If You Give a Vet a Soapbox...My Response to the Anti-Vaccine Movement

Moments ago I finished -- with a dramatic flourish -- an e-mail response to a very good client whose insightful questions about his pets constantly keep me on my toes. What started as a quick note developed into a lengthy and impassioned epistle. I found myself so wound up by the time I hit "Send" that I couldn't help but expound my point of view to anyone who would listen. Dear reader, that may be you if you choose to continue.

Hey Dr. Kim,

Not sure if you saw the attached article or not. It was a good read I think, and thought you may find it interesting. All is well with Puppy. We will see you in a few weeks for another check up with him. Hope your weekend was well! 

Thanks,

Puppy Owner

Subject: puppy vaccinations

I found this link that may be of interest to you now that your puppies have just received their second shot. This is a very important read, for you to discuss with your vet.

The puppies will be ready for their rabies shot in a couple weeks but according to this article which has some very strong articles to support, there is no need for anything more than rabies this year.

Know that I gave the parvo/distemper shot to them at home at 7 1/2 weeks old. There were not exposed at the vet's office. This is the safest way/time to give a vax not knowing what all the puppies would be exposed to as they went to their new homes....

Kindest regards~
Puppy Breeders
http://www.dogsnaturallymagazine.com/five-things-your-vet-says-that-arent-true/

Dear Puppy Owner:

I'm glad you sent the article. I could read on this subject for hours, clicking links to this and that!

So much of the article is correct. As I read it, though, I felt myself waiting for the author to complete a train of scientific thought as I learned in immunology training [the study of the immune system]. And when they didn't I realized it must be because the omitted part would actually lessen the effectiveness of their argument. There are so many points in the article where I wanted to shout "But that's not the whole story! You forgot about individual variation or herd health medicine or maternal antibody variability or compliance or practicality, economics and human fallibility!" 

People mistakenly believe the practice of immunology in human and veterinary medicine is done in favor of the individual. Vaccination critics believe an individual's risk outweighs the public's benefit. But the cold hard truth is immunizations are not done solely for the best interest of the patient but for the public interest.

A dog is not vaccinated against rabies to protect him from dying of rabies (although he indeed benefits in this way). A dog is vaccinated against rabies to create a barrier of protection to the human population from rabid domestic animals. If animals who interact closely with the human population (such as dogs) cannot contract and pass the rabies virus, then fewer humans will die of rabies. That is the goal of rabies vaccination in pets. A corollary argument is that a dog vaccinated against parvovirus (or distemper, etc.) helps protect the whole population of dogs from parvovirus. Just as parents who refuse to vaccinate their children are relying on "herd immunity" (i.e., the fact that the U.S. population is well vaccinated against certain deadly illnesses) to protect their unvaccinated children, pet owners who do not vaccinate have relatively "protected" pets because the animals they interact with are vaccinated and cannot pass on disease.

I could write a dissertation in response to the arguments laid out in the article! But I do want to point out two things regarding the Breeder's e-mail and how it relates to Puppy:
1) Puppy Breeder's email says the pups were vaccinated against parvo/distemper at 7-1/2 weeks and do not need any further shots besides rabies. This statement does not even agree with the article much less current standard of practice. The article says a single vaccine at 12 weeks is sufficient, not one prior to 8 weeks of age. 
2) Dr. Ron Schultz's research is quoted extensively in the article in support of vaccinating only once at 12 weeks. Dr. Schultz was my immunology professor at UW School of Veterinary Medicine. [I am a 2007 DVM graduate.] We were taught to make sure the final "distemper" vaccine was given at or after 16 weeks (not 12). 

There are many scientifically proven reasons for boostering more than once in puppies. There are different types of immunity and boostering increases long term "memory" in the immune system. Also, maternal antibodies interfere with vaccination in puppies. That's why puppies (and babies) receive a series of vaccines. The reason we do not wait until 12-16 weeks is because we cannot be sure a) whether the mother was properly vaccinated and b) whether the puppy/baby received enough immunoglobulins through first milk colostrum (a bigger risk in large litters where pups fight for resources). 

