Month: November 2019

135 Cytopoint- the “new” injection for itching

All dogs itch once a while. Some dogs have seasonal allergies, and have seasonal itching and scratching. These are pretty easy to manage with oral histamines, weekly bathing, and parasite control. A few have severe allergies to pollen, parasites, or even food, and they are miserable. All that scratching and itching traumatizes the skin, it becomes inflamed, and it can get infected. In the “old days” we use steroids like prednisone to stop the itching, but it can have bad side effects. About 8-10 years ago we started using Apoquel (oclacitinib tablet), which is potent like steroids, but is not steroidal, so there is no suppression of immune system. Many of these cases used to be sent to the dermatologist for allergy testing, but Apoquel controls the inflammation quickly and orally.

Now there is an injection for itchy dogs called Cytopoint. CYTOPOINT helps interrupt the itch cycle; allowing dogs to stop scratching so damaged skin can heal. And it works by an entirely different mechanism. Instead of blocking histamine and other pro-inflammatory compounds, Cytopoint neutralizies IL 31, a cytokine that mediates the itch cycle, not the inflammation. It is the first monoclonal antibody (mAB) therapy for chronic canine allergic and atopic dermatitis. I think of it more like a vaccine for itch than inflammation.

Cytopoint won’t magically heal red or infected skin. It doesn’t stop the allergic reaction but breaks the itch cycle, which is monumental for some dogs. Allergic dogs may still need bathing to control exposure, and infected skin will still need therapy, but that darn scratching will go way down. No more constant licking feet or hearing that collar jingle from scratching face or ears ( if it is atopy triggered).

How do we assess itchiness? As vets, we ask the owner to rate the itchiness on a scale of 0-10. Zero is not itchy at all. Ten is the worst imaginable, round the clock, can’t sleep, can’t eat, bleeding skin. My clients often rate the severely affected dogs as 8 /10. Apoquel and Cytopoint should reduce the score to 3-4/10. Apoquel is a tablet given once to twice a day, safe for dogs over 12 months of age. Cytopoint is an injection that lasts 4-8 weeks, so it can be more cost effective for some dogs. And if the Cytopoint isn’t enough by itself, it is safe to also give Apoquel since they work by entirely different mechanisms.

So if your itchy dog isn’t well controlled on Apoquel, or the cost of being on it daily is cost prohibitive, come and let’s see if Cytopoint would be a better choice. At least we have options before sending you to the veterinary dermatologist.

134 What’s New with Diabetes in Pets

The role of diet in treating and possibly preventing diabetes in dogs and cats is undergoing lots of scrutiny lately. The old thinking on treating diabetes was to use insulin, decease simple carbohydrates to prevent blood glucose spikes, and eat high fiber diets to smooth out the whole glucose curve. Higher fiber diets could also help pets lose weight since obesity is often associated with the onset of diabetes, even though they might be sick and skinny at the time of diagnosis.

The latest theories on cats with diabetes is that free feeding high carbohydrate dry food to inactive indoor cats can lead to obesity, higher glucose levels after eating, and higher insulin concentration. These blood levels of glucose and insulin are believed to lead to pancreatic cell failure and ultimately diabetes. We know that weight loss to an optimum weight will help manage the diabetes, and sometimes can lead to remission of diabetes in cats. The weight loss ideally is slow and steady, ~ 1%/week, usually on a high protein/low carb diet to maintain muscle mass.

The latest studies on dogs didn’t show much difference between normal fiber and high fiber diets in regulating glucose levels on diabetic dogs. The most successful study was feeding any diet the dogs would eat consistently before in insulin, with no snacking between meals. Of course, weight loss in obese diabetic dogs is always recommended, but that is another whole can of worms about the “best diet” to lose weight.

On a high tech almost sci-fi note, I have one patient who has the human Libre Freestyle Sensor implanted under the skin of her back and the owner can track her glucose with her cell phone app! It isn’t approved for dogs and has to be replaced every 14 days, but it is a big leap in glucose monitoring technology.


To learn more about diabetes in pets https://www.avma.org/public/PetCare/Pages/Diabetes-in-Pets.aspx


https://catfriendly.com/feline-diseases/diabetes/

http://www.pethealthnetwork.com/dog-health/dog-diseases-conditions-a-z/november-national-pet-diabetes-month

133 How to Trim a Dog’s Toe Nails with a Dremel Tool

As vets, we kind of take nail trimming for granted. How hard can it be to trim a dog, cat or bird’s nails? We have plenty of staff, big towels, and even anti-anxiety medicines to help in some cases. The reality is it is hard for most owners to do. And long nails, especially in dogs, can break off accidentally and cause the dog a lot of pain and bleeding, or they can scratch owners and flooring. Cats seem to have fewer problems with long nails, but I did have an aged Siamese cat brought in for inability to walk/possible euthanasia that was just long nails growing into the pads.

