in the eyes. Then we try to sort out if there is a medical reason for the bleeding or just poison exposure.

Most rat and mouse bait contains an anticoagulant that can be treated with Vitamin K for varying lengths of time depending on the product.  Some mouse bait contains warfarin or diphacinone, so called "first generation" anticoagulants that require 14 days of vitamin K. Other products contain "second generation" anticoagulants like difenacoum, brodifacoum and bromadiolone that require 30 days of treatment with vitamin K.

Fortunately, the EPA set new rules in 2011 to save wildlife from exposure to second generation anti-coagulants. This was after they measured anticoagulant residue in up to 70% of the wildlife tested. Apparently, there has been a 50% reduction in cases of poisoning in children since the new rules took effect. Seems to me that maybe keeping our kids safe should trigger some rules of their own, but keeping wildlife healthy is important too.  Second generation anti-coagulant poisons are still available but only in bulk packaging to be used by professional exterminators. The makers of d-Con finally agreed to comply with the ruling in May of this year after fighting it for three years. 

Anticoagulant rodenticides are pretty scary, but now there are some newer poisons in rodenticides that contain bromethalin - a neurotoxin with no antidote! Many dogs can recover from bromethalin poisoning if detected early and given supportive care for as long as 6 weeks (expensive supportive care).

So what can you do?  

• Check the active ingredient before purchasing a rodenticide product. Make sure it has warfarin or diphacinone - first generation anti-coagulants. 
• If you have an exterminator come to your house, ask for a list of active ingredients of the products that they are using and make sure they don't use bromethalin or one of the second generation anticoagulants. 
• Make sure the bait is in a protective container and not just scattered loosely.
• You can also check the shelves at your local grocery or hardware store and send the store a nice note if they have second generation anticoagulant rodenticides or bromethalin on the shelf. Ask them to discontinue stocking those products. You could even send the store a copy of this blog. Who knows, maybe it will save a pet's life or even a child's?

Oh, No! Heartworm Preventatives Aren't Perfect Anymore

Year Round Heartworm Prevention is Important                  by Dr. Michael Fagan

For twenty-plus years, we've enjoyed the privilege of telling our clients that our heartworm preventative medications were 100% effective in preventing heartworm disease if given monthly throughout the entire mosquito season.  Now we have to settle for telling you that they are Very Effective. 

Very Effective is still a good thing, but some aspects of our overall prevention strategy have become even more important.  Over the past several years, there have emerged a few strains of heartworms that are resistant to the entire class of drugs used as heartworm preventatives (known as macrocyclic lactones, or ML).  So far, it appears that none of the available products (Heartgard, Iverhart, Revolution, Interceptor, Advantage Multi), are superior to any other:  while every product is still very effective, each has been documented to be less than 100%. 

What this means for our patients:

• It is very important to give monthly heartworm preventive year-round.
• Annual heartworm testing is essential to identify any dog that have acquired a resistant heartworm infection. 

One of our patients, a year
after heartworm treatment

Dogs that do become infected with ML-resistant heartworms tend to be infected with lower numbers of worms than dogs that are not on preventatives at all.  They still need to be treated with injections of melarsomine to eliminate the adult heartworms for their own health, but also to eliminate the source of resistant worms that could be transmitted to other dogs.

Treating dogs that are infected is expensive and painful. The drug (melarsomine) is currently only available on a case-by-case basis from European production facilities. Melarsomine is injected deep into the muscle along the spine and it hurts! Dogs must be kept quiet for two months during treatment which means no running or playing. We are currently treating a really sweet black lab who moved here from the Southern U.S. where resistant heartworms have been identified.

 

Should a Pet With Cancer Get Chemotherapy?

by Michael Fagan, DVM

“Cancer” is a word that can induce fear and other emotions.  Many people have personal experiences with cancer and chemotherapy that they don’t wish to impose on their pets.  To be sure, cancer and the many treatment options we can offer are not to be taken lightly.  However, we do have many patients that have received treatments for cancer with favorable outcomes, from cures or long term remission to improved quality of life for many months to years.

The most important factor in determining treatment options and recommendations is what type of cancer the pet has developed.  “Cancer” is a very broad term, with many different types and variable response to different kinds of treatment.  Each patient with cancer is unique.  We offer options based on the type of cancer, symptoms or lack thereof, the pet’s overall health, and owner preferences.  Some cancers are best treated by surgical removal.  Others respond best with radiation, chemotherapy, or immunotherapy.  Some have a poor prognosis regardless of treatment, and control of pain or other symptoms takes priority before opting for euthanasia. We will often consult with a veterinary oncologist as we explore the options available.

The goals of treatment are also unique to each patient, but as a general rule, we aim for a cure only if we can preserve good quality of life throughout the process.  More often, we are trying for a long term remission or control of tumor growth for many months to a few years.  The most common treatment for cancers that are not curable with surgery is chemotherapy of one form or another.

Herein lies a vital difference between veterinary and human medicine:  in human medicine, the treatment goal is often to eliminate the cancer and then recover the patient; in veterinary medicine, we want to preserve good quality of life while limiting the cancer.  In other words, we use drugs, doses, and treatment schedules that minimize side effects while still providing the benefit of remission or delayed growth of the cancer cells. 

With chemotherapy, we have had lymphoma patients live longer than two years; bladder cancer patients, one to two years; dogs with nasal tumors, over a year; most with minimal side effects from the chemotherapy and reduction or elimination of symptoms caused by their cancer.  Unfortunately, not all patients respond, and not all tolerate the chemotherapy equally.  Each patient needs to have its treatment protocol customized. 

