Lungworm case numbers?

Re: Lungworm case numbers?

Rob Loxley — Wed, 20 Feb 2013 13:49:50 GMT

[quote user="Bob Russell"]

found it pretty ineffective against several of the parasites it is supposed to kill.

Once you lose faith in a product it can be very difficult to regain it!

[/quote]

To be fair the demodex protocol is changed from the original license, but I'd still go for Aludex 1st line in a generalised case...

Re: Lungworm case numbers?

Kate Dawes — Wed, 20 Feb 2013 12:10:58 GMT

We have had at least 4 confirmed cases in the last year (Bristol). One of these was 1 year old bitch that bleed profusely during and after spaying. She appeared completely healthy on pre-op exam (the owner initially would not believe she could have lungworm as he knew his dog so well and she was fine!). Angiostrongylus confirmed on faecal sample. Referral was not an option as not insured. She did recover with supportive care, but it was all pretty scary and not an experience any of us want to repeat. Another was a dog that bled profusely after skin biopsies - this was referred and received blood transfusions.

We have for the last 12mths been recommending Advocate as routine parasite control to include angiostrongylus and have had pretty good uptake. After the above episode we also advise all dogs in for routine surgery have had recent advocate treatment. We have not yet had any confirmed cases that have been on advocate. I know there is concern that it may not give 100% efficacy, but we considered the other options (milbemax or fenbendazole) were not likely to result in good client compliance. 4 cases may not be a lot, but these dogs can seem fine then have a problem that can quickly become fatal, so we need to be making clients aware of it.

Re: Lungworm case numbers?

Bob Russell — Wed, 20 Feb 2013 09:15:02 GMT

I have requested original papers confirming the efficacy data for Advocate because years ago when we used it we found it pretty ineffective against several of the parasites it is supposed to kill.

Once you lose faith in a product it can be very difficult to regain it!

Re: Lungworm case numbers?

Hanna Bennett — Tue, 19 Feb 2013 20:04:53 GMT

we've had 1 confirmed case (south yorks/north notts) and a couple of odd coagulopathies that we are very suspicious of - local practices similar. we are starting to recommend advocate as preventative but would still treat active infection with fenbendazole. of the cases i've seen i'd err on prevention rather than cure - one pts despite fully insured and blood transfusion within hours of admission - my own dogs get advocate now, so figure if i'm worried my clients need to be aware of it at the very least

Re: Lungworm case numbers?

emma o'connor — Tue, 19 Feb 2013 16:46:06 GMT

We have seen a few suspected cases over the past 12 to 18 months, a couple have been referred to local specialists due to the severity of disease, and they never managed to confirm the diagnosis on any testing, but still were convinced of the diagnosis , and the dogs responded to treatment. Of those not referred mostly were chronic coughing cases, a couple were confirmed with by finding larvae in faecal smears, others more treated due to suspicion if we couldn't find the larvae. One dog presented with bleeding from a venepuncture site, and bleeding from the mouth after intubation, when in for routine castration, the procedure was cancelled, and larvae found on the mucous at the end of the ET tube! We have also had a couple of fatalities when referral was not an option and the dogs presented very poorly, one was confirmed on faecal testing to be lungworm, the other we couldn't confirm, but did suspect it as the cause. All suspected and confirmed cases have been treated with fenbendazole after discussion with our local medicine referral service. However, as a practice due to the cases we have seen, we do promote advocate as a way of control especially in dogs that have a history of eating grass/slugs/snails, but be careful to make it clear we believe it is not 100% preventative. We get a lot of clients asking about it having spoken to other dog owners/ breeders etc. If they are concerned about ticks (we are also in an area with plenty of ticks) we suggest using a seresto collar, or alternating the advocate with advantix.

Having seen first hand how bad these dogs can be on presentation, I would rather suggest an owner uses advocate if they are concerned about risk, certainly until more products are available on the market.

Re: Lungworm case numbers?

Bob Russell — Tue, 19 Feb 2013 13:46:47 GMT

[quote user="james herriot lied"]

[quote user="Bob Russell"]

Has anyone seen lungworm prevention fail with Advocate.

[/quote]

Yes.

I tend to do BALs on these; also occasionally on dogs with suspect heart issues just to be sure. Out of a few dozen BALs, I've probably seen 10 (ish) positives.

Must dash, caesar's just come in.

[/quote]

According to our Bayer rep this is not possible. It prevents 100% of cases!

Oddly (apparently) the reason Seresto went up 10% in November was because vets thought it was too cheap! Never heard this one before!

Re: Lungworm case numbers?

james herriot lied — Tue, 19 Feb 2013 13:30:33 GMT

[quote user="Bob Russell"]

Has anyone seen lungworm prevention fail with Advocate.