Over-vaccination is a real concern, but I do believe in the societal and clinical benefits of vaccinating my pets as well as my children. Some vets (as indicated in the article) recommend annual vaccination for everything, but this method of practice is changing. Dr. Schultz taught us that many pets have more than 1 year (and even more than 3 years) of protection from vaccination, it's true. Many viral vaccines are FDA licensed for administration every 3 years. Until new research and licensing shows protection for a majority of animals beyond 3 years, most vets will vaccinate every 3 years for rabies and "distemper." Yes, you can have antibody levels tested for parvovirus or distemper virus and choose not to vaccinate if levels remain high. However, this is not commonly done because the serology test is not inexpensive. 

Some types of vaccines (for bacterial diseases such as Lyme, Leptospirosis and Bordetella) do NOT provide proven protection much beyond one year. In fact, Bordetella is sometimes given every 6 months to dogs at high risk for Kennel Cough because the body does not make the same long lasting immunological response to bacterial diseases as it does to viral disease. (This probably explains the recent Whooping Cough outbreaks in humans...Whooping Cough is related to Kennel Cough; both are caused by Bordetella organisms!!! As children we receive the "Pertussis" vaccine but lose protection over time and may become susceptible as teenagers or adults.) The canine vaccines I just mentioned are lifestyle vaccines. Not all dogs should or do receive them.

Whew. I'm exhausted. This is such an emotional topic from either side! I find it interesting that the same diseases "anti-vaccine people" claim stem from vaccination in this article are the same diseases "anti-grain pet food people" claim stem from commercial diets. It would be foolhardy of me to say any of these claims are complete nonsense! There is so much we do not fully understand of the intricate workings of the body and our environment. There are many truthful statements in the article. Good physicians, veterinarians, and scientists continually study and learn. Good doctors pay attention to what works and what doesn't, rely on a body of properly done objective studies (believe me, anyone can do a study to prove what they want to prove!), and think about the whole picture when it comes to health and disease management.

I would be happy to discuss the article, my comments and any additional questions you may have at Puppy's visit next week!

Dr. Kim 

Shortly after my earnest e-mail shot through cyberspace, my kind client responded with a mildly exasperated yet placating e-mail, soothing my raging frustration. I didn't have much convincing to do apparently. As long as such mental gymnastics don't give me a coronary, I'll just be grateful for the chance to debate interesting and important topics with other people who care. 

What's Eating Gilbert Grape? Better Not be Your Dog!

Picking up dog poop has become a very interesting and unsettling experience for me lately. In an effort to reduce our landfill waste, my family has been setting aside produce scraps, coffee grounds and overripe fruit for our backyard compost heap. These organic "greens", mixed properly with "browns" such as old leaves and straw, do not tend to attract varmints (such as gluttonous yellow Labradors). However, having this week found dog poop consisting mostly of whole green grapes I think something has gone awry with my compost heap.

The grape poop is concerning for a couple of reasons. The least of my worries is that one of my exuberant children is stocking the compost heap improperly meaning the pile will not mature as quickly. More concerning is the fact that my dog is obviously gorging himself on a potentially toxic fruit -- grapes. 

In spite of the fact that some dogs have historically eaten grapes with no obvious ill effect, grape ingestion has been repeatedly and definitively linked with sudden kidney failure in dogs. No one knows for sure the exact number of grapes or raisins necessary to cause toxicity, but cases have been documented involving from over a pound of grapes to as little as a single serving of raisins!

Toxicities have been seen involving all varieties of grapes, home-grown and store-bought. Affected dogs usually begin vomiting within a few hours after eating the fruit and then develop diarrhea, tiredness, abdominal pain and decreased appetite. Partially digested grapes might be seen in the vomit or diarrhea. (Hmmm, the poop grapes I've seen are whole ... maybe EdGrrr has been spared because he doesn't chew? One can hope...) Kidney enzyme elevations are typically seen on bloodwork anywhere from 24 hours to several days after the grapes are eaten.

Immediate and aggressive veterinary intervention is crucial to give an affected dog its best chance for survival. As damage within the kidneys progresses to end-stage kidney failure, urine production stops completely and euthanasia is typically performed due to the grave prognosis for the pet. Fortunately, with early detection, decontamination, intensive-care hospitalization and monitoring, dogs can survive the immediate threat of grape and raisin toxicity.

