No shots for you!

So, let's say you are totally, completely against vaccines. Or you are the proud pet parent of a dog who has allergic reactions to vaccines. Now what?

This is where the art of medicine starts to play more of a role. Each pet is an individual. And we, as veterinarians, need to keep this in mind and be ready to tailor protocols to meet the individual's needs, keeping health and safety in mind at all times. This, folks, is the basis of the concept of holistic medicine- treating the whole patient. We vets do it almost without thinking every day. There is very little that is set in stone for us.

Vaccines are very important. They keep our pets protected from life-threatening diseases, and some diseases that may not be life-threatening, but can be debilitating. These same vaccines also help protect the people in our pets' lives, as well. There are several diseases that we can catch from the animals in our lives. Rabies is one obvious one. Leptospirosis, a bacteria that affects the liver and kidneys, is another. If a pet is able to get a recommended vaccine, I strongly urge owners to comply.



But some won't, and some can't. So now what?

There are a few options for vaccines. If you have a dog or cat that gets a mild reaction to the vaccine (like hives or mild vomiting) we can pre-medicate with a steroid and Benadryl, or a steroid or Benadryl. This helps to decrease the immune system's response to the perceived immune trigger. Most of the time this seems to help.

If, however, your pet has had a more severe reaction, or has had a reaction despite pre-medication, we may consider other options. One option is to choose to stop giving vaccines. I cringe a little as I type this, because discontinuing the vaccines carries inherent risks. Therefore, anytime I have this discussion with a pet's people, I try to make it very clear that we are balancing risks and benefits, and in choosing to not vaccinate we are incurring some risks that need to be known. We are knowingly leaving a gap in out pet's immunity. The risk of life-threatening parvo or distemper in an adult, otherwise healthy dog that has at least had the puppy series of vaccines is probably fairly low. But it does exist. There is always a risk of being exposed to, and contracting, kennel cough. Or lepto.

Choosing to stop vaccines means most kennels and pet resorts will not board your pet. You may need to make other arrangements when you go out of town. Some groomers require up to date vaccines for grooming appointments. Don't be mad at them- they have responsibility to keep all of the pets in their care safe.

There are tests for the level of immunity in a pet's system. You may have heard of titer tests. If you are against vaccines on principle, you may have discussed them with your vet. Titer tests can be helpful, but they are not perfect.

A titer is the concentration of something. A titer test is a test to determine the concentration of that thing. The way this works with immunity, a blood sample is drawn at the vet's and sent to a laboratory. The lab technicians (or a machine) place drops of the blood sample into small vials. They serially dilute each sample. In other words, the vials will have all blood, 1/2 blood. 1/4 blood, 1/16 blood, 1/32 blood, etc. They then check to see at what dilution the blood sample stops reacting to an analog for the disease. The last one to react is reported back to us. I get a report that says something like- titer IgG parvo 1:400 (making up the details here). Then I compare that ratio number to what is generally considered to be protective immunity. This gives us a yes or know answer to the question: is my pet protected from this disease?
Sounds cool, right? Blood test says yes, there is protection, then there is no need to vaccinate this year. Blood test says no, then we need the shot. Great. Next patient, please....

Problem is this- titer immunity does not necessarily correlate to true protection. UGH

We use the test anyway. I get titer tested periodically to see if my rabies vaccines I got a decade ago are still effective. We send blood to Kansas to be tested for pets going to Hawaii or Europe- they must be rabies titered. But I don't titer my own pets in place of vaccines. I give the shots.

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Why? I believe that the immunity given by the shots is important. I believe that the titers are useful, but not absolute. I believe that the risk associated with vaccines is much smaller than the risk of disease. I want to take advantage of the amazing, incredible protection modern medicine is able to provide. But that's my decision, for my pets. If you want to discuss the ins and outs of vaccines for your pets, I will. I have many pets that have altered vaccine schedules, a few that I do not vaccinate at all. Holistic. Individual. Tailored.

Enjoy your pets!

Shooting the grown-ups

I hope those of you who are checking this out now feel you have a better understanding of the importance of the series of puppy vaccines vets recommend. It's a fairly straight forward recommendation, and as for as I know pretty much every veterinarian makes the same recommendations.

Things get a little bit murkier once the pets are grown up- say, over a year old. This is where having one group making protocols that we all follow might help, but the independant nature of vets doesn't really allow that. For now.

