The First Visit to the Veterinarian

1. The First Visit to the Veterinarian dr. Ákos Máthé Department of Internal Medicine

2. A golden chance • To examine the new patient • To bond a new client to your practice • Health examination - congenital defects • Vaccination programs • (Parasites: flea control and deworming) • (Nutritional management)

3. Health examination • History • For how long has the owner the puppy/kitten? • How and where did she/he acquire it? • Information about littermates, parents • Previous vaccinations, flea control, deworming • Patients appetite, any abnormality

4. Health examination II. • General physical examination • Clinical impression: behaviour, grooming,nutritional state etc. • Rectal temperature • Skin, ears, eyes, parasites • Lymph nodes, mucous membranes • Respiration and circulation • Mouth and abdominal palpation • Testicles • Movement, skeletal deformities

5. Common congenital and inherited problems discovered by physical examination • Heart murmurs • Abnormal bite • Problems with dentition • Umbilical hernia • Cryptorchidism

6. Congenital heart murmurs • „Innocent murmurs” • Healthy pups/kittens • Left craniodorsal heartbase, 1-3 degree • Varies with body position • Usually disappears at 14-16 weeks of age • Pathologic murmurs • 4-6 degree with precordial thrill (fremitus) • Cyanotic mucosae +/-, abnormal pulse +/-

7. Most common congenital heart abnormalities • Patent ductus arteriosus • Poodle, collie, German shepherd, Siamese, Persian • Pulmonic stenosis • Beagle, English bulldog, fox terrier • Subaortic stenosis • Newfoundland, boxer, golden retriever • Atrioventricular valve dysplasia • Great Dane • (Persistent right aortic arch - history with regurgitation) • German shepherd, Irish setter

8. Abnormal bite • Normal bite: lower incisors are just behind upper incisors, mandibular canine occludes in interdental space between lateral upper incisor and maxillar canine • Brachygnathic bite (short mandible) • Lower canines may occlude at level of upper canine • Can cause palatal trauma  orthodontic techniques recquired • Prognathic bite (long mandible) • Normal in brachycephalic breeds (Bulldogs, Boxers, Persian and Himalayan cats) • Mild form: level bite (excessive wearing) • Rostral crossbite

9. Dentition problems • Anodontia • Absence of one or more teeth • Retained deciduous teeth • Increased plaque formation  parodontal disease • Abnormal positioning of permanent teeth • Removal necessary as early as possible • Yorkshire terriers • Supranumerary teeth • Crowding

10. Umbilical hernia • Failure of normal closure of umbilical ring • Contains part of the omentum, sometimes intestinal loop • Airedale terriers, Pekingese, pointer • Usually does not cause health problem

11. Cryptorchidism • Testicles are not in the scrotum by 8 weeks of age • Unilateral > bilateral • Testicle is in the abdominal cavity or in the subcutis of inguinal region • Hereditary, probably autosomal recessive • Poodles, Yorkshire terriers, chihuahua, Pekingese, Maltese, Persian cats • In dogs risk of neoplasia in cryptorchid testicle • Should be castrated!

12. Vaccination - general considerations • Only vaccinate animals in good health • Always take temperature • Owner should keep puppy/kitten indoors until basic vaccinations are completed, and have taken effects! • Select protocol based on patients planned lifestyle • Cat: - outgoing or indoors? - breeding and show animals • Dog: - frequent walks/hunts in forrests? - access to rodents - dog kennels

13. Vaccination - general considerations II. • Use as few antigens as necessary for patient profile • Use multivalent vaccines rather than combine vaccines yourself • multivalent vaccines are tested for antigen interference  they are safe and effective • If you use more than one vaccine at once never mix them, and inject to multiple locations

14. Causes of vaccination failure • Host • Maternal antibody interference • Immune deficiency/suppression • Incubating disease at time of vaccination • Breed: Rottweilers, Staffordshire terriers, Dobermanns, German shepherds are more susceptible for parvovirus

