Thursday, October 2, 2014

Veterinarians and Ebola Virus Disease (EVD)

You have probably heard in the news lately (unless you're Amish, or live off grid in Alaska) that there is a bit of an infectious disease problem in West Africa. And that this disease made an appearance in Dallas, Texas a couple of days ago in the person of one Thomas Eric Duncan.

What you might not have heard is that veterinarians know, or certainly should know, a great deal about Ebola Virus Disease (EVD) since this is yet another deadly zoonotic disease whose origins are probably in a number of African bat species.

Under the concept of One Health, it is the responsibility of both physicians and veterinarians to be cognizant of and preferably conversant in any diseases which can be spread from animals to humans or vice versa. It is also, or should be, our responsibility to reach out to clients in order to educate them about these diseases, particularly when they might affect our own community.

So here are some links to sound, factual scientific information about this disease. If you want the panicky rumor mill type stuff, you'll need to go to Alex Jones' horrifyingly irresponsible website or elsewhere on the intertubes.

CDC's Ebola page is pretty much the sine qua non of EVD resources.

WHO's web page is also good, but is more geared toward international public health considerations and not personal health.

Texas Department of State Health Services has limited information pertaining to this particular case, apparently in keeping with their beliefs in small government. This doesn't seem like it serves the interests of Texans very well, just between you and me.

The New York Times has an excellent Ebola page

NBC news has gathered all their Ebola coverage together in one place to make things easier.

As far as what I am doing or not doing, and thinking or not thinking about this new public health threat in the US - I have spent some time mulling over what steps I can personally take to ensure that, should EVD appear in SoCal, I am part of the solution and not part of the problem. So I am reading up on appropriate hygiene and how one applies that to the home, the workplace, and going out in public places. We might need to change our behavior and habits if it comes to that. I want to be ready.


Sunday, July 27, 2014

Why We Are Phasing Out Use of "Antibacterial" Handsoaps

Here at Cat's Meow Veterinary Clinic we have always used (and will continue to use) surgical scrub soap containing chlorhexidine for use on patients and prior to gloving up for surgery. But our everyday handsoap for use at sinks throughout the hospital is another matter.

Some years back I made the decision to switch to "antibacterial" handsoap containing triclosan because, well everyone was doing so and it seemed to make sense. But the devil is in the details. In the ensuing years there have been disturbing reports of environmental persistence by this chemical (yeah, we REALLY need another DDT, don't we?), and more frighteningly, its negative effects on soil and water microbes.

Now there are plenty of microbes we want to have a negative effect on: specifically the potential pathogens found on dirty hands. But the last thing I'd ever want to see is for those effects to spread beyond my hands and into our waterways and outdoor ecosystems. And that is exactly what is happening.

In 2011 Tufts University produced a white paper evaluating triclosan. They expressed concerns about bioaccumulation in fatty tissues of animals including humans, contributions to antibiotic resistance, and environmental effects.

I decided, based on these concerns, that it would be wise to end our use of products containing triclosan wherever possible. So we've been gradually using up the jug of Dial Antibacterial Handsoap we had on hand (I felt this was preferable to sending it en masse to a landfill - dilution is the solution to pollution in this case) - and I am happy to report that we are now down to the final 8 ounces or so in the final dispenser.

Research studies have shown that vigorous handwashing with ordinary soap removes just as many bacteria as soaps containing triclosan, with far less environmental impact. It's all about mechanical removal, it turns out, and not about "sterilization" of hands (which is physically impossible anyway).

So I'm about to do a little happy dance as the last of that nasty orange stuff goes away. I now use a handsoap with no dyes, though it does have some fragrance. And as soon as I can find a jug of fragrance and dye-free handsoap, I will phase that in. I believe I spotted one at Whole Paycheck, but avoiding those pesky unintended consequences is well worth the cost.

Saturday, July 12, 2014

Updated Information on the Rabid Skunk in Long Beach

We just got this press release from the Long Beach Health Department. I am relieved that it was NOT the skunk variant, which would have been an ominous development with serious public health implications, particularly for our local feral cat population.

