From the FDA Website:

If you’re purchasing medications for your pet online to save money or for convenience, there are Internet sites that represent legitimate pharmacies.

But the U.S. Food and Drug Administration has found that there are others that sell unapproved pet drugs and counterfeit pet products, make fraudulent claims, dispense prescription drugs without requiring a prescription, and sell expired drugs. Any of these practices could mean that the products you are buying could be unsafe or ineffective for your pet.

In general, FDA regulates the manufacture and distribution of animal drugs, while individual state pharmacy boards regulate the dispensing of prescription veterinary products.

If you are ordering pet medications online, you should look closely to ensure that you’re ordering from a reputable pharmacy, says Martine Hartogensis, D.V.M., deputy director of the Office of Surveillance and Compliance in FDA’s Center for Veterinary Medicine (CVM).

Protecting yourself and your pet requires awareness of the importance of involving a veterinarian even when ordering online. If an online pharmacy does not require a prescription from a veterinarian before filling any order for prescription drugs, that’s a red flag.

Here are some other things to consider when looking at sites offering pet medications.

How to Recognize Legitimate Online Pharmacies

Look for pharmacy websites ending in “.Pharmacy.” You may be used to looking for the Vet-VIPPS seal on your pharmacy’s website. But as of late August, 2017, that no longer holds true. Instead, you should look for pharmacy websites ending in “.Pharmacy.” Under the National Association of Boards of Pharmacy (NABP) new Pharmacy Verified Websites Program, pharmacies must meet strict standards for enrollment. Once accepted, they are given “.Pharmacy” website addresses to help you quickly identify trustworthy, worldwide online pharmacies and pharmacy-related websites, so you can safely make purchases.

Order from an outsourced prescription management service that your veterinarian uses. These state-licensed Internet pharmacy services work directly with the veterinarian, require that a prescription be written by the veterinarian, and support the veterinarian-client-patient relationship. Ask your veterinary hospital if it uses an Internet pharmacy service.

But First, Consult Your Veterinarian

An online foreign or domestic pharmacy may claim that one of its veterinarians on staff will “evaluate” the pet after looking over a form filled out by the pet owner, and then prescribe the drug. But that could be a sign that the pharmacy isn’t legitimate. Written information—without a physical examination of your animal—may omit important clues to your animal’s condition, and is no substitute for a vet physically examining your animal.

CVM is especially concerned that pet owners are going online to buy two types of commonly used veterinary drugs that require a prescription: heartworm preventives, such as Heartgard, Trifexis and Interceptor; and nonsteroidal anti-inflammatory drugs (NSAIDs), such as Rimadyl or Metacam.

“Both types of drugs can be dangerous if your vet doesn’t get involved,” says Hartogensis. “It’s not generally a concern if you use a legitimate online pharmacy and mail in a prescription from your veterinarian, who is monitoring your pet. But if there is no veterinarian–client–patient relationship, it’s a dangerous practice.”

Heartworm disease is a potentially fatal condition transmitted by the bite of a mosquito that is carrying larvae of the heartworm parasite. Dogs, cats, and ferrets can get heartworm disease. Heartworm preventives, given daily, monthly, or semiannually, depending on the product, kill the larvae before they become adult worms.

The American Heartworm Society recommends that you get your pet tested every 12 months for heartworm and give your pet heartworm preventive 12 months a year.

Veterinarians often prescribe NSAIDs to relieve pain in pets. You should not buy NSAIDS on the Internet without a veterinarian’s involvement because

• your pet should undergo blood testing and a thorough physical examination before starting NSAIDs,
• your pet should be monitored by a veterinarian while taking NSAIDs,
• your veterinarian should discuss possible side effects of NSAIDs with you, and
• the prescription should be accompanied by a Client Information Sheet that explains important safety information to you.

Updated: October 11, 2017

 

While you are busy making your festive plans for Thanksgiving, Hanukkah, and Christmas, please don’t forget to include your pets. The holidays are a time for giving, but there are some things you should not share with your little best friends. Once you know the hazards, a little precaution and prevention will make holidays a happy time for everyone.

