Among the happiest of pet visits are the ones with new puppies or kittens! No one can resist those cute faces and funny antics, and owners are always excited to show off their newest family members. Because deworming, along with vaccinations, is a crucial step to keep your patients and their owners happy and healthy, let’s look at the multitude of products available and factors that impact which deworming protocol you should use to get those fur babies off to their best start.

Most veterinarians will agree that pyrantel (Nemex; Zoetis) is the best medication to use in the earliest phases of puppy or kittenhood. Safe enough for 2-week-old pediatric patients, this drug is used by most breeders and shelters to begin killing parasitic roundworms and hookworms. It is not effective against whipworms or tapeworms or against the larval stages of roundworms and hookworms; thus, multiple, spaced doses are recommended to kill off all burgeoning larval infections. The drug has a large safety margin, and adverse effects are minimal. With large worm burdens, puppies and kittens can vomit or defecate abundant numbers of live worms, so warn owners that this may occur at home. Pyrantel works within 2 hours and stops working after about 24 hours.

Fecal testing is also essential in these youngsters to determine which types of worms may be present and if they are infected with any of these protozoans. Checking multiple samples as pets grow is key to offering correct treatments. Because no fecal testing is 100% accurate and larval stages complicate treatments, it is important to check samples at the end of all vaccinations so that any parasites can be effectively removed.

Older puppies and kittens can be given many types or classes of medications to kill these invaders, but age and weight are deciding factors in which drugs you choose for deworming. For example, praziquantel (Droncit; Bayer) is marketed for puppies 3 weeks and older and kittens 4 weeks and older. Meanwhile, fenbendazole (Panacur; Merck Animal Health USA) is marketed for younger animals but must be given 3 days in a row for effectiveness. Fenbantal (Drontal Plus; Bayer) is intended for puppies aged 8 weeks and weighing at least 2 pounds. 

To further complicate your choice of dewormer are the combinations of multiple drugs, which are used the most now and go by various trade names. When designing a deworming protocol for your practice needs, read label directions carefully to discover when and how a dewormer can be given. Selecting a few different types of drugs and clearly labeling them for staff with the charting age and weight along with dosing information will simplify the process for everyone and remove the need for calculations at the time of service.

Anticipating our patients’ needs is important as well. For example, the kitten loaded with fleas will need a deworming in the future that will cover tapeworm infection. The puppy that lives outside on a farm will need a different deworming plan than one who’s an apartment dweller. Knowing which heartworm prevention is going to be used in the household will also dictate any additional required medications. You should always have an open conversation about intestinal parasites with owners so they understand protocols and consequences.

Additionally, the age of first contact will determine schedules of deworming for new patients. For example, a 12-week old puppy that comes in for a visit can get 2 dewormings 2 weeks apart, as opposed to a 4-week-old patient who will need multiple doses every 2 weeks. Again, owners will need to be made aware that it is not a one-and-done deal just because their breeder/shelter/friend said their pet was “dewormed.”

Animals placed on heartworm prevention can alternate their medication with their parasite control schedule because most heartworm preventatives today have added deworming medications. This can decrease scheduled deworming appointments for our young customers.

The types of parasites will also steer our course of action. Whipworms have a long prepatent period, so parasite control often relies on an appropriate choice of monthly heartworm prevention. Schedules for deworming only would be the day of, then in 3 weeks, and again in 3 months. The Companion Animal Parasite Council recommends deworming for zoonotic parasites at least 4 times, spaced 2 weeks apart, and then monthly (a monthly heartworm preventative would count for this). This protocol will cover the prepatent period of these zoonotic parasites and is the best choice for the safety of pet parents.

Other considerations for your deworming protocol are ease of use, amount of medication given (is it one dosage or dosing over several days), timing for repeat dosing, and—as always—owner compliance. Many choices are available today (liquid, pill, topical, and injectable). Be sure to look at all these factors as you decide what to use in your specific practice. Flexibility with medication type and dosing modalities can help those frustrated pet parents be more accepting of these medications for their puppies or kittens.

Our owners are excited as they welcome new pets into their homes. They want everyone to see and enjoy their newest furry companion. It is our job to make sure there are no unwanted “pets” carried along inside those cute, cuddly patients.

Dr Michele Leso graduated from the University of Pennsylvania School of Veterinary Medicine in 1995. A general practitioner for 25 years, Dr Leso recently shifted gears to join a Pet Urgent Care System. She shares her home with her husband of 30 years, their 5 children, and dogs, cats, rabbits , and one very mixed-up sheep.

