The Pet Quarterly Fall 2014 by VetBoost

Pet Care News From Your Veterinarian ®

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Fall 2014 | Volum e 11, No. 4

Curing

Coughing

Preventing “kennel cough”

Targeting Tartar Does your pet have a sore mouth?

Creepiest

Crawlers Warning signs of ear mites A Look at

Cataracts

Help your dog see again

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Fall 2014 | VOL. 11, No 4

Picture-Perfect Pets Pet Care News From Your Veterinarian

IN THIS ISSUE 2

Targeting Tartar Why dental tartar may accumulate on your pet’s teeth—and what you can do about it.

Nala

Clay County Animal Hospital Orange Park, Fla.

Creepy Crawlers Deep in your cat’s ear, tiny mites may be breeding and biting. A Look at Cataracts Treatment options that can help your dog see again.

Buddy

Collingswood Animal Hospital Port Charlotte, Fla.

Tianie

Tavares Animal Hospital Tavares, Fla.

Coughing 10 KCuring eep your dog safe from the highly contagious “kennel cough,” or CIRD. Pet Tales 13 Happy Halloween to your

Bella

Interlachen Veterinary Clinic Interlachen, Fla.

pets and more. Tim

Piedmont Animal Hospital Apopka, Fla. Pet Quarterly® is an educational resource provided by your veterinary hospital. Comments are welcome at info@petquarterly.com ©Copyright 2014. All rights reserved. Pet Quarterly® magazine does not make any representations as to opinions or facts as presented. Reproduction of contents in any form is prohibited without prior written permission of the publisher. Postmaster: Send address changes to: Pet Quarterly, 2951 34th Street South St. Petersburg, FL 33711

Pixie

Tavares Animal Hospital Tavares, Fla.

Sam II

Tavares Animal Hospital Tavares, Fla.

Pet Quarterly | Fall 2014 1

Dental Health

Targeting Tartar The scoop on dental tartar and what you can do about it. By Sharon Hoffman, DVM Diplomate American Veterinary Dental College

For five years, a Miniature Poodle had tartar cleaned from the surfaces of his teeth without anesthesia. He began to have odor from his mouth and pain. He could no longer chew dry dog food—he would drop it from his mouth when he tried. The dog was referred to a veterinary dentist. Dental X-rays and an oral exam under anesthesia revealed that severe periodontitis was causing the pain and odor. The dentist had to extract six teeth. The results were dramatic: In a couple of weeks, the poodle was playing with toys and enjoying dry dog food again. As this story illustrates, just removing tartar from your pet’s teeth is not enough to keep your pet’s mouth healthy and pain-free.

What is the difference between tartar and plaque?

Key Points An accumulation of dental tartar can be a warning sign of a sore mouth. Daily brushing—or daily dental diets or chews— will help remove plaque before it becomes dental tartar. Pets should have an annual oral exam, dental X-rays and professional dental cleaning.

2 Fall 2014 | Pet Quarterly

Dental tartar, also called dental calculus, is mineralized plaque biofilm (a community of bacteria that cling together and attach to teeth, gums and areas below the gum). Plaque can be removed with a toothbrush; tartar cannot. Plaque begins to build up on teeth within hours after removal. If dental plaque is not removed daily, minerals from the saliva join the plaque and create tartar in two to four days. Plaque is soft, sticky and difficult to see because it is colorless. Tartar is hard and yellow or brown. Tartar provides a rough surface to which even more plaque biofilm can attach, becoming “scaffolding” for the plaque. Think of plaque as a very bad gang of bacteria that gets

under the gum and destroys the bone and ligament needed to hold teeth in their sockets. Pockets form around the tooth root due to bone loss. This condition is called periodontal disease (commonly referred to as gum disease). Once it develops, it cannot be cured; it can only be controlled with periodontal treatment and daily maintenance.

What do I need to know about tartar? The amount of tartar on teeth is NOT an indicator of the severity of periodontal disease. Periodontal disease occurs under the gum, where dental X-rays are needed to diagnose the extent of disease. Pets can have painful periodontal disease without any tartar on the crowns of the teeth. Removal of dental tartar from the crowns won’t treat periodontal disease, nor does it prevent tooth loss. Tartar, by itself, does not affect the health of our pets. In fact, studies have shown that tartar without plaque biofilm does not cause disease. It is the plaque biofilm that causes periodontal disease, pain, odor and tooth loss in pets.

