The shortage of opioid drugs affects veterinary medicine, too. Here’s how

By Kim Campbell Thornton

Andrews McMeel Syndication

If you don’t take pain medications or haven’t had surgery recently, you probably don’t think the opioid crisis you’ve been hearing about on the news has anything to do with you. But if you have pets, they could be affected. Not because they’re at risk of falling prey to drug dealers pushing controlled substances, but because pets who need surgery or treatment for acute pain are beneficiaries of the same pain-relieving medications used in humans.

A shortage of the medications -- caused by a double whammy of inspection issues and production delays related to upgrades at a Pfizer facility in Kansas, plus a DEA-mandated 20 percent decrease in overall opioid production in an attempt to curb abuse by humans -- means the drugs are less available for use in veterinary medicine.

Veterinarians use injectable opioids such as morphine, fentanyl, methadone and hydromorphone for surgical procedures and acute pain from trauma. Human doctors get priority when those and other opioid drugs are distributed, leaving veterinarians to scramble for ways to manage pain in pets.

“The opioid crisis the government is talking about is people OD'ing,” says Sheilah Robertson, a veterinarian who specializes in analgesia and anesthesiology and who is the senior medical director for Lap of Love Veterinary Hospice. “It’s a different crisis to us. Our crisis is that we’re short of opioids that our patients need.”

The shortage is expected to continue into 2019, according to a June 19 statement by the Food and Drug Administration. In one attempt to mitigate the shortage, the FDA and Pfizer coordinated the release of some products that were on hold due to potential quality issues, distributing them with instructions for safe handling and use to reduce risks to patients.

What the shortage means for pet owners is that in some instances, a pet’s surgery or other procedure may need to be postponed or performed with drugs that are less effective in managing pain, says pain expert Robin Downing, DVM, director of the Downing Center for Animal Pain Management in Windsor, Colorado.

The potent drugs are a cornerstone of pain relief before, during and after surgery, Dr. Downing says. Their use in anesthesia reduces the need for inhalant anesthetics. In turn, that reduces the risks associated with general anesthesia.

To get around the shortage, veterinarians are having to think creatively. They may use less-potent opioids such as butorphanol and buprenorphine in combination with drugs that provide local anesthesia and nonsteroidal anti-inflammatory drugs, known as multimodal analgesia. Local anesthetics completely block pain, and a single dose of some new drugs in that category work for 24 to 72 hours. Multimodal analgesia can also help to reduce grogginess, nausea or vomiting after surgery.

Sometimes there’s a learning curve to using unfamiliar drugs and techniques, though.

“I’ve taken calls from numerous veterinarians asking about alternatives to the opioid they usually use, which they are now having difficulty obtaining,” says Jordyn Marie Boesch, DVM, a lecturer in anesthesiology at Cornell University College of Veterinary Medicine. “The good news is that there is often an alternative opioid available. The silver lining is that the shortage is introducing veterinarians to many other ways of providing analgesia that they may not have been familiar with before.”

Veterinarians also hope drug companies will take steps to have some opioids labeled specifically for use in animals. In Europe, for instance, versions of fentanyl are made specifically for use in dogs and cats.

“If there’s a human shortage (of opioids in Europe), it doesn’t affect veterinarians, and that’s what we would like to happen here,” Dr. Robertson says. “We know that taking a drug through all the trials and FDA costs a lot of money, but we can no longer depend on our supply from human-labeled drugs anymore.”

Q&A

Cat play for

the beginner

Q: I’ve just gotten my first kitten! What kind of toys should I get her, and are there any special ways that cats like to play?

A: Congratulations on your foray into feline servitude, er, companionship. Cats are wonderful friends and wonderfully entertaining, especially during kittenhood. The right toys and play will help your kitten fulfill her natural instincts, get lots of exercise and mental stimulation, and learn how to interact with you and other people.

Cats are hunters at heart. They are wired to prowl, stalk, chase, kick and bite. A number of toys, from simple to complex, can help them meet those needs, and proper use of them can prevent injury to your own delicate skin.

Puzzle or interactive toys that allow cats to forage for food or treats by pawing inside a box or snagging food from a textured mat challenge cats’ brains, teach them to overcome obstacles and build their fine motor skills. Batting at a wand with a dangling toy or feather; chasing a ball, wind-up or battery-operated mouse; or hunting the dot from a laser pointer or flashlight is great exercise, especially if you direct the beam up and down the stairs a few times. Soft toys stuffed with catnip excite the “bite, kick and disembowel” instinct.

