We are thankful that the crisis appears to be over. Thanks to everyone for their patience and understanding in this difficult time.

Why Were Cat Vaccines In Short Supply?

The official story is that supply chain disruption caused by COVID and diversion of resources into human vaccines made feline vaccines scarce. However, this was just the last (and worst!) in a long line of shortages that have been occurring since well before COVID. The full answer must therefore also reflect the fragility of modern global supply chains.

Please note that this only applied to cat vaccines. Dog and rabbit vaccines are in good supply.

How You Can Protect Your Cat

If your cat is overdue for vaccination and there aren’t vaccines available in your area, please don’t be too alarmed. There are three easy ways you can reduce their risk of infection:

1. Keep your cat indoors
2. Wash your hands and change in-contact clothing after patting cats from outside the home
3. Use pet sitters instead of catteries if you can

If using catteries, choose from facilities like those on our list which provide individual, easily cleaned spaces, not communal areas.

Don’t Forget Health Checks Too!

Vets have always strongly encouraged cat owners to see the value in the regular checkup itself. From our perspective, these get more and more important as a cat ages, but often it’s still the F3 vaccine reminder that prompts the visit.

At Walkerville, we were encouraging cats to still come in for their check if they hadn’t had one in the past 12 months. We gave them a full physical, plus an optional blood test. Later, when the vaccines became available, we only charged the difference if no new checkup was required.

Our attention to hygiene and quarantine means the risk of in-clinic infection was very low. Indeed, to our knowledge, it never happened!

Will My Cat Need A Booster?

A common question is what to do when vaccines are plentiful again. After a delay in vaccination, it is customary to need to give two boosters 4 weeks apart to reestablish immunity.

Whether this will be necessary will depend on the time delay, but also the needs of each cat. There are no hard and fast rules, but a good guideline would be as follows:

• No booster required if only a 3 month delay
• Booster for 3 to 6 month delays in high-risk cats (outdoors, cat boarding, new kittens in the home etc)
• Boosters for all cats after a 6 month delay

The unpredictability of vaccine protection means that even the last point will be up for negotiation. This might especially apply to cats who have had many regular vaccines in the past, giving them a solid base of immunity.

Getting a New Kitten Without Vaccines

If you plan on getting a new kitten, there are important considerations.

My view is that it would be a mistake to not adopt right now. To do this would leave a greater number of kittens in a much higher risk environment. It would be extremely concerning if the shelters were overflowing right now of all times.

Of course, the shelters will have made special rules to cope with this crisis. You’ll need to check these with your local facility before adopting.

What might be best avoided is bringing kittens into homes with existing cats if their vaccines are more than 3 months overdue. Complete avoidance of handling cats from outside the home would also be strongly recommended.

Put yourself on a waitlist at your local vet. Hopefully they will prioritise kittens needing their first vaccines once supplies resume.

That’s all for now but I strongly welcome your comments and questions below.

Related: What Cat Flu Looks Like | Feline Enteritis / Parvovirus

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

What can be done for these poor suffering creatures? I’ve talked about noise phobias before, but now we have a new tool in our fight against this major welfare issue.

Sileo: The New Noise Sensitivity Drug

Sileo (pronounced “SEE-layo” not “si-LAY-o”) is a syringe loaded with a gel containing dexmedetomidine, an alpha-2 agonist sedative. It’s the first time that a drug of this strength has been registered for dog owners to use.

Therefore, we have to be very careful, as you’ll see later. That’s also why dog owners can only get it prescribed after a checkup and a discussion with their vet.

Sileo is indicated for the alleviation of acute anxiety and fear associated with noise in dogs. Ironically, (but perhaps understandably given the difficulty) Sileo has not been evaluated during thunderstorms even though they are likely to be its main use. It has been trialled against fireworks, with the results you see above.

Sileo’s Safety In Dogs & People

The first thing you’ll notice once you get it is the extremely child resistant packaging. This should serve as a warning to keep it well away from children at all times and wear gloves when using. The good news it that is took me to actually read the instructions before I could open the box.

Vets already know too well that dexmedetomidine can cause low blood pressures, body temperatures and heart rates. We also see it being a little unpredictable from dog to dog. The same dose that ‘barely touches the sides’ in one dog can be dangerous to another.

For safety’s sake, please avoid using Sileo in any dog with significant sickness or pre-existing illness. This could include even temporary problems like the severe stress caused by the noise phobia itself if they become heat stressed or dehydrated. If it is used in very hot or cold conditions, you will also need to be careful that your dog’s body temperature stays in the correct range.

I would also be very careful combining it with other anxiety medications that cause sedation like trazodone or clonidine. Dogs with noise phobias often have a whole drugs cabinet and it would be very tempting to use more than one in times of stress.

Lastly, I would never use it in young puppies or in breeding females.

Having given all these dire warnings, the fact remains: there is a tremendous need for an effective drug for noise phobia in dogs. That’s why it’s often worth taking the risk.

When To Give Sileo 

Like all anxiety medications, Sileo will work best if it is given before exposure to whatever causes the fear. Therefore, try to predict the stressful event (such as by watching the weather radar for approaching thunderstorms), and give it 30 to 60 minutes before. This is how long it takes to work.

If you aren’t able to predict, it’s still worth giving the drug as soon as you hear the noise or your dog starts showing signs of anxiety. It just may not work as well under these conditions.

After giving the correct dose, do not give any more, even if the results are insufficient. After 2 hours, you can give a second dose, and then every 2 hours up to a maximum of 5 doses, as long as your dog remains free of side-effects.

Sileo is not supposed to be swallowed, and will probably not work if it is. Instead, it is applied to the inside of the mouth between the upper teeth and the cheek. Therefore, absorption could be a problem in dogs with severe gum or dental disease. It could also be a problem if you feed your dog shortly afterwards. I would wait 30 minutes.

