Tag Archives: dr cindy lizotte

Point of view on raw feeding by a raw feeder!

I came across this blog and I enjoyed the point of view of a raw feeder on raw feeding that was different than most. It is a very common sense approach and I would encourage whomever is looking for information about raw diets to keep an open mind and read this blog link. We often hear about the people wanting to feed their dogs like wolves…..dogs are not wolves. They are domesticated and that makes a big difference on how they evolved. I am open minded about the subject and I like to stay objective when I look at arguments from both sides.

http://therawfeedingcommunity.wordpress.com/2014/12/12/your-dog-is-not-a-wolf-stop-trying-to-feed-it-like-one/?blogsub=confirming#subscribe-blog

 

raw diets

Vaccine schedule, pet size and titer tests (VacciCheck).

I recently read a new blog about vaccines that was written by Dr. Ana Falk and shared by Dr. Jean Dodds on her website: Dr. Jean Dodds’ Pet Health Resource Blog | Vaccinations: A Global Perspective.

We at IVC (Integrative Veterinary Care) are sharing the link with our clients, as it provides a different point of view on vaccinations. In this article, Dr. Ana Falk discusses homeopathic vaccines (nosodes) and also introduces a different perspective regarding vaccinating versus treating parvovirus and distemper in pets. I share the same point of view as Dr. Falk, and I find this article well-written, providing another supporting opinion. Most veterinarians advocate use of vaccines, following proper protocol and schedules. Although Integrative Veterinary Care promotes fewer vaccines, we still do support them because we feel that they are important in preventing diseases that may cause death from fatal illness and disease. It is easier for us to prevent these diseases then to treat them.

Rabies and titer testing

A question by Marie Gallant on our Facebook page asks about the usage of vaccines versus natural options. This prompted us to look into relevant links and supportive information for our clients. In regards to rabies vaccines for our clients, this is our opinion: By law, for rabies in New Brunswick, we follow the manufacturer’s recommendation. Dogs and outdoor cats older than 12 weeks of age need Rabies vaccines once, then again a year later, followed by vaccination every three years. 

In the past, we have sent all our blood tests and titers to Kansas State University for lab testing. However, we are happy to announce that we now have access to in-house blood testing for core dog vaccines titers (Distemper, Parvovirus, and Hepatitis) through one of our affiliate hospitals in Moncton (Elmwood Veterinary Hospital). The cost is the same as the core vaccine fee, making this option more affordable for our clients! Although ideally Rabies titers would be performed, the cost of a Rabies vaccination is cheaper than the actual Titer test, so many owners choose to vaccinate instead of the test.

What vaccinations are recommended? 

Before giving any and all vaccinations, I will evaluate your dog on an individual basis. For all vaccines, I try to minimize its use and will only vaccinate when I believe it’s necessary for the individual dog. I typically don’t recommend the Lyme vaccine and only use it for dogs that are getting ticks weekly. I also try to avoid giving Leptospirosis when I can, and if I do, then it is only given to dogs at risk (hunting dogs and dogs that spend time off-leash). Leptospirosis should not be given to dogs under twelve weeks of age, although I have seen it done by some vets.

More vaccines equal more chances of allergic reactions and other side effects. When giving vaccinations, we are injecting something foreign into the animal’s body. This can sometimes hyper-stimulate the immune system into doing things it should not! In the past few years, new studies have shown how long vaccines last in our pet’s bodies — because of the lack of this information just a few years ago, I believe that we have been over-vaccinating our pets.

Depending on the exposure, I will do vaccines for some diseases every three years (or  titer testing) instead of yearly. I do support the puppy booster series (two-three shots in one month intervals). Having experience treating Parvovirus in unvaccinated puppies, knowing that a vaccine could have saved the animal is sad. Personally, I do not vaccinate my pets anymore since they have no contact with other dogs as well as one of my dogs having an immune disease.

