Emergency Preparedness

If an emergency such as flood, fire, tornado or hurricane were to happen today, how prepared would you be to survive? Have you planned ahead in the event one of these emergencies should occur. Did you include your pets when you made these plans? If not, now is the time, before an emergency situation occurs, to make sure you have a disaster plan in place and that your pets have been included in this plan.

I live in southeastern Florida and I am painfully aware of the effects of a hurricane. I saw first hand, as a pharmacist disaster responder, the devastation caused by hurricane Andrew. Two years ago I lived through the effects of hurricane Wilma. I know that hurricane season begins June 1, and I make sure that my property is secure and that I have extra food, water and other necessary supplies on hand PRIOR to June 1.

What considerations are necessary before a disaster strikes:

1. If you must evacuate, take your pet with you, if possible. However, if going to a public shelter know before hand if it is pet friendly. Not all shelters allow pets. You need to plan in advance for shelter needs for you and your pets.
2. Is the pet current on vaccines? Pet friendly shelters may require proof of vaccination.
3. Have a current picture of your pet.
4. Make sure you have a collar, identification tag and a leash on hand.
5. Have a pet carrier for each animal large enough for the pet to stand and turn around in.
6. When you create your evacuation plan, don't forget to include your pet in the plan.

What considerations are necessary during the disaster:

1. If the shelter allows pets, bring along the; collar with ID and rabies tags, leash and pet carrier.
2. Bring an ample supply of food, water and food bowls
3. Bring any necessary medications and any specific care instructions.
4. Bring newspapers or trash bags for clean up.

What about after the disaster:

1. Pets may need to be re-oriented to their home and should be kept on a leash since familiar scents and landmarks may be altered. In addition, pets can be easily confused and become lost.
2. Have a picture of your pet with you in case your pet cannot be found after the disaster. Check with local authorities such as animal control to see where animals can be recovered.
3. Be aware of behavior changes in the pet as a result of the disaster. Your pet may become aggresive or defensive.

Use these links to Pethealth101 for additional information on a pet disaster plan for dogs and a pet disaster plan for cats.

Prescriptions and the Internet

When I graduated from the Brooklyn College of Pharmacy in 1968 and began to practice, the only way a consumer could get a prescription filled was by going to the local, corner drugstore. Since that time, there have been some major changes to the way consumers are able to get prescriptions filled.

The first change to occur was the advent of pharmacy chains whose names we are very familiar with today. The growth of these companies enabled consumers to get prescriptions filled without having to travel great distances to find a pharmacy.

The next change to occur was prescription coverage by insurance companies. Consumers were now able to get their medications (usually a one month supply) at their local pharmacy or, if they wanted to, they could phone in or mail away an order to the insurance company's "mail order pharmacy" to get a larger quantity (usually a three month supply) of medication.

The third change to occur was the advent and proliferation of computers and the creation of the "web". The insurance companies recognized the convenience factor and value of the web and they created web sites for their mail order pharmacies so that their clients, still having the choice to phone or mail in their prescription order, could now go on-line and from the comfort of their home order a refill or a new prescription. It wasn't too long before the major chains created their own internet web sites. Consumers now had a way to buy, by mail order, those items that were carried in the "brick and mortar" store, including their prescriptions, once again, from the convenience of their home. Consumers now had a choice. Go to the store or order on-line.

About 6 or 7 years ago, or so, another change occured. Unfortunately, it was a negative change and it was announced to the public by the introduction of a new type of email called spam. Spam is still with us today. Many of these spam emails had, and still have, links to web sites where you can get practically any type of prescription medication including narcotics and Viagra, without a prescription, simply by filling out a questionnaire on the web site. This type of business, known as an "internet pharmacy" , is for the most part located outside the United States. These businesses are not licensed as pharmacies anywhere in the United States and, therefore, are practicing illegally which has been causing major concern at the FDA and with the various state boards of pharmacy. There's a saying that "if it sounds too good to be true it probably is". These internet pharmacies sound too good to be true in that they offer prescription medications, with no prescription required. However, there's another saying that goes "caveat emptor" meaning let the buyer beware. Why? Because it turns out that the "pills" the consumer receives from these companies often contain none, or at least very little, of the medication they expect. In addition, the "pills" are sent from countries such as Belize or Ghana and often arrive in a plastic baggie with no pharmacy label. Consumers are taking a big risk by purchasing prescription medications from these companies. An internet pharmacy, where prescription medications can be purchased without a prescription, is an illegal entity in the United States.