How To Give Sileo

Sileo comes in a metered dose syringe with a rotating ring to set the correct dose. The earlier model had a locking mechanism but it caused many overdosages in the USA due to the ring lock not engaging. Having used this update, it seems hard to accidentally overdose.

Please read the enclosed leaflet very closely as it contains detailed descriptions and pictures of how to use it properly. 

In brief, you rotate the ring right down to the syringe barrel then back until the correct number of dots is exposed between the syringe barrel and the ring. It will then cause the plunger to stop at the correct place when you squeeze it into your dog’s mouth.

Sileo Dosage Chart

If the dose is more than 6 dots, divide the dose between both sides of the mouth.

Sileo Side Effects 

Alpha-2 agonists are known to cause vomiting in some dogs. Therefore, don’t be too concerned is there is a brief vomit as it starts to take effect. Any more than this and you will need to seek help. 

Other side effects will generally be related to excessive drowsiness and sedation, including a low heart and breathing rate, and low temperature. Adverse effects should not last more than two hours but there will be some variation between dogs.

If your dog appears excessively sedated, or breathing too slowly, please seek immediate veterinary care. There is an antidote available which should almost immediately reverse the effects.

How Well Does Sileo Work?

The graph at the start shows the results of a European placebo-controlled double-blinded field study. 71 dogs with a history of fireworks phobia were treated at New Year’s Eve with a maximum of five doses at two hour intervals. For comparison, 73 dogs were treated with a placebo containing no drug.

You can see that 75% of the treated dogs had a good or excellent response, compared with 33% of placebo-treated dogs. There was a statistically significant difference (p<0.0001) between dexmedetomidine and control in favour of dexmedetomidine.

At the same time note that there were still plenty of dogs who responded very poorly. And it’s also worth noting that in this study, the treatment was able to be started in most cases before the onset of the noise.

So:

• Sileo won’t help every dog enough on its own
• Sileo may cause excessive side effects in some dogs
• Sileo will be expensive for larger dogs if it’s needed very often

For all these reasons, we need to not forget the other options.

Medications For Noise Sensitivity

Dogs with anxiety to noise are treated with both drugs and environmental manipulations. A quick list includes:

• being a calming and reassuring presence
• creating a ‘safe zone’ where your dog likes to hide
• getting a dog behaviourist consultation
• benzodiazepines like alprazolam and diazepam
• clonidine
• trazodone
• gabapentin
• dexmedetomidine

Visit this page for a longer discussion of these options. One thing I will take the time to specifically warn you about here, though, is Adaptil. You can read why on this page, but a simple summary is that it just doesn’t do enough. The placebo effect shown above should be sufficient warning to always be guided by science when you can.

And one last grumble. As an ancient-language fan, the name ‘Sileo” grates on me a bit. It’s Latin for “I am silent”, which speaks all too loudly to how we sometimes approach mental health in animals. That is, as problems for us, not them.

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

They are a great help, and I’m not going to tell you not to use them. But I want you to be careful.

What Is A Lick Mat?

A lick mat is a textured flat surface made out of rubber, usually with suction cups to attach it to the floor. The pattern on the top is designed to trap food and make it hard to eat quickly. The aim is to get dogs and cats to spend their time in licking instead of other unwanted behaviours, or to alleviate boredom and anxiety. Unlike other slow feeders, licky mats promote licking behaviour, instead of food seeking or foraging.

Uses For A LickiMat 

The uses being promoted for the LickiMat® on their website include:

• Entertainment & distraction
• Reduction of anxiety & stress 
• Boredom buster 
• Slow feeding
• Raw feeding
• Environmental enrichment
• Improving oral health

Some of these uses make a lot of sense. A lick mat is a great way to get a dog to tolerate unpleasant situations like bathing, grooming, nail clipping and vet visits. That’s only so long as your dog is highly food-motivated.

You could also use it as an aid to crate training and getting your dog accustomed to car trips. It’s also a great way to alleviate stress in temporary situations, like fireworks and thunderstorms, or owners leaving the house.

So what’s the problem? Firstly, some of the claims make little or no sense.

Do Lick Mats Improve Oral Health?

LickiMat’s manufacturers claim that by stimulating saliva production it can clean the tongue, teeth and gums. Well, as someone who is well-acquainted with the literature on what actually keeps pets’ mouths clean, this statement lacks any basis in fact.

In fact, the sorts of treats being used on these mats should logically make periodontal disease worse, not better. Always remember that periodontal disease in dogs and cats follows the same course as it does in humans: you wouldn’t expect your teeth to be better by licking peanut butter off a rubber tray either.

What about the claim that scraping the tongue freshens your pet’s breath? Ludicrous. I’ve been a vet for close to 30 years, and I’ve never yet seen bad breath caused by tongues!

Are Lick Mats Calming?

One of my major concerns not just with lick mats but more generally is the contrast between being busy and being happy. While I think these products are great for preventing anxiety in stressful situations, it’s a big claim to say that such products improve anxiety that’s already present. As with my complaints about Adaptil and Feliway, such claims might stop dog and cat owners choosing remedies that actually help them.

Beware the manufacturer claim that “the extended licking action promoted by LickiMat releases a calming hormone”. So far there’s no evidence for anxiety reduction with lick mats or any ‘hormone’ being released. Yes, a mat might keep them busy and less prone to expressing anxious behaviours, but that’s not the same thing.

These two complaints are minor quibbles compared with my concerns about safety. Here are two ways.

Intestinal Obstruction & Hygiene

In the past month we have seen two animals need veterinary attention as a result of lick mats.

The first is a dog called Murphy. He was left alone with a lick mat for just a moment, and promptly chewed it up and swallowed it. Thankfully his owners immediately saw what happened and brought him down. That’s his vomit in the picture at the start.