Indoor adult cats are vaccinated every three years or more depending on their risk of exposure to other cats. Cats that go outside will get some vaccines every 3 years (herpesvirus, panleukopenia and calicivirus) and leukemia yearly. Kitten vaccines follow the puppy vaccines booster series schedule then they are vaccinated a year later. After this we  do the adult cat schedule mentioned above.

 What is the importance of size? 

Let’s talk about size when it comes to vaccines! Does size really matter? Do we need to give less then the usual 1ml vaccine per dog no matter what size they are? In most veterinary schools, students are taught that it is necessary to give 1ml per dog because this amount was required to stimulate an immune response. Unlike drugs (like antibiotics) that are dose-by-weight in kg, vaccines are dosed per pet. This means that a 5lbs Yorkshire is receiving the same amount as a 100 lbs Great Dane is.

size for vaccines

Because drugs are metabolized by the organs like the kidney and the liver, we need to dose them per weight in order to get an effective level in the blood and tissue so that they can do their job to fight infections and such. The bigger the animal, the more area to cover. But, since vaccines are designed to boost the immune response, it involves the immune system which is not measured by weight and so vaccines are not processed by the body as a drug would.

So, in theory, size should not matter since it is all the same immune system. I decided to personally investigate this a bit, as I struggled to understand how this worked.

Recently, I did titer testing on a 16 lbs Papillon. Although she was now about nine years old, she had only received her puppy vaccinations. Despite nine years of not receiving any vaccinations, it was very interesting to find that both her Parvovirus and Adenovirus titers were still up to date, while her Distemper was a bit lower than the recommendation. (http://www.vaccicheck.com/) Technically, this required her to receive a booster shot for Distemper virus, while Parvovirus and Adenovirus was unnecessary.

The time that vaccinations stay in the body depends on the individual. Not every dog will have such a strong immune response to a puppy vaccine that it supports them for nine years. However, we always recommend titer testing every three years, as suggested by Dr. Dodds’.

Now, let’s jump back to the question about the amount of vaccine in relation to the size of the animal. Although in veterinary school I was taught that size did not matter, I read that horses and other large animals actually did differ in the amount of vaccines. For dogs and cats, 1ml is recommended, while horses and cattle receive 2ml and extremely large animals, such as elephants, receive 2-4ml.

So, if size really does not matter, why are horses receiving a higher quantity of vaccines than dogs, for instance? I decided to email Dr. Dodds’ and ask her opinion on the subject.

Dr. Dodds said that her nearly five decades of veterinary experience have shown that the dose of Distemper and Parvovirus can be reduced by 50%, but not more, for small breed dogs (based on their body weight), yet still convey full duration of immunity and protection. This rule applies to both puppies and older small dogs weighing less than twelve pounds. In Dr. Dodds’ studies, she found that greater than 95% of the dogs given a half dose amounted to what is considered to be protective antibody titers for both Distemper and Parvovirus.

She also noted that by reducing the volume of a vaccine, we are decreasing the likelihood of an adverse reaction to the vaccine. Common adverse symptoms often occur within three days of vaccination and can more intensely affect dogs of a young age, small size, neutered dogs, as well as the amount of vaccines given at one time.

Dr. Dodds’ research did not include Adenovirus, so it is unknown if this virus applies to the same idea that dogs under twelve pounds can receive 50% of the typical vaccination amount. Dr. Dodd mentioned that she may be possibly starting a pilot study in regards to small-breed dogs, like the Maltese. Hopefully we will soon have more data that safely recommends giving smaller breeds less vaccines.

As medicine evolves, so do our beliefs and opinions on it. As veterinarians, we can only recommend what we know, what we have learned, and what is supported by scientific data. But as veterinarians, it is also our responsibility to continue learning, question things, and learn from our mistakes.

Giving multiple vaccinations at once

In my personal experience, I have found that giving more than one type of vaccine at one time often leads to more adverse reactions, particularly in small-breed dogs. Although I have seen adverse reactions in large-breed animals, they are typically mild. Unfortunately, severe vaccine reactions in small dogs are more common.