Some of the more common holiday hazards include:

Bones: The holiday turkey or chicken will leave a lot of tantalizing bones, but don’t feed them to your pet. Beware of steak bones, too. Small bones or bone chips can lodge in the throat, stomach, and intestinal tract.

Fat: Those wonderful potato latkes (watch the hot oil!), gravies, and poultry skin can cause severe gastrointestinal upset as well.

Holiday plants: Holly and mistletoe are extremely poisonous when eaten. The lovely poinsettia may not be truly poisonous, but its milky white sap and leaves can certainly cause severe gastric distress. With so many hybrid varieties available each year, the best approach is to keep the plants out of your pet’s reach.

Electrical cords: Holiday lights mean more electrical cords for kittens and puppies to chew. Be sure you have cords secured and out of the way.

Candles: Lighted candles should never be left unattended and that is even more important if left at kitty’s eye level or within puppy’s chewing zone. An exuberant tail, a swat of a paw, and candles and hot wax can quickly become disastrous. Anchor candles securely and away from curious faces and feet.

Pine needles: Check around holiday trees and boughs frequently. Ingested pine needles can puncture your pet’s intestines if sharp enough.

Holiday tree: Make sure your tree is well secured. If you have a tree-climbing cat or large dog with a happy tail, anchor the top of the tree to the wall, using strong cord or rope. Preservatives often used in the water in a tree stand can cause gastric upsets, so be sure it is inaccessible or not used. Avoid sugar and aspirin additives in the water as well.

Ornaments: Sharp or breakable ornaments, dreidels, and even aluminum foil should be kept out of reach. String objects, especially tinsel and ribbons, are to be safeguarded at all costs. They are thin and sharp and can wrap around intestines or ball up in the stomach.

Stress and company: With everyone coming and going, watch out for open doors and sneaky pets. Make sure your pets have collars and tags on in case of escape. Ask guests to keep an eye out for pets under foot and remind them that sometimes your normally friendly dog or cat may be less than willing to deal with enthusiastic children and rooms full of unfamiliar people. Provide a special quiet place with a blanket and fresh water for your pets to retreat to when the festivities get too stressful. Did you know that some caged birds are afraid of the dark? Try a night light or leaving the front of the cage uncovered. Before traveling with your pets, make sure they have all required vaccinations and health papers. If they are on medications, have enough to last through the trip. When traveling by air, be aware of airline restrictions regarding outside temperature and number of animals allowed per flight. Someone may have already booked a pet, and there are no more allowed. Check with the airline reservations or travel agent. Remember that even the most gentle and trusting pet may bite when in pain. If you must muzzle, use a soft towel or cloth strips and remove it as soon as possible so the pet can breathe more easily. Beef- flavored toothpaste? Sounds pretty awful, but it’s just one of a number of specially formulated pastes for pets. Never use human toothpaste: it irritates a pet’s stomach.

On April 9, 2015, I reported that five dogs had passed away from canine influenza out of 1,000 known cases in the Chicagoland area. Chicago is densely populated with dogs and provides a rich resource of social opportunities for them, so these factors would contribute to the flu spreading so quickly. Most of us assumed the influenza strain was the H3N8, which is common in the United States. A few days later, Cornell University stated it was a different flu strain, H3N2, that was first found in Asia. Rumors have circulated that the virus was introduced to the U.S. through dogs rescued and imported from Asia, but there is still no evidence to confirm these rumors.

For the month preceding the announcement, panicked pet parents were having their dogs vaccinated with the H3N8 vaccine, which offers no cross-immunity to the H3N2 strain. I completely empathized with the panic. We have to remember the source fueling the anxiety: sensationalist journalism in an attempt to grab attention. Don’t get me wrong, media outlets are a necessary part of society because they distribute vital news and information.