One relatively new approach to chemotherapy is using small daily doses instead of higher intermittent doses.  This tends to reduce toxicity and has a different effect on tumor growth.  Rather than actively killing tumor cells directly, low-dose daily therapy (called metronomic therapy) may work by reducing the blood supply to the tumor and by allowing the immune system to respond more aggressively. 

The bottom line is that we have many options for treating the many kinds of cancer that we diagnose in pets, including surgery, radiation (by referral to a veterinary oncologist), traditional or metronomic chemotherapy, immunotherapy (there is a vaccine for melanoma!), and/or palliative care (control of pain and other symptoms caused by the cancer). In animals we also have the option of euthanasia when appropriate but that is a subject for another blog. 

"Is Your Veterinarian Being Honest With You?"

Dr. John Hallett

Sometimes, my dad would lecture me and my brother about something my brother did wrong, and I would interrupt to say, "But dad, I didn't do it." Dad didn't like interruptions, especially when he was on a roll sharing his life lessons with his captive audience. Dad would scowl at me and say, "Son, if the shoe fits, wear it!" I was insulted that I had to sit through a lecture when my brother was the one who left the dirty dishes in the sink or tracked mud in the house. Dad was trying to say, "if this doesn't apply to you, then just listen anyway."

Last week, there was a 20/20 episode on ABC asking "Is Your Veterinarian Being Honest With You?" Many veterinarians are insulted by the episode and are angry that our profession is being accused of cheating pet owners.  I, however, have decided to take my dad's advice because "the shoe doesn't fit."

I realize that a small number of veterinarians do things that are dishonest or unethical or just outdated. I agree with 20/20 that pet owners should be educated and involved in their pet's care, and they should ask questions.  The veterinary community is not highly regulated, and there is wide variation in the level of care offered in different facilities. 

Let's look at some of the points made in the 20/20 piece.

Recommending services to boost the clinic's income:

I believe that a veterinarian can and should make a profit by practicing good medicine, educating pet owners, involving owners in the decision making process, and by charging appropriately for what is done. Veterinarians do not have to resort to selling unnecessary vaccines or procedures just to make money.  Not every client is going to follow every recommendation, but when they leave my office, they will be educated and involved.

Two areas cited by 20/20 are dentistry and lumps:

Dentistry:

I do my best to do a complete oral exam on awake dogs and cats. It is hard. They move, they lick me, some try to bite, and none will tell me that a particular tooth aches. I try to predict when a pet needs a dental cleaning under anesthesia based on what I see in the exam room. The problem is that I often miss problems that only become apparent once the pet is anesthetized because that allows me to probe the gum line and look closely at all the teeth. We are constantly reminded that 60% of the tooth is hidden below the gum line and only becomes visible when dental radiographs (X-rays) are done. Dental radiographs can't be done without general anesthesia in pets. We also have to balance the cost of labwork, monitoring, and safe anesthesia with the need for dental work. I wouldn't cut corners to save a few dollars with my own pet, and I won't with my patients either.  I do my best to recommend dental cleaning and evaluation under anesthesia before teeth need to be extracted, but I can't always do that based on my oral exam in an awake patient. I rarely recommend annual dental cleaning and never based on age alone, but if I see gingivitis, a crevice between calculus buildup and the gum, a gingival mass, or if I smell bad breath, then I will recommend a procedure. For more information on veterinary dentistry, watch this 3 minute video from our practice.

It is interesting to note that one of the dogs that 20/20 argued did not need dental cleaning did have an oral mass clearly visible next to the upper left premolar. That mass should be removed under general anesthesia and submitted for biopsy. Hopefully, it is benign, but some oral masses can destroy bone in the jaw (or worse).

That brings me to lumps and tumors: 

My oncology professor taught us that you can't tell what a mass is just by feeling it. Masses on the skin and under the skin are easily assessed with a fine needle aspirate using the same size needle we use for vaccines.  If I see fat cells under the microscope, then it is most likely a benign lipoma. Without the needle aspirate, I'm just guessing. Anybody can guess. People pay me for my educated opinion and expect me to make recommendations based on my 23 years of practice experience and the most current information available in the veterinary literature. They pay me to look in the microscope, not to guess.

If an owner tells me that a mass has been there for years and hasn't grown or changed, then I am less likely to suggest an aspirate. I educate the owner, tell them the cost, and let them decide. If the owner chooses to wait and monitor the mass, then that is their educated decision, and I tell them to return if the mass grows rapidly, bleeds, or becomes painful. Sometimes, I see things in the microscope that are clearly cancer or are worrisome, and I recommend removing the mass and sending the tissue in to a pathologist for review. Of course, we discuss cost, risks, and potential benefits with the owners.

I love helping animals, but I do not work for free. I do have staff to pay, expensive equipment, overhead, and personal bills, but those bills do not drive my decisions. Providing excellent care for my patients is always my goal.  I treat all my patients the same way I treat my own pets. Yes, keeping pets healthy can be expensive, but consider that veterinary care is far less expensive than human medical care, even with the Affordable Care Act on the way. I believe the majority of veterinarians are honest, but there are unethical or lazy people in all professions including veterinary medicine.

My advice to pet owners: 

• Ask your veterinarian questions
• Discuss options and potential outcomes
• Ask for articles from reputable sources if you want to learn more
• Get a second opinion from a board certified specialist if needed
• Ask your veterinarian what continuing education they attend or how they stay current

My advice to veterinarians: 

• If the shoe fits, wear it! Otherwise, stop complaining about a TV show and use it to educate your clients.

If you would like to watch the 20/20 episode, click here.