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Friday, December 30, 2011

A Reevaluation of Opinions

Part of being a life long learner is to actively seek out new knowledge AND to critically evaluated the beliefs and opinions you currently hold and test them against the new information that you learn.  Vet school is a perfect environment for this.  Most of my animal knowledge is related to husbandry and performance, not medicine - however medicine is intimately linked with husbandry practices and training and I do my best to integrate medicine into my existing knowledge framework. 

There are 3 subjects in particular that I have either reconsidered or developed a more rounded views on, since adding medicine to the mix. 

Vaccinations - In general, I’ve become more strident about vaccinations and timing of vaccinations for younger animals, and more relaxed about vaccinating older animals.  In my last post I touched on why the timing of vaccinations given to young animals is important, however I didn’t get to the older animal part - specifically Arthus reactions and vaccines.  The term “Arthus reaction” is a term used for a *type III sensitivity and is characterized by pain and swelling at the site of injection.  It can happen with a wide variety of drugs, however, during class it was presented (and is the classical example) as occurring when a vaccine is given to a hyperimmunized animal.   The typical patient that this occurs in is the older horse - probably more common in horses than shorter lived species like dogs because horses receive more vaccines over their lifetime than dogs by virtue of time. 

Imagine a horse in it’s late 20’s, who has routinely been vaccinated twice a year, every year for the recommended vaccines.  This wouldn’t be atypical.  I think most horse owners are very conscientious about following protocols by route - consider the worming schedules and how many people insist on worming every 8 weeks, even though their risk is low and the indications are that it isn’t needed?  If this older horse had a performance career, it’s likely they were vaccinated 4x a year - thus by the time it’s in it’s 20’s, likely it’s immune system is highly sensitized to the vaccine.  Do older horses still need vaccines?  Sure - if it doesn’t have the antibodies, the vaccine will do exactly what it's suppose to do.  However, if I’ve owned this geriatric horse for most of it’s life, never missed a vaccine, and the horse is retired on my property - I’m more likely to skip the vaccine, or at least discuss the issue with my vet before routinely popping the needle into the neck. 

The protocols for dogs may be changing as well - vet clinics are reducing the number of “core vaccines” recommended for older dogs with a known vaccine history.

The bottom line?  I wouldn’t be afraid to talk to your vet about the possibility of reducing the number of annual vaccines for your older pet.  Based on the number of mainstream vets and the recommendations at the Davis teaching hospital, you won’t come off as a wackadoo and you may save your pet/horse some discomfort. 

Growth plate significance - For those of you that missed it, go back and read my post on growth plates and the consequences of damaging them.  If you own a large breed dog or a horse, you should care - a LOT.  I may have been a bit ambivalent before on the subject - but no more!

Old injuries - I’ve purchased every singe horse I’ve owned without a vet exam.  After learning about various types of diseases, injuries, and compensation injuries, I’m not sure I would consider a new horse without a pre-purchase exams with radiographs as indicated to check out old injuries.  I’ve had the attitude that an old injury healed (depending on the nature of the injury) isn’t that big of a concern.  Now, without checking out the injury thoroughly, and checking for compensation injuries in the rest of the body, I wouldn’t even consider the horse as a prospect.  The body compensates for injury in wonderful ways - however not all those compensation mechanisms are conducive to a lasting performance career.  The feed bill for a forced-early-retirement-pasture-ornament dwarfs what I would spend up front to check out a horse throughly before purchase. 

Flexion tests - ….are one tool in the tool box.  Don’t take the results of a positive flexion test too seriously - especially if there’s no other indications of a problem.  You can make a sound horse look lame, a positive flexed horse may never go lame, and a negative flexed horse may be lame.  For an interesting look at flexion, read chapter 8 “Manipulation” by Mike W. Ross in Diagnosis and Management of Lameness in the Horse.

CBC panels  - If I think there is one change vets should be making, it’s encouraging owners to do routine CBC panels.  These blood panels tell vets SO MUCH about what is going on with the animal, and it doesn’t cost that much.  Tess will be getting a CBC before getting spayed, where as before I probably would have tried to find a clinic that would do the spay without it. 

In my (humble as always) opinion, vets should stop bemoaning the loss of income from vaccines being given less often or being given by clients, and instead educate clients on other diagnostics that valuable to keeping animals sound and healthy - such as CBC panels.  I would love to see vets be more open to clients giving their own vaccines who want to (except for those with a public health zoonosis risk such as rabies) and perhaps even offer to demonstrate correct technique.   Also, encouraging vaccination protocols that align with current research  (such as every 3 year boosters etc.).  As an educated consumer, I know I can effectively give my own vaccines and I know that it isn’t absolutely critical for some vaccines to be given annually.  Thus, I feel a bit ripped off when vets insists that only they can properly give vaccines, and use vaccines as the excuse for the yearly wellness exam.  Instead - give me a reason to bring my animal in yearly by offering something that only you can do (like a CBC) and supports the animal’s health. 

Of course, there could be a whole point to this issue that I’m not seeing - but at this point and based on my experiences at small animal clinics, this is where opinion on the whole subject is.  I’ll update you if it changes.  :)

*type III Sensitivity - Localized reaction, soluble antigen forms immune complexes - kicks off an inflammation cascade - which includes swelling and pain. 

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