Saving Big Money With a Ball Point Pen

When a veterinarian submits a "prospective bill" before doing the work, look it over and see what you can cross out.

1. Are you being double billed? It happens.
2. Has the vet or vet tech tacked on procedures that you do not want, such as teeth cleaning? It happens. Teeth cleaning in dogs is almost never medically necessary. Dog teeth and human teeth are not the same for one simple reason: a dog is dead at age 15, not at age 80.
3. Has the vet tacked on a bunch of expensive pre-anesthesia tests? If your dog is not old, is in fine health (other than perhaps a wound), and has done well with anesthesia before, consider skipping it.
4. Is this vet trying to test for heartworm in a dog that is under 9 months of age? That's a scam or a mistake -- cross it out and consider changing vets.
5. Is the vet anxious to sell you Rimadyl for pain? Cross it out and say you'll give the dog buffered children's aspirin in the proper dose instead.
6. Is the vet trying to sell you year-round heartworm medication even though you have a real winter in your area? That's a scam -- cross it out.
7. Is your veterinarian pushing annual vaccinations and "boosters?" Forget it; all vaccines after the first year are good for the life of the dog. Your vet knows this, or should. A rabies vaccine is the only one that needs to be renewed (for legal reasons) and then only every three years, and you do not need to get it done at the vet. The cheapest rabies tag in your community can be gotten from the local animal shelter.
8. Has your new puppy been spayed or neutered? Ask to take it home that day. Some veterinarians are big on keeping pets overnight, but this is medically unnecessary and just another "tack on charge." In many cases, your dog will spend the night at the vets without an overnight attendant even being on duty. Why would you pay to leave your dog in a cage far from home with no one to even check up on it?
9. Ask the vet for a prescription for a generic and get the prescription filled at WalMart or Costco for a few dollars. You can do this with a large number of pet medications, including antibiotics, and you can even get antibiotics without a prescription. If WalMart or Costco don't have the drug you are looking for, and you will need it for the life of the dog or cat, see if it can be ordered mail order. And yes, you can ask for a double-dose and split the pill for your dog, same as is done for humans.
10. Are you kenneling your dog at the vets while on a short vacation? Just say NO to the "guilt" charges they will suggest adding -- nail trimming, baths, "vaccine boosters," and those "extra walks" that will either not be done or will be just a "once around" a 12-foot yard. A kennel is not a spa, and a short trip out of town is no reason for you to allow yourself to be gouged. Remember: the dog will be walked so the crate does not have to be cleaned and the dog washed (for free!).
    
    _ _ _ _ _ _ _ _ _Related Links

• A Business Plan Based on Fencing Out the Truth
• Is Your Veterinarian Clean? Don't Count On It.
• Veterinary Trades Say It's Time to Rip-off the Rubes
• The Billion Dollar Heartworm Scam
• Rimadyl: Relief From a Swollen Wallet
• Vet Care Reaches Human Care Costs
• SuperGlue to Close Wounds
• The Billion Dollar Lyme Disease Scam
• Veterinary Billing Without Oversight or Regulation
• A Season to Everything
• Cruciate Ligament Injuries in Dogs
• Vet Pricing Has Nothing To Do With Care

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Red Fox as Weapons of Mouse Destruction

If you use the slightest bit of common sense, the chance of getting rabies from a raccoon, fox, possum, skunk or groundhog is very low, even if you work your terriers to such quarry year-round.

The chance of getting Lyme disease is a little bit higher, but it too is a very rare problem -- far rarer than most people think.

Lyme disease was first identified in Old Lyme, Connecticut in the 1970s. This zoonotic disease is passed to humans by blacklegged deer ticks which are infected with the spiral-shaped Borrelia burgdorferi microbe.

The illness was probably around a long time before being discovered, but prior to the 1970's it was rare enough that no one bothered to name the illness, much less study it.

Then, beginning in the early 1970s, the deer population in the Middle Atlantic and Northeastern United States began to grow rapidly. At the same time, more and more people began moving into the country, generally onto small farms located next to small woods.

Small woods in the Eastern U.S. are often dominated by young oak trees, and these same small woods serve as daytime shelter for fairly dense deer populations of 50-200 animals per square mile (as compared to 25 per square mile in pre-Columbian times).

Very dense deer populations are possible in the eastern U.S. because the deer are able to feed at night in nearby hay, corn and soy fields.

The proximity of houses to shelter-belt forests means deer jungled up in these woods are safe from hunters who cannot legally fire weapons in such close proximity to occupied buildings.

Most people assume deer are the primary reservoir for Lyme disease, but scientists now believe the primary reservoir for is not deer, but something quite a bit smaller -- the whitefooted mouse.

Ticks are not born with Lyme disease. The Borrelia microbe is not passed from female tick to egg, but from Borrelia-infected mammal host to blacklegged deer tick, and from the tick to humans as part of the multiple-host lifestyle of all ticks (for more on that, see >> here).