The second is Tex the cat. He ate a piece of his lick mat without anyone noticing. When he started vomiting, his owner realised what was wrong. That’s his x-ray below; the white rectangle in his belly is the piece, now blocking his intestines.

There’s also a picture above of that piece matched with the rest of the mat, after we took it out. Without major surgery, he would have been in a lot of trouble. The same could have been true for Murphy of course.

This should come as no surprise. Vets have always said that anything flavoured like food, but not digestible is extremely dangerous. So here’s the newly updated list:

• corn cobs
• satay sticks
• icecream sticks
• meat wrapping
• cooked bones
• lick mats

How To Use Lick Mats More Safely

“You must fully train your dog before leaving her/him alone with a LickiMat.” So say LickiMat.

These products are being promoted for pets left home alone, which in my view is madness. In the general enthusiasm for anything new, we’ve forgotten some basic rules.

It is my strong view that no dog should be left alone with a lick mat. Even after ‘training’, whatever that is. There’s no telling when a dog will get frustrated and just chew it up. Cats might be at a lower risk, but Tex shows us it can still happen, especially with the softer silicone products.

Another thing: watch out that these mats are properly cleaned after each use. This is particularly important if you’re using them with raw food. It would be smart to buy ones that are dishwasher safe.

What Can I Use Instead Of A Lick Mat?

I’m not opposed to using food as a distraction when they need to be left. If you do, I recommend slow feeder bowls, Kong Wobblers, Bobalots and Nina Ottoson products with long track records of proven safety. Or you can hide food around the house or garden.

To be fair, LickiMat make a ‘Tuff’ version, and even a keeper tray to make chewing harder. But I have seen both the red and black rubber Kongs destroyed and know only too well how destructive a determined dog can be.

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

1. A poorer recognition of the signs of arthritis in cats and therefore lower demand
2. The smaller market and financial benefit to drug companies (dogs visit the vet at least twice as much as cats)
3. The difficulty in giving medications to cats
4. The increased risk due to the prevalence of kidney disease

Now, in 2023 we are witnessing the appearance of a wholly new approach to treatment that might overcome many of these concerns.

These are exciting times, but we also need to be cautious and realistic. You’ll see in this article that it is by no means a silver bullet. However, with Solensia there is real hope for cats that we have a new and effective tool to improve their quality of life.

What is Solensia?

Solensia is a trade name for frunevetmab in Australia. It neutralises nerve growth factor (NGF), which has been shown to be involved in the perception of pain. As a monoclonal antibody, it has the potential to be highly specific to its target, and block it almost completely.

In Australia, Solensia has been registered for the alleviation of pain associated with osteoarthritis in cats.

How Well Does It Work & How Quickly?

In our clinic, we have seen some cats benefit greatly after starting Solensia, but what does the evidence say? The results of a single placebo-controlled study conducted by the parent company are shown here and referenced below.

There are three important things to note here:

1. All arthritis treatments show a caregiver placebo effect, but for this particular product, it is especially large
2. The difference between the two groups is statistically significant for Months 1 and 2, so we are confident that Solensia is helping at least some cats
3. Unquestionably, there will be many others who receive insufficient benefit and require different arthritis remedies

My view is that the large placebo effect is a direct result of the difficulty we have in correctly identifying signs of pain in cats. However, it is also possible that it only brings benefit to a minority. Our own experience is that Solensia can be very effective in some cats, but hard to judge as well.

A further clue that anti-NGF treatments are helpful is in the clearer results we see for the canine equivalent, Beransa.

Based on laboratory studies, a positive response would be expected to appear at around day 6.

Solensia Dosage & How Often

Solensia is given by vets at a dose of 7 mg by subcutaneous injection for cats between 2.5kg and 7kg.. Above this, two vials are needed but I would suspect that most of these cats would benefit more from weight loss. If desired, the dose is repeated every month. It is generally recommended to try at least two doses before deciding whether it is effective enough.

NGF is important for foetal and juvenile development. Therefore, Solensia must not be used in breeding, pregnant or lactating cats, or those less than 12 months of age.

Human Health Risks

Similarly, pregnant women, women trying to conceive, and breastfeeding women should take extreme care to avoid accidental self injection or needle stick injuries. To be safe, it is best that they take no part in giving the injection or even holding their pet.

Just to be clear, a treated cat poses no risk to humans.

Solensia Side Effects

Up to 10% of cats given the injection showed signs of hypersensitivity such as skin itching, hair loss, and dermatitis. When this occurs, it is advised to stop the treatment. The itch does not respond well to normal treatments for dermatitis until the injection is stopped

If you read the comments section below, you will see that it is dominated by reports of adverse skin effects. In our clinic we have indeed seen a few reactions, but not much more than the reported 10%. My view on this is that although the rate here appears much higher, owners with affected cats will be more likely to post than those with no problems.

In other ways, our prior experience with monoclonal antibodies like Cytopoint shows us that they are much safer than traditional drugs like anti-inflammatories. This is because as naturally occurring proteins, they require minimal metabolism or detoxification by the liver or kidneys.

It is therefore likely that Solensia can be used at normal doses in cats with kidney disease, unlike anti-inflammatories which become more dangerous. However, until there are studies of their use with liver or kidney disease, caution is still advisable in these cats.

Solensia appears safe when used in combination with other drugs, and at the time of vaccination. The only concern with using multiple treatments could be that if an adverse effect occurs, you may not be able to work out which one caused it.

How Much Does Solensia Cost?

The cost in 2023 for a single injection of Solensia is around $90. This is in the same region as the higher priced anti-inflammatory drugs.

Our experience so far is that for some cats, it maintains their quality of life when other choices fail. It can also be used when other treatments aren’t safe enough to use and for those cats that owners cannot easily medicate. In summary, we believe is worth a try if costs allow.

Anyone who has an arthritic cat knows that we still aren’t doing enough for them. The development of monoclonal antibodies brings us just one step closer, and just might give us more time to enjoy our lovely old cats.