Some veterinarians have been telling their clients that 1-800-PetMeds is an "internet pharmacy" using that term in the most derogatory way to mean we are not licensed and we carry foreign product.

Lets clear up these misconceptions:

1. 1-800-PetMeds is a mail order pharmacy and is licensed and authorized as a pharmacy in all 50 states. Customers can place orders by calling 1-800-PetMeds or by mailing in their order. 1-800-PetMeds also has an internet site where customers are able to place orders from the convenience of their homes.
2. 1-800-PetMeds only sells FDA/EPA approved medication. 1-800-PetMeds does not sell foreign medications.
3. 1-800-PetMeds will require a prescription from your veterinarian for any medication that requires one.
4. 1-800-PetMeds understands the need for a veterinarian-client-patient relationship to exist in order for a veterinarian to write a prescription.
5. 1-800-PetMeds does not "solicit" prescriptions from your veterinarian.
6. As a licensed pharmacy, 1-800-PetMeds pharmacy staff will gladly call your veterinarian for your prescription. This is not soliciting. This is a professional part of any pharmacy practice just like the pharmacy staff at your pharmacy would call your physician for your medications.
7. 1-800-PetMeds pharmacy staff includes licensed pharmacists and a support staff of pharmacy technicians. A tour of 1-800-PetMeds is available on our web site.
8. Unlike an "internet pharmacy" our pharmacy staff is available to answer questions regarding your pets medications.

Insulin and Syringes

My dog Sandy, a cute little Lhasa Apso, was diabetic. She also had Cushing's disease (which probably caused her diabetes), hypothyroidism, arthritis, allergies and cataracts (caused, most likely, by her diabetes). Unfortunately, Sandy passed away 2 years ago at the age of 13. Sandy had been diagnosed with diabetes and Cushing's disease about 5 years earlier.

I attribute the fact that she lived those 5 years to: a) my pharmacist background and training which taught me the importance of patient compliance which meant giving each dose of medication when it was due, b) being able to recognize changes in her behavior that were signals to me that the insulin dose needed to be adjusted and, c) taking Sandy to the veterinarian as often as her conditions required a visit.
Sandy's diabetes required twice a day dosing with insulin and I want to share these considerations which are necessary when using insulin:

• Insulin such as Vetsulin for dogs and PZI Vet for cats are suspensions and need to be shaken prior to use. HOWEVER, you do not "shake" insulin by pumping your arm up and down. You "Shake" insulin by gently rolling it between your hands.
• Vetsulin and PZI Vet should be stored in an upright position in the refrigerator.
• Vetsulin and PZI Vet are U-40 insulins. This means there are 40 units of insulin in each 1 ml of product. The "human" insulins (Humulin-N, Humulin-R, etc.) are U-100 insulins. This means there are 100 units of insulin in each 1 ml of product.
• It is critical that the correct insulin syringe is used for the type of insulin being used.
• Specifically, use U-40 insulin syringes for Vetsulin and PZI Vet and use U-100 insulin syringes for Humulin-N, Humulin-R and other "human" insulins.

For those of you with diabetic dogs, here's what I want you to remember:

1. For the health of your pet, you MUST be compliant as an owner which means giving your pet the insulin shot every day. Some dogs are given one injection a day, others are given two (or more). Follow your veterinarian's instructions carefully.
2. Roll the vial don't shake it.
3. Use U-40 insulin syringes for U-40 insulin and use U-100 insulin syringes for U-100 insulin.
4. Needles, syringes and lancets are known as "sharps". They are called sharps because that's what they are. The best way to dispose of sharps is to use a sharps container.
5. A sharps container is a single-use container that is filled with used syringes, needles and lancets. When filled to capacity the sharps container can be disposed of safely. Your veterinarian should be able to tell you where these filled sharps containers can be safely dropped off.
6. One brand of U-40 insulin syringes is now packaged in a sharps container. You remove the unused syringe from one part of the container and after use place it back into the used syringe section of the container. When all syringes have been used, the container can be disposed of safely.
7. Insulin syringes should be used one time only. You should not reuse syringes.