Almost all whitefooted deer mice have Borrelia coursing through their veins. In addition, almost every tick that bites a whitefooted mouse ends up carrying Borreleia. For reasons not yet understood, other Borrelia-infected animals do not pass Borrelia on quite so easily. While possums, raccoons, fox, coyotes and most birds can carry Borrelia, and often host deer ticks as well, the ticks that feed on these animals become infected with Borrelia only 10% of the time as compared with a 90% infection rate for whitefooted mice.

Clearly, a key component to controlling Lyme disease is reducing the number of whitefooted mice in an area.

Mice populations, it turns out, tend to explode with acorn production which tends to be cyclical. In high-mast years when the ground is littered with vast numbers of acorns, the whitefooted mouse population in small oak woods will explode, and with it the incidence of Lyme disease in an area. Deer coming into these woods pick up the ticks and ensure their dispersal while supplying the tick with a large blood meal (absent a human host).

Obviously, ending acorn production in the Eastern woods is not in the cards. So what else can be done?

One thing that seems to reduce mice populations is to increase the degree of ecological diversity in an area. As the variety of plant sources increase, the popualtions of meso-predators such as possums, raccoons, fox and coyote tends to increase, and with it a decline in mice populations.

Predators, such as fox, are impotant to keeping whitefooted mice populations -- and to some extent Lyme disease -- in check. Fox are highly mobile predators that continuously suppress mice populations all year long. In the absence of mice, fox easily switch to berries, crickets and grasshoppers, young rabbits, voles, and even roadkill and garbage. When mice populations do rise, however, a few red fox can go a long way towards knocking their numbers back down again.

How many mice can a fox eat in a year? If it eats little else, a fox can knock off about 5,000 mice a year. That's not enought to eliminate Lyme disease in an area, but it can have a significant impact, and every little bit helps.

What else can be done? In many areas more deer culling needs to be done, especially of does. With a reduction in deer densities, forest understory has a chance of growing back in, and with it will come an increase in bird populations and other non-mouse fauna.

Such simple precautions such as spraying your pants with bug spray before going out walking in forest and field can help reduce the chance of tick-borne infection quite a lot, as can mowing walking paths short. Move brush piles and firewood stacks away from the house as they are havens for mice populations. After returning from a day in the field, check yourself over for ticks, paying especially close attention to areas you do not normally look at, such as the back of your legs and your back and neck.

If you find a tick, do not worry -- a tick has to feast on you for three days or so before it is able to transmit Borrelia. If a tick bite, or a bite from an unknown bug, develops a large red ring around it, see a doctor immediatly or (if you have doxycline in your vet kit) take a 3-day regime of doxycline. Lyme disease generally very easy to treat in its early stages with a simple one or two-week regime of antibiotics.

And, of course, practice agressive flea- and tick-prevention on your dogs. I hunt most weekends and generally wash the dogs with a low-cost flea shampoo after they return. A few days later I look them over pretty carefully to see if they have any ticks on them that I might have missed while washing them (it helps to have smooth coated dogs!). Other folks use Frontline. Whatever works for you is fine.

The most important element of flea and tick control is vigilance -- paying close attention, on a daily basis, to your dogs. Simply running a hand over their coats once a day will tell you a lot, and not just about ticks, but about weight gain and muscle tone as well.

The Red Fox: the ultimate weapon of mouse destruction.
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Are You Throwing Money Down the Drain?

Most of the common antibiotics prescribed for humans are exactly the same as the ones used for dogs, and the pill, capsule and gel-caps versions of these antibiotics are good for many years past their expiration date.

The fact that expiration dates on pill antibiotics are a marketing fraud has been widely know for years. In an article entitled "Drug Expiration Dates - Do They Mean Anything?", The Harvard Heath Letter summarizes a 20-year study done by the FDA for the U.S. military:

It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.... So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use.... Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way.

The Wall Street Journal put this story on their front page a few years back. But don't take my word for it: You can read the article, in its entirety, right here.

Do drugs really stop working after the date stamped on the bottle? Fifteen years ago, the U.S. military decided to find out. Sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every two to three years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the U.S. Food and Drug Administration, ultimately covered more than 100 drugs, prescription and over-the-counter. The results, never before reported, show that about 90% of them were safe and effective far past their original expiration date, at least one for 15 years past it.

In light of these results, a former director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer. Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

Medscape has posts here and here (PDF).

The U.S. Department of Defense has a post here.

The AMA has noted that antibiotics are good for years past their shelf life and has raised questions about how much medicine is being tossed down the sink.

So how come so few veterinarians seem to know this?

The answer, I think, is illuminating.

You see, on some important issues, veterinarians are often taught very little. The entire "course" given on canine nutrition, for example, may be a single lecture from a dog food salesman. The lecture on flea and tick remedies may be a lecture from a Merial salesperson who will detail "the spread" to be made from selling non-prescription Frontline as if it were a prescription drug (hint: it's not).