Therefore, talk to your vet about whether it might be good for your cat.

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

These are exciting times, but we also need to be cautious. No treatment will work on every dog, and after initial overexcitement, some new products end up being major disappointments. However, with Beransa there is real hope for dogs that we have a new and effective tool to improve their quality of life.

What is Beransa?

Beransa is a trade name for bedinvetmab, also called Librela outside of Australia. It neutralises nerve growth factor (NGF), which has been shown to be involved in the perception of pain. As a monoclonal antibody, it has the potential to be highly specific to its target, and block it almost completely.

In Australia, Beransa has been registered for the alleviation of pain associated with osteoarthritis in dogs.

How Well Does It Work & How Quickly?

In our clinic, Beransa has quickly become the number one treatment chosen by our vets for new patients with arthritis. This has been based on a number of factors:

1. A very high success rate, interestingly higher than in the trial featured below
2. Minimal to no observed side effects, especially compared with traditional anti-inflammatory drugs
3. A similar cost to other treatments, especially in larger dogs

What does the evidence say? The results of a single placebo-controlled study conducted by the parent company are shown here and referenced below.

They show that around one in two dogs show benefit after a month. Like with all arthritis treatments, there is a large caregiver placebo effect, so it is important to stay as realistic as possible about its efficacy in each patient.

How To Use Beransa

Personally, I believe the study shown here and our clinical experience are enough to recommend trying Beransa in the right dog. However, I also strongly believe that we should not forget the other tried and trusted remedies for arthritis in dogs.

This is especially because Beransa only targets pain, not the underlying disease process. Now make no mistake: treating the pain is the most important thing, but it isn’t everything. If we add the treatments known to slow down the arthritic process, our dogs should have better function in the years to come as well as right now.

In particular, I encourage all dog owners using Beransa to at least continue the Hills j/d diet and regular pentosan injections. Both are extremely safe and can slow the degenerative process.

Beransa Dosage & Frequency

Beransa is given at a dose of 0.5 – 1 mg/kg by subcutaneous injection. It comes in a variety of vial sizes to cater for dogs of different weights. If desired, the dose is repeated every month. It is generally recommended to try at least two doses before deciding whether it is effective enough.

NGF is important for foetal and juvenile development. Therefore, Beransa must not be used in breeding, pregnant or lactating dogs, or those less than 12 months of age.

Human Health Risks

Similarly, pregnant women, women trying to conceive, and breastfeeding women should take extreme care to avoid accidental self injection or needle stick injuries. To be safe, it is best that they take no part in giving the injection or even holding their pet.

Just to be clear, a treated dog poses no risk to humans.

Beransa Side Effects

Reactions such as swelling and heat may occur at the site of injection, but these seem rare. Hypersensitivity reactions are also possible but appear more common in the cat form of this drug, Solensia.

Our experience with monoclonal antibodies like Cytopoint shows us that they are much safer than traditional drugs like anti-inflammatories. This is because as naturally occurring proteins, they require minimal metabolism or detoxification by the liver or kidneys. However, until there are studies of their use with liver or kidney disease, caution is still advisable in these dogs.

Beransa appears safe when used in combination with other drugs, and at the time of vaccination. The only concern with using multiple treatments could be that if an adverse effect occurs, you may not be able to identify the cause.

How Much Does Beransa Cost?

The cost in 2023 for a single injection of Beransa is between $100 and $130 depending on the size required. This is in the same region as the higher price anti-inflammatory drugs.

Beransa or Librela may not be a silver bullet, but just having another option is a great blessing. Our experience so far is that for some dogs, it maintains their quality of life when other choices fail. It can also be used when other treatments aren’t safe enough to use.

Anyone who has an arthritic dog knows that we still aren’t doing enough for them. The development of monoclonal antibodies brings us just one step closer, and just might give us more time to enjoy our lovely old dogs.

Therefore, talk to your vet about whether it might be good for your dog.

References

Corral, M. J., Moyaert, H., Fernandes, T., Escalada, M., Tena, J. K. S., Walters, R. R., & Stegemann, M. R. (2021). A prospective, randomized, blinded, placebo-controlled multisite clinical study of bedinvetmab, a canine monoclonal antibody targeting nerve growth factor, in dogs with osteoarthritis. Veterinary anaesthesia and analgesia, 48(6), 943-955 Full Text

Kronenberger, K. (2023). In dogs diagnosed with osteoarthritis, how safe and effective is long-term treatment with bedinvetmab in providing analgesia?. Veterinary Evidence, 8(1) Full Text

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Nowhere in dog care is there more argument than if bones should be fed as part of a regular diet.

You’ll see a lot of advice that it’s dangerous. It certainly can be. However, if you follow our bone feeding advice, you will minimise the risk, but not eliminate it.

You’ll also see a lot of advice saying it has no benefit, or that certain manufactured products are better. This is a much more complicated issue and as you will see, not entirely true.

Why Is There So Little Proof?

Absence of evidence is not always evidence of absence.

In other words, there can be no proof of benefit without studies designed to look for it. The problems with bones is that they generally lack companies with the financial incentive to fund major studies.

Therefore, we know that toothbrushing, Dentastix, Greenies, dental foods and even mouthwashes can help, but we just don’t know enough about bones. It was this gap that we attempted to resolve in 2010.

The Walkerville Vet Bone Feeding Study

For 12 months, we surveyed dog owners at the time of vaccination, asking many questions about their diet. We also gave their mouth a dental score.

At the end of the study, we had 479 completed surveys. Then, owing to the fact that we’re always busy, we put them aside for a few years but never forgot them.

In 2017 I approached a statistician at the University of Adelaide about publishing the study. He was very helpful, and together we statistically analysed the data so that this was possible. Here’s what we found.