In my practice, I have began splitting up vaccinations for small dogs, and thus far, have not seen a severe reaction in over three years. Now, whether this is because of the amount of the vaccine dose or because the dog only received one vaccine at a time, I don’t know for sure.

As far as splitting off vaccinations, I like to give a Rabies vaccination separate from other core vaccines in smaller dogs. I have also stopped vaccinating my clients yearly and now evaluate the dog’s individual case to determine the frequency of vaccinations needed, as well as titer testing.

In a nutshell… 

The moral of the story is if the dog is under twelve pounds, we should consider reducing the dose of the vaccines for them. To be safe, We can recommend a titer test a couple of weeks later to see if the dose was effective. According to Dr. Dodds’ research, if we give more than 50% of the standard dose, 95% of these dogs will respond well.

However, reducing the dose is going against the manufacturer’s label, and this can put veterinarians in a risky place if the animal acquires Distemper or Parvovirus at a later date. This is a common dilemma in the veterinary profession — every time a veterinarian recommends something “off-label,” such as giving less than a 1ml vaccine for a small dog, they are putting their veterinarian’s license directly at risk. The only way we can reduce this risk is to ask the owner to write a client consent form, acknowledging that their pet is being vaccinated against the manufacturer’s label. Unfortunately, until manufacturers modify their labels to allow for different doses, changing dosages will remain scary territory for veterinarians. This constant legal threat explains why it is difficult for veterinarians to modify dosages and alter their standard practice and routines.

Recommended links and resources

We at IVC (Integrative Veterinary Care) agree with what Dr. Dodds’ opinion on vaccines. You can visit her page: (http://www.itsfortheanimals.com/HEMOPET.HTM).

Here is the link to Dr. Dodds’ vaccine schedule for those who are interested:
(http://www.weim.net/emberweims/Vaccine.html). Although we use a different vaccine company, it is still the same principle. There are many websites discussing vaccines and it can be hard to know what to believe or agree with. Dr. Dodds’ beliefs on vaccines are similar to mine and I trust her knowledge on the subject.

 Dr. Dodds’ blog also talks about vaccine titters and vaccines: (http://drjeandoddspethealthresource.tumblr.com/tagged/vaccines#.UiPABteNTIU)

Dr. Dodd’ recommended vaccine schedule: (http://www.weim.net/emberweims/Vaccine.html)

Our Facebook page, Integrative Veterinary Care: (http://www.facebook.com/integrativeveterinary)

Written by Dr Cindy Lizotte, DVM, MBA, CVFT (CHI institute), CVA (IVAS), Grad Dip Vet Western Herb Med (CIVT) Cert CVHM (IVAS)

Boxer puppy with neonatal conjunctivitis.

Emma, a puppy that had to be bottlefed when she was 5 days old, developed neonatal conjunctivitis when she was about 9 days old. Emma and her littermates are going to day6be part of our Immunity blog series because of the simple fact that all their issues are related to a weak immune system. We will be looking at herbs to support her immune system once she is started on normal dog food and not bottle fed anymore. She, like the three other puppies in the litter have been a constant struggle, having to deal with one medical problem after another. This is often the case when the mother is too old and weak to have normal healthy puppies. Their mom was very sick and had to be euthanized for humane reasons. To the right is a picture of Emma at 5 days of age.

Emma and her littermates were all born with unclosed fontanelles which in some cases has been linked to hydrocephaleus and seizures issues in some smaller breed dog. Although this is not a condition often seen in young boxers, we are hoping it they will close up by around 6 months of age. She and her littermates also had demodex lesions, fleas and weak hind legs that required physio and acupuncture (we will be posting a blog about this and their other issues in January 2014. In cases like these, with dogs that have multiple problems, is where I find that Integrative Veterinary Medicine shows its true potential.