Why should I be concerned about dental tartar? An accumulation of dental tartar can be a warning sign of a sore mouth. An abundance of tartar could also hide a fracture of the tooth beneath it. If your pet is unwilling to chew, especially on toys or chews that it previously enjoyed, an oral exam and dental X-rays by a veterinarian are needed to find the source of pain.

A buildup of tartar may mean that your pet’s food does not effectively remove plaque, which is the first step toward tartar. You may have to change your pet's food to a dental diet. Tartar can also be an indication that your pet may have crowded teeth, which can predispose to tartar buildup. Tooth crowding can lead to other oral issues.

What is the treatment for dental tartar? While tartar can be removed from the crowns of teeth, without a thorough periodontal exam this is merely a cosmetic procedure instead of a dental treatment. Clean teeth above the gum may still have severe and painful disease under the gum. Pets should have an annual oral exam, dental X-rays and professional dental cleaning under anesthesia performed by a trained veterinary professional. This will detect disease that requires periodontal treatment or surgery. Untreated disease under the gum leads to tooth loss, and in some cases, jaw fractures. Prevention of periodontal disease begins at home with daily dental hygiene. Brush your pet’s teeth daily. Your veterinarian may recommend dental chews or a dental diet proven to remove plaque on a daily basis. While tartar may be unsightly and can be removed by various methods, it is what you can’t see below the gum that jeopardizes the pet’s oral and general health. n Dr. Sharon Hoffman is a Board Certified Veterinary Dental Specialist.

Tartar can be yellow or brown and is hard. Plaque is colorless or white and is soft and sticky. Plaque is visible at the gum margin in this photo.

Periodontal pockets have formed around the tooth roots of these teeth.

Daily brushing removes plaque biofilm.

Do Try This at Home To help remove plaque and tartar/calculus, choose products approved by the Veterinary Oral Health Council. For an approved list, including some that even “picky non-chewers” will enjoy, visit www.vohc.org. There are dental diets and treats for cats as well. Pet Quarterly | Fall 2014 3

Parasite Control/Dermatology

Creepy Crawlers Deep in your cat’s ear, tiny mites may be breeding and biting … how to recognize and treat these painful pests in cats and kittens. By Stephanie Gandy Murphy, DVM

If your cat has gone from lazing on the windowsill to scratching its ears and shaking its head, ear mites (Otodectes cynotis) may be the culprit. These tiny, eight-legged parasites can live in a cat’s ear canal, feeding on earwax and cellular debris and causing irritation, inflammation and infection. These pesky creepy crawlers are one of the most common causes of ear infections in cats, particularly kittens and outdoor cats. Ear mites can also wander and may be found on your cat’s head, neck, back and even tail. Ear mites are extremely contagious from cat to cat and cat to dog; one innocent kitten can infect any cat or dog in your home.

Key Points Often kittens and cats with ear mites have brown, crumbly “coffee ground” debris within the ear canal. Mites feed on the earwax and cellular debris within the ear canal. Cleaning the ear prior to treatment is just as important as the medication.

4 Fall 2014 | Pet Quarterly

Warning Signs The classic case for an ear-mite infestation typically involves a young, recently rescued kitten that appears happy and healthy but continuously scratches its ears. In moderate to severe cases, you will see brown, crumbly debris that looks like coffee grounds within the cat’s ear canal and folds (including the “Henry’s pocket,” the small flap at the outside base of a cat’s ear). Any attempt to examine or touch the kitten’s ear results in intense itching and head shaking. An ear-mite infestation is itchy, uncomfortable and painful. Sometimes, cats with chronic ear-mite infestations develop secondary bacterial and yeast infections as well. Cats may shake their heads so violently trying to relieve the discomfort that they rupture blood vessels within the ear, resulting in a hematoma that causes the ear to puff like a pillow.

Getting Help If you suspect ear mites, be sure to take your cat or kitten to your veterinarian to confirm your suspicions and get treatment right away. Your veterinarian will examine your cat’s ear canal and scoop out debris to observe under the microscope. The adult mite resembles a tick, and the eggs resemble footballs. >>

21 Days Time it takes for an ear mite egg to reach adulthood. This is why ear-mite infestations often require two treatments about three weeks apart.

