Giardia--The Parasite Your Vet May Not Be Looking For

First of all, I want to apologize for another "parasite blog." I'm really not all that preoccupied with small creatures that invade our pets (and sometimes us). It's just that I received a report last week summarizing the number and types of parasites found from our patients' fecal tests over the past two months. The report was furnished by our outside lab service (Antech Diagnostics). I was stunned to see that 17% of the patients were infected with Giardia. That's almost one out of every five. Statistics from all St. Louis-area practices showed a slightly lower infection rate of 14%.

There are a couple of things that make these numbers highly significant. First of all, Giardia is one of those parasites that is contagious to people. Giardiasis is typically mild in humans with diarrhea as the primary symptom. Additionally, getting Giardia from a family pet is uncommon, with only a few documented cases. Having said that, Giardia infections in immune-compromised persons (people with AIDS, chemotherapy patients, very old or young people) can cause devastating, even life-threatening illness. The other significant thing to note is that most veterinarians do not routinely test for Giardia.

Giardia can sometimes be detected on routine fecal floats done by most veterinarians, but more often than not, the fecal float will not detect the parasite, even if it's done properly. The most accurate way to find Giardia is by performing a specific test (called an ELISA) to look for it.

At our hospital, we strongly urge Giardia testing on all new pets. We offer the test as an optional service to all pets on an annual basis. Many veterinarians do not recommend Giardia testing on asymptomatic pets. This is probably because they think it isn't very common (wrong!), or that their fecal flotation tests will detect it (less than 50% of the time!) In light of the report I received, we might start pushing pet owners to test for this parasite every year. We have a link on our hospital website with more information on Giardiasis: http://www.horseshoepets.com/giardia.html

Killed By Our Own Pets?

One of my favorite people sent me an article from aolnews.com, titled "Letting Sleeping Dogs Lie in Your Bed Can Kill You" . The article quotes the chief veterinarian from the California Department of Health as well as a veterinary professor at UC-Davis. They are both experts on zoonotic diseases, which are diseases that can be transmitted from animals to people.

The article is factual and well-written, but seems maybe a little distorted in terms of the fears that it may raise in people about their relationships with their pets. It is true that there is a growing concern among DVMs about zoonotic diseases, and at my practice it is policy for the doctors to discuss with pet owners ways to reduce the risks of zoonotic infections. I will describe for you my recommendations for you to enjoy a cuddle-y relationship with your pets without being afraid of catching something.

Be aware that the most common zoonotic pathogens (at least in the Midwest) are intestinal parasites (roundworms, hookworms, and giardia are the ones we see). These parasites produce eggs which are passed out in the pet's feces. The eggs then get in the soil and are picked up by people if they get some of the "contaminated" dirt on their fingers, then put their fingers in their mouth. To reduce your risk: 1.Pick up your pets' feces daily to reduce the risk of eggs getting in the soil 2.Practice good hygiene - no fingers in mouths, wash hands before eating 3.Keep your pets on heartworm/parasite control products every month. I recommend Sentinel for dogs and Revolution for cats 4.All new pets should have a fecal float and giardia test done before being brought home 5.All pets should have fecal floats +/- giardia tests done at least once a year 6.Puppies and kittens should be dewormed multiple times before they reach 16 weeks of age.

Dogs who live near rural areas where there are raccoons, opossums, deer, livestock, or even rodents; or who are at risk for drinking or swimming in any standing water, should be vaccinated for leptospirosis. All pets should be vaccinated for Rabies.

Do not let your pet lick your face or any open sores on you. Control potential flea infestations with monthly flea-control products (again, I recommend Sentinel and Revolution). Pregnant women should not clean litter boxes, and litter boxes should be scooped out daily.


Special precautions should be taken by immune-compromised people living with pets. This would include HIV-positive individuals, people on chemotherapy, people receiving dialysis treatments, the very old and infirmed, and infants. These special precautions should be discussed with the veterinarian and also the attending physician. Not to "toot my own horn," but I find that in the majority of situations, the veterinarian is more knowledgeable than the physician regarding zoonoses.