As for antibiotics, vets will learn by heart the branded and generic names of various drugs, and what they treat, but they may not learn other essential information.

And, as alarming as it may sound, that's true for many human doctors too.

Pharmacist and U.S. Army Colonel George Crawford, who used to be in charge of the Department of Defense's pharmaceutical Shelf Life Extension Program (SLEP) notes :

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

Right. Apparently no one does in veterinary school either.

You would think veterinarians and doctors might learn about this stuff in a Continuing Medical Education (CME) course, right?

Except there is a little joker in the deck.

You see, those CME courses are heavily subsidized by drug and vaccine makers, who help pay the speaker fees and travel costs for many of the lecturers.

Drug and vaccine makers make money when people throw good medicine down the drain, and they make money when dogs are over-vaccinated.

The business of canine health care is business, and good health and integrity often take the hind post.

Everyone in the system -- vets, pharmacies, and manufacturers -- profit when dogs are over-vaccinated and non-expired medicines are thrown down the drain.

Billions of dollars are wasted every year as a consequence.

The problem with over-vaccination and flushing good medicines down the drain is more than money, of course.

Throwing good antibiotics down the drain unnecessarily adds to the antibiotic load in our sewers, streams and rivers -- the very kind of thing that can help establish a beach head for real pathology in our own communities.

For those looking for information on antibiotic type and dosage to treat simple flesh wounds, urinary tract infections, and ear infection on your dogs, see this link on the main web site.

For those looking to obtain antibiotics without prescription, simply look in almost any dog supply catalogue in the country (see here, here, here, here for example) or simply go to Amazon.com (see here) and order. 

Antibiotics without prescription have been sold to treat common farm and kennel ailments for years, and they work fine with a few caveats:  know what you are dosing for, know how what you should be dosing with, know how much to dose, and know how long to maintain the dosing regime.   A barbed-wire flesh wound or cut foot is a pretty simple thing to diagnose, but some others are not.  If you are in doubt about what is going on with your dog, go to a vet.
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The Billion Dollar Heartworm Scam

This is a repost from this blog on this day in 2008.

PLEASE ACTUALLY READ THIS POST
BEFORE YOU START TO WRITE ABOUT WHAT YOU *THINK* IT SAYS:

Almost everything you have been told and taught about heartworm is probably an exaggeration or an outright lie, and this misinformation is probably costing you more money than it needs to.

Here's the truth:

• Heartworm is not a canine pandemic.
• In fact, heartworm is pretty rare in much of the country, and in very cold areas of the country a veterinarian may go his or her entire career without seeing a single case. Look at the map, above, put out by a major vendor of heartworm tests (Idexx) who has every reason in the world to overstate (rather than to understate) the problem. You will notice how low the baseline state numbers are -- 500 cases is the top of the color scale -- and that this map covers seven years of data collecting. You will also note that this map does not show adult heartworm infestation in dogs, but simply the number of dogs that tested positive for heartworm. More on that important distinction in a minute.
  . . . . Data on heartworm incidence rates at the local level reinforces how rare heart worm really is. For example, on the map above, California is coded red-hot with 500 cases. And yet, when a total of 4,350 dogs in 103 Los Angeles County cities coming from 21 participating animal hospitals were tested, only 18 heartworm-positive tests turned up. And yet, veterinarians are training their staffs not to talk about heartworm tests and medications as an option, but as a need, and for this "needs to be given" message to be bombarded on the customer 3-5 times per office visit.
  .
• Heartworm infection is NOT rapid and will not kill your dog overnight.
• It takes about three months for microfilaria (baby worms) to grow inside your dog to a larval stage, and even longer for these larva to mature into adult heartworms. If your dog is dosed with a simple Ivermectin treatment at any time during this period before adult worms are present (a period that lasts about three months long), the larvae will never develop into adult worms, and will die. Read that statement again: a single dose of Ivermectin will stop heartworm dead up to 3 months after your dog is first infected.
  .
• In most of the country, only seasonal heatworm "prevention" is needed.
• The short story here is that heartworm is a kind of nematode (dirofilaria immitis) spread by mosquitoes (and only by mosquitoes). The lifecycle of the nematode involves six stages, and a dog can get infected with heartworm only if two of these stages are fully completed inside the body of the mosquito, and those stages can only be completed inside the body of the mosquito if the temperature stays above 57 degrees for at least 45 days straight, both day and night. If the temperature drops below 57 degrees even once during that 45-day period, the lifecycle of the nematode is broken, and heartworm cannot be transmitted to your dog. What this means, in simple terms, is that a year-round program of Heartgard (sometimes spelled 'Heartguard") or some other "preventative" medicine is NOT needed in most of the country outside of Florida, the Rio Grande Valley of Texas.
  . . . . . Look carefully at the maps below (click to enlarge). These maps come from “Seasonal Timing of Heartworm Chemoprophylaxis in the United States” by Dr. David Knight and James Lok of the American Heartworm Society. Find your area on the map, and begin heartworm treatment on the first day of the month noted in Map A, and end treatment on the first day of the month noted in Map B. In short, if you are living in Virginia, you would begin treating your dog June 1st (top map) and end treatment on December 1st (bottom map).
  . . . . . This is a very aggressive treatment schedule -- more active than is really needed. After all, if heartworm larvae gets into your dog on June 1st, they will have NO IMPACT on your dog for months and months. In fact, if you are in Virginia simply treating your dog with Ivermectin (Heartgard) on September 1st and again on December 1st will give 100 percent heartworm protection for your dog. Even in areas where heartworm is a year-round vexation (Florida and the Rio Grande Valley of Texas), a once-every-three-months dose of Ivermectin will give your dog 100% protection.
  
