Many vets use response to steroids as a predictor of response to Atopica or allergy vaccine. This can be useful in that dogs that respond very well to steroid therapy are likely infection free and atopic; however, patients that do not respond may have severe infections masking any benefit from the steroids. Alternatively dogs may respond well but still have food allergy which can be variably responsive to steroids in which case allergy vaccine would be useless.
I believe that a pattern approach is more accurate and useful.
February 27, 2009
February 25, 2009
MRSI and MRSS and MRSA
All 3 bacteria are potentially zoonotic.
FQ antibiotics increase the risk.
All patients should be identified to limit contagion.
Daily bathing can eliminate the infections.
Dual antibiotic therapy is ideal (based on cultures).
Identify and treat the underlying allergy or endocrine diseases.
Wash hand after touching the infected patient.
Where gloves when possible.
FQ antibiotics increase the risk.
All patients should be identified to limit contagion.
Daily bathing can eliminate the infections.
Dual antibiotic therapy is ideal (based on cultures).
Identify and treat the underlying allergy or endocrine diseases.
Wash hand after touching the infected patient.
Where gloves when possible.
Cyclosporine Monitoring Program
Based on the most recent adverse event data, there are only 4 consistent adverse effects occurring in 1% or more of treated patients.
1. Vomiting
2. Loose stool
3. Lethargy
4. Anorexia
1. Vomiting
2. Loose stool
3. Lethargy
4. Anorexia
February 23, 2009
Generic Cyclosporine
During Western States Veterinary Conference, 7 Veterinary Dermatologists met to discuss cyclosporine uses.
There was general agreement regarding generic alternatives to Atopica:
1. Generics lose 10-50% of the efficacy compared to Atopica.
2. The cheapest generic with good efficacy only saved the owner $15/month at 100mg daily dosing. (based on Feb. 2009 web research)
3. Several derms had their prescriptions changed by the pharmacist to less effective generics without the dermatologist's knowledge or consent.
4. The use of compounded cyclosporine is likely useless.
5. Using a nonFDA veterinary approved product is less than ideal and loses all drug surveillance and pharmacovigilance required by the approved product.
There was general agreement regarding generic alternatives to Atopica:
1. Generics lose 10-50% of the efficacy compared to Atopica.
2. The cheapest generic with good efficacy only saved the owner $15/month at 100mg daily dosing. (based on Feb. 2009 web research)
3. Several derms had their prescriptions changed by the pharmacist to less effective generics without the dermatologist's knowledge or consent.
4. The use of compounded cyclosporine is likely useless.
5. Using a nonFDA veterinary approved product is less than ideal and loses all drug surveillance and pharmacovigilance required by the approved product.
Atopica use for Cats
Atopica is currently the only veterinary approved FDA cyclosporine and its use in cats is off label. Saying that, there is consensus among Veterinary Dermatologists that Atopica in cats is effective for multiple, steroid-responsive diseases and is "Beautifully Tolerated" in cats. Uses included; miliary dermatitis, eosonophilic granulomas, indolent ulcers, "Fat Chin" syndrome, Atopy, food allergy, insect hypersensitivity, chronic otitis, Lupus, Pemphigus, IBD, Stomatitis, chronic asthma, etc...
The dose ranges from 5-10mg/kg with higher doses being used to treat more serious disorders. Most cats need daily therapy for 30-60 days or until good control of the symptoms is reached, then the administration frequency can be reduced to every other day for 2 weeks and usually every 3rd day.
Cyclosporine is very well tolerated with cats demonstrating fewer adverse effects than dogs. Most cats do not vomit and thus do not need Reglan.
The most concerning issues are Toxo and FeLV, FIV.
Cats with FeLV and FIV should not be treated; however, cyclosporine is almost always safer than steroids.
The current consensus is that some cats are "Super" absorbers of cyclosporine which results in a greater immunosuppression. If the cat then encounters an infectious agent (Toxo) it is at a greater risk. Toxo negative cats that are "super" absorbers seem to be at greatest risk. The incidence of Toxo in treated cats is very low but several reports are in the literature.
To limit the Toxo risk, keep cats inside during daily cyclosporine therapy. Post administration peak blood levels may identify "super" absorbers.
The dose ranges from 5-10mg/kg with higher doses being used to treat more serious disorders. Most cats need daily therapy for 30-60 days or until good control of the symptoms is reached, then the administration frequency can be reduced to every other day for 2 weeks and usually every 3rd day.
Cyclosporine is very well tolerated with cats demonstrating fewer adverse effects than dogs. Most cats do not vomit and thus do not need Reglan.