Neonatal conjunctivitis is described as being an infection and inflammation of the conjunctivae. In some cases it can happen before or after the puppies open their eyes. In Emma’s case, the infection set in her left eye behind her closed eyelids. This caused her eyelids to become very swollen. Since the pus was stuck between her eye and her closed eyelid, it caused major swelling since the pus had nowhere to drain. In cases where the eyes are open, it will cause squinting, discharge, redness, swelling and other signs that are typically associated with pink eye in people.

neonatal conjunctivitis

This a picture of another puppy that had neonatal conjunctivitis like she had, the exact same left eye and the swelling was as obvious as it is on this puppy. No pictures of Emma were taken at that time

Neonatal conjunctivitis will require immediate veterinarian attention, because it may lead to permanent damage to the eye and in some cases it may lead to blindness. If you are unable to bring your puppy to a vet, then there are a few things you may do at home.

Treatment for Emma’s neonatal conjunctivitis.

In this case, since Emma was only 9 days old, we wanted to avoid surgery at all cost. A vet can use anesthesia to open the eyelids in cases where they are still closed, flush the eye, instill eye drops and suggest home treatment afterwards. Because the eyelids are not meant to be open that early mechanically (before they are ready on their own), tear gel or artificial tears will need to be applied every 2-4 hours in the eyes because puppy have limited tear production abilities.

But, because I wanted to avoid any type of surgery and anesthesia on Emma, we elected to try lukewarm compress on her eyelids.  We took cotton balls with lukewarm water and gently applied it to left eyelid (about 2 minutes of compress). Then we gently did a small left to right movement with the cotton ball and pus stared to come out from what we call the medial canthus area (the area where the left eye corner is the closet to the nose). We did this 4-5 times a day and after 72 hours, pus stopped coming out. We also applied over the counter polysporin eye drops every 4 hours (even if her eyelids were closed). We aimed to get in the same area where the pus would come out. If pus can drain, that means there is a hole and hopefully eye drops will get in from that same hole. About 5 days later, she opened her eyelids naturally. She reacted with a tiny yelp when polysporin was applied, so we discontinued that. She was now 14 days old. We switched from polysporin eye drops to fucithalmic gel and we kept doing artificial tears for a few days.

A few days later, her eye took a turn for the worst. Basically, the epithelium of her cornea detached itself from the stroma of the cornea (formed a liquid bubble). The eye looked mushy like what we see in a burst eye (perforated eye) or uveitis, but it looked bigger like we see in glaucoma cases (bupthalmia).

Once her left eye started to bulge out to the point her eyelids would not close over it, it seemed painful. This happened in under 24 hours, going from an almost-normal looking cornea to an abnormal looking eye that looked like it had ruptured. She started to whine constantly and had to be rushed to the vet hospital for emergency eye surgery (and of course this always happens during a huge snowstorm when the clinic is closed). Emma was put under general gas anesthesia and I was mentally preparing myself to remove an eye the size of an eraser pencil tip, thinking for sure her eye had ruptured for some unknown reasovideo-cornealayersn at this point.

While under anesthesia, I used a q-tip to investigate the origin of what I suspected was a hole in her cornea, trying to determine the cause of all of her trouble. Suddenly the bubble popped and liquid started to come out, exactly like we see in ruptured eyes, but imagine my surprise when I saw an intact stroma hidden behind that bubble. Basically, with the q-tip, I tore a hole in what was the epithelium part of the cornea and the stroma underneath was intact!

visi0245

So, if you look at these pictures, the entire epithelium had detached itself from the stroma and stuck in between was fluid with blood and pus. That meant that the eye itself was not leaking fluid which also meant NO EYE REMOVAL!

After doing some research, the closest thing I found that would come close to describing this condition is a condition called Keratoconus in peopthCZG380EZle. Emma had a condition that I had never seen before and that I could not find documented cases of in dogs. You can see on this image that the cornea is bulging out, so if you try to close your eyelids, well technically that bulge would get squeezed in between them.