Bone Feeding Study Results

The graph gives a quick summary of the dog dental scores we collected. There was a dramatic difference in the rate of periodontal disease based on how often bones were fed. This difference was statistically significant at several points.

We also found that certain breed groups (Terriers, Gundogs, Working Dogs) were less likely to have dental problems when compared with Toy breeds.

According to these results, the feeding of bones to dogs is associated with better periodontal disease scores.

Although this suggests that the bones are keeping the teeth clean, we must be careful to not claim causation; we can’t prove that one causes the other. For example, owners who feed bones might generally be more conscious of dental care in other ways. Of course, we tried to ask about such things in the study, but only a long-term study would answer that question properly.

Regardless, the results are compelling and unique. It certainly suggests that dogs who are given dietary bone will benefit.

So Why Isn’t It Published?

To the best of our knowledge, this is the first time any such study has been conducted anywhere in the world. But it still hasn’t made it into a scientific journal.

We have submitted the manuscript to several journals, and there are three main reasons why it remains unpublished.

1. We have not tried the low ranking journals. Any paper can be published if you’re not fussy about where.
2. Legitimate criticism has been made that we were too close to the data. Claire and me both knew the patients, and it’s conceivable that our dental scores were biased as a result. Of course we don’t think so!
3. The journal reviewers are leaders in the field of veterinary dentistry, which is generally antagonistic towards bone feeding. Just read this quote from one:

It has already been established that diets with coarser materials will help to decrease the incidence of plaque and calculus accumulation, however there are major concerns in regards to the other problems that raw diets and diets with bone can cause.  From an oral health stand point, the incidence in dental trauma  or fractured teeth and endodontic disease should also be compared.  Without this comparison it is irresponsible to recommend this type of diet.

It’s like saying we aren’t allowed to publish on the benefits of early reading in children if we don’t also look at associated eye diseases. The reviewer’s comments are, of course, not evidence-based as no one has looked at rates of problems with bones either.

I would love that study too, but no-one asked the dental chew manufacturers to prove their safety. Are we not allowed to show a benefit if it exists?

So we continue to try. In the meantime, here’s a link to the full scientific paper, including references to other bone studies over time. Enjoy, and feel free to ask lots of questions in the comments below!

Related: How To Feed Bones To Reduce Risk | Other Ways To Keep Dogs’ Teeth Clean

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

So it was with great hope that here in Australia we awaited the arrival of Purina’s new food designed to reduce human allergies to cats and kittens. Imagine the possible benefits if it works:

• More people being able to enjoy the company of cats
• More cat rescue and less rehoming
• Better relationships for allergic partners of cat owners

But could it also be too good to be true? If it encourages people who can’t keep cats to get them, surely this will be a backwards step instead. I found my first Devon Rex in an animal shelter where she’d been dumped for just this reason.

I’m going to take you through the science behind Purina LiveClear® as impartially as I can. By the end, you’ll have a good idea of what to expect if you try it.

How Purina LiveClear Works

It starts with the major cat allergen of humans: Fel d 1. This complex protein is found in the saliva, sebaceous glands, skin and fur of cats. It’s very stable, and can easily become airborne, from where it causes all the usual signs of allergy in people: sneezing, runny eyes, asthma etc

Cats probably spread most of the Fel d 1 around by licking their coat. So the people at Purina thought: what if we developed a food that blocks the Fel d 1 from the saliva?

It’s actually very clever.

They expose chickens to cat allergens and collect their eggs. These then contain high levels of anti-Fel d 1 antibody. The egg proteins are sprayed onto cat biscuits so that cats end up having antibodies to their own allergen in their saliva. Theoretically then, when they groom themselves, the Fel d 1 is taken out and inactivated.

As an aside, it’s worth noting that in the trials the food was fed continuously, which makes sense when you see how it works. However, as any vet knows, it can be hard to do this without having a fat cat.

Does Purina LiveClear Reduce Allergens?

According to Purina’s own research, cats who eat LiveClear have a 47% reduction in allergen on their coat. And this is true, if a little oversimplified.

The reality is the graph here. It shows the same cats divided into four groups based on how much allergen they had in their coat. You can see that the top 25% have a lot more than the rest. You can also see that the actual levels vary for all of them week by week.

In fact, a look at the original paper shows that even these data points are averages of substantial individual variation.

Of course what matters most is how this translates to its effect on people. Is an average 47% reduction enough, and does the weekly variation make a difference?

Does LiveClear Reduce Human Allergy?

To give Purina some credit, they could have stopped here, but they went on do do human trials. They exposed people affected by cat allergy to blankets from cats fed either a control food or LiveClear. The study was double-blind, meaning that neither the researchers or test subjects knew which was which.

In other words, a high-quality piece of work. Sadly for Purina and cat allergy sufferers everywhere, the results were disappointing.

The following table shows the P-values for each symptom. Values less than 0.05 are generally regarded as significant. As you can see, there were no significant differences between reaction levels to blankets from treated or untreated cats.

Difference Between LiveClear & Control Food In Allergy Symptoms

Hang On- Purina Said It Worked!

Actually, there were differences found when the results were compared with earlier known exposure (i.e. no longer blinded). This should be yet another demonstration of the enduring power of the placebo effect. And yet that’s not what was said.

While I honestly think that LiveClear will help some people, using an unblinded allergen exposure as a comparison is not the way to find the proof.

Well, you might say, if the subjects felt better, does it matter whether it was a placebo effect or not?* That’s an ethical discussion for another day. What we really need is a good blinded study using cats in their own homes to get closest to the real world scenario.

So Is Purina LiveClear Worth It?

The evidence so far suggests that Purina LiveClear is an unreliable way to reduce cat allergy symptoms in the home. I certainly would not recommend that allergic people plan on having cats based on this intervention alone.

Despite this, I applaud the company for such an innovative approach, and I’m not writing the food off completely either. For just as some cats will produce unacceptably high Fel 1 d levels, others are likely to respond well, especially combined with other approaches. You won’t know unless you try.