The most concerning issues are Toxo and FeLV, FIV.
Cats with FeLV and FIV should not be treated; however, cyclosporine is almost always safer than steroids.
The current consensus is that some cats are "Super" absorbers of cyclosporine which results in a greater immunosuppression. If the cat then encounters an infectious agent (Toxo) it is at a greater risk. Toxo negative cats that are "super" absorbers seem to be at greatest risk. The incidence of Toxo in treated cats is very low but several reports are in the literature.
To limit the Toxo risk, keep cats inside during daily cyclosporine therapy. Post administration peak blood levels may identify "super" absorbers.
February 13, 2009
Atopica Off Label
Usually at a double dose of 10mg/kg
administered daily for 60 days or until
good response; then taper to every other day.
Pemphigus
Lupus
Sterile panniculitis
Chronic Otitis
Perianal fistulas
Food allergy
IMHA
ITP
IBD
Encephalopathy
Arthritits
Immunemediated blepheritits
Stomatitis
Asthma
Eosinophilic granuloma
Miliary dermatitis
indolent ulcers
linear granulomas
insect hypersensitivity
administered daily for 60 days or until
good response; then taper to every other day.
Pemphigus
Lupus
Sterile panniculitis
Chronic Otitis
Perianal fistulas
Food allergy
IMHA
ITP
IBD
Encephalopathy
Arthritits
Immunemediated blepheritits
Stomatitis
Asthma
Eosinophilic granuloma
Miliary dermatitis
indolent ulcers
linear granulomas
insect hypersensitivity
When a dog is 10 out of 10 itchy
When a dog is SEVERELY itchy
a 10 out of 10 on the Visual Analog itch scale
consider:
Yeast dermatitis
Fleas
Scabies.
a 10 out of 10 on the Visual Analog itch scale
consider:
Yeast dermatitis
Fleas
Scabies.
What's in My Pharmacy
Antibiotics
Simplicef
Primor
Clindamycin
Shampoos - you only need 5 topicals + a wipe
Antibcterial - Duoxo PS 2% chlorhexidene
AntiYeast - Malaseb
AntiItch Conditioner - ResiCort Conditioner
Demodex - Pyoben
NonMedicated - Etiderm
Wipes - Malaseb
and Genesis Spray for SPOT treatment
Ear Therapies
Yeast, Cocci, Allergy - Mometomax
Swimming dogs - VetSolutions Swimmers Tx
Pseudomonas - T8keto with Baytril (4oz + 12cc LA Baytril)
Cleaner - EpiOtic ADVANCED
Ear Mites - Milbemite
Simplicef
Primor
Clindamycin
Shampoos - you only need 5 topicals + a wipe
Antibcterial - Duoxo PS 2% chlorhexidene
AntiYeast - Malaseb
AntiItch Conditioner - ResiCort Conditioner
Demodex - Pyoben
NonMedicated - Etiderm
Wipes - Malaseb
and Genesis Spray for SPOT treatment
Ear Therapies
Yeast, Cocci, Allergy - Mometomax
Swimming dogs - VetSolutions Swimmers Tx
Pseudomonas - T8keto with Baytril (4oz + 12cc LA Baytril)
Cleaner - EpiOtic ADVANCED
Ear Mites - Milbemite
February 7, 2009
FQs increase MRSI, MRSS, and MRSA
Mounting evidence in the human and veterinary literature is revealing a connection with a patients exposure to FQ therapy and the increased risk for developing an Methicillin Resistent Staph infection.
Don't use FQs for pyoderma.
Don't use FQs for pyoderma.
Kill Pseudomonas
Topical therapy alone is the best way to eliminate Pseudomonas infections.
4oz of a trisEDTA solution (I prefer T8) combined with 12cc of LA Baytril overwhelms the Pseudomonas's resistant mechanisms and kills the bacteria.
Fill the ear canal or lavage the wound BID for 2 weeks the reassess via cytology and organism counts. If ineffective for otitis media, lavage the bullae to remove inspisated pus and retreat for 2 more weeks.
Oral FQs only lead to resistance since the MIC of Pseudomonas is SO high and the oral dosing is ineffective/incapable of achieving high enough tissue levels.
4oz of a trisEDTA solution (I prefer T8) combined with 12cc of LA Baytril overwhelms the Pseudomonas's resistant mechanisms and kills the bacteria.
Fill the ear canal or lavage the wound BID for 2 weeks the reassess via cytology and organism counts. If ineffective for otitis media, lavage the bullae to remove inspisated pus and retreat for 2 more weeks.