Pet Quarterly | Fall 2014 5

Parasite Control/Dermatology

The initial cleaning process can be very painful for a cat with a severe ear-mite infestation and an irritated ear canal. Let your veterinarian handle this tricky process of cleaning your cat’s delicate ears.

Treatment at Home Once all the debris is cleared out, your veterinarian will determine whether your cat’s eardrum is intact and choose the best treatment for the situation, usually either drops that go into the ear or a liquid that you can apply to the skin of the cat’s neck. In some cases, your veterinarian may recommend ivermectin, a medication that can be injected under the skin or administered orally. The ear mite’s life cycle is 21 days, so a repeat injection and/or oral dose will be needed in three weeks. Follow instructions for dosage and frequency of administering the medication. Make sure to complete the course of treatment to completely eliminate the mites and prevent a new crop from appearing. Prompt treatment of this deeply uncomfortable condition will make your cat or kitten much happier, free of the pesky creatures crawling, biting and breeding deep inside its ears. n

Your veterinarian will clean and flush your cat's ear canals to remove mites and eggs.

Cleaning the Ears When it comes to treatment, the first step is to gently clean the cat’s ears. Your veterinarian will gently flush the infected ear canals with a warmed ear-cleaning solution to remove the cellular debris and wax that the mites feed on. This also breaks down the wax, allowing the medication to penetrate and kill the mites and eggs.

Dr. Stephanie Gandy Murphy is a feline veterinarian.

Classic Case of Ear Mites n

Outdoor kitty

Debris in ears that looks like coffee grounds

n Very

6 Fall 2014 | Pet Quarterly

itchy

Shaking head

Hair loss around ears and neck

Senior Wellness

after surgery

Before cataract surgery

A Look at

Cataracts If your dog has cloudy eyes or is bumping into furniture, the problem may be cataracts. Your veterinarian can help with treatment options.

By Tammy Miller Michau, DVM, MS, MSpVM, DACVO

Snickers, a 13-year-old Miniature Pinscher, slowly developed cataracts as she aged. She had the classic signs—her eyes were cloudy, she often bumped into objects, and she slept most of her days away. Snickers’ owners thought that the dog was just “getting old,” but her primary care veterinarian noticed the dog’s worsening cataracts and suggested surgery, referring Snickers to a veterinary

ophthalmologist. After cataract surgery, Snickers began to play again, watch squirrels out of the window, and returned to her routine of happily following her owners around the house. Cataract surgery can restore a dog’s vision and improve its quality of life. Your veterinarian can help you decide if your dog might benefit. Here’s a look at this condition in dogs. >>

Pet Quarterly | Fall 2014 7

Senior Wellness

What Is a Cataract? A cataract is an opacity, or cloudiness, in the lens of the eye that may lead to blindness. If your pet is diagnosed with cataracts, your veterinarian and a veterinary ophthalmologist can help determine if your pet is a candidate for cataract surgery.

Common Causes of Cataracts Heredity, diabetes mellitus and age are the most common causes of cataracts in dogs.

8 Fall 2014 | Pet Quarterly

When to Operate?

Signs of Cataracts Cataracts typically start as small spots. As they progress, the eyes become cloudier, turning blue, gray or white. Blindness occurs if cataracts take over the lens of the eye. Dogs may run into objects, sleep more and move carefully and slowly.

If a cataract is not causing blindness, it may not require treatment. When cataracts progress and vision is affected, cataract surgery is an option that can increase a dog’s quality of life. This is especially true of elderly or deaf dogs; vision restoration can make a huge difference in their quality of life. Many dogs that are blinded from cataracts can adequately adjust to their vision loss. It is important to keep them in a safe and stable environment and have them examined routinely to prevent complications and pain.

Cataract Side Effects

Hereditary Cataracts All breeds may get cataracts, but certain breeds—such as Boston Terriers, Alaskan Malamutes, Poodles, Bichon Frises and Cocker Spaniels— are more prone. Hereditary cataracts often occur in younger animals, developing rapidly over days or slowly over weeks or years.

Cataracts in all stages can cause lens-induced uveitis (LIU), an inflammation of the eye that must be medically treated, whether or not surgery is performed. LIU can lead to complications such as glaucoma or a detached retina. An additional potential complication is lens luxation (where the lens slips out of place). If the lens falls into the front part of the eye, severe pain and glaucoma can result.