Even if your dog has eaten grapes or raisins in the past with no obvious ill effect, the safest advice is to avoid feeding any grapes, raisins or other dried fruits to your pet until this toxicity is better understood. As for EdGrrr? I think he has once again dodged a bullet in his ongoing battle with dietary excess. And my family will need to fine tune our kitchen waste composting techniques.

P.S. Compost Joe's Premium Soils & Organics regularly offers group and individualized home composting lessons. Equipment for backyard composting and finished compost is also available.

Witchy Over Itchy

As a new mom at Little League, I was relieved to bump into an acquaintance mother in the stands. She had brought her adult Boxer and my American Bulldog puppy was enamored of her.

As the two dogs rough-house in the grass near us, the woman suddenly announces how angry she is at her current veterinarian (always dangerous territory)! Turns out her veterinarian said not to breed her female dog because she has allergies. Before I can respond another mom interjects dismissively, "Pfht! All dogs have allergies." Feeling ambushed, my veterinarian instincts overcome my social delicacy instincts and I blurt out "No! Allergies-are-an-expensive-and-difficult-problem-for-many-owners-and-terrible-for-dogs. I-even-know-of-one-dog-who-was-put-down-because-of-her-suffering!"

You could hear a pin drop.

While the Boxer's owner stares at me with mouth slightly agape, I try to salvage the conversation by asking calmly about her dog's symptoms and severity. To no avail. The conversation has died and cannot be resuscitated. At least for this baseball game, I have become a pariah among Little League moms.

Having had some time to reflect on the scene, I find myself agreeing with Second Mom's statement that "all dogs have allergies." It certainly seems that way some days as dog after dog visits my veterinary clinic with complaints of painful ear infections, inflamed paws and uncontrolled itching.

Yes, many dogs like people have mild seasonal allergies. We don't discourage people who suffer from hay fever from procreating. We don't even stop people with life-threatening peanut or shellfish allergies from marrying and having kids. The thought is just plain ludicrous. But dogs are not people, obviously. It is our responsibility in this age of pet-overpopulation to be cautious and judicious about which dogs we allow to reproduce and why. Many allergies in pets have a hereditary component. If not breeding a known allergy sufferer might prevent similar suffering in future canine generations, all the veterinarians I know would be in favor of that.

Canine allergies vary in cause and severity. Like bee sting reactivity in people, canine allergies may worsen with time. A mild seasonal allergy causing red, itchy eyes for a few weeks in a puppy can worsen with successive allergy seasons. The season itself may lengthen to all year round as the pet accrues additional allergy triggers including house dust mites and other unavoidable airborne particles. Symptoms too may worsen with some dogs living their entire lives with expensive, difficult-to-manage chronic ear infections, anal gland problems, and skin disease. Gastrointestinal upset ranging from picky eating, frequent vomiting and soft stools may indicate food allergy, which are historically difficult to diagnose and very expensive to manage.

Yes, Second Mom, so many dogs suffer from some degree of allergies I think most pet owners do consider it normal. The constant foot licking some dogs do, for example, may not be merely boredom. Butt scooting, reported with hilarity as if the dog performs the act for comic relief, may actually signal a food allergy. And let us not forget cats whose allergies are perhaps more challenging to manage than dogs': the puke piles you step in several times a week are not strategically placed to annoy. And not all bald cat bellies and legs are due to obsessive-compulsive disorder. Just because these things are common does not make them normal and acceptable in our pets!

Faced day-after-day with disgruntled, frustrated pet owners and miserable pets who hate taking the medicine that will provide merely temporary relief from their allergy symptoms, I forgive myself the "faux paw" of erupting at my fellow Little League moms. I hope they will forgive me knowing my rudeness is just exuberance on behalf of my afflicted patients.

P.S. Some breeds of dogs are more commonly affected by allergies than others (remember, that hereditary component of allergies?) so do your research befor acquiring a new pet. Ask the breeder or former owner if the dog or its parents have a history of allergies or allergy symptoms (itchy skin, excessive licking, ear or anal gland problems, chronic upset stomach) so you can go into the adoption with eyes wide open.