  

(click on maps to enlarge)

Maps created by DH Knight and JB Lok

• There is no "preventive" medicine for Heartworm.
• Despite what your veterinarian may have told you, there is NO "prevention" for heartworm infection; there is only heartworm treatment. ALL heartworm medicines work the same way -- they kill heartworm microfilaria present in the body of the dog.
  .
• Heartworm "prevention" medicines are actually toxins.
• The drugs used to kill heartworm microfilaria are Ivermectin (Heartgard, Heartgard Plus, Iverhart, Merial and Verbac) or Milbemycin (Interceptor, Safeheart, Sentinal and Norvartis). Both drugs are nematode poisons, and in both cases a single dose will kill all microfilarial infection that occurred up to 90 days earlier (i.e. all Stage 3, 4 and young Stage 5 heartworm infections).
  .
• Humans cannot get heartworm.
• Heartworm cannot be passed on to humans -- we are the wrong host animal. Very rarely a heartworm-positive mosquito will bite a human and a small benign cyst may develop in the lung of a human, but this is NOT heartworm, and can be best thought of as a tiny scar showing where a bit of microfilaria attached to the lung wall where it was killed off by the human body.
  .
• Some breeds are more sensitive to Ivermectin.
• Some lines of collies and collie-crosses have sometimes fatal reactions to ivermectin, the most common heartworm preventative medicine. Though this is not common, and is even rarer today with low-dose Ivermectin such as Heartgard, and seems to only hold true for collies, serious thought needed to be given to dosing any collie, collie-cross, or herding dog with white feet. For these dogs, the safest heartworm medicine is Interceptor, though in fact the Heartgard box features a Border Collie on it face, and many working Border Collie folks dose their own dogs with a low dose of sheep drench 0.08% Ivermectin.
  .
• What about that wormy heart-in-a-jar at my vets office?
• Most veterinarians have a "fear bottle" in their office which shows a canine heart riddled with spaghetti-like heartworms. Nothing generates cash like a heartworm fear bottle -- a veterinarian will often place one prominently in his or her office as a kind of cash-generating machine since one look will sell a heartworm test and year's worth of Heartgard, no questions asked. So where do these fear bottles come from? I've been told by a pharmaceutical sales representative that most of these wormy hearts in these jars come from stray animals killed in Mexico, and that the heart specimens themselves (often decades old) were given out by pharmaceutical company representatives when they first began selling Heartgard back in 1986. One thing for sure: today, you can got to Maine and find a wormy heart in a jar even though the local veterinarian has never even seen a dog with this problem in the last 20 years.
  .
• Do I have to go a veterinarian to get Ivermectin?
• No. More on that in a second. Suffice it to say that it's not necessarily a bad thing to go to a vet for a prescription for Heartgard, especially if you are going to see your vet on another matter anyway. I would not buy Heartgard from the vet, however, without first checking prices online. Most vets price-gouge their customers by 100 percent or more for medicines sold in their offices, and in most states a veterinarian cannot charge you more for writing a prescription for a medically necessary medicine as part of an incidental visit.  In addition, be aware that former executives from Merial, the maker of Heartgard, are now making a generic version of this product, PetTrust, that is considerably cheaper.
  . . . . . Another cash-saving tip is to get a prescription for Heartgard for a dog twice the size of your dog, and then split the tablets in half. This trick results in considerable savings because the marginal cost between one Heartgard weight category and the next is often very slight despite the fact that one pill contains twice as much active ingredient as the next.
  . . . . . Finally, remember that, depending on outside temperature, you do not have to dose your dog all year long in large parts of the U.S.
  . . .Of course, if you want to dose your dog every month and do so cheaply and without going to a veterinarian for a prescription, there's a trick here too. Here it is:  Order Ivermectin in a pre-mixed solution from J.R. Enterprises. The cost is $25 for a 65-cc bottle of .05% Ivermectin, which is enough to treat five 20-pound dogs for 26 months. J.R. Enterprises even throws in a measuring spoon! Since this Ivomec and polypropelene gylcol solution is not FDA-approved for dogs, they sell it for experimental purposes only. That said, it works fine, and this is exactly the kind of heartworm preventative medicine used on all dogs all across this country prior to the advent of Heartgard and "the billion-dollar heartworm scam" in 1986.
  . . . . . .Finally, and if for no other reason that to explain how J.R. Enterprises does it, here's how you can treat a huge number of dogs with non-prescription Ivermectin for a dirt-cheap price. Whether this is cost-effective or not (and whether it is worth the trouble or not) really depends on how many dogs you have. In case you run a shelter, here's the scoop 1) Buy a 0.08 percent sheep drench online or at a feed store. Sheep drench is sold in various sized containers, but the smallest on Amazon is about $30 for 8 oz.  This will be high-grade Ivermectin made by Merial, an established veterinary pharmaceutical company. You will be giving only a very small dose of this sheep drench to your dog.  You dose by weight, and if you want to be very sure you have dosed enough, you can double the dose and the dog will be fine (but see the Collie warning at point #7).
  