You don’t have to spend a lot on toys. Rotate them every few days to make sure your kitten always has something new and interesting to play with. Put away toys with string where she can’t get to them if you aren’t there to supervise.

Protect yourself from kitty tooth and claw injuries. Don’t “arm wrestle” with your kitten, and walk away if she tries to play rough with you. Most important, continue playing with her into adulthood to help her stay healthy and svelte. -- Dr. Marty Becker and Mikkel Becker

Do you have a pet question? Send it to askpetconnection@gmail.com or visit Facebook.com/DrMartyBecker.

THE BUZZ

Cat recovers well

after hip surgery

-- Fridgey, a 2-year-old Bengal cat who has had bilateral hip problems, gave veterinarians at Purdue Veterinary Teaching Hospital in West Lafayette, Indiana, their first opportunity to perform total hip replacement surgery -- a common procedure in dogs -- on a cat. He underwent the surgery in March, followed by extensive physical rehab sessions to get him back in shape, including sessions on an aquatic treadmill. Fridgey has recovered well, his veterinarians report. Between surgery and rehab, the cost of Fridgey’s care was approximately $10,000, but owners Tyler and Faith Goldsberry had pet health insurance, which covered 80 percent of the expense.

-- Summer is still in full swing. If you haven’t been to the beach with Rover yet, here are 11 dog-friendly options: Muir Beach in Marin County, California; Dog Beach in Fort Myers Beach, Florida; Jekyll Island off the coast of Georgia; Montrose Dog Beach in Chicago; Long Meadow Dog Beach in Brooklyn’s Prospect Park; Cape Hatteras National Seashore in North Carolina’s Outer Banks; Ecola State Park in Cannon Beach, Oregon; Kinney Shores in Saco, Maine; Edisto Island Town Beach and State Park in South Carolina; Padre Island National Seashore in Corpus Christi, Texas; and Magnuson Park in Seattle.

-- Got a constipated canine or a cat who’s hacking up hairballs? Add a little plain canned pumpkin to his diet. The added fiber can get things moving in your pet’s digestive tract, and it also helps to reduce the incidence of hairballs. For pets with mild diarrhea, the fiber helps to firm up loose feces. Pets on a diet will appreciate some pumpkin mixed with their food to help them feel fuller. Ask your veterinarian how much to give, based on your pet’s size, and be sure to use plain canned pumpkin, not the sweetened pie filling. -- Dr. Marty Becker, Kim Campbell Thornton and Mikkel Becker

ABOUT PET CONNECTION

Pet Connection is produced by a team of pet-care experts headed by "The Dr. Oz Show" veterinarian Dr. Marty Becker and award-winning journalist Kim Campbell Thornton. They are affiliated with Vetstreet.com and are the authors of many best-selling pet-care books. Joining them is dog trainer and behavior consultant Mikkel Becker. Dr. Becker can be found at Facebook.com/DrMartyBecker or on Twitter at DrMartyBecker. Kim Campbell Thornton is at Facebook.com/KimCampbellThornton and on Twitter at kkcthornton. Mikkel Becker is at Facebook.com/MikkelBecker and on Twitter at MikkelBecker.

Some dogs and cats seem to be wusses when it comes to pain. Is there a genetic reason behind it?

By Kim Campbell Thornton

Andrews McMeel Syndication

Does your dog or cat act as if you’re killing him when you trim his nails, even if you’ve never “quicked” him? Scream bloody murder when all the vet tech has done is wipe her skin with alcohol? Some breeds have a reputation for being crybabies because they have what seem to be excessive physical or vocal reactions to even minor procedures. Are they wimps, or could there be a genetic reason for their behavior?

Some breeds do seem to feel pain more acutely than others, according to Michael C. Petty, DVM, who presented a lecture on managing pain in surgical patients at the 2018 VMX conference in Orlando, Florida, in February. He specifically calls out beagles, Shetland sheepdogs, and Northern breeds such as Siberian huskies -- known for their excessive vocalizations. Other veterinarians agree.

“I think Arctic breeds probably do have a heightened pain response,” says Tamara Grubb, DVM, assistant clinical professor of anesthesia and analgesia at Washington State University’s College of Veterinary Medicine. Right now, she’s speaking simply from experience, but she believes that one day researchers will find that certain breeds have a genetic predisposition for a heightened pain response.

We know from studies in humans that complex environmental and genetic factors result in a high degree of individual responses to pain. Subtle changes in DNA may at least partially explain the different ways people perceive and express pain. There appear to be a number of genes in humans and animals that influence sensitivity to pain.