This sounds like a long list of precautions, but most of them are simple and inexpensive. I know how much I enjoy snuggling up to my dogs and cats, and I do so with confidence knowing my risk of "catching something" is virtually nil.

Veterinarians and "Doing the Right Thing"

OK. I have learned something new about myself: I'm not a very faithful blogger! No one wants to hear my excuses, so I'll move right on to my current topic, "Doing the Right Thing."

Being a veterinarian is incredibly rewarding in many ways. It really feels like a privilege to have this job. I have always felt that it also carries an obligation to "give back" to pets who need help that have no way of getting it without the assistance of a compassionate veterinarian and veterinary team. I enjoy this aspect of my profession as well. It feels good to provide assistance to sick/injured animals who are so trusting of us.

About a year ago, we were brought a very unhealthy puppy who had been found abandoned in a garbage can. My associate, Dr Chris Randla, treated his injuries and oversaw his care as he recovered. The story gained widespread recognition, and a children's book, "Tommy The Throwaway Dog" has been published to tell the story. Around the time the author, Laura Marlowe, came to our area for a book signing (Tommy was there too), we had a similar situation brought to us.

A dog was found in a rural part of our county, staggering along a fence row with an arrow all the way through his abdomen. His owner was located through a microchip, but she didn't want the dog back. Hope Rescues took him and brought him to us for emergency surgery. His spleen and part of his small intestine were removed by Dr Wendy Mollet, and he was treated for peritonitis. He now lives with a physician in a fancy St Louis suburb.

We work closely with several humane organizations to help dogs and cats in trouble. In my opinion, the humane organizations (Partners 4 Pets, Metro-East Humane Society, Hope Rescues, APA) do the hard work of caring for these animals day-in and day-out. The least we can do is lend medical advice and treatment. The humane organizations do get charged for our services, but at a deep discount. We cheerfully lose money on these cases. In addition to this, each doctor at our hospital has a $1,000 Client-Assistance account to help pay medical expenses for pets whose owners show a sincere desire to treat them, but cannot afford all that is needed. The client assistance money is provided by our hospital.

Now, it sometimes gets ugly when someone we've never seen before has a pet that has probably never seen a veterinarian, and now it is sick. Or injured. The person usually comes rushing in demanding treatment. We tend to be less sympathetic in these cases, and immediately we are called "heartless" and "in it for the money." My opinion is that this is a person who never saw to the care of her pet until disaster struck, and now feels it should be our problem. I usually recommend the owner turn the pet over to a humane organization who we WILL work with to help. It may sound "snooty," but I truly feel that pet ownership is a big responsibility, and an irresponsible pet owner does the pet a disservice.

In the meantime, we'll keep trying to "do the right thing."

And I'll try to be a better blogger.

The Scooting Dog

It never fails. My beagle, "Wilson", has made a real sport out of embarrassing me in front of guests. It may be a dinner function at our home, or friends hanging out in our living room enjoying some wine. That is when Wilson will position himself where the majority of company can see him, then proceed to sit down, elevate his back legs ever so slightly, lift his tail, and drag his butt across the floor. Sometimes it's in a circle, sometimes in a straight line, but either way, he certainly seems to be conscious of the best route to maintain the attention of the crowd. And the look on his beagle face? Pure ecstasy.

Of course everyone in the room is thinking, "Look, the vet's dog's got worms." Because that's what people think when they see a scooting dog. And what a nice thing to think when you're having a pasta dish at the vet's house.

The truth is, the majority of dogs who scoot, do so because they have an anal sac impaction. Anal sacs are paired structures just under the skin on either side of the anus in dogs and cats. The sacs are lined with glands which secrete a foul-smelling substance which fills the sacs over time. In some dogs, the full sacs create an itchy sensation, which they try to relieve by scooting. Usually the scooting dog can be relieved simply by emptying the anal sacs. All veterinarians, and even some groomers can do this. Some dogs need it done monthly, and some never need it at all.