  * up to 14 pounds: 1 drop (0.05 cc)
  * 15 to 29 pounds: 0.1 cc
  * 30 to 58 pounds: 0.2 cc
  * 59 to 88 pounds: 0.3 cc
  * 89 to 117 pounds: 0.4 cc
  * 118 to 147 pounds: 0.5 cc.
  
  • Do I need to have my dog tested for heartworm before starting Ivermectin?
  • Generally, no. Unless your dog is an older dog loaded with years of untreated heartworm (which you will know from the dog's long-term lethargy and chronic coughing), a dose of Ivermectin will not do your dog harm. A puppy, under six months of age, of course, will always test negative for heartworm because the microfilaria have not yet had a chance to develop and circulate. Testing a dog under age 6 months for heartworm is a common veterinary scam; do not fall for it!
    .
  • Is curing heartworm expensive and difficult?
  • No it is not. Any veterinarian who tells you otherwise is not keeping up with the literature. It turns out that even if your dog has adult heartworms, if the dog otherwise appears healthy (i.e. it is active, not lethargic, and does not have a chronic cough), a monthly dosing of Ivermectin at a dosage normally used to kill roundworms (a dosage that is 3 times higher than that used to simply prevent heartworm), plus a once-a-month 5-day dosing of Doxycycline (sold as Bird Biotic, and the same antibiotic used to treat Lyme disease) will kill all the adult heartworms if it is sustained for a period of 18 months. This treatment works better than previous Ivermectin-only treatments because the Doxycline wipes out the Wolbachia microbe that grow in the gut of the adult heartworm, essentially sterilizing all of the female heartworms. A round-worm strength dosing of monthly Ivermectin will not only prevent new heartworm microfilaria from taking hold in your dog, it will also work to dramatically shorten the life of any existing adult worms in your dog. Bottom line: after 18 months of treatment, your dog will be heartworm-free at very little cost compared to other remedies.
    . . . . . A repeated caution, however: if you have border collies or herding dogs with white feet that also appear to have full-blown heartworm, consult a veterinarian, as some lines of collies are very susceptible to Ivermectin toxicity. This is very rare, and the cause is unknown, but it is an area of concern among collies and collie-crosses.
  
  PLEASE BE ADVISED THAT I WILL NOT ANSWER QUESTIONS ABOUT DOSING YOUR DOG.   If you are too lazy to read this post or too confused and wrapped around your own axle to follow simple directions, I cannot help you.  Please go to a veterinarian.
  • Related Posts:
    ** Rimadyl: Relief From a Swollen Wall
    ** A Business Plan Based on Fencing Out the Truth
    ** Veterinary Billing Without Oversight or Regulation
    ** The Billion Dollar Lyme Disease Scam
    ** Lyme Disease: Hard to Catch and Easy to Halt
    ** Veterinary Trades Say It's Time to Rip-off the Rubes
    ** Is Your Veterinarian Clean? Don't Count On It
    ** A Season to Everything
    ** Cruciate Ligament Injuries in Dogs
    ** Vet Pricing Has Nothing To Do With Care
    .

The Billion Dollar Lyme Disease Scam

Center for Disease Control (CDC), Lyme disease cases (human) for 2006.

"Lyme disease vaccines and testing, as well as Lyme treatment of asymptomatic dogs, is a huge scam costing American dog owners hundreds of millions of dollars a year."

In a previous post about Lyme disease, I gave good medically-sound advice, which can be summarized as follows:

1. Just say NO to Lyme disease vaccination. This is junk billing.



2. Just say NO to Lyme testing; the tests ALL give false positives, none of the tests tell you if your dog has the disease, and ALL the tests cost more than Lyme treatment which is the only definitive test of the disease.
   


3. Treat suspected Lyme disease with doxycycline (5 mg per pound of dog) which you can purchase without prescription and without visiting a vet. If your formerly lame, lethargic and stiff-jointed dog shows marked improvement after a few days, keep the dog on doxycycline for a full 5 week regime.
   