July 3, 2014
Contact: Mitchell Kushner, MD, City Health Officer, 562.570.4047
For immediate release
First rabid skunk to test positive in Los Angeles County
since 1979 confirmed to be rabies variant carried by bats

The California Department of Public Health confirmed today that the rabid skunk found last week in Long Beach was infected with a rabies virus variant from the Mexican-free-tailed bat. While bats in the area have tested positive for rabies in past years, this was the first confirmed case of rabies in a skunk in Los Angeles County since 1979. Mexican-free-tailed bats are very common in Southern California, and are the species of bats that most commonly carry rabies in the state.
Bat-to-mammal transmission is not uncommon, and the rabid skunk likely had an encounter with a bat infected with rabies. “This is the time of year that we might see more bat rabies, and potentially spillover to terrestrial mammals,” said City Health Officer Dr. Mitchell Kushner. “We do not anticipate that this spillover event is anything more than an isolated incident.”
The testing was important to determine that a skunk variant of rabies, which is only noted in Northern California, has not be re-introduced to Southern California where it has not been seen since 1979.
Continued vigilance in testing wildlife that is ill or exhibiting unusual behavior is still recommended. Anyone noticing obviously ill wildlife or unusual symptoms by animals should contact Animal Care Services at 562-570-7387. The Health Department and staff from Animal Care Services remind residents that they should not try to capture or trap wildlife, and that all domestic pets should receive their scheduled rabies vaccine to prevent pets and humans from getting rabies from other animals.
For more information on rabies, call Long Beach Animal Care Services at 562-570-7387.
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Tuesday, July 8, 2014

Preventive Care for Kittens

It's been quite a while since I wrote the previous edition of my kitten prevention recommendations, and I can't find the post easily, so I think it's time to write an updated version.

Kittens should be seen promptly when first acquired (within a day or two) to assess their age and look for any urgent problems, in addition to coming up with a game plan for vaccinations, parasite control, diagnostic testing, and neutering. Generally this first visit is at about 8 weeks, but in younger kittens it can be much earlier. We do recommend that, whenever possible, kittens stay with their mom and litter mates until 8 weeks to allow the greatest chance of normal psychological and behavioral development.

At 8 weeks:

FVRCP-C #1 - first in series of three distemper/upper respiratory preventive vaccinations
Parasite control - flea control and internal parasite treatment as indicated - typically we administer an oral dewormer and outline what external parasite control you should be using, depending on individual circumstances.
Basic physical examination - eyes, ears, skin, mouth, heart/lungs, abdominal palpation
Q&A - be sure to come with a list of questions to ask the doctor because that's one of the most important parts of the visit

At 12 weeks:

FVRCP-C #2 - second in series
FeLV #1 - first in series of two feline leukemia preventive vaccinations
Parasite control - another oral deworming
Physical examination - just like the first time, but looking for normal weight gain and growth and development of any abnormalities or signs of illness
This is the earliest possible date to do FeLV/FIV testing, but obtaining a blood sample at this age is difficult so we usually defer it unless the kitten looks suspicious.
Q&A - ask away

At 16 weeks: 

FVRCP-C #3 - final in the series (boosters annually or every three years depending on brand)
FeLV #2 - final in the series (boosters every 1 or 2 years depending on brand)
Rabies - not part of a series (booster in one year, then every 1 or 3 years depending on brand)
Physical examination - weighing again and looking over to make sure all appears normal
FeLV/FIV test if kitten cooperative.
Q&A - keep asking - we're here to answer


We recommend spaying females at 6 months of age and males at 8 months. Yes, it can physically be done earlier, but we feel that it is not in the cat's best long-term medical interests to jump the gun. It is rare for females to come into heat before even 5 months, and if she goes into heat it doesn't need to change our plans for surgery - it just costs a little more. We do NOT wait until she goes out of heat because that takes months and is unwarranted. Just be sure to keep her indoors 100% of the time until she has been spayed.

As for males, we especially do not want to do surgery prematurely as this has been associated with hip fractures in young males, and in our experience it also increases the risk of obesity and urinary obstruction down the road. It is quite rare for males to spray prior to 1 year of age, and if the stinky urine odor from hormones kicks in and bothers you too much, we can move the date up 2-4 weeks to keep you from going crazy.

We most commonly get our blood samples for FeLV and FIV testing at the time of spaying/neutering since the patient is 100% cooperative when anesthetized and we don't have to scare them to get it.

Down the road: 

This isn't the end of medical care for kitty - it's just the start. All cats, regardless of lifestyle, breed, or owners' perception of risk, need to see a vet annually for an exam and vaccinations through age 8, and then twice a year after that, at a minimum. Once cats are mature, one calendar year ages them like four years in a human. These annual visits are a great way to discuss any concerns you have about ongoing minor concerns.