Less-common causes of scooting include skin conditions around the anal/tail area (fleas, food allergies, hot spots) or proctitis (which is a form of colitis). Incidentally, the majority of dogs with worms do not scoot! Occasionally, the anal sac may become infected or form an abscess. In that case, there will be pain and a thick discharge from the area. Any dog who is scooting for the first time should see a veterinarian to make sure of the cause. If it is simply an anal sac impaction, subsequent episodes can usually be dealt with by having someone at the veterinary clinic (we use vet techs for this), or the groomer clean out the sacs.

I know of some vets who recommend routine emptying of anal sacs in all dogs. I personally do not agree with this, and only recommend emptying the sacs if they're bothering the dog (ie the dog is scooting). Of course, in Wilson's case I'm thinking of making an exception to that policy, just to save my dignity.

Itchy Dogs

It's been a rough autumn for dogs with allergies. I am spending most of my recent days, it seems, treating uncomfortable itchy canine patients. My clients are frustrated, my patients are miserable, and my staff, well, they're learning a lot about skin disease!

While airborne allergens cause people sinus and airway irritation, in dogs they almost always cause dermatitis. There are many many causes of skin disease in dogs (demodectic mange, sarcoptic mange, ringworm, hypothyroidism, etc...), but well over half the cases we see have an allergic component. There are three major categories of allergic skin disease in dogs: flea allergies, food allergies, and atopic dermatitis (environmental allergies). It can be difficult to sort out which type of allergy a dog may have, especially since it's not uncommon for a dog to suffer from more than one of the three major types. Add in the fact that allergic skin disease is often complicated by secondary bacterial and/or yeast infections, and the diagnosis can be challenging!

Treatment of atopic dermatitis first involves identifying and addressing all other skin issues (bacterial or yeast infections, dry or greasy skin, fleas, thyroid conditions, etc...) Once these have been identified and treated, the allergic condition will be easier to manage. In a dramatic oversimplification, I will describe four medical approaches to control atopic dermatitis:
Glucocorticoids ("steroids")-This group of medications typically works really well for atopic dogs. They are also pretty inexpensive. Unfortunately, they can cause all kinds of long- and short-term side-effects. They are considered the least-safe drugs for long-term therapy. Dogs on long-term or repeated doses of glucocorticoids should be monitored with blood and urine tests. (Side note: Clients love these drugs because they're cheap and work great. They tend to get testy when we recommend other, safer options, or require labwork to refill the glucocorticoids!)
Antihistamines -These drugs do not work as well as glucocorticoids, but can be effective in mild cases or patients whose severe symptoms have been controlled with glucocorticoids. Sometimes we have to try several different kinds of antihistamines to find the one that works best for a given dog.
Atopica -This is the new "wonder drug" for atopic dermatitis. It is reported to work nearly as well as glucocorticoids while being much safer for long-term use. It is a much more expensive drug, and must be given year-round. Therefore, I only use it for patients whose symptoms occur over half the year and do not respond well to antihistamines.
Hyposensitization Therapy -This is similar to what is done in people with severe allergies. The dog is tested to find out what she's allergic to, then small amounts of those substances are given to her by injection at regular intervals so she will become tolerant of the allerge ns. This is an expensive, and time-consuming process. I have had mixed results in my patients who have had this done. It is certainly the most "natural" approach to treating atopic dermatitis.

The most important thing that I have learned about atopic dermatitis over the years, and the thing I always emphasize to new veterinarians and veterinary students, is that no two atopic dogs are the same and the dog owner must always be forwarned that it will take some time and patience to discover what will work best for their dog.

Sleep Tight (Don't Let The Bedbugs Bite!)

When I was a kid, my Mom used to tuck me in at bed time with the admonition, "Sleep tight! Don't let the bedbugs bite!" In my mind, there was no literal interpretation of what she said; it was just a way of telling me she loved me and to sleep well. It wasn't until my Veterinary Entemology class that I even knew that bedbugs were real. Even then, we were taught that bedbugs were no longer a problem in the US thanks to DDT. So...I pretty much forgot about bedbugs.