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From age and weight to each patient’s needs to type of parasite, this veterinarian outlines key considerations of this crucial step for young pets. 

Factors affecting your deworming protocols for puppies and kittens

Hemangiosarcoma is often the first thing that comes to mind when a splenic mass is found in a dog. Although it is the most common malignant splenic tumor, it is not the only differential. Unfortunately, obtaining a definitive diagnosis and prognosis for the patient requires histopathology, which must be obtained surgically. The decision to go forward with surgery in the face of a potentially poor prognosis can be a difficult one for clients, especially in an emergency situation when the tumor has ruptured and is actively hemorrhaging.

During a session at the American Veterinary Medical Association Virtual Convention, Sue Ettinger, DVM, DACVIM (oncology), a veterinary oncologist at the VCA Veterinary Referral and Emergency Center in Norwalk, Connecticut, discussed key facts that practitioners need to know about hemangiosarcoma to help their clients make the best decision for their pet and family.

Clinical signs of hemangiosarcoma vary greatly depending on tumor location and how advanced the disease is at diagnosis. Tumor location can vary from the skin to subcutaneous tissue to visceral organs. The most common primary visceral sites are the spleen, heart, and liver. Because it is a cancer of blood vessels, it metastasizes quickly, with the liver and lungs being the most common targets.

Some patients with splenic hemangiosarcoma present with nonspecific signs such as decreased appetite, lethargy, or gastrointestinal distress, and other patients present in hypovolemic shock after an acute collapse. It is also possible for patients to have no clinical signs, with the mass being found by accident.

Ettinger reminded clinicians that although large breed dogs are generally at increased risk, any dog can present with hemangiosarcoma. Golden retrievers, German shepherds, and Labrador retrievers are thought to be at highest risk, and a genetic predisposition is suspected.

Ettinger noted that only approximately 45% of splenic masses are hemangiosarcoma, based on what she referred to as the “double two-thirds rule”: Two-thirds of patients presenting with a splenic mass have a malignant tumor, and of these malignancies, two-thirds are hemangiosarcoma. According to Dr Ettinger, published literature reports between 45% to 65% of splenic masses in dogs to be hemangiosarcoma.

Differentials for the one-third of dogs with benign masses include nonneoplastic masses like hematomas, abscesses or nodular hyperplasia, or a benign hemangioma. Differentials for the remaining malignancies include lymphoma, histiocytic sarcoma, and osteosarcoma.

In Ettinger’s experience, emergency clinicians have a higher suspicion of hemangiosarcoma when a splenic mass is identified, despite the double two-thirds rule. This is likely because patients presenting with a splenic mass in the emergency setting often have ruptured tumors and hemoabdomen, which both increase the index of suspicion for malignancy. In one study that evaluated dogs presenting with nontraumatic hemoabdomens, 80% of the splenic masses were neoplastic, with 88% of those diagnosed as hemangiosarcoma.

Another exception to this rule is that nonruptured splenic masses found incidentally, which Ettinger nicknamed “incidentalomas,” are less likely to be malignant. In a 2016 study, only 30% of these masses were malignant.

Ultimately, the definitive diagnosis of any splenic mass is through histopathology. However, several diagnostics should be performed prior to surgery to assess patient risk and stability.

Blood work is an essential part of the preoperative work-up and should include, at a minimum, a complete blood count (CBC) and a chemistry panel. CBC results may raise the suspicion of malignancy if anemia, nucleated red blood cells, abnormal red blood cell morphology, or thrombocytopenia are present. CBC results can also help assess risk of perioperative mortality. Patients with marked preoperative thrombocytopenia or anemia (hematocrit levels<30%) have an increased risk of death.

Coagulation status should be assessed with a prothrombin time or partial thromboplastin time blood test, in house if available. If these tests are not available in house, perform a buccal mucosal bleeding time evaluation or toenail clip to assess clotting. Half of patients with hemangiosarcoma will present with a coagulopathy.

Chest radiographs should be performed prior to surgery to assess for gross metastatic disease. Taking 3 views of the chest is essential to maximize the chances of detecting a lung nodule if one is present.

If available, abdominal ultrasound can be a helpful tool because it is less affected by effusion than radiographs. It allows the clinician to confirm the presence of any splenic tumors and assess the degree of effusion and for gross metastasis to other abdominal organs. Additionally, the architecture of the mass can be evaluated, which guides the decision to perform fine needle aspiration (FNA). FNAs are not recommended on cavitated splenic masses. Generally, cytology is low yield and inaccurate for hemangiosarcoma, and obtaining the sample has a high risk of hemorrhage due to the friable nature of the mass. If a solid splenic mass is visualized, an aspirate may be helpful to aid in the diagnosis.