We still had a chance to save her eye. So, I debrided the entire epithelium part of the cornea (usually we would do a grid technique on deep ulcer). In this case, the entire superficial layer of the cornea was stretched out, abnormal looking and hiding a pocket of infection/fluid that I suspect came from her original neonatal conjunctivitis. I removed as much of the epithelium  as I could, but even under anesthesia the exam of the eye was hard since it was tiny. Looking at her eye, we could see a line when I suspect the infection got in between the lawyers of the cornea (between 10-12 o’clock there was a 3-4 mm line where the sclera and the cornea joined). I suspect this is the tear that allowed the infection to set in. Usually, I would do serum drops in cases where we have deep ulcers, but since this looked superficial and because this was a 1 lbs puppy, we elected not to take blood from any veins to make serum drops. We did a third eyelid flap similar as what you can see in this Youtube video. This protects the eye in hopes to allow the cornea to heal itself. It brings vessels and nutrition to the sick and injured cornea. It keeps the eye moist and allows us to apply medication to the eye with less of a struggle. I usually use a human contact lense more often now days then a third eyelid flap but finding a contact lense that tiny would have been a challenge. So, as a last resort, we had to do a third eyelid flap under anesthesia.

She was put on Artificial tear gel every 4 hours, Oflaxacin (my favourite for Boxers with indolent ulcers) twice a day, Diclofenac twice a day and Atropine twice a day. The third eyelid flap was removed 7 days later and it seems that her cornea is slowly healing. She was also put on a probiotic called Fortiflora.day1 thrid eyelid flap for ulcer

Emma had a third eyelid flap surgery on December 18th. This is her on December 22th. On the upper left eyelid, there are 3 tiny purple stitches.

dec22 eye drops with eye flap
December 22th: Emma getting tear gel. We see the purple stitches on her eyelid flap on her upper eyelid.
dec23
December 23rd: Emma is drinking from a bottle. Her third eyelid flap still holding well.
dec24
December 24th: This is a few minutes after we removed her eye flap. There is still a lot of swelling and corneal edema (blueness on her eye).

dec30

December 25th, a lot less swelling

dec26

December 26th: Note the eye cornea seems to be healing!
dec26pict2
December 26th: Note the cornea is intact and it is beautiful to see this after we thought her eye had ruptured!
dex29
December 29th: Her cornea is showing signs of healing!
dec29 7 days after flap removed
December 29th: This is about 11 days after her ulcer was noted and debrided, and about 5 days after her third eyelid flap was removed.
dec30

December 30th: There is still a lot of swelling with her third eyelid, but once her cornea is fully healed up we will start her on Maxitrol to reduce all that. Her cornea is almost ready, it will be 14 days post-ulcer on January 1st 2014.  A few days later, she was started on Maxitrol twice a day for 7 days once we tested her eye with a fluorescine stain to make sure the ulcer was healed up! This will reduce any scaring left on her cornea and allow what we hope is a full return to normality.

boxer jan 4

 January 4th, 2014. Left eye looking a lot better and almost normal!

boxer jan 7th

January 7th, you can barely see a scar in her left eye!

cindy lizotte

Last update: January 22th, barely not scar visible in her left eye! We will be looking into each herbs and the Immunity support formula that we will be using on these puppies as the immunity series blog progresses. This is more a case presentation so that we may see how she and the rest of the litter progress as we move into re-balancing their immune system. Sometimes even very sick puppies can be supported to make them healthier long term and this is our goal with herbs and natural supplements. Integrative Veterinary medicine means that we combine conventional therapies with natural therapies in order to try and promote a more a healthier life! The goal is to nurse these sick puppies back to health in hopes that we will not have complications related to their immune system as they grow older.

Written by Dr Cindy Lizotte, DVM, MBA, CVFT (CHI institute), CVA (IVAS), Grad Dip Vet Western Herb Med (CIVT) Cert CVHM (IVAS)