Last time we talked about immunity, and the fact that when we give the last set of puppy shots, we expect the body to make and store a blueprint of the fighting factors it can use against specific diseases. These blueprints are stored for a time, but not forever. So we generally recommend vaccinating again about a year after the dog or cat had the last in the series of vaccines. This puts them in the office at about 1 1/2 years of age. They get their good, complete exam (which, frankly,  is the most improtant part of the whole visit), and a repeat of the shots they had as a youngster.

Which vaccines, you ask? OK, this is part of the variation.

Which vaccines are used can depend on several factors. Let's talk dogs first. There are three vaccines that are considered "core." These are the shots that are recommended for all dogs, regardless of lifestyle or where in the states they live. Those are rabies, parvovirus and distemper virus.

Then there are non-core vaccines. These can be given based mainly on lifestyle or location. Lyme disease, leptospirosis, bordetella, canine flu are included in this catagory.

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Most vets will give core vaccines to every patient, then add non-core based on that individual patients needs. Lyme for those in lyme endemic areas or hikers, leptospirosis for those expected to be exposed to wildlife or standing water sources, bordetella for those who will be staying at a kennel or  going to the groomer. Canine flu is usually resaerved for dogs kenneled or shown. So this is why your veterinarian or vet tech/nurse will ask about lifestyle. We need the information to develop a plan to keep your dog safe.

Cats have two core vaccines- rabies and feline distemper, also called FVRCP, CVR, and a few other things. Plus non-core vaccines like feline leukemia, FIV, and FIP. The decision to add the non-core generally is based on whether your cat is indoor or indoor/outdoor. Be honest with your vet. We just want what is best for your cat. And yes, even cats that are indoors all the time need that exam and the core vaccines. Rabies is required in much of the country for all cats and dogs.

Sounds simple, right?

After that 1 1/2 year old appointment, things get tricky. The core vaccines have been reliably shown to provide immunity that lasts at least 3 years. But not all vets give the shots every 3 years. Some still give them yearly. Some give all three core shots once every 3 years. Some divide them up, so your dog gets one shot each year, on a rotation. Confused yet? I don't blame you.

Let's throw more into the mix. The non-core vaccines tend to have immunity that does not last 3 years. In fact, there's evidence that the bordetella vaccine may only last 6-8 months. So what to do? It depends. No, really. Some places require bordetella every 6 months, some yearly. The other non-core shots are generally boostered every 12 months.

So, the bottom line here is each veterinarian develops a protocol based on current information that he or she is comfortable recommending. Talk to your vet. Ask about the protocol they employ.

Here's my opinion at this time. The exam is the most important part of the whole vet visit. Yes, I can do a complete exam in just a few minutes. Usually while I'm taking to you, asking quiestions. That few minutes of exam is a distillation of 8 years of college and 12 years experience. I could make it take longer, but it wouldn't be any more complete. Just sayin'.

I come from a practice that has been using a 3 year rotating protocol for dogs. We do all core vaccines as puppies, and at the 1 1/2 year appointment. Then we divide them out- distemper, parvo, rabies- one each year on a rotating basis. This means fewer shots at each of those yearly visits. Non-core are all yearly, as needed based on lifestyle.

Cats get baby series, then both core vaccines at 1 1/2. Then FVRCP every 3 years, but rabies yearly. This has to do with the type of rabies vaccine we use for the cats. Ask us. Ask any of us vets at anytime. We are happy to discuss our vaccine protocols and the reasons behind them.

Enjoy your pets!

puppy shots

"The breeder told me he had all his shots."


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There are few things clients say to me that aggravate me more. This one isn't the clients fault. Breeders who give out wrong information or are deliberately misleading about needed vaccines drive me nuts. Please don't get me wrong. There are many really good breeders, people who breed because they love a certain type of dog or cat and want to do it right- breeding for temperament, health and longevity.

But there are some people who don't know what they are doing. And they seem to delight in putting really bad information out there like it is gospel truth. For example- "the pup has had all needed shots" at 8 weeks of age. UGH

OK here are the facts. Puppies and kittens get antibodies (infection fighters) from their mother, if the mother was properly vaccinated. These antibodies provide immunity to the puppies. Newborns drink these antibodies in their mother's milk. The antibodies cross over the intestinal lining intact and get to work keeping the babies safe from common diseases. This is good.