Oral FQs only lead to resistance since the MIC of Pseudomonas is SO high and the oral dosing is ineffective/incapable of achieving high enough tissue levels.
February 6, 2009
Use the BEST steroid
Stop the oral and long acting injectable steroids - they are BAAAD!!!!!!!!!
Use Dexamethazone NA Pos (1cc/10-20lbs) IM (4mg/ml)
Repeated as needed; every 2-3 weeks.
The ultrashort acting steroids causes almost NO PU/PD and other adverse effects
but
the allergy reaction is suppressed for weeks.
Try it; You WILL like it . . . . .
Use Dexamethazone NA Pos (1cc/10-20lbs) IM (4mg/ml)
Repeated as needed; every 2-3 weeks.
The ultrashort acting steroids causes almost NO PU/PD and other adverse effects
but
the allergy reaction is suppressed for weeks.
Try it; You WILL like it . . . . .
Stop Steroid Abuse
Chronic steroids even if at a very low every other day dose prematurely age our patients.
Joint breakdown
Immune System weakening
Muscle weakness
UTI
Thin hair
Thin skin
Loss of stamina
Joint breakdown
Immune System weakening
Muscle weakness
UTI
Thin hair
Thin skin
Loss of stamina
Magic Force Field for Fleas
Capstar administered everyother day seemingly blocks flea spit.
Flea allergy dermatitis can be blocked by the everyother day capstar.
This is especially useful to diagnose any cat with skin disease since most are
flea allergic AND most have no obvious fleas.
Additionally, in dogs, if the owner is in FLEANIAL, the Capstar qod can
result in dramatic - OBVIOUS - improvement.
I use Capstar to diagnose flea allergy dermatitis in all dogs with lumbar dermatitis and all cat with skin disease; especially if I can't find fleas.
Other flea adulticides require ALL pets to be treated and take months to reduce the flea population enough to improve the flea allergic patient.
The Capstar protects the individual animal enough to make an obvious diagnosis.
Flea allergy dermatitis can be blocked by the everyother day capstar.
This is especially useful to diagnose any cat with skin disease since most are
flea allergic AND most have no obvious fleas.
Additionally, in dogs, if the owner is in FLEANIAL, the Capstar qod can
result in dramatic - OBVIOUS - improvement.
I use Capstar to diagnose flea allergy dermatitis in all dogs with lumbar dermatitis and all cat with skin disease; especially if I can't find fleas.
Other flea adulticides require ALL pets to be treated and take months to reduce the flea population enough to improve the flea allergic patient.
The Capstar protects the individual animal enough to make an obvious diagnosis.
Convenience improves compliance
Once a day treatments are easier for owners to remember and result in better outcomes.
Try to convert medications to daily protocols if possible:
Simplicef
Primor
Ketoconazole
Fluconazole
Otic Treatments
Convenience improves compliance
Try to convert medications to daily protocols if possible:
Simplicef
Primor
Ketoconazole
Fluconazole
Otic Treatments
Convenience improves compliance
February 5, 2009
Diagnosis by exclusion is ILLOGICAL
We were taught Dermatology backwards . . .
Diagnosis by exclusion is illogical.
A Pattern Approach is Better!!!
Footlicking, periAnal dermatitis, lumbar dermatitis, and a positive ear scratch test are 85% accurate.
Diagnosis by exclusion is illogical.
A Pattern Approach is Better!!!
Footlicking, periAnal dermatitis, lumbar dermatitis, and a positive ear scratch test are 85% accurate.
Appointments: Derm like Diarrhea
Dermatology appointments should flow like Diarrhea appointments. The 3 Slide technique for dermatitis should be used like fecals for diarrhea. The 3 Slides will demonstrate treatable organisms more often than the fecals. Technicians do it better....
February 4, 2009
Free CE Online 8 hours
There is over 8 hours of free online CE at CEforVets.com
This is a Novartis sponsored site but the content is pretty
free of bias product materials.
This is a Novartis sponsored site but the content is pretty
free of bias product materials.
Welcome to itchnot.com's Blog
Since the University shut-down my archive site, I am replacing some of the most useful features with EVEN MORE useful features.
This Blog replaces the "What's New" page and will contain a contemporaneous listing of the best ideas that I run across in my search for better medicine and good business practices.
I hope you find this useful :)
This Blog replaces the "What's New" page and will contain a contemporaneous listing of the best ideas that I run across in my search for better medicine and good business practices.
I hope you find this useful :)
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