Treatment Options Once a cataract has formed, surgery is the only way to remove it. If a cataract is not causing blindness, it may not require treatment. When cataracts progress and vision is affected, cataract surgery by a veterinary ophthalmologist is an option. Cataract surgery can significantly improve the quality of life for many dogs, especially elderly or deaf dogs.

Surgery and Follow-up Rechecks

Cataracts vs. Nuclear Sclerosis What’s not a cataract? A condition called nuclear sclerosis. All dogs older than about six years of age develop this hardening of the center of the lens, which causes the lens to have a grayish-blue appearance. In dogs, nuclear sclerosis usually does not affect vision.

Cataract surgery in dogs is very similar to human cataract surgery. The eye lens is removed and replaced with a new man-made lens. Post-operative care and follow-up rechecks are critical. An e-collar may be needed for one to two weeks. Your pet will go home on a regime of eye drops that are gradually tapered over one to six months. n Dr. Tammy Miller Michau is a board-certified veterinary ophthalmologist.

Pet Quarterly | Fall 2014 9

Curing

Coughing Even dogs who have never seen the inside of a kennel are at risk for developing â&#x20AC;&#x153;kennel cough,â&#x20AC;? or CIRD, especially if they are not vaccinated. By James Randolph, DVM

Quick Tip When visiting your veterinarian, consider that other pets in the waiting room may be ill. Prevent your pet from interacting with them.

10 Fall 2014 | Pet Quarterly

General Wellness

Rosie, a sweet, 14-year-old Beagle, came into my office with a terrible cough. Harsh. Hacking. Gagging. “It began when I was visiting my cousin this weekend, and she said it might be kennel cough. Is that bad?” her owner said, concerned and eager for quick treatment. She was also confused, because Rosie had never been kenneled. After a thorough examination, we determined that Rosie had a lowgrade fever, clear nasal discharge, some sneezing accompanying that awful cough, and a little raspiness in her trachea (windpipe). Her activity level and appetite were slightly decreased. >>

Key Points Canine Infectious Respiratory Disease (CIRD) is the latest name for “kennel cough.” The condition is highly contagious. CIRD can be caused by as many as 14 organisms. A Bordetella vaccination alone provides a good foundation for CIRD prevention, but it will not completely protect against CIRD. Keep up with vaccinations as recommended by your veterinarian.

Pet Quarterly | Fall 2014 11

General Wellness

Is It Kennel Cough? When I finished the examination, Rosie’s owner, asked, “Is it kennel cough?” The answer was “Yes,” although it would be more accurate to say that Rosie has Canine Infectious Respiratory Disease (CIRD), a highly contagious condition that is also called Canine Infectious Tracheobronchitis (CITB). Respiratory-tract infections such as this can occur in dogs that have never been kenneled. The condition is seen all over the United States, with the highest prevalence in Kentucky, Utah and Florida, according to Banfield Pet Hospital’s State of Pet Health Report 2014, a nationwide report on pet health.

Causes: Bordetella and Beyond While Bordetella bronchiseptica, or Bordetella for short, is frequently involved, it isn’t always the sole player. CIRD can have as many as 14 causative organisms, in any combination. These include Adenovirus Type 2 and Parainfluenza (CPV-2)—the “H” and “P” in the DHLP vaccine. Veterinarians have vaccinated against these viruses for decades. Canine Influenza (CI) is a newer viral cause of CIRD. We began vaccinating Rosie against CI the year before last, when a laboratoryconfirmed case near our city proved

Did You Know? Puppies are more susceptible to catching CIRD, especially if they are unvaccinated.

that the virus had made its way here. It has now been confirmed to be present in 41 states.

Treatment Options With so many possible causes, how do veterinarians make a specific diagnosis? Most of the time, we don’t—and usually, we don’t need to in order to develop a treatment plan. Symptomatic treatment is often good enough to make patients well. Broad-spectrum antibiotics are effective for common respiratory-tract bacteria, and cough suppressants help stop the honking, nonproductive cough and allow pets to rest. When a dog doesn’t respond to treatment, we begin testing for possible causes and alternative treatments.