If you already live with a cat, but are allergic, or have an allergic partner, then there’s not a whole lot to lose. LiveClear is clearly as safe as any other cat or kitten food. If it doesn’t help, all you’ve done is bought a more expensive version!

Related: The Shaky Evidence For Feliway In Cats | Other Ways To Reduce Household Feline Allergens

* Strictly speaking, this is a nocebo effect, where the known allergen exposure is likely to have increased the subjects’ perception of symptoms. Then compared to the lower tested levels later, a significant difference appears. Clear? No, I didn’t think so!

Sources

Bonnet, B., Messaoudi, K., Jacomet, F., Michaud, E., Fauquert, J. L., Caillaud, D., & Evrard, B. (2018). An update on molecular cat allergens: Fel d 1 and what else? Chapter 1: Fel d 1, the major cat allergen. Allergy, Asthma & Clinical Immunology, 14(1), 1-9

Pezzali, J. G., Smith, S. C., & Aldrich, C. G. (2018). An overview of the effect of diet on the allergenicity of cats to susceptible humans. SOJ Vet Sci, 4, 1-9

Ramadour, M., Birnbaum, J., Magalon, C., Lanteaume, A., Charpin, D., & Vervloet, D. (1998). Cat sex differences in major allergen production (Fel d 1). Journal of allergy and clinical immunology, 101(2), 282-284

Satyaraj, E., Gardner, C., Filipi, I., Cramer, K., & Sherrill, S. (2019). Reduction of active Fel d1 from cats using an antiFel d1 egg IgY antibody. Immunity, inflammation and disease, 7(2), 68-73

Wedner, J. H., Mantia, T., Satyaraj, E., Gardner, C., Al-Hammadi, N., & Sherrill, S. (2021). Feeding cats egg product with polyclonal-anti-Fel d1 antibodies decreases environmental Fel d1 and allergic response: A proof of concept study. J Allergy Infect Dis, 2(1), 1-8

One disease in particular, myxomatous mitral valve disease (MMVD) is said to account for 75% of heart disease and affects 85% of small dogs over 13 years old. Not all of these will need treatment, but many will. Later I’ll show you how to tell.

There is no question that recent advances have made MMVD much less of a death sentence than it once was. So it’s good to get to know pimobendan, the newest, and most commonly used of these treatments.

How Pimobendan Works

Pimobendan is a drug that unusually has two separate positive effects. First, it increases the strength of contraction of the heart, increasing the amount of blood delivered. Second, it dilates blood vessels in the general circulation, reducing the heart’s workload.

Pimobendan needs to be given at a dose of 0.2–0.3 mg/kg twice a day on an empty stomach, leading to the following inescapable logic. If it needs to be given one hour before any food and 12 hours apart, then even starting with a 7am dose will result in an 8pm dinner time. Now of course, we don’t recommend feeding dogs after dark…

You can picture the disappointment in peoples’ faces when they think this through. It’s definitely a drug for the early risers in the house. The only other alternative is to make their main meal in the morning.

Lifespan Of Dogs On Pimobendan

Early work demonstrated that pimobendan could help dogs with MMVD, but by how much was uncertain, and so vets like me were slow to change treatments that were already working. Then two large international studies appeared. With them came a sea-change in how we viewed this drug.

Each of them has something important to say about both effects and side effects. Both are referenced below.

2008: The QUEST Study

252 dogs with naturally occurring MMVD and congestive heart failure were divided into two groups: one taking pimobendan and another taking benazepril, the leading heart treatment at the time. Both were allowed other treatments as needed. They were then studied over the following years until one of the following three things happened:

1. sudden death
2. euthanasia for cardiac reasons
3. treatment failure

For pimobendan, the median time to this endpoint was 188 days. For benazepril it was 140. So a good result, but far from impressive. However, it’s worth pointing out here that these survival times are artificially short; many dogs in the study had already been affected for some time before beginning.

Real life is better. The point is more that in matched groups, pimobendan outperformed its rival.

2016: The EPIC Study

To my knowledge, the EPIC study was the first in veterinary medicine to be stopped early because of what was found. 354 dogs were chosen who had MMVD but were not yet in heart failure. At this earlier stage they had enlarged hearts as determined by xray and ultrasound.

Up to the time of the study, treatment was not believed to help at this stage, and so they were divided into dogs given pimobendan and dogs given a harmless placebo instead. This time the endpoint was chosen to be one of:

1. development of left-sided heart failure
2. euthanasia for a cardiac reason
3. death presumed to be cardiac in origin

The median time to this endpoint was 1228 days in the pimobendan group and 766 days in the placebo group. In other words, dogs with enlarged hearts but without heart failure had an extra 60% or 462 days of disease-free life if they took pimobendan.

This of course was a stunning result. Once it became obvious, all of the dogs were put on pimobendan.

Pimobendan Side Effects

Similar rates of adverse effects were reported for pimobendan and benazepril. This suggests that the drug is at least as safe as other heart treatments,

Pimobendan also recorded similar side effects to the placebo. Deaths in the pimobendan group were 46.4% versus 57.2% in the placebo group. This suggests that pimobendan is safe compared with any drug.

If you want to take a closer look, I’ve included the reported side effects from both studies in two tables after the references.

Help! Pimobendan Killed My Dog!

What then do we make of online reports of terrible events after dogs took pimobendan? The high rates of death and side effects in the placebo group provide the best clue. These are old dogs with a high risk of illness from any cause.

We humans are notoriously bad at separating causation from correlation. In fact, with any one dog, it’s virtually impossible to decide if a sudden death is caused by a drug or not. It’s only by looking at large groups that we can see the trend. Sometimes it’s real, other times it’s not.

Pimobendan may in fact cause deaths in some dogs. Even if so, the evidence tells us that they are heavily outweighed by the dogs that survive for longer.