The latest trend I see for nails is grinding a dog’s nails with a Dremel tool. Show dog owners have been doing this for years, starting with young puppies to overcome the noise factor. Those dogs always had great short smooth nails. A few years ago, a battery powered product called Pedipaws was marketed to grind nails. I found it to be under powered to grind nails, but was satisfactory to smooth the rough edged AFTER a nail clipping.

Lately I have revisited the Dremel tool (or any brand powered craft tool – mine in a Craftsman) on dogs in the hospital and my own young adult, Chuck. We are finding it does work with the right coarse sanding drum attachment. It leaves a nice smooth nail, is less scary for many dogs than clipping, but takes a lot more time. I think most owners could do this at home, with the right tool, and a lot of patience.

Before you head out to the grinding process, you must familiarize your dog with the Dremel tool. The introduction should be simple and slow. Don’t rush, since you could create a bad association of the tool and your dog.

The first part of the introduction involves using special high value treats that your dog is crazy about and can eat slowly. Some of the treats to use include salmon, steak, and grilled chicken or even peanut butter. Once you have the food, turn on the Dremel tool while feeding your dog with the delicious foods. Then turn off the Dremel tool and stop the feeding. The association becomes Dremel off /no food, and then Dremel on/ special treats. Also, let your dog sniff and touch the Dremel tool while it is off. This investigation of the tool makes your dog less fearful around the Dremel.

Next, While running the Dremel tool (noise),have your dog get used to having his or her feet touched. Feed treats. We want the noise and foot handing NOT to be a scary experience. You may only be able to touch a foot, or a few nails at first. Be patient. With time your dog becomes accustomed to the noise. With multiple practice sessions, your dog is now ready to be trimmed off its nails.

Also, try to get your pup to lie on its side on the floor, rather than standing up. This provides a relaxation mood to the dog and a perfect position for the trimming activity. Taking the process slow is both beneficial to you and your dog. I found with Chuck, standing up with his foot flexed and flipped back like a farrier does a horse worked better. He does NOT like for me to pull on his feet.

Once these steps are accomplished, you are ready for the crucial part :  trimming of the nails.

1) Prepare your Dremel tool with the little sand paper drum. The treats  should be ready and nearby.  Ideally, have a partner to offer treats while you concentrate on the nails. Your dog should be in a comfortable position.

2) At this stage ask your dog to give you his or her paw, and then hold the paw firmly without squeezing it. Separate the nail from the rest of the part, by pushing gently at the top of your dog’s paw.
The nail will extend slightly from the pressure applied. If your dog has a longer coat the fur might be caught by the spinning Dremel. It is recommended to either trim the hair first, or put a “sock” on the foot with the a hole for the nail. This keeps the fur out of the spinning Dremel spindle.

3) Turn on the Dremel tool, on low power, and touch the tip of your dog’s nails with the spinning Dremel. The tip of the nail will be ground awayl. Take care not to apply too much pressure as this will injure your dog or cause the tip to slip.
Start grinding across the underside of the nail. This removes the uneven edges and the rough stuff. Then grind on the  tip of the nail  to an angle so it will be flat on the floor when the dog stands. Take off the sides, corners and the rough edges that are surrounding the tip.
While doing this your grinder should be moving, not just holding in one place too long. Get close to the quick without nicking it. When the quick recedes further back, the nail will get much shorter.

In order to smooth the nails, grind the small loose layer that runs alongside each nails bottom gently. Do this by rotating the Dremel in one or two swipes around the nail. The smoothing achieves perfect rounded corners and prevents the cracking of nails.

4) During and after finishing the trimming process, reward your dog by offering treats and praises.  A second person makes this much easier at first.
Shorter sessions are less traumatic and comforting; hence take a little break after trimming each nail. Even if you just do a few nails the first time, without fear, it will be easier. Wait a day or two and try for a few more. Overtime, most dogs will tolerate the higher speed setting, and the whole process is much faster. With practice, you will be able to trim perfectly the long nails.

Dremel tips-https://rotarytoolsguy.com/trim-dog-nails-with-dremel-tool/

Trainer tips- https://www.youtube.com/watch?v=18UjGBiMpQM
Vet video-https://www.youtube.com/watch?v=5sRVhIOqjeU