Dogs – Page 2 – C-VILLE Weekly

Control issues: New restrictions on prescribing opioids for pets

It’s been hard to escape news of the opioid crisis over the past few years. And it’s just as difficult to ignore the complicity of the nation’s health care system in creating it. Opioid medications—drugs similar to morphine and named for the opium poppy plant that produces them—have an important role to play in patient care. Used correctly, they are vital tools in controlling pain and suffering. But they have not always been used correctly, and the resulting addiction crisis has come at great cost in dollars and, more importantly, lives.

These drugs are also used in veterinary medicine. The past few decades have seen an increased emphasis on pain management in veterinary patients, and I believe that is a good thing. Short-term use of opioids is a safe and effective way to control acute pain associated with things like surgery or trauma. The danger comes with long-term use, as opioid receptors in the brain become accustomed to the drug and demand more of it.

There remain, however, many cases where long-term opioid use is justified. Some animals have concurrent medical conditions that preclude use of non-opioid alternatives. And sometimes, it’s the only thing that works. While animals can become addicted in theory, it is uncommon in practice. They simply have no control over their own dosing, which limits the potential for escalating abuse.

Recent changes in Virginia state law have established a prescription monitoring program that creates a consolidated database intended to track use and misuse of controlled drugs. This includes opioid medications like tramadol, and even some non-opioid medications like gabapentin that have the potential for abuse. These laws extend to veterinarians and have resulted in significant changes in the way we can prescribe these medications. The concern isn’t that animals are becoming addicted, of course. It’s that these drugs might be diverted for human use.

Veterinarians were given two options to comply with this program, and the first—submitting daily reports of all controlled substances prescribed—just isn’t feasible for most practices. Instead, most have elected to accept a waiver that limits them to dispensing one week of medication. If more than that is required, it must be prescribed through an external pharmacy so it can be monitored appropriately. It also requires that these animals be evaluated at least once every six months to keep the prescription active.

What does this all mean for pet owners? Mostly, it means that things are less convenient than they were before. If your pet requires ongoing use of a controlled substance, it is important to make sure that she is seen by her vet every six months. Your vet may be able to help by sending an automated reminder. It is also important to request refills well before your current supply runs out to avoid problems and delays.

I don’t know how much of a role veterinarians really play in the opioid crisis, but we’re wrapped up in it all the same. While these drugs shouldn’t necessarily be feared, they deserve respect and care in their use. Inconvenient as they may be, these new regulations are intended to make sure that care is taken.

Dr. Mike Fietz is a small animal veterinarian at Georgetown Veterinary Hospital. He received his veterinary degree from Cornell University in 2003 and has lived in Charlottesville since.

Breathing easier: Getting through reverse sneezing

Anything that looks this terrifying must be an emergency. The poor dog is standing with her legs braced and head thrust forward, and the corners of her mouth are pulled taught in a frightening grimace. Her belly contracts and her ribcage tenses in powerful bursts, and a thundering snort marks each strained breath. She’s distressed, and it feels like it’s gone on far too long. You reach for the phone and before you can dial your vet, it’s over. She wags her tail and goes about her day.

Alarming as it might appear at the time, this describes a typical bout of reverse sneezing, and it is simply an attempt to alleviate some kind of discomfort in the rear of the nasal cavity. In much the same way that a regular sneeze tries to blow an irritant out of the nose with an explosive burst of air, reverse sneezing attempts to suck an irritant back into the throat so it can be swallowed or spit out.

In most cases, the cause of irritation is minor and temporary. Perhaps a bit of dust or a blade of grass from the yard got stuck in the wrong place. If so, you may see a few episodes before it clears up for good. If allergies are responsible, you might see a pattern of symptoms occurring only in certain months. But so long as symptoms are sporadic, there isn’t any cause for alarm.

If reverse sneezing is observed frequently over a long period, however, it could indicate that more is going on. Brachycephalic breeds (like pugs, bulldogs and others with scrunched-up faces) can develop reverse sneezing because their soft palate is too long and hangs in the way. Nasal mites (yeah, that’s really a thing) are another potential cause and stubborn cases of reverse sneezing might be treated just to see what happens. And rarely, tumors and polyps in the nasal passageway can be responsible, but these may require advanced imaging like CT scans to locate.

Regardless of the cause, there isn’t much to do during a bout of reverse sneezing. It will stop on its own once the irritation is cleared. I’ve seen all sorts of suggested remedies. Some people recommend covering one or both nostrils, blowing gently in the dog’s nose or stroking the throat. I don’t know of any evidence that these methods help, but since the problem is self-limiting, I suspect that nearly any action can be misinterpreted as effective. Most episodes are finished in a few minutes no matter what you decide to do. My preference is to leave them alone. Getting in the dog’s face may add a new irritation while they try to manage the first one.

Thankfully, reverse sneezing is one of those things that looks far worse than it is. While some cases eventually warrant a deeper look, most of them blow over in a hurry, and you and your dog can both breathe a sigh of relief.

Dr. Mike Fietz is a small animal veterinarian at Georgetown Veterinary Hospital. He received his veterinary degree from Cornell University in 2003 and has lived in Charlottesville since.