The genes that dictate coat color may also affect behavior or pain sensitivity in some way. It’s been found, for instance, that people with red hair are more sensitive to certain types of pain because they have specific gene variants. In his lecture, Dr. Petty says, “These people have a lower thermal threshold, need higher levels of anesthetics and don’t always respond to the effects of lidocaine like other people do. I suspect that some animals have the same issue.”

A study at the University of California, Davis Veterinary Medical Teaching Hospital found that cats with calico and tortoiseshell coats are more likely to hiss, chase, bite, swat or scratch when being handled by humans. Maybe their coat color genetics are linked to greater sensitivity to pain, although one of the authors, Melissa J. Bain, DVM, said they didn’t look at reaction to pain in their study.

It could also be that there’s no real link between coat color and certain behaviors. It may simply be what’s known in evolutionary biology as a spandrel: a byproduct of the evolution of some other characteristic -- in this case, pain sensitivity -- but with no direct relationship.

Some animals who more readily express pain also react differently to certain drugs. Veterinary anesthesiologist Jordyn Boesch, DVM, says breeds such as Siberian huskies and Alaskan malamutes become restless, anxious or depressed under the influence of certain doses of opioids used during procedures requiring anesthesia. That doesn’t mean that opioids shouldn’t be used with them, but that they should receive the lowest effective dose, she says.

Can you teach your pet to exhibit less drama when you trim nails or visit the vet? Dr. Petty noted that dogs and cats may benefit from Fear Free techniques or the feline-friendly handling guidelines developed by the American Association of Feline Practitioners. Techniques for at home and in the veterinary clinic include providing emotional and physical support, including offering a favorite treat or toy during the procedure; reducing the risk of nausea and vomiting by providing medication before car rides to the vet and prior to surgery; and environmental management of light, noise, odors, slick floors and other factors that can affect a pet’s comfort level.

Q&A

The rise of

cat worship

Q: Did the ancient Egyptians really worship cats?

A: You bet! They worshipped many deities, and several of them had feline personas. That’s not surprising. Early Egyptians paid homage to particular animals for reasons that often related to services they performed or admirable qualities they displayed. The cat’s prowess at hunting, with the resulting vermin control in grain storage areas, made them well worthy of worship in the eyes of ancient Egyptians.

As Egyptian culture evolved, so did the prominent role of cats in the pantheon of gods. One was the goddess Mafdet. She personified execution -- we all know that cats are excellent executioners of mice -- and was also associated with protection from venomous animals. Her name meant “she who runs swiftly,” and one of her titles was “slayer of serpents.” Clearly, the Egyptians had those cat attributes nailed.

Another cat goddess was Bast, also known as Bubastis. She took the form of a cat as well and was considered to be the protector of the pharaoh. Not surprisingly, considering the fertility of cats to this day, Bast also represented fertility and motherhood, and women visited her temple to pray for children. At Bast’s temple lived sacred cats who were cared for by priests.

Sekhmet, a lion-headed goddess, symbolized the sun. Her name meant “one who is powerful,” and she was considered a war goddess. One of her titles was “Lady of Slaughter.”

You can see where this is going. Egyptian cats were idolized as killing machines. But they were appreciated for their softer side as well. Household cats were cared for and adored. When the family cat died, Egyptians shaved their eyebrows as a sign of mourning. Today, many of us keep cats as pets, but they remind us always that they are special and deserving of devotion, just as they were 5,000 years ago. -- Kim Campbell Thornton

Do you have a pet question? Send it to askpetconnection@gmail.com or visit Facebook.com/DrMartyBecker.

THE BUZZ

Water dispensers

recalled by IKEA

-- If you purchased a Lurvig water dispenser from IKEA for your dog or cat, return it immediately for a full refund. The company is recalling the dispensers after two dogs suffocated when their heads became stuck in the water dispenser. The water dispensers were sold in U.S. stores and online between October 2017 and June 2018, for $7.99. “IKEA urges customers to stop using the water dispenser and return it to any IKEA store for a full refund,” the company said in a statement on its website. A receipt or other proof of purchase is not required for the return.

-- The ASPCA Animal Poison Control Center is receiving an increasing number of calls regarding pets who have eaten marijuana plants or dried cannabis, as are local veterinarians. Animals can get sick from eating cannabis or edibles, becoming depressed or fatigued, dribbling urine and developing a low body temperature and slow heart rate. More serious side effects from products with higher concentrations include low blood pressure, agitation and seizures. At least one pet has died. The message to owners: Don’t be afraid to call a poison control hotline or to take your pet to the vet if you know or suspect he has ingested marijuana. They won’t turn you in, and they do want to care for your pet.