When Should My Dog Take Pimobendan?

Pimobendan is a much better drug at stopping dogs going into heart failure than it is in treating them once they do. So here’s a quick summary of how to use pimobendan in 2022 and beyond:

1. Get regular checkups (at least annually) to look for early signs of heart disease. This is mainly the appearance of a heart murmur.
2. Once a murmur appears, watch fitness, coughing and resting respiratory rate closely and get a checkup at least every 6 months.
3. Follow your vet’s advice on further testing. Sooner rather than later they will want to do chest xrays and possibly cardiac ultrasound to look for the signs of heart enlargement.
4. Even if things are normal, expect things to change and so repeat the tests every 6 to 12 months based on your vet’s advice. Eventually you’re likely to spot the right time to start pimobendan.
5. Once started, most heart disease will stabilise but dose adjustments and extra medications will still be necessary as the disease slowly worsens (hopefully over years, not months). Therefore, keep attending scheduled checkups and get advice straight away if anything changes.

Most importantly, trust the science. It’s very hard to judge the efficacy of any treatment used to prevent a disease instead of treat it, but we actually have a lot to go on here.

Related: A Dog With Dilated Cardiomyopathy (also treated with pimobendan) caused by a grain-free diet

Update: Mitral Valve Repair

I hesitate to add this as I fear giving dog owners false hope, but several comments below have spurred me to also discuss the surgical option. As of 2023, there are now several centres around the world that offer open heart surgery to improve mitral valve function. It is not replacement of the valve, but instead modifying its shape or adding support so that the leak is less significant.

Costs are extreme (I would guess $40-50K) and availability currently limited to the UK, France, Japan and the USA. If you Google ‘dog mitral valve repair’ you should find useful information from these sites. There is no doubt that this procedure will become more commonplace with time, and hopefully more realistic.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

References

Boswood, A., Häggström, J., Gordon, S. G., Wess, G., Stepien, R. L., Oyama, M. A., … & Watson, P. (2016). Effect of pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly: the EPIC study—a randomized clinical trial. Journal of Veterinary Internal Medicine 30,(6), 1765-1779. Full Article.

Häggström, J., Boswood, A., O’grady, M., Jöns, O., Smith, S., Swift, S., … & DiFruscia, R. (2008). Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: the QUEST study. Journal of Veterinary Internal Medicine, 22(5), 1124-1135. Full Article.

Keene, B. W., Atkins, C. E., Bonagura, J. D., Fox, P. R., Häggström, J., Fuentes, V. L., … & Uechi, M. (2019). ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. Journal of veterinary internal medicine, 33(3), 1127-1140. Full Article.

Minoxidil : A Baldness Treatment

Minoxidil has become extremely popular due to its ability to stimulate hair regrowth on the scalp of people. It was originally marketed as Rogaine, but is now available as an over the counter generic in liquid, foam and shampoo forms.

When cats lick even a tiny amount, it causes vomiting, drooling, low blood pressure, severe illness and often death. Because the product is applied to the skin, it can easily come into contact with cats either directly, by licking the area, or even from pillows.

I first discovered this toxin one year ago after a report from the Animal Poison Control Center that you can read here. In their list of the top causes of poisoning deaths in cats, it included a drug I had never heard of.

If I didn’t know about it, it meant many other vets didn’t either, and very few cat owners.

The message is simple: if you use minoxidil in any form, be extremely careful:

• Clean up areas carefully after use, especially spills or stray drops
• Do not allow your cat to come into contact with treated areas of skin
• Prevent access to bedrooms 
• Clean sheets and pillowcases frequently

PPD: A Hair Dye Ingredient

Para-phenylenediamine (PPD) is a fixative found in many hair dyes and henna temporary tattoos. It causes a deeper, longer lasting and more intense colour. Oral ingestion leads to intravascular hemolysis, rhabdomyolysis, myoglobinuria and acute renal failure. 

In other words, this means massive destruction of red blood cells and muscle cells. The release of their contents into the circulation causes downstream kidney damage. This is the same process you sometimes hear about with overexercise in hot conditions. 

I only heard about this toxin last week, but I saw a case a year ago that I’m now convinced was caused by it. 

Mimi’s Acute Renal Injury

Mimi’s owners came to me for a second opinion after he was diagnosed with acute kidney failure. The interesting thing is that despite an extensive search for the toxin, it was never found. However, due to the timing, Mimi‘s owners strongly suspected that a hair dye had caused it.

At the time, I conducted a search to the best of my abilities and found no link between dyes and poisoning. The case remained a mystery. Mimi survived only thanks to heroic efforts by his owners and a number of veterinary teams.

Knowledge of the toxicity of PPD is well known in human medical circles, but no documented cases of poisoning exist in animals. It’s likely that the lack of evidence is due to a lack of recognition, not occurrence. Like in Mimi’s case, it’s near impossible to prove a particular toxin causes kidney failure due to the delay between poisoning and diagnosis.

Once again, prevention is about minimising exposure:

• Use hair dyes and hennas without PPD if possible
• Use dyes and hennas in a well-ventilated place where your cat cannot join you
• After completion, clean up any spills and splashes carefully
• Rinse basins, baths and showers thoroughly since cats often like to lick these areas after use
• Don’t allow your cat to lick the dyed areas

Diclofenac (Voltaren)

A third common cause of cat poisoning deaths is the human use of potent anti-inflammatories. Once again, the risk is mainly from products applied to the skin. Products like Voltaren gel contain diclofenac, which even in small quantities will cause kidney failure.

Cats are likely to be poisoned either by licking the treated areas, or getting spilt product on their paws or coat. In addition to the methods above, prevention should also include covering the treated areas with clothing and keeping the products in a secure place.