[/quote]

Yes.

I tend to do BALs on these; also occasionally on dogs with suspect heart issues just to be sure. Out of a few dozen BALs, I've probably seen 10 (ish) positives.

Must dash, caesar's just come in.

Re: Lungworm case numbers?

Bob Russell — Tue, 19 Feb 2013 09:38:57 GMT

My suspicion has been that this is a marketing campaign that is feeding on fear. I wanted to get other peoples views.

The Bayer rep says 100% prevention, full-stop! Vague comments about 'if we don't use it we could be in trouble.......'.

We discuss lungworm and test if suspicion arises but always negative but it seems to be running wild in neighbouring practices!

Has anyone seen lungworm prevention fail with Advocate. I am not interested in going to war with anyone but I do want to know fact from marketing.

Re: Lungworm case numbers?

Sandra Milburn — Tue, 19 Feb 2013 09:34:18 GMT

I have seen confirmed cases of lungworm. 4 in Kent (SBT, that was presented too late, no funds, had to be PTS'd, GSD and Rottie both with hyphaema and a Yorkie that was diagnosed on fecal testing only, but had not presented with any clinical signs at all!). 5th case was another Yorkie in NW London!

Am now working in West Sussex and we are just starting to try and do in house testing, to try and gauge what the prevalence is. We are aware of the limitations re false negatives. Here we treat especially young dogs monthly, older dogs as indicated depending on lifestyle etc. Often do 7 day Panacur course more regularly rather than using Advocate monthly. My treatment of choice is Panacur for 7 days in any case, in preference over Advocate.

Re: Lungworm case numbers?

Marie Kubiak — Tue, 19 Feb 2013 09:28:48 GMT

[quote user="Mark Rowland"]

Here you go Marie

[/quote]

Thanks Mark!! Seems there's still some disparity on this, my one I submitted samples to two separate labs for comparison and one pathologist said A. vasorum and cited the same paper you did, the other pathologist said A. vasorum not responsible but a similar and related nematode causes disease in red panda,so not 100% sure if it was a true A. vasorum case or not. Have treated our female with fenbendazole, the keepers don't think they can get close enough to apply advocate on a monthly basis anyway.

Marie

Re: Lungworm case numbers?

Yantha Smyth — Tue, 19 Feb 2013 09:13:26 GMT

I am not convinced advocate is 100% at prevention of lungworm cases, though I am sure it prevents a high proportion. I was at a referral center tour and cpd evening once and their demo on the CT image screen was the lungs of a fatal case of lungworm in a dog that had been on advocate. I think there is a tendency to treat known cases with fenbendazole, with or without advocate. Confirmed cases I have seen have not been on advocate. I actually saw alot more cases of lungworm when i was locumming in Sutton in the early 2000's, when it was little-publicised and advocate was not born yet- so FBZ was the obvious choice.

I often wonder about the true geographical incidence and risk, and as a locum working in various locations wonder if the use of advocate is related to this (if known) or on other factors such as perceived risk, marketing etc. I agree it would be very useful if the laboratories could publish their numbers and locations to give an idea of confirmed cases by region.

Re: Lungworm case numbers?

Mark Rowland — Mon, 18 Feb 2013 20:44:18 GMT

Here you go Marie

Pneumonia from Angiostrongylus vasorum infection in a red panda (Ailurus fulgens fulgens).

J Vet Diagn Invest. March 2009;21(2):270-3.

Janet C Patterson-Kane¹; Lynda M Gibbons; Ryan Jefferies; Eric R Morgan; Nanny Wenzlow; Sharon P Redrobe

¹School of Veterinary Science, The University of Queensland, St. Lucia, Queensland 4072, Australia. j.pattersonkane@uq.edu.au

Article Abstract

A 9-year-old, male, captive red panda (Ailurus fulgens fulgens) in an urban zoo in the United Kingdom presented with respiratory distress and weight loss. The animal was euthanatized, and a postmortem examination was performed. The lungs were diffusely consolidated with extensive mineralization. Microscopically, there was extensive obliteration of normal pulmonary architecture by sheets and coalescing nodules of partially mineralized fibrous tissue and granulomatous inflammation centered on large numbers of nematode larvae and eggs. First stage nematode larvae were isolated from lung tissue and were characterized as Angiostrongylus vasorum on the basis of their morphology and sequencing of the 18S ribosomal RNA gene and the entire second internal transcribed spacer. Although A. vasorum has previously been reported in red pandas in a zoological collection in Denmark, this study is the first reported case in the United Kingdom and occurs against a background of geographical spread and increased incidence of disease in domestic and wild canids. Angiostrongylus vasorum should be considered a differential diagnosis for respiratory disease in the red panda and taken into account when planning parasite and pest control programs for zoological collections.