This immunity from mom doesn't last forever. And thanks to some amazing scientists over the years, we have developed ways to re-create immunity. Our immune systems have memory. Once you have been exposed to and defeated a disease, the body keeps a blueprint of the successful disease-fighting agents on file. Then, if the same disease is found later, it can be fought off faster, sometimes before we realize we are sick. Vaccines take the place of the initial disease encounter. They are tailored to stimulate the immune system to fight off an invader that doesn't actually make us sick, but then the blueprint is still available to fight off the real thing, should it ever be encountered. Obviously, I'm trying to simplify a bit. I'm sure you can find more complete explanations, I just didn't want to copy an immunology text onto the blog. Maybe just one picture, for kicks and giggles:


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Back to the puppies and kittens. Mom's immunity in their systems lasts a few weeks. But somewhere between six and fourteen weeks of age, that immunity goes away. The babies are now susceptible to diseases. Nasty, life-threatening things like parvovirus. This is where we step in.

Most puppies and kittens will start getting vaccines about 6-8 weeks of age. They really don't need them any earlier, except perhaps if they were never nursed. This is not a random age choice. This is the early end of the loss of mom's immunity. We will then booster the vaccine (re-vaccinate) every 3-4 weeks until the puppy or kitten is over 14-16 weeks old. There is science to this, I swear. The vaccine provides better immunity that mom's alone in this time frame, but the lingering effects of mom's immunity and the immature state of the immune system don't allow the blueprints to be stored long-term. So we have to remind the system what it needs to be prepared to fight.

One the puppy or kitten is over that 14-16 week mark, the immune system can be expected to store the blueprint longer, generally for about a year for most diseases. So we usually give the last set of vaccines at about 4-5 months of age. Then we can schedule spay or neuter (but that's a discussion for another day).

So there you have it. This is why I go slightly nuts when I am presented with a cute, fuzzy, 10 week old puppy and am told that he had all his shots.

Or picture this scene:

Pitiful puppy on the exam table, about 5 months old, thin, tired, dehydrated because she has spent the last few hours/days vomiting and having severe diarrhea. The parvovirus test is positive for the disease.


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Me: "Parvo is a virus that causes life-threatening vomiting and diarrhea. I can't treat the virus. All we can do now is support her system and hope that she can fight the virus off herself. She may die. And the treatment to try to save her life will be expensive."

Owner: "But the breeder said she had all her shots! They gave her her parvo shots!"

Me: "How long have you had her?"

Owner: "Since she was 8 weeks old."

See the reason for my anxiety? This is a preventable disease. Now the person in the above scene will need to find money to pay for treatment that might not work. The owner didn't know. She was making decisions based on the information she was given when she bought the puppy. If the breeder had done the responsible thing, recommended monthly visits to the vet to discuss care and get shots, this could have been completely avoided.

Enjoy your pets!

SHOOT!

Let's talk shots.

I like lemon drops. And my brother once got smashed on something called a Louisiana leg-spreader.

But that's not really what I want to discuss. Sorry. Instead, let's talk about the shots we vets give your pets. The vaccines.

Some people will have you believe that vaccines are not important for health. Some will tell you that vaccines are actually dangerous. Some will tell you that they are absolutely essential at every annual or semi-annual vet visit. So what is the truth?

The truth is fluid. We are constantly re-evaluating the risks and benefits of all vaccines. This is actually true on the human side of medicine as well as on my side. So there may be changes in the recommendations of which vaccines to give, when in life and how often to give them. Even the best methods to administer them. Vets "in the trenches" are left to shuffle through the evidence and the recommendations and develop protocols for our patients that we are comfortable with.

And herein lies one of the basic issues. I'm not exactly sure just how it works with people, but at the pediatrician level at least there appears to be one set code of rules for vaccines. These are set by a group and are followed by all pediatricians. Schools require that these codes are followed. There is consistency. Vets get recommendations from groups such as the American Animal Hospital Association or the Association of Feline Practitioners, but we don't have a group that we allow to set the rules that we all follow. Veterinarians are pretty independent by nature, and we don't like to be dictated to.

So this leaves us in something of a quandary. Where do we get our information? Who do we trust? Do we trust the companies that make the vaccines to have the best, unbiased information? We need to know the agenda of whomever we are trusting for the data that we use to set our vaccine schedules. We hope that our associations will look at all the evidence available and help develop recommendations that are based on good science. Are they?

This is why the protocols we all follow may change from time to time. We are all, as a group and as individual veterinarians within our own practices, continually re-examining the evidence we have at hand. We are sometimes slow to change, but that is because we need to be convinced that the change is safe and effective. So this month I want to talk shots. I will not claim to have all the answers. I may well ruffle some feathers. I hope to make you think just a little about some of the blanket statements you hear.

Then maybe we can go out for a lemon drop or two.