In response, I got an anonymous post saying that there was a new Lyme test that was 100 percent accurate, that this fool-proof test should be followed up with more tests, that capsules given to a dog were "problematic," that doxycycline would upset a dog's tummy, and that doxycycline should be administered longer than 5 weeks. In addition this anonymous person wanted me to know that doxycycline will not cure Babesiosis.

My tolerance for nonsense is low, and it's even lower from anonymous posters, and so I let fly, calling prattle exactly what it was, and noting that the medical literature agreed with me.

In response, I got back a short nasty-gram from someone signed "Gil" who did not give an email address or offer a single corrective citation to what I said.

No matter. The world is a small place, and it was not hard for me to figure out who "Gil" was.

Gil Ash has a small web site about Lyme disease in which she suggests that folks should ignore what anyone else says (including their own veterinarian) and keep looking around until they find a vet who will take their money to do Lyme testing, Lyme titers, and Lyme treatment. The veterinarian she seems to lean on for Lyme disease information is a "holistic" vet in Texas (where there is very little Lyme it should be said -- see map) who specializes in ... horses.

A second poster then chimed in, suggesting I needed to take a chill pill because Lyme was a really serious disease, and she should know because she owned a "potential" Search-and-Rescue dog that had been wrecked by Lyme disease. Her evidence for the horror of Lyme is that her own dog had tested positive for Lyme and was fearful of noise, lights and sounds, and was aggressive to other animals (but not to humans).

Whoo boy!

Now, to cut to the chase, Gil's advice on Lyme disease is not supported, and I assume Gil knows it, as it's simply NOT that hard to find good information on Lyme disease.

I will cover Lyme disease in detail in a second, but for now let me get rid of a stray strand of worry and confusion that Gil attempts to throw into the mix: Babesia.

If you are worried about Babesia, you probably shouldn't be, as it turns out you are 20 times more likely to be hit by lightning than to catch Babesia microti, the human version of the disease, while Babesia gibsoni, the more serious canine version of the disease is not much more common, and its occurrence seems to be almost entirely limited to Pit bull terriers. Babesia canis, the less virulent (and more common) form of Babesia is generally asymptomatic, and does not require treatment. Finally, it should be noted that Babesia symptoms in dogs (when they occur) are not the same as that for Lyme, which generally presents as lameness and stiff joints.

As to the second poster, it turns out that blaming an animal's unrelated problems on Lyme disease is such a common phenomenon it is actually mentioned in the literature on Lyme. Here's a hint: a bit of bacteria does not tell an animal to bite other dogs but to leave the human in the house alone.

Fear and aggression are NOT symptoms of Lyme disease. Fear and aggression are, more likely, due to a twist of genetics and/or poor socialization of the animal.

OK, now back to Lyme disease. First, a little history.

America is a huge country, and we are no longer a new one. With a population of well over 300 million people, and the modern historical time line going back more than 300 years, I think it's safe to say there have a few hundred million dogs in the U.S. over that time. And yet, Lyme disease was not diagnosed in humans until 1975, and was not diagnosed in dogs until 1984.

What does this suggest?

Well, for one thing, it suggests that Lyme disease may not be very common.

Which it isn't.

In fact, Lyme disease is very rare over most of the U.S., and the prevalence of the disease is heavily skewed to a few relatively small regions of the country (see map at top).

And while relatively few humans catch Lyme disease, dogs are even less likely to catch it.

The good news is that since 1984, when Lyme was first identified in dogs, a heck of a lot of stuff has been written about Lyme disease's prevalence, symptoms, epidemiology, diagnosis, and treatment in dogs.

Most of this literature is marketing stuff cobbled up by drug companies trying to sell Lyme tests, Lyme vaccines, and Lyme cures, but some legitimate research on this disease has been done as well.

This legitimate research has, for the most part, shown that most of the "problems" associated with Lyme disease, other than leg lameness, joint stiffness, and lethargy, cannot be replicated in a laboratory setting in which dogs are intentionally infected with Lyme disease.

I could reference all of this literature, but it's not necessary, as the "Consensus Statement of the American College of Veterinary Internal Medicine on Lyme Disease" offers an excellent "best practices" paper as to what can and should be done regarding Lyme.

Read the whole thing if you want, but I will summarize -- in plain English -- the basics of what you need to know, with appropriate highlighted text to be found on the PDF:

1. Lyme disease in dogs is very rare nationally, and Lyme disease itself is endemic to only a small portion of the U.S.
   


2. It is much harder for a dog to catch Lyme disease than it is for a human.
   


3. 95 percent of the dogs that catch Lyme from a tick are asymptomatic (no symptoms).
   
   
4. An asymptomatic dog does not need to be tested for Lyme, as an asymptomatic dog does not need treatment, and treatment will not completely rid the dog of Lyme infection in any case.
   
   
5. All Lyme tests and titers give false positives or otherwise offer up only meaningless information that tell you nothing about whether the dog actually has Lyme disease or will come down with it.
   