Timely Tick Talk

Over Memorial Day weekend I got a somewhat cryptic text message from a friend:

HIM: Any tricks besides vasoline to get ticks out. It's under Liddy's skin and won't back out.

ME: Tweezers at the base of the head and slow gentle pressure. We need to get Liddy on a flea/tick preventative!

I thought that was the end of it until Tuesday when I received an urgent call at the clinic that they still had been unable to pull out the tick and needed help. During my examination I found a small hairless bump by Liddy's ear. There was no evidence of a bite, no mouth parts left behind. Polite interrogation of the owner revealed that no one had actually seen a tick on Liddy. The owner had found the bump (most likely a tiny cyst) and assumed it was tick that had buried itself in her skin! 

This interaction reminded me there are many myths associated with ticks, with "ticks crawling under the skin" being a common one. While a client once reported to me that the cause of all her sinus problems was a woefully confused tick that had crawled up her nostril and died (yuck!), ticks do not burrow under the skin of their victims. They do embed their mouth parts in the skin while taking their blood meal, however, and these mouth parts can become lodged in the skin if the tick is improperly removed before it is done feeding.

A Wood tick crawling around on my porch...
located amid a mowed lawn and sparse trees

Having found a high number of Wood ticks in unusual places this spring (my kitchen sink, porch and pillow) I feel a tick talk is in order. 

MYTH: “Tick season” occurs only during the warm summer months.

FACT: In central Wisconsin, ticks are out and about from early spring until snow covers the ground (often March through November).

MYTH: My pet doesn’t go “up north” into the woods, so I don’t have to worry about tick bites.

FACT: Ticks are found throughout Wisconsin. They live predominantly in tall grasses and shrubs. Ticks sense an approaching animal and hop on as it passes by.

MYTH: My pet is safe from Lyme disease because I’ve never found deer ticks on him.

FACT: Exposure to one species of tick increases risk of exposure to other species as well. Deer ticks might go unnoticed on your pet while they are attached and feeding because they are so tiny. Ticks can attach under and in the ears and between the toes, places that often go unchecked. Ticks engorged with blood look dramatically different from “empty” ticks, so it is difficult for the untrained eye to determine which species of tick is present. Furthermore, deer ticks are not the only culprit; many species of ticks are known to carry diseases that can harm people and pets.

MYTH: My dog is vaccinated against Lyme disease, so I don’t have to worry about ticks.

FACT: Lyme disease is a common disease transmitted by the deer tick. Fortunately there is an effective vaccine against Lyme disease. However, many dogs in Wisconsin are infected with anaplasmosis, a different disease carried by deer ticks. There is no vaccine to protect against anaplasmosis. Another tick species, the Lone Star tick, has reportedly made an appearance in southern Wisconsin, bringing a collection of "new" tick diseases to the state.

MYTH: My dog isn’t lame so I know he doesn’t have a tick disease.

FACT: Lameness and joint swelling are indeed typical signs of tick disease. Other symptoms may include fever, lethargy and loss of appetite. However, many dogs found to have tick disease have no obvious signs of illness. Tick disease screening is a simple blood test recommended as part of a dog’s annual wellness examination.

MYTH: I only have cats. All this talk about ticks doesn’t apply to my kitties.

FACT: Ticks can and do feed on cats. Scientists believe that cats can get some of the same tick diseases people and dogs get. Use of an appropriate flea and tick preventative on cats that spend time outdoors is a good idea. NOTE: Before applying any over-the-counter flea and tick preventative to your cat, please check with your veterinarian to make sure it is safe for cats.

The best protection against tick diseases is achieved by using a combination of tactics. Inspect your pet carefully after being in grassy or wooded areas. Removing a tick within the first 48 hours of attachment drastically reduces transmission of disease. (Wash your hands thoroughly after removing a tick from your pet.) Ask your veterinarian if vaccination against Lyme disease is recommended for your dog. Topical flea and tick preventative should be used during the spring, summer and fall at a minimum.

As for Liddy, the owners are applying a topical antibiotic/anti-inflammatory and we will follow up with additional testing if the bump does not resolve on its own.