-- Beagles rank sixth among the breeds registered by the American Kennel Club. The small scenthounds are known for a merry temperament and a love of sniffing. Don’t expect to go at a fast pace on a walk with a beagle because he’ll constantly be stopping to smell the roses -- and whatever else has an interesting scent. Beware: Beagles howl and they are food thieves, but generally they will charm you into forgiving them with a melting look from their soft brown eyes. -- Dr. Marty Becker, Kim Campbell Thornton and Mikkel Becker

ABOUT PET CONNECTION

Pet Connection is produced by a team of pet-care experts headed by "The Dr. Oz Show" veterinarian Dr. Marty Becker and award-winning journalist Kim Campbell Thornton. They are affiliated with Vetstreet.com and are the authors of many best-selling pet-care books. Joining them is dog trainer and behavior consultant Mikkel Becker. Dr. Becker can be found at Facebook.com/DrMartyBecker or on Twitter at DrMartyBecker. Kim Campbell Thornton is at Facebook.com/KimCampbellThornton and on Twitter at kkcthornton. Mikkel Becker is at Facebook.com/MikkelBecker and on Twitter at MikkelBecker.

33 places to share your vacation with your dog

By Kim Campbell Thornton

Andrews McMeel Syndication

Whether your plans this year include a vacation or a staycation, there’s no reason to leave your dog out of the fun. Dog-friendly spots abound across the United States and include botanical gardens, breweries, festivals, hikes, museums and more. No matter where you’re located, there’s a good chance you’ll be within driving distance of at least one of these activities. Assume that dogs must be leashed unless informed otherwise. Check AirBnB, FlipKey and VRBO for pet-friendly rentals.

“Barkansas” is filled with natural wonders for dogs -- and their humans -- to explore, including Lake Wilson Park south of Fayetteville and Lake Ouachita Vista Trail near Mount Ida. For a more manicured experience, visit Garvan Woodland Gardens in Hot Springs or the 1886 Crescent Hotel and Spa in Eureka Springs, with 15 acres of gardens and hiking trails. In Little Rock, you and your dog can take self-guided tours of the Arkansas River Trail, Arkansas State Capitol Grounds and Arkansas Civil Rights Heritage Walk.

It’s hard to find a place in California that isn’t dog-friendly. In Laguna Beach, enjoy outdoor dining at Brussels Bistro or Watermarc. In summer, take your dog to Laguna’s beaches before 8 a.m. or after 6 p.m. The rest of the year, leashed dogs can play all day. In Santa Barbara, visit the botanical gardens or the Sunday art sale and walk.

Visiting Chicago? Sign up for Mercury’s 90-minute Canine Cruise, a floating history and architecture tour of the city with dog-friendly highlights such as the oldest fire hydrant in the city and the park with the most squirrels. Departs Saturdays and Sundays through Oct. 7.

In Kentucky, Shaker Village and Kentucky Horse Park are two top attractions that allow leashed dogs. Shaker Village has pet-friendly trails and overnight rooms. At KHP, pets are allowed on the grounds, in the museum lobby and at restaurant outdoor seating.

Maine attraction? In Bar Harbor, you and your dog can cruise Frenchman Bay on the Margaret Todd schooner (go midday for fewer people) or explore Acadia National Park.

If you’re summering in Nantucket, take Fido on a private charter with Endeavor Sailing Excursions or take him kayaking at Francis Street Beach. Afterward, kick back with a brew at dog-friendly Cisco Brewers.

Dogs can’t appreciate the art inside Kansas City, Missouri's, Nelson-Atkins Museum or Kemper Museum of Contemporary Art, but they are allowed on the grounds, dotted with sculptures. In St. Louis, look for a paw print logo at shops and restaurants to identify those that are dog-friendly. Enjoy Yappy Hour at Anheuser-Busch Biergarten every day the outdoor garden is open.

Asheville, North Carolina, is home to majestic Biltmore Estate on 220 acres. Explore the grounds with your dog, then settle him in the on-site kennel while you tour the house. In Wilmington, start your morning at Java Dog Coffee House and finish the day with dinner on the deck at The George restaurant on the Riverwalk.

Hit the water with your dog in Bend, Oregon, where you can float the Deschutes River by kayak, paddleboard or other craft that holds your dog. Other dog-friendly activities include riding the Mount Bachelor Pine Marten chairlift up to hiking trails. In Portland, visit the world-famous Rose Garden or sign up for a Portland Food Cart Tour. Dine at Tin Shed Garden Cafe, where your dog gets fed, too.