6. A dog with symptoms of Lyme disease should not be tested for Lyme, as tests and titers do not prove that Lyme is the causal agent of any observed problem. The ONLY 100% indication that Lyme disease is a causal agent of a problem in a dog is if the dog responds to appropriate antibiotic treatment. Said treatment is cheaper than either a test for Lyme disease or an assay titer.



7. The best treatment for Lyme disease is oral doxycycline (5 mg a pound) for five weeks. Longer treatment periods have not been shown to be therapeutic. Doxycycline is also an effective treatment for several other tick-borne diseases such as Ehrlichiosis, Anaplasmosis and Rocky Mountain Spotted Fever. Note that neither doxy nor any other treatment will rid a dog of Lyme antibodies; they will remain in the dog forever, and repeated infection from another tick bite is always possible.



8. Most dogs that come down with Lyme-related lameness, lethargy, or joint stiffness get dramatically better after 2-3 days worth of treatment with doxycycline. If so, continue doxycycline treatment for a full 5 weeks. In humans, long-term doxycylin treatment has not been shown to be more effective than placebos, and there is no evidence to suggest it as a sensible regime for dogs



9. Lyme vaccines are more likely to do harm than good, and should NOT be given even in Lyme-endemic areas.



10. Some dog owners and veterinarians are only too happy to blame other medical issues on Lyme disease. However, if your dog does not get better after a five-week treatment of doxycycline, the problem is probably something other than Lyme, such as an a congenital autoimmune disorder.
    

What's all this mean?

Boil it all down, and what you have is a simple fact: Lyme disease vaccines, testing, and medically unnecessary treatment of asymptomatic dogs is a huge scam costing American dog owners hundreds of millions of dollars a year.

As noted in my earlier post, you should say NO to Lyme disease vaccination and NO to Lyme testing. If your dog comes up lame or stiff, do nothing for two weeks; it's probably as simple as a sprain, bruise, or cut pad. If the dog does not get better, however, and no other problem seems evident, treat the dog with doxycycline that you have ordered on your own and without a prescription. If the dog dramatically improves in 2-3 days, then the issue is Lyme disease, and continue to treat with doxycycline for a full 5-week regime.

Bird-biotic doxycycline can be ordered from Amazon or Revival Animal Health, and contains a 100 mg dose of doxycycline, which is a perfect dose for a 20-pound terrier. Scale up or down for a larger or smaller dog, dosing 5 mg per pound of dog, twice a day (once every 12 hours).

This is a repost from April 25, 2008.

• Related Posts:
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  ** Veterinary Trades Say It's Time to Rip-off the Rubes
  ** Is Your Veterinarian Clean? Don't Count On It.
  ** Cruciate Ligament Injuries in Dogs
  ** Vet Pricing Has Nothing To Do With Care

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Antibiotics Past the Expiration: Proving the Rule

A good comment came in to my original reply to Scotte Weese at the "Worms and Germs" blog who, without doing any research at all, and without contacting me, decided to blast this web site and blog for explaining how to get good antibiotics, without prescription, to treat dogs with small cuts and lacerations.

For those left scratching their heads:

• The original Terrierman.com post on antibiotics is here.
  
  
• My reply to Weese (written and posted only after he did not bother to read what was sent to him) is here: Is the "Worms and Germs" Blogger Incompetent?
  
  
• When Mr. Weese typed out more nonsense, I expained the danger of listening to this man in a post entiled: The High Cost of Veterinary Ignorance

So what was the good comment from a reader? It came from Mary who wrote to note:

While I agree with your post, I just wanted to mention that one of the drugs you name, Doxycycline, is one of the few that should not be used after its expiration date. Drugs in the tetracycline family can cause kidney damage when used after they expire.

Full credit to Mary who reads on her own. As I note in my reply to her:

"Tetracycline drugs are not drugs I normally use on my dogs (see original post ) and YES tetractycline and doxycycline are not drugs that can be kept for a decade past expiration, as most other antibiotics can, BUT it appears they too are good for quite a bit longer than their expiration dates.

As I noted in my reply, doxycycline is bought in very large amounts by the U.S. Government, and if it is kept at regular room temperature in a sealed container (as all antibiotics in your home are, I trust) it too is good for more than a year past its expiration date.

But don't take my word for it. Since so few people read anymore, I have pictures.

The following photos are lifted from a PowerPoint Presentation (PDF version) created by the Centers for Disease Control (CDC) and the U.S. Department of Health and Human Services.



This is the kind of warehouse where Strategic National Supply antibiotics and medical materials are stored.



These are a couple of doxycycline containers from the Strategic National Supply of antibiotics.



This is an original doxycycline label from the Strategic National Supply of antibiotics. Note that the drugs are to be stored at room temperature: 68-77 degrees.



This is an extended expiration date doxycycline label from the Strategic National Supply of antibiotics. Expiration dates on antibiotics are routinely extended for several years as part of the Shelf Life Extention Program (SLEP) as previously noted on this blog.