Re: Lungworm case numbers?

Marie Kubiak — Mon, 18 Feb 2013 20:15:26 GMT

[quote user="robloxley"]

And they'd have no ulterior motive...!

[/quote]

Yes, that was why I took their 'treat and prevent with our magic drug' approach with a pinch of salt! To be honest, I haven't seen a dog for years, I don't have a great working knowledge of lungworm but they were there to schmooze the small animal vets and offered me free sandwiches so I sat in!

Kind of tempted to try it on the pandas as a preventative but not sure Bayer would have much data to help me out and don't think the curator would be happy if it had an idiosyncratic reaction...

Marie

Re: Lungworm case numbers?

Rob Loxley — Mon, 18 Feb 2013 19:27:46 GMT

[quote user="Marie Kubiak"]We had the Advocate rep come out and tell us we are in a high risk area[/quote]

And they'd have no ulterior motive...!

We've not diagnosed nor suspected a case of lungworm and see upwards of a dozen flea cases some days, so forgive me if I'm going to worry more about the most effective flea control. It would be interesting if one of the big nationwide labs would publish their lungworm findings, as it might be very informative, especially geographically.

IMHO, Bayer hit on a marketing goldmine with lungworm, and have run a campaign based on fear rather than facts.

Re: Lungworm case numbers?

Bob Russell — Mon, 18 Feb 2013 16:33:20 GMT

Apparently six cases up the road, with two deaths. Four cases at another practice nearby. To some extent I feel the 'discussion' with the rep was aimed at making sure I was being 'responsible' in my choices!

Milbemax a definite no-no because a lack of any evidence of its efficacy and because it is off-licence I could be in trouble if I had not let the owner know that Advocate is licenced for prevention.

All done in a very nice 'we don't want to frighten people' way but it has left us all thinking a bit more!

Thanks for the discussion so far!

Re: Lungworm case numbers?

Martin Atkinson — Mon, 18 Feb 2013 16:11:26 GMT

[quote user="Marie Kubiak"]Cert holder who does screen all possible cases we have had 3 cases in the last 2 years. Incidentally she prefers fenbendazole for treatment, not advocate.[/quote] I agree with fenbendazole for treatment but Advocate is for prophylaxis is it not? I have a little run of lungworm cases 18 months ago but none since. However, I suspect we may be under diagnosing unless they are spectacular - all the cases I diagnosed presented as bleeding problems with a cough a secondary feature on questioning the owners. We are in a supposed high incidence area and don't have much of a problem with ticks, not at least tick borne disease, so as fipronil is increasingly being discredited, I don't want to encourage sales of it anyway from shops and Advocate also does hookworm and demodex, its a no-brainer to choose it over Stronghold in dogs as the only other viable alternative.

Re: Lungworm case numbers?

Joyce Whitehead — Mon, 18 Feb 2013 15:37:31 GMT

We haven't had a confirmed case in a dog, or, to be honest, even a suspicious case (and we are in North Yorkshire). We go have however had an Aelurostrongylus case confirmed in a feral Tom cat in for neutering. (Euthanased and PMed due to odd signs and appealing changes on lung radiographs).

Re: Lungworm case numbers?

Gillian Mostyn — Mon, 18 Feb 2013 15:20:31 GMT

I have not diagnosed a case yet.

Re: Lungworm case numbers?

Marie Kubiak — Mon, 18 Feb 2013 15:14:25 GMT

We had the Advocate rep come out and tell us we are in a high risk area in the Midlands. In a busy 15 vet practice with a medic Cert holder who does screen all possible cases we have had 3 cases in the last 2 years. Incidentally she prefers fenbendazole for treatment, not advocate. The cat and dog vets do push advocate as a preventative and it would appear that it is taken up well as part of a puppy starter pack but not continued long-term so ?usefulness.

I have had one case in an imported red panda this year but in all likelihood it won't come back as Angiostrongylus as the cause but one of the exotic lungworms.

Marie

Re: Lungworm case numbers?

KMurphy — Mon, 18 Feb 2013 15:13:27 GMT

We're also in an area with a lot of ticks and use very little Advocate. In Glasgow (30-45mins drive away), apparently, lungworm cases are on the rise but I've not yet diagnosed one, nor had a high level of suspicion for a case.

I do have discussions with clients about their dog's habits so if there's a dog that loves chomping on slugs/snails we'll usually discuss the risks (usually say quite low in this area but can never say never) and a few clients have opted to treat regularly with Advocate with supplemental tick treatment as required. Other than that, I don't routinely recommend Advocate for anything. We're much more Seresto/Advantix.

I don't think RCVS can start reprimanding us for not using specific products!