The First Visit to the Veterinarian

dr. Ákos Máthé

Department of Internal Medicine

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)

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

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

Common congenital and inherited problems discovered by physical examination

• Heart murmurs

• Abnormal bite

• Problems with dentition

• Umbilical hernia

• Cryptorchidism

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 +/-

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

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

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

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

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!

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

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

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

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

Postvaccinal complications

• Immunologic~ Type I.: urticaria, anaphylaxis

(Leptospira, rabies, FeLV, felinerespiratory 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)

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

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

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

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

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

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

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) yearly

Ra 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

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