But, put canine influenza in perspective compared to your office environment. You have 10 people who all have the same symptoms and are out for a few days. 30 people who have mild symptoms who can still make it to work. 20 people who never come down with the disease because of natural immunity. 10 people with stellar immune systems. 5 who were vaccinated. But, your colleague, Larry, develops pneumonia.

So, in instances like the Chicago outbreak of 2015, I implore you to refer to professionals like myself, the American Veterinary Medical Association (AVMA), the American Animal Hospital Association (AAHA), or a collegiate research institution before vaccinating your companion animal for any flu strains.

Statistical Perspective

Exposure

In February 2016, Cornell University released a H3N2 testing summary compiled from twelve reputable laboratories across the nation.

• Time period: March 8, 2015 – February 2, 2016.
• Sample size: 13,900 United States dogs tested for H3N2.
• 12,228 (88%) tested negative for H3N2.
• 1,672 (12%) tested positive for H3N2.
• A positive nasal swab PCR test could indicate the dog is in the midst of illness.
• A positive serum test could indicate the dog has recovered from an H3N2 infection and will have a titer against the H3N2 virus.

This is not the entire dog population tested or exposed, but the sample size is significant. These statistics demonstrate that the virus may not be spreading as quickly as we had previously thought or to the degree the media has touted.

Fatality

The AVMA reports that the fatality rate is less than 10% (low) for any strain of canine influenza at this time. Others like myself estimate 2-3% as the 10% includes older data. Indeed, when I reported the five dogs that unfortunately passed away, they only represented 0.5% of the known cases of H3N2 infection in Chicago.

Developing Symptoms

The veterinary community categorizes the symptoms by either mild or severe. Most dogs exposed will only develop mild symptoms.

Mild Symptoms (Common):

• Soft, moist cough that persists for 10 to 30 days
• Lethargy
• Reduced appetite
• Fever
• Sneezing and discharge from the eyes and/or nose

Severe Symptoms (Rare):

• High fevers
• Clinical signs of pneumonia, such as increased respiratory rates and effort
• Pneumonia (Streptococcus) may develop in about 2% of cases due to a secondary bacterial infection

If a dog does pass away from influenza, he is probably malnourished, parasitized or otherwise debilitated. Also, if he is one of the few dogs that harbors Streptococcus organisms in his upper respiratory tract or lungs (uncommon), then the combination with canine influenza virus can be serious and even fatal.

Dealing with an Outbreak

An outbreak occurs because several dogs in one area have never been exposed to a virus and do not have natural immunity to it. We need to consider the severity of what has “broken out”. Is it a cat running out of the house or a tiger escaping the zoo?

When you hear about an influenza outbreak in your area, please:

• Take a deep breath;
• Start preventative measures such as avoiding dog parks, dog beaches, doggy daycares, grooming facilities, dog-friendly businesses, daycares and just saying “hello” to the neighbor dogs;
• Provide your dog immune boosters like curcumin (found in turmeric);
• Clean and disinfect clothing, equipment, surfaces, and hands after exposure to dogs showing signs of respiratory disease; and,
• Use portable water bowls during walks and do not allow him to drink from communal water bowls.

Vaccine

A vaccine is available for H3N2. I am pleased that many veterinarians are not promoting this vaccine at their practices because it may take several weeks to be effective. They, too, are advocating the preventative measures listed above. The majority of dogs that are infected from exposure, will then have natural immunity and will not need to be vaccinated. Naturally generated immunity is preferred to vaccination for influenza.

In fact, if an outbreak is in your area and then you decide to give him the required two doses/three weeks apart (plus annual booster), viral loads may have decreased by the time the vaccine is effective and your dog may have already been exposed to the virus. Some of my colleagues may argue that the first vaccine may lessen the effects of possible flu symptoms, but again the majority of dogs develop only mild symptoms.

Jean Dodds, DVM

Hemopet / NutriScan

11561 Salinaz Avenue, Garden Grove, CA 92843