Although some textbooks recommend echocardiography prior to surgery to screen for right atrial masses, it is not necessary in most cases, according to Ettinger. A better use of the client’s money is an electrocardiogram, monitoring during and after surgery because arrhythmias are common in patients regardless of whether the mass is benign or malignant. The presence of intraoperative ventricular arrhythmias doubles the risk of perioperative mortality.

Hemangiosarcoma is a treatable cancer, and when treated, dogs do live longer. However, according to Ettinger, the 1-year survival is less than 10% no matter how aggressive treatment is. The best prognosis is seen with non-ruptured, low-grade splenic tumors.

Surgery is the first-line treatment for splenic masses. During surgery, the abdomen should be fully explored. The gross appearance and size of the primary mass at the time of surgery does not correlate with malignancy. Suspected metastatic lesions on other abdominal organs, such as the liver, may actually be hematomas, extramedullary hematopoiesis, or another benign process. Thus, all suspicious lesions should be biopsied and submitted for histopathology along with the entire spleen. Surgeons must remember that hemangiosarcoma can only be diagnosed definitively by histopathology and should not make intraoperative assumptions about malignancy.

Ettinger cautioned that iatrogenic spread of neoplastic cells is possible due to the highly friable nature of the tissue. To minimize seeding of neoplastic cells during surgery, the abdomen should be thoroughly lavaged prior to closure, and fresh gloves and instruments should be used for closure.

Surgery alone is considered a palliative treatment, which controls local disease and reduces risks of acute hemorrhage in the future. Average survival time following palliative surgery is 1 to 3 months.

Average survival time can be extended to 6 months when surgery is followed by systemic chemotherapy.

Doxorubicin-based protocols are the most common, but the number of treatments that a patient can receive are limited by the accumulated cardiotoxicity. Other protocols, including the use of metronomic chemotherapy, are being investigated to maximize survival times and quality of life following surgery.

There is also new, ongoing research into therapeutic options for hemangiosarcoma, but limited data are available at this time. Ettinger said that a new drug called eBAT is being studied at the University of Minnesota as both a treatment and preventative option, but it is not commercially available. Losartan, an angiotensin subtype II receptor blocker in dogs, is also being studied as a possible palliative option due to its antitumor effects. Ettinger expressed excitement about the possibility of new therapies but noted that more research is needed.

Ettinger also discussed the use of supplements as a part of both palliative and curative-intent treatment protocols. Polysaccharopeptides are derived from Asian mushrooms and are thought to have antitumor activities through several different mechanisms of action. Several blends are available, but many are proprietary, which makes comparing brands difficult. Ettinger recommended I’m-Yunity, the product used in a small study of 15 dogs that showed a slight increase in survival times beyond surgery alone, though the study lacked a placebo group.

 However, because this product can be expensive, she offered K9 Immunity Plus as an alternative

 with the reminder that this blend has not been studied.

Yunnan Baiyao, a Chinese herbal mixture commonly used in patients with hemorrhage, may also be helpful for patients with hemangiosarcoma. Ettinger suggested this product as a palliative measure for patients with metastatic nodules that could rupture and bleed or for patients with a splenic tumor that has ruptured and the client declines surgery.

When discussing hemangiosarcoma with clients, Ettinger described it as an “aggressive and malignant cancer of blood vessels” that can occur in many locations in the body. She stresses to clients that noninvasive tests will not tell us if a splenic mass is hemangiosarcoma and that we must wait for biopsy results to give accurate diagnosis and prognosis. Treatment of hemangiosarcoma is fought on 2 battlefronts: locally and distantly. Locally is where the cancer is growing, and distantly is to control metastatic disease.

Despite the poor long-term prognosis, Ettinger noted that “a lot of my clients who treat are very happy they did, even with surgery alone, because the quality of life they get is good.”

Kate Boatright, VMD, a 2013 graduate of the University of Pennsylvania, is an associate veterinarian and freelance speaker and author in western Pennsylvania. She is actively involved in organized veterinary medicine at the local, state, and national levels and is a former national officer of the Veterinary Business Management Association.

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During a session at an AVMA Virtual Convention, a veterinary cancer specialist discusses key facts about the disease to help clients make the best decision for their pet. 

dvm360 September 2021

Factors affecting your deworming protocols for puppies and kittens

Essential information for veterinary practitioners about hemangiosarcoma

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