Degrees of CIRD If your pet is diagnosed with CIRD, a classification system for various degrees of illness helps determine how sick your pet is. CIRD researchers would classify a patient such as Rosie

with “uncomplicated CIRD.” A chest X-ray would rule out pneumonia, and a blood test would probably show no elevation in white blood cell count, a possible sign of infection. The uncomplicated patient begins to respond to symptomatic treatment within a few days, as Rosie did. If your pet has complicated CIRD, which is more serious, your veterinarian will run more tests to determine the best course of treatment. Many patients with complicated CIRD require aggressive therapy to survive, such as colloidal IV fluids, bronchodilators and oxygen therapy. Animals classified with complicated CIRD may die, especially puppies. The best protection is prevention. Vaccinations are available for Bordetella, Canine Influenza, Adenovirus and Parainfluenza (CPV-2). Your veterinarian is the expert on what preventive measures are best for your pet. n Dr. James Randolph is a small-animal veterinarian.

Catching a Cough CIRD is contagious and it can be transmitted if your dog breathes air shared with an infected dog. This can happen at a dog park, training class, pet store or even in your neighborhood. That’s why your veterinarian will recommend keeping your pet’s vaccinations current. 12 Fall 2014 | Pet Quarterly

Pet Tales

Top Reasons for Veterinary Visits

Why are pets heading to the veterinarian? The top five reasons for dogs and cats are quite different, according to VPI pet insurance.

Cats Pet Tales by Laci Schaible, DVM

The top five problems of felines are a bit more serious than those of dogs, which suggests that our cats should be visiting the veterinary office more often. A few highlights:

1. Bladder or urinary tract problems 2. Periodontitis/Dental disease 3. Chronic kidney disease 4. Hyperthyroidism 5. Upset stomach/Vomiting

Cats n Bladder and urinary problems often cause inappropriate elimination, a key reason cats are given up to shelters. Urinary problems in cats can be due to a range of diseases, including cystitis, urinary tract infections, urinary blockage, hyperthyroidism, diabetes and behavioral problems. These diseases are nothing to scoff at … or to punish the cat for. n Chronic kidney disease in cats can present with frequent urination, weight loss, vomiting and decreased appetite. This is a serious progressive disease that afflicts many middle-aged to older felines and claims many lives. n Hyperthyroidism can mimic chronic kidney disease but has a better prognosis, as this disease can be controlled. Its symptoms in cats may include weight loss, poor hair coat, increased thirst, increased appetite and urination, and increased activity levels.

Dogs 1. Skin allergies 2. Ear infections 3. Non-cancerous skin masses 4. Skin infections 5. Arthritis

Dogs n The top reason that dogs need to visit the veterinarian—skin allergies—can be frustrating for both dog owners and dogs alike. Skin allergies are relatively easy to suspect as the problem but difficult to pin down, because your veterinarian may need to perform a workup to find the cause of itching and scratching. n Dogs that suffer from skin allergies and frequent skin infections are also more likely to suffer from ear infections, which usually present with shaking of the head and scratching at the ears. The goal is to prevent exposure and control the symptoms. Each of these top diseases will have a better diagnosis when caught early. Regular veterinary visits and routine blood work can detect many conditions before your pet even shows symptoms.

Pet Quarterly | Fall 2014 13

Pet Tales

Hitting the Road with Your Pets Traveling with your pet this holiday season? Boredom, stress, anxiety, digestive issues and a whole host of other issues can arise when a pet is taken from its regular living arrangements. Help make the trip go smoothly for your pets: n Keep to a regular schedule of feeding, watering, walking and litter-box breaks. Resist temptation to change foods or add some human food. There are few things worse than a pet with digestive issues while traveling. n Tire the pet out prior to a long leg of travel. Take long walks or play laser tag in the hotel room. A content pet is a happy pet, and a happy, contented pet will nap. n Bring a favorite toy and blanket from home for the pet to provide some familiarity. 14 Fall 2014 | Pet Quarterly

n Talk

to your pet and be sure to fit in extra belly rubs and scratches. n Don’t try out new medications during travel time! If you think your pet needs a sedative for travel, talk to your veterinarian in advance and do a trial run. n Seek veterinary care right away if your cat refuses to eat from the stress of travel. This puts the cat at risk to develop hepatic lipidosis (fatty liver disease), a serious disease sure to ruin all holiday plans and require an extensive veterinary stay. If your pet is not travel-ready this holiday season, do not force your furry friend to travel. Travel is typically more stressful for cats than dogs. If your cat is prone to anxiety or has been a poor traveler in the past, consider looking into feline boarding facilities or a pet sitter.