15. Causes of vaccination failure II. • Human error • Improper vaccine handling, storage • Skin disinfection used • Early exposure of patient to virulent strain • Use of passive immunization within 3 weeks • Wrong vaccination protocol

16. Postvaccinal complications • Immunologic • Type I.: urticaria, anaphylaxis (Leptospira, rabies, FeLV, feline respiratory diseases) • Type II.: cytotoxic reaction - IHA, AITP (parvovirus, distemper) • Type III.: immune complex deposition - uveitis (attenuated CAV-1) • Local granulomas or sarcomas (cats)(Leptospira, rabies, FeLV)

17. Postvaccinal complications II. • Fever • Any modified live virus (MLV) • Abortion, congenital malformation • Any MLV, especially parvoviruses • Clinical disease • Cat: calicivirus, herpesvirus • Dog: parainfluenza virus, distemper

18. Vaccination program for puppies(having colostral immunity) • 8-9 weeks: D, A, Pv, (Pi,CoV) • 12-13 weeks: D, A, Pv, (Pi,L,CoV,Ly) • (14-15 weeks: may go to street/park) • 15-16 weeks: Ra,(D, A, Pv, Pi,L,CoV,Ly,) • <1 year: Ra • D = distemper CoV = coronavirusA = CAV-1 or CAV-2 L = LeptospiraPv = parvovirus Ly = Lyme diseasePi = parainfluenza virus Ra = rabies

19. Remarks for dog vaccinations • Use high titer potentiated MLV Pv vaccines in puppies • Give additional vaccination for Pv to Rottweiler, Staffordshire terrier, Dobermann, German shepherd puppies at 15-16 weeks of age • Only give CoV if owner asks for it or wants „complete protection” • Do not give CoV and L simultaneously if possible

20. Remarks for dog vaccinations II. • Boosters: D, A, Pv, (Pi,L,CoV,Ly) yearly, Ra every 1-3 years depending on law • Do not use MLV-s in pregnant bitches • Colostrum deprived puppies • Vaccinate at 3, 6, 9, 12 weeks with D, A, Pv using inactivated Pv first, then potentiated MLV Pv • (Pi, L, CoV) are optional at 9, 12 weeks

21. Vaccination program for kittens(having colostral immunity) • 8-9 weeks: P, Rh, C, (Ch,FeLV) • 12-13 weeks: P, Rh, C, (Ch,FeLV,FIP, Ra) • 15-16 weeks: (P, Rh, C, Ch,FeLV,FIP) • P = panleukopenia FeLV = Feline leukaemia virusRh = rhinotracheitis FIP = Feline infectious peritonitisC = calicivirus Ra = rabiesCh = Chlamydia

22. Remarks for cat vaccinations • If inactivated P is used, give it 3 times, MLV P is enough twice • P, Rh and C also exist as intranasal vaccines • but parenteral P is more effective • intranasal Rh and C are more effective, but may cause mild disease • Give inactivated P, Rh, and C to pregnant queens and immunosuppressed cats (FeLV +, FIV +) • FIP is intranasal, only useful for seronegatives

23. Remarks for cat vaccinations II. • There is no benefit and no harm if you give FeLV vaccine to a positive cat • FeLV vaccination does not provide complete protection • FeLV vaccination does not cause test positivity • Boosters: P, Rh, C, (Ch,FeLV,FIP)yearlyRa every 1-3 years • Colostrum deprived kittens: • P, Rh, C at 3, 6, 9, 12 weeks (use inactivated P for first time) • (Ch, FeLV) at 9, 12 weeks • (FIP,Ra) at 12, 15 weeks

24. Microsporum canis vaccine • Killed vaccine • Useful as part of treatment regimen against ringworm • Three times with 3 weeks intervals • Only IM to dogs, IM or SC to cats • Local reactions

25. Thank you for your attention!