Now guess what? Theeeey're baaaaack. But you probably already know that if you read Time magazine (they made the cover!), or just about any US newspaper. Thanks to increased overseas travel and the disappearance of DDT, bedbugs have returned with a vengeance! They have been found in five-star hotels, upscale department stores, and homes across the US, but especially in the big cities. People are cancelling travel plans for fear of bedbugs.

The good news is, bedbugs don't spread disease like fleas, lice, and ticks do. However, they're still nasty little creatures that leave an itchy rash when they bite. And they are soooo difficult to eradicate.

Bedbugs look like apple seeds with legs. They tend to come out at night, so you may not see them. They like to live under mattresses and baseboards. Sometimes they leave behind "bedbug poop" which are small round black spots which may be found on bedding, headboards, or near baseboards. Bedbugs do not live on pets or people - they will bite us (or our pets) to take a blood meal and then scurry back to their hiding places.

You need the help of a professional exterminator to get rid of them. Don't even bother with over-the-counter pesticides. Let the exterminator know about your pets, so they can use pet-friendly products. Washing all pet bedding (and cloth toys) with hot soapy water is also recommended. Most pet flea and tick products will not prevent bedbug bites. The best way to protect the pets is to eradicate the bedbugs from the house. DO NOT put insecticides on your pets that are not labeled for such use.

The most effective way to control bedbugs is to avoid them! The ways to do this are beyond the scope of my blog, but here is a link to the CDC's webpage on bedbugs: http://www.cdc.gov/nceh/ehs/Topics/bedbugs.htm.

Having pets does not increase your risk of acquiring bedbugs! In fact, you are more likely to bring bedbugs to the pet than the pet is to bring bedbugs to you. So do what you can to avoid them, and "Sleep tight..." You know the rest.

The Attachment Score

One of the most challenging aspects of being a veterinarian is the different levels of attachment our clients feel toward their pets, and to a lesser degree, the varied income levels of the clients. To many, the pet is an important member of the family, and anything that can be done should be done to keep the pet healthy. This level of attachment is independent of family income -we see "financially-challenged" people frequently forgo their own needs to pay for their beloved pet. Conversely, there are well-to-do people who feel that even basic care for a pet is too expensive. Of course, there are infinite variations on these attitudes and income levels. I certainly am not implying that wealthy people care less about their pets! What I am saying is that the amount of money spent on a sick pet is often not a function of the owners' income!

Unfortunately, and to my own chagrin, I have a tendency to recommend the best medicine for pets whose owners I estimate are best able to afford it, and scale back my recommendations to people who I estimate to be lower-income. Shame on me! After 23 years of practice I should know better. It is humbling and embarrassing when I suggest to the owner of a sick pet that we should try some medication, and if that doesn't help, maybe we should take an Xray...and the person says, "Wouldn't it be better to take the Xray now? Why wait?" The truthful answer would be that I was trying to save her some money, which completely devalues what that pet means to her. I have to remind myself that I am doing my job best when I present all the best options, and let the client decide. Period.

If the depth of attachment felt toward our pets could be rated on a scale from 1 to 10, we aren't all "ones", and we aren't all "tens". It would be helpful if pet owners came in with little cards which say "I have a 'seven' relationship with my pet," or "I have a 'four' relationship with this pet." Although even if that were the case, it really shouldn't affect the way I do my job. I will say this: after I get to know a client, I can cater to their level of attachment and concern for the pet, at least in the verbage I use to communicate the pet's needs. Interestingly, many clients will have a "five" level of attachment to one pet, but a "ten" level of attachment to another. We really do have our favorites.

This blog was inspired by two conversations I had this week. One was with a college student who was concerned because I hadn't recommended testing her older dog for a parasite we had found in her new puppy (I was trying to save her money. Old habits are hard to break). The other conversation was with a fashionably dressed middle-aged lady who told me that testing her dog for parasites was a ridiculous waste of money (ie the dog is not that important). I guess they don't have to have a card with a number on it after all.