Pet Tales

Breed Profile

Ragdoll

Happy Halloween for Your Pets The candy is prepped and your house is adorned with spooky decorations. Is your pet Halloween-ready too? Try these tips to make this busy holiday safe and stress-free for your pets.

The Ragdoll is a large, relaxed, easy-going cat that is great with children and other pets. Many will allow themselves to be dressed in clothes and carried around by youngsters with so little resistance that they literally flop like rag dolls, which is where they get their name. While they aren’t particularly active, they are friendly and may even enjoy a game of fetch. The Ragdoll’s medium-length coat has a soft, silky texture requiring little routine grooming beyond weekly combing or brushing. There is little shedding of the coat except in the spring and fall, when grooming requirements rise. Ragdolls are generally healthy, but they have one health issue that can be a large concern: hypertrophic cardiomyopathy (HCM). Hypertrophic cardiomyopathy is the most common form of heart disease in cats and causes enlargement of the heart muscle. It is a hereditary condition. If your veterinarian detects a heart murmur, an echocardiogram can confirm whether your cat has HCM. The Ragdoll may live to reach 20 years of age, but most live to about 15 years old.

Keep your pets in an enclosed room away from trick-ortreaters. Even an even-tempered pet may be frazzled by the frequent doorbell ringing, unfamiliar costumes and strangers—and may bite out of fear.

Ragdoll

Make sure your pet is properly identified (microchip, collar and ID tag) in case it escapes through the open door while you’re distracted with trick-or-treaters.

Candy is dangerous to pets! Xylitol (a common sweetener in sugar-free candies) and chocolate are poisonous to pets. Lollipop sticks are choking hazards. Keep candy secure from your pets.

Skip the glow sticks around your pet’s neck. While the material isn’t toxic (in case your pet should bite the glow stick), it tastes really gross to your pet and causes excessive salivation. Glow sticks also pose a strangulation hazard.

Consider skipping the pet costumes, as they cause stress to most pets. If you must deck out Fido, keep it simple. Avoid strings, belts, sashes and anything that can get in a pet’s eyes. Also never leave a costumed pet alone, as the pet may eat the costume in an effort to get it off, which can cause a GI obstruction. Pet Quarterly | Fall 2014 15

Pet Tales

Ask the Veterinarian Q: I’ve heard mixed advice about when to neuter my dog. What is the most upto-date recommendation? A: Traditionally veterinarians have recommended spaying and neutering dogs around six months of age. In 2013, however, a study by a team of researchers at the University of California, Davis, revealed compelling evidence that this may not be the best recommendation for every dog. The study examined the effects of neutering on a number of joint disorders and cancers in Golden Retrievers. The study also compared intact dogs versus those neutered at less than one year of age and those neutered after one year of age. Researchers found that neutering males after puberty seems to decrease the occurrence rates of hip dysplasia, cranial cruciate ligament injury and lymphosarcoma. While there were some medical benefits discovered with delayed spaying in the females, there were also other increased problems, so the recommendation for females is less clear. As your dog’s advocate, it is best to discuss this information with your veterinarian to decide what is best for your own dog.

Is Ice Dangerous? There is an old myth that has resurfaced recently about ice being a dog killer when ingested. This is not true! Neither ice nor ice water will kill your dog. The story claims that ice when ingested causes stomach contractions and twisting of the stomach—a condition called gastric dilatation volvulus (GDV) or bloat. There is no truth to this. Drinking or eating copious amounts quickly followed by exercise is a risk factor for GDV, not ice or ice water.

chewables CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm larvae (Diroﬁlaria immitis) for a month (30 days) after infection and for the treatment and control of ascarids (Toxocara canis, Toxascaris leonina) and hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense). DOSAGE: HEARTGARD® Plus (ivermectin/pyrantel) should be administered orally at monthly intervals at the recommended minimum dose level of 6 mcg of ivermectin per kilogram (2.72 mcg/lb) and 5 mg of pyrantel (as pamoate salt) per kg (2.27 mg/lb) of body weight. The recommended dosing schedule for prevention of canine heartworm disease and for the treatment and control of ascarids and hookworms is as follows: Dog Weight