Please remember that the pharmacists at 1-800-PetMeds are available to answer any questions you may have regarding the use of insulin and insulin syringes.

Grapes and Raisins

Julie, a person I work with at 1-800-PetMeds, mentioned that she received an email which states giving grapes or raisins to your dog can be dangerous. Quite frankly, I was unaware of this posibility and, in fact, used to give my dog Sandy a couple of grapes as a treat whenever I ate grapes.

It turns out, that this is not an urban legend. It is reality. Grapes and raisins can be poisonous to dogs. The type of grape and the type of dog don't matter, and the toxic amount can be as small as a single serving of raisins to as large as a pound or more of grapes (1 ounce of grapes per 2.2 lbs of body weight).

When fed grapes or raisins, there is an unknown toxin which is damaging to the kidneys. Initially, pets fed grapes or raisins will exhibit gastrointestinal signs such as vomiting and diarrhea. Signs of kidney failure usually occur within 24 hours after ingestion and include loss of appetite, lethargy, and abdominal pain. The dog may stop drinking and urinating.

Key points to remember:

• Since the amount of grapes or raisins that can cause toxicity can vary, it's best not to give your dog grapes or raisins at all.
• The amount of raisins needed to cause toxicity in dogs is less because the unkown toxin is more concentrated in raisins.
• Do not leave grapes or raisins where your dog can get at them easily.
• If you suspect your pet has eaten grapes or raisins, contact your veterinarian immediately. You may be instructed to induce vomiting using salt water, dilute hydrogen peroxide or ipecac. Your veterinarian will tell you which to use.
• For more information regarding grape and raisin toxicity log onto:
  http://vetmedicine.about.com/od/toxicology/f/grape_raisin.htm

Log onto www.PetHealth101.com for additional information regarding pet health and poisons in general.

Client-Patient-Veterinarian relationship

A client-patient-veterinarian (CPV) relationship occurs when a veterinarian has physically examined a pet for the purpose of diagnosing any medical condition that may be present. Having performed this examination, the veterinarian is able to prescribe medication to treat the condition. Having a CPV is required for a veterinarian to prescribe heartworm prevention medication such as Heartgard Plus, Interceptor and Sentinel to healthy pets as well.

Having a CPV in order to prescribe medications for a pet is a requirement in every state. In order to establish a CPV, the pet must be examined at least once a year.

Even though a CPV is required to prescribe heartworm preventatives, there is no regulation that prevents the veterinarian from prescribing two years of heartworm preventative therapy at the time a prescription is written. Choosing to authorize the dispensing of a prescription for one year or two years is a practice guideline the veterinarian establishes himself or herself. What has to be taken into consideration, other than the pet being healthy and heartworm free, is the veterinarian's confidence in the compliance of the owner in giving a dose of preventative medication once a month, every month, year round without fail.

What are important points to remember:

• A CPV can only occur from a physical examination of the pet by a veterinarian, not by answering an on-line questionaire.
• Having had this physical exam, your veterinarian may prescribe two years of heartworm prevention meds. This is up to the veterinarian.
• A physical exam may be necessary more often than once a year if the pet is being treated for a physical condition that requires periodic monitoring and/or testing, or, if the pet has been started on a new medication and tests are required to make sure the medication is doing no harm or is acting as expected.

1-800-PetMeds wants to be the pharmacy for your pets prescription and non-prescription needs. If your veterinarian is going to put your pet on a medication, remember to ask for a prescription while at the vets office so you can mail it into our pharmacy, or, ask your veterinarian to fax a prescription from his office to the 1-800-PetMeds pharmacy. Of course the 1-800-PetMeds pharmacy team is available to call your veterinarian for the prescription as well.

