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Commentary on veterinary drugs
I am often asked to make comments on the treatment recommendations made by the veterinarians who are caring for your pets. Generally, these requests simply reflect the desire by most to reaffirm that the care they are receiving for their beloved family member is appropriate for the medical condition at hand. However (and to the frustration of many readers), I must refrain from making case-specific comments because the reality is that I simply do not have all of the information required to formulate and present appropriate recommendations. This information is contained in your pet's medical records that reside at the veterinary clinic you attend and, as such, your veterinarian remains the best source of veterinary information and advice. The professional relationship and trust that you share with your veterinarian, often termed the veterinary-client-patient relationship (VCPR), is the cornerstone of your pet's excellent health care. Never hesitate to pose your questions to your veterinarian or their health care team, as it is this open communication that supports each and every individual VCPR.

However, it is not uncommon for questions directed my way, while prompted by a specific case scenario, to be more general in nature, and on these I am happy to wade into the debate!

One such area of query has been with regards to veterinary pharmaceuticals - principally in trying to clarify both the suitability and value (i.e., cost) of the various products available. While a pharmaceutical product's suitability can only be answered under the VCPR, I would like to comment on the value question by providing a brief overview of the veterinary pharmaceutical industry, the current availability of pharmaceuticals for veterinary use and their costs, and various other pharmaceutical options.

Veterinary pharmaceuticals are governed by the same federal regulatory authority that oversees human pharmaceuticals; therefore, similar regulations apply. As such, for any pharmaceutical product to become commercially available, it must undergo stringent testing to demonstrate safety and efficacy for the specific species (e.g., dog or cat) and disease before the pharmaceutical company is granted a manufacturing license, demonstrated as a Drug Identification Number (DIN), which in essence, represents the federal government's seal of approval. This information is referred to as a product's label indication, as it appears both on the package label as well as being further explained by a more comprehensive package insert - a valuable document for all pet owners to be familiar with. Following licensing, the product is then manufactured under a federal audit and inspection program designed to provide quality assurance for the consumer (e.g., product content, potency, stability, etc.). This entire process ensures consumer protection, by providing the end user of a veterinary specific product sporting a DIN both quality assurance as well as insurance, with the latter applying to those rare situations where a licensed product results in an unexpected adverse outcome and where the pharmaceutical manufacturer will provide support to assist with its resolution. Unfortunately, the small size of the veterinary market combined with the high costs associated with bringing a licensed product to market, put the veterinary community and the patients that we treat at a relative disadvantage in that we simply don't have licensed products to address all of the various ailments and species that we treat. As veterinarians, we often have no other choice but to identify and use alternative sources of these needed medications and this principally takes two forms:

1. Pharmaceuticals that are licensed (i.e., sport a DIN), but not for the ailment or the species that we intend to use them in. The most common representation of this scenario is a pharmaceutical that is licensed for use in people but has also been studied for use in certain animal illnesses and this is termed "off-label use." Common examples include antibiotics, insulin, or anti-seizure medications. While not having had the same rigorous safety and efficacy testing as a veterinary licensed product specific to that ailment in question, quality assurance is provided by virtue of their DIN designation and clinical use has resulted in protocols that address issues of safety and efficacy. However, because these medications are not licensed for veterinary use, the manufacturing company cannot support them to the same degree as a veterinary licensed product.

2. Pharmaceuticals provided by compounding pharmacies. Compounded medications are pharmaceuticals that have been reformulated into an altered delivery vehicle, such as a liquid or transdermal ointment rather than a pill, or flavoured for easier consumption. Their benefit rests in providing access to non-commercially available pharmaceuticals and improving ease of administration. They are also often cheaper than licensed products with this cost disparity generally due to the fact that, as they bypass the aforementioned federal regulatory review and strict manufacturing protocols, they avoid the attendant costs. However, this lower cost comes at a potential price, and that price is an outcome of unregulated quality assurance, often resulting in potency and stability variability, and therefore no clear knowledge of product safety and efficacy. Several articles in the veterinary literature have clearly demonstrated these product limitations, especially for transdermal ointments. Again, as these products are not licensed, as in the aforementioned scenario the pharmaceutical industry cannot support these as they would a veterinary licensed product.

However, as the pet owner, the ultimate decision of pharmaceutical used in your pet is yours. It is your veterinarian's responsibility to make you aware of your options and the ramification of your choices, which can be clearly different depending on the product chosen. As a consumer, we always want to get the best value for the money that we spend and this applies to the veterinary pharmaceuticals that we purchase. Therefore, to ensure value and assure the best possible therapeutic outcome, current recommendations dictate that a veterinary licensed product be used first when one is available; if none exists, seek out a human licensed product and finally a compounded product. Again, the final decision rests with you.

Dear Dr. Walt: I have a 10-year-old female cat who seems to be constantly in heat. She is very disturbing at these times as she becomes very vocal - especially at all hours of the night. Her 'cat calls' are very audible as we live in an open-concept house and she likes to make her 'calls' in the very resonant stairways. Is she too old to be spayed? If not, will spaying eliminate this problem?

A simple answer to the latter question is 'yes' and the former 'no.' Assuming your cat is healthy in all other respects (something that should be ascertained by your veterinarian prior to the procedure), surgery should not pose any significant complications and can actually prevent a number of health issues that unspayed females may be prone to, such as uterine infections. However, the procedure is always safer and easier for both surgeon and pet if done at a young age. Besides, it also would have prevented the decade of unwelcome 'singing' that you have been exposed to, not to mention a potential outdoor misadventure that may have contributed to the pet overpopulation problem.

So my response question would be, 'Why has it taken you so long to come to this decision?'

Dear Dr. Walt: I inherited a friend's 1-year-old black lab puppy when they left the country. She is a lovely dog with a great temperament and very rarely barks. However, when she is left alone in the house she starts barking, chewing the furniture, and urinating on the carpet. I have tried leaving the house for short periods and returning, I don't make a fuss when I leave or return, but we've only made it about 10 minutes before 'panic' starts. Help!

I admire your commitment to address the behavioural issues you are facing and happy to hear that some progress is being made. As is often the case for many behavioural problems, progress is a series of many 'baby steps'. What you describe is a condition commonly referred to as separation anxiety. It is complex in its origin and generally requires both pharmaceutical and behavioural modification to control or correct. However, much like the condition itself, treatment is complex and your chance for a successful outcome can be improved by employing the expertise of a veterinary behaviourist - an individual specialized through additional training to specifically deal with problems having a behavioural basis.

Therefore my recommendation would be to have your veterinarian evaluate for potential contributing medical conditions and, if none, then seek a referral for you and your puppy to a veterinary behaviourist. Best of luck!

 About Dr. Walt Ingwersen
Dr. Walt Ingwersen is Chief Veterinary Officer at PetCare Insurance Brokers Ltd PetCare Insurance Brokers Ltd. He is a 1982 graduate of the Ontario Veterinary College. Board certified in Internal Medicine, he has the distinction of being the first Canadian editor of the Journal of the American Animal Hospital Association, a position he currently holds.

Involved in many aspects of the national and international veterinary community, "Dr. Walt" is the recipient of the President's Award for outstanding contribution to the veterinary profession awarded by the Canadian Veterinary Medical Association (CVMA). He is also Chief Veterinary Officer and Chairman of the Veterinary Advisory Board at PetCare Insurance Brokers Ltd. -- Canada's leading provider of insurance for dogs and cats.