Chewables Ivermectin Pyrantel Per Month Content Content

Up to 25 lb 26 to 50 lb 51 to 100 lb

1 1 1

68 mcg 136 mcg 272 mcg

57 mg 114 mg 227 mg

Color Coding 0n Foil Backing and Carton Blue Green Brown

HEARTGARD Plus is recommended for dogs 6 weeks of age and older. For dogs over 100 lb use the appropriate combination of these chewables. ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable, the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food. The chewable should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors), potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days) after the dog’s first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog’s last exposure to mosquitoes. When replacing another heartworm preventive product in a heartworm disease preventive program, the first dose of HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication. If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the recommended dosing regimen will minimize the opportunity for the development of adult heartworms. Monthly treatment with HEARTGARD Plus also provides effective treatment and control of ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). Clients should be advised of measures to be taken to prevent reinfection with intestinal parasites. EFFICACY: HEARTGARD Plus Chewables, given orally using the recommended dose and regimen, are effective against the tissue larval stage of D. immitis for a month (30 days) after infection and, as a result, prevent the development of the adult stage. HEARTGARD Plus Chewables are also effective against canine ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense).

ACCEPTABILITY: In acceptability and field trials, HEARTGARD Plus was shown to be an acceptable oral dosage form that was consumed at first offering by the majority of dogs. PRECAUTIONS: All dogs should be tested for existing heartworm infection before starting treatment with HEARTGARD Plus which is not effective against adult D. immitis. Infected dogs must be treated to remove adult heartworms and microfilariae before initiating a program with HEARTGARD Plus. While some microfilariae may be killed by the ivermectin in HEARTGARD Plus at the recommended dose level, HEARTGARD Plus is not effective for microfilariae clearance. A mild hypersensitivity-type reaction, presumably due to dead or dying microfilariae and particularly involving a transient diarrhea, has been observed in clinical trials with ivermectin alone after treatment of some dogs that have circulating microfilariae. Keep this and all drugs out of the reach of children. In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a Poison Control Center for advice concerning cases of ingestion by humans. Store between 68°F - 77°F (20°C - 25°C). Excursions between 59°F - 86°F (15°C - 30°C) are permitted. Protect product from light. ADVERSE REACTIONS: In clinical field trials with HEARTGARD Plus, vomiting or diarrhea within 24 hours of dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation. SAFETY: HEARTGARD Plus has been shown to be bioequivalent to HEARTGARD, with respect to the bioavailability of ivermectin. The dose regimens of HEARTGARD Plus and HEARTGARD are the same with regard to ivermectin (6 mcg/kg). Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death. HEARTGARD demonstrated no signs of toxicity at 10 times the recommended dose (60 mcg/kg) in sensitive Collies. Results of these trials and bioequivalency studies, support the safety of HEARTGARD products in dogs, including Collies, when used as recommended. HEARTGARD Plus has shown a wide margin of safety at the recommended dose level in dogs, including pregnant or breeding bitches, stud dogs and puppies aged 6 or more weeks. In clinical trials, many commonly used flea collars, dips, shampoos, anthelmintics, antibiotics, vaccines and steroid preparations have been administered with HEARTGARD Plus in a heartworm disease prevention program. In one trial, where some pups had parvovirus, there was a marginal reduction in efficacy against intestinal nematodes, possibly due to a change in intestinal transit time. HOW SUPPLIED: HEARTGARD Plus is available in three dosage strengths (See DOSAGE section) for dogs of different weights. Each strength comes in convenient cartons of 6 and 12 chewables. For customer service, please contact Merial at 1-888-637-4251.

16 Fall 2014 | Pet Quarterly MERHRT130002 Rv2 Brief Summary 1

11/27/13 12:03 PM

ONE BITE C A N TRA NSM I T HE AR TWO R M DIS E AS E

ONE DOSE E VE RY MON TH WILL HELP PROTECT HIM

MOSQUITOES CAN TRANSMIT POTENTIALLY DEADLY HEARTWORM DISEASE TO YOUR DOG. Just one dose of HEARTGARD® Plus (ivermectin/pyrantel) a month helps prevent heartworm disease, and treats and controls the most common intestinal parasites. All in a real beef chew dogs love.

Ask your vet about HEARTGARD Plus.

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Important Safety Information All dogs should be tested for heartworm infection before starting a preventative program. HEARTGARD Plus is well tolerated. In rare cases digestive and neurological side effects have been reported. For more information, contact your veterinarian or visit www.heartgard.com. ® HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. ©2013 Merial Limited, Duluth, GA. All rights reserved. HGD13PRAD (05/2013)

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