The Common Link

All three of these toxins show us how susceptible cats are to household poisoning. This is for three reasons:

1. Cats are naturally inquisitive and will seek out and investigate new things
2. Cat seem inherently sensitive to a wide range of chemicals
3. Anything that contacts the outside of a cat will invariably be licked off and swallowed

The third point means we should add a final form of prevention: if anything not known to be safe gets on your cat’s coat or paws, you will need to give them a bath. This is not a decision taken lightly, but it may be life-saving.

Moreover, I would be careful about any medicines, dyes or other household chemicals, regardless of whether they contain diclofenac, minoxidil or PPD*. If we are learning one thing, it’s that cats will show us just how toxic a chemical can be.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Sources

Anuradha, S., Arora, S., Mehrotra, S., Arora, A., & Kar, P. (2004). Acute renal failure following para‐phenylenediamine (PPD) poisoning: a case report and review. Renal failure, 26(3), 329-332

Tater, K. C., Gwaltney-Brant, S., & Wismer, T. (2021). Topical Minoxidil Exposures and Toxicoses in Dogs and Cats: 211 Cases (2001–2019). Journal of the American Animal Hospital Association, 57(5), 225-231

* Just look at the ingredient list for a non-PPD containing hair dye for example: how many of these do you think have been tested in cats? Cetearyl Alcohol, Ammonium Hydroxide, Glyceryl Stearate, Ceteareth-20, Toluene-2,5-Diamine Sulfate, Octyldodecanol, Sodium Laureth Sulfate, Ethanolamine, Sodium Cetearyl Sulfate, Fragrance, 2-Methylresorcinol, Resorcinol, Serine, Sodium Sulfite, Oleic Acid, Potassium Stearate, Glycerin, Tetrasodium EDTA, m-Aminophenol, Carbomer, Linalool, Potassium Hydroxide, Citronellol, Ascorbic Acid, Butylphenyl Methylpropional, Linoleamidopropyl PG-Dimonium Chloride Phosphate, Propylene Glycol, Sodium Sulfate, Hexyl Salicylate, 2-Amino-3-Hydroxypyridine, Hydrogen Peroxide, PEG-40 Castor Oil, Disodium Pyrophosphate, Disodium EDTA, Sodium Benzoate, Phosphoric Acid, Behentrimonium Chloride, Dimethicone, Amodimethicone/Morpholinomethyl Silsesquioxane Copolymer, Magnesium Citrate, Magnesium Chloride, Hydrolyzed Keratin, Polyquaternium-37, Macadamia Ternifolia Seed Oil, Panthenol, Isopropyl Myristate, Citric Acid, Phenoxyethanol, Stearamidopropyl Dimethylamine, Isopropyl Alcohol, Sodium Methylparaben, Dicaprylyl Carbonate, Laureth-23, Laureth-4, Sodium Hydroxide, Hexyl Cinnamal, Benzyl Salicylate, Benzyl Alcohol, Limonene, Lauryl Glucoside, Trideceth-5, Salicylic Acid.

The Background

For almost my whole career, there has never been an excess of vets looking for work. In fact, at times the supply has been very tight. Yet, we more or less got by.

The reasons for this are up for debate but one of them is not too few veterinary students. Instead it’s that not enough of these vet students end up having long careers.

I’ve talked before about working conditions inside the industry, and the pressures placed on young vets by the public. Into this we can add COVID-19.

It’s quite likely that the crisis we’re in would still have happened without it, but COVID stopped vets migrating to Australia and only made it worse. It’s done the same for vet nurses and the employment market as a whole.

The Current Situation

Veterinary practices around Adelaide are rapidly falling into one of two camps: either adequately staffed or chronically understaffed. Earlier in the year we saw two country branch practices close and I don’t think we’re far away from this happening in the city too.

But this isn’t my concern.

What worries me is the desperation any practice will have for a vet, any vet. Yet these environments are possibly the very worst in which to put a new graduate. I’m not confident that either employee or employer will always foresee the problem before it happens.

In other words, we could end up burning out young vets at an even faster rate.

What New Graduates Need

A vet fresh out of vet school is not the same as a doctor in the same position. They have much less practical experience, and still require 6 to 12 months of on-the-job training. Therefore, in my opinion, they need two things:

1. Continuous support from experienced vets present in the clinic
2. A low workload that can grow in keeping with their skill acquisition

Don’t think they aren’t already great, by the way. I always say a new grad is at least as good as an experienced vet as long as they have enough time and support.

The Opposite Scenario

Today’s vet graduates risk being placed into practices where:

1. There is no experienced vet available, or only part-time
2. There is a high existing workload
3. Experienced nursing staff are in short supply
4. There is poor morale

I don’t blame the practice owners for hiring them. After all, they either do this or consider closing down. But I hope the young vets get a very realistic view of what they face.

To put this in context, when I graduated. I benefited from (almost) always having someone to answer questions, and very good nurses who could also teach me a lot. I also went into a practice that was expanding. So rather than replacing a missing vet and having to pick up the existing caseload, it grew with me.

The Consequences

My view is that the first 6 to 12 months of a vet’s career are make or break. It’s here they will learn the resilience we all need to draw on in a tough industry.

If they lose their confidence early, it’s very hard to get it back. If they don’t get taught the right way, they learn bad habits in how they think, what they do and how they cope.

Of course, I generalise, and many vets have become highly successful from isolated beginnings. But to me, the risk is too high. These are people who have dedicated their lives to being a vet, and we should do nothing to put that at risk.

The Future

Maybe I’m an optimist, but I actually see a bright future. If this crisis is not the stimulus we need to look at our situation with fresh eyes, then what is? In the short term some practices may close, but what should remain is a world where young vets are nurtured and conditions for everyone improve.

Have a safe Christmas and New Year. If you can, spare a moment to tell the young professionals around you how much you’ve appreciated all they’ve done. Let’s just say that when the nurses tell me there’s an email waiting for me, my first thought isn’t, “oh good, some more praise!”.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.