In Oklahoma, dogs are welcome at Woolaroc Museum and Wildlife Preserve, a 3,700-acre working ranch in Bartlesville with bison, elk, longhorn cattle and more.

Leashed dogs can attend shows at Northern Sky Theater in Fish Creek, Wisconsin, presenting family-friendly musicals under the stars through August.

Don’t see your city or state here? Future features will focus on pet-friendly breweries and wineries and winter destinations, whether you’re looking for warm or cold weather. Bark voyage!

Q&A

Appetite may

signal illness

Q: My pet always eats well, and lately he’s been eating more than usual. I’ve always thought that a good appetite means he’s healthy, but something just seems off about him. Should I be worried?

A: We all like to see our pets enjoy their food, but eating a lot isn’t always a sign of good health. It’s normal for pets to have a big appetite when they’re growing or have an active lifestyle. Pregnant or nursing animals also eat more food than normal. But an increased appetite in the absence of those situations can be cause for concern.

Puppies and kittens with a pot-bellied appearance who are eating but losing weight may have an infestation of intestinal parasites such as roundworms. A fecal exam will tell the tale.

Pets who eat ravenously and still want more but are losing weight may have a health problem. Those signs can indicate diabetes mellitus in dogs and cats; hyperthyroidism in cats; or exocrine pancreatic insufficiency (EPI, for short), in which the body has difficulty digesting food and absorbing nutrients.

Increased appetite accompanied by seizures can signal insulinoma, a pancreatic tumor. An unexplained appetite increase along with hair loss and increased thirst and urination can indicate a condition called Cushing’s disease.

If your pet has any of these signs, your veterinarian will conduct a physical exam and ask questions such as what your pet eats, how often, how long since you first noticed the problem and whether you’ve noticed other changes in your pet’s daily routine and habits. She may recommend screening tests such as various types of blood work or a urinalysis. Once the problem is determined, your pet can be treated. -- Dr. Marty Becker

Do you have a pet question? Send it to askpetconnection@gmail.com or visit Facebook.com/DrMartyBecker.

THE BUZZ

Bird brain?

Think again

-- Why are parrots so smart? Canadian neuroscientists have discovered that the brainy birds have a neural circuit that transfers information between the cortex and the cerebellum. Called the medial spiriform nucleus (SpM), it’s similar to an area of the brain in primates, the pontine nuclei, that performs the same function. “This loop between the cortex and the cerebellum is important for the planning and execution of sophisticated behaviors,” said Doug Wylie, the study’s co-author and professor of psychology at the University of Alberta in Edmonton. Parrots have an SpM that is two to five times larger than that in other types of birds. The paper, “Parrots have evolved a primate-like telencephalic-midbrain-cerebellar circuit,” was published earlier this month in the journal Scientific Reports.

-- One of the final vestiges of ancient American dogs is a type of cancer: canine transmissible venereal tumor (CTVT). Analysis of DNA from the remains of 71 ancient dogs located in North America and Siberia found that they were a distinct population, unlike modern and ancient Eurasian dogs. Little of their DNA remains in modern dogs, based on DNA analysis of 5,000 dogs, including village dogs, from North and South America. The closest detectable link to indigenous American dogs is CTVT, a contagious cancer clone derived from a single dog who lived some 8,000 years ago. Scientists speculate that the dogs died of CTVT or from infectious diseases that arrived with European dogs.

-- If your cat keeps you up at night, feed into his night-owl personality by giving a meal before bedtime. Cats like to eat at night and typically rest afterward. Or set timed feeders to open during the night, at whatever time your cat typically awakens you, or early in the morning so you can sleep in. Set out food-filled puzzles or hide treats that your cat can hunt for at night. Soon you should be sleeping through the night. -- Dr. Marty Becker, Kim Campbell Thornton and Mikkel Becker

ABOUT PET CONNECTION

Pet Connection is produced by a team of pet-care experts headed by "The Dr. Oz Show" veterinarian Dr. Marty Becker and award-winning journalist Kim Campbell Thornton. They are affiliated with Vetstreet.com and are the authors of many best-selling pet-care books. Joining them is dog trainer and behavior consultant Mikkel Becker. Dr. Becker can be found at Facebook.com/DrMartyBecker or on Twitter at DrMartyBecker. Kim Campbell Thornton is at Facebook.com/KimCampbellThornton and on Twitter at kkcthornton. Mikkel Becker is at Facebook.com/MikkelBecker and on Twitter at MikkelBecker.