How do I dispose of unused medications?

According to the Pharmaceutical Research and Manufacturers of America (PhRMA), about three to seven percent of prescribed medicines are unused. It used to be the recommendation that these drugs, rather than being left at home, should be flushed down the toilet to prevent harm to children and pets. Unfortunately, the U.S. Fish and Wildlife Service has found that these medications, when flushed down the toilet or thrown directly into the garbage, can and do find their way into waterways causing reproductive problems in fish and making some bacteria more resistant to certain drugs.

Following the release of guidelines issued by the American Pharmacists Association (APhA) , the U.S. Fish and Wildlife Service has developed a joint educational campaign with APhA called SMARxT Disposal in order to better inform the public regarding disposal of unused medicines through municipal hazardous waste collection programs or, at least, in the trash:

APhA and the U.S. Fish and Wildlife Service say just three small steps can make a huge difference:

1. DO NOT FLUSH unused medications. Consumers were once advised to flush their expired or unused medications; however, recent environmental impact studies report that this could be having an adverse impact on the environment. While the rule of thumb is not to flush, the Food and Drug Administration (FDA) has determined that certain medications should be flushed due to their abuse potential. Read the instructions on your medication and talk to your pharmacist.

2. When tossing unused medications, protect children and pets from the potentially negative effects. APhA recommends that consumers:
- Crush solid medications or dissolve them in water (this applies for liquid medications as well) and mix with kitty litter or sawdust (or any material that absorbs the dissolved medication and makes it less appealing for pets or children to eat), then place in a sealed plastic bag BEFORE tossing in the trash.
- Remove and destroy ALL identifying personal information (prescription label) from the medication container.
- Check for approved state and local collection programs or with area hazardous waste facilities. In certain states, you may be able to take your unused medications to your community pharmacy.

3. Talk To Your Pharmacist. Research shows that pharmacists are one of the most accessible healthcare professionals. As the medication experts on the healthcare team, pharmacists are available to guide you on how to properly dispose of your unused medications.
Following these simple steps can help protect your family and community, minimize a potential negative impact on the environment, and prevent the illegal diversion of unused medications.

OTC and Rx. What's the difference?

In veterinary medicine, as in human medicine, medications can be over-the-counter (OTC) or prescription.

OTC medications, which are obtained without a prescription, are drugs that can be used to treat conditions that don't necessarily require a vets care and have been proven to have high safety standards when used in the treatment of these conditions. Examples of OTC products include (but are not limited to):

• Frontline Plus or K9 Advantix
• Glucosamine and Chondroitin supplements
• Vitamins
• Most shampoos

OTC products may be federally regulated by FDA if there is a labled claim to the cure, prevention, mitigation or treatment of a disease (such as diphenhydramine for allergies), EPA (if product is an insecticide as used in flea and tick products) or not federally regulated if there is no medical claim (nutritional supplements).

Prescription medications, which require a prescription prior to dispensing by a pharmacist, are sometimes called legend drugs because they carry a warning (legend) that says "Rx only" or "Caution: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian". What's the difference? "Rx Only" medications are drugs FDA approved for use in humans. However, it is a common practice for vets to use these medicines in animals as well. An example would be Tapazole (methimazole) used in both humans and cats for hyperthyroid disease.

Drugs that have the warning "Caution: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian", are drugs FDA approved for use in animals and can only be used in animals and can only be prescribed by a veterinarian. An example would be Deramaxx (deracoxib).

Flea and Tick Season is upon us

Those of us living in the south are used to using flea or flea and tick preventative products such as Frontline Top Spot or Frontline Plus year round. Those of us who live in cooler climates may tend to use Frontline Top Spot or Frontline Plus only during the warm months such as April through September or May through October based on the belief that fleas and ticks don't survive in cold weather. The only problem is that fleas and ticks can survive indoors in the winter so a good rule of thumb is to treat your pet with flea or flea and tick preventative year round. The added benefit is compliance. If we are used to applying a dose each month, we are less likely to forget to apply a dose and therefore we are protecting our pets better.