As I have noted on this blog in the past, doxycycline is a very useful drug to have in your home veterinary kit for two non-wound issues: Lyme disease treatment, and as an adjunct to effective and low-cost heartworm treatment.

Doxycycline, labeled for birds, can be bought from any veterinary supply place that caters to dogs, such as Doctors Foster and Smith, Revival Animal Health, Lambert Vet Supply or even Amazon.com.

This is the same medicine, made in the same factories, and at the same dosage, as antbiotics sold by your veterinarian or local pharmacy.

As always, follow directions and dose the right drug for the proper problem at the right amounts and for the required amount of time. Read the instructions and follow them!
.

The High Cost of Veterinary Ignorance

I have good news this flu season. And the good news is that the U.S. Government is not paying too much attention to Scott Weese over at the "Worms and Germs" blog.

His advice: Throw away all your medicines as soon as they hit their expiration date.

Instead, the U.S. Department of Health and Human Services (HHS), is listening to the FDA's Francis Flaherty and his team which have actually done the work on drug expiration dates.

So too is the Center for Disease Control (CDC), the U.S. Department of Defense (DoD) and the Department of Homeland Security (DHS).

Instead of tossing out billions of dollars worth of drugs, such as Tamiflu and antibiotics, the U.S. Government is keeping those drugs on the shelf, secure in their efficacy despite the fact that many are years past their "expiration" date.

Why is this good news for America?

Simple: Not only does this save tax dollars, but it may also save lives.

To put a point on it: If the U.S. followed Scott Weese's advice to throw everything down the drain as soon as a manufacturer's expiration date was crossed, we might not have the Tamiflu we now need as we enter this Fall's flu season.

How many American lives might that cost?

Who knows, but with up to 90,000 deaths now predicted by the CDC due to Swine Flu this Fall, I think the number "zero" is not in the mix.

Even when told about the FDA expiration date research and the Strategic National Stockpile of drugs kept by the Center for Disease Control, Scott Weese has not bothered to find out what kind of drugs are kept, or how long they are kept for.

Here's a hint: Thousands of TONS of antibiotics and other drugs (such as Tamiflu) are kept for YEARS past their putative expiration dates.

The fact that many common drugs, including Tamiflu, pill, capsule and caplet antibiotics, are safe and effective for years past the manufacturer's suggestion, is not closely held information.

As Johns Hopkins Health Alerts notes.

Think of expiration dates -- which the U.S. Food and Drug Administration (FDA) requires be placed on most prescription and over-the-counter medications -- as a very conservative guide to longevity....

In a study conducted by the FDA on a large stockpile of medications purchased by the military, 90% of more than 100 medications were safe and effective to use years after the expiration date. More recently, the FDA approved two-year extensions on expiration dates for a number of drugs, including the antibiotics Cipro (ciprofloxacin), penicillin, and tetracycline ....

If your medications have been stored under good conditions, they should retain all or much of their potency for at least one to two years following their expiration date, even after the container is opened.

The good news is that HHS has pre-positioned flu drugs, antibiotics, and other emergency medical supplies in 50-ton "Push Packs" around the nation. As The Richmond Times Dispatch notes:

The Strategic National Stockpile contains medications and supplies that would be needed in a mass disaster or other emergency. Examples of emergencies include a pandemic flu outbreak, hurricanes and terrorist attacks.

The stockpile includes such drugs as the flu medicine Tamiflu and the antibiotic Ciprofloxacin, as well as medical supplies, such as those for administering drugs intravenously or for keeping a patient's airway open.

Virginia, for instance, received 280,000 treatment courses of flu drugs from the federal stockpile in the recent H1N1 swine-flu scare. The state already had nearly 800,000 treatment courses of antivirals in its own stockpile.

A stockpile can consist of drugs on hand in an existing inventory, or it can be vendor-managed inventory that a state has contracted to purchase.

According to the U.S. Centers for Disease Control and Prevention, the federal stockpile is routinely checked to make sure the items are within their recommended shelf life. That's done by making quarterly checks on some items and an annual inventory, which includes inspections of environmental conditions, security and overall package maintenance.

Now that it looks as if the stockpile drugs sent to states might not be needed anytime soon [note: this article was written in May of 2009], what happens, for instance, to the 280,000 extra treatment courses Virginia received?

States will likely get to keep the drugs, a state official said.

The shelf life of some stockpile drugs can be extended beyond their expiration date under the Food and Drug Administration's Shelf Life Extension Program. That effort started as a way for the Department of Defense to save money by not having to throw away drugs that were still usable just because the expiration date had passed.

Tamiflu has qualified for that program. Batches or lots of Tamiflu in the stockpile that meet rigorous testing standards can have the shelf life extended from five years to seven years.

When drugs from the stockpile are used, it's done under FDA Emergency Use Authorizations. The FDA issues special letters to consumers and special prescribing instructions for health-care providers.

In fact, as the FDA web site notes, Tamiflu expiration dates, even for oral suspensions (liquid) are being extended by two years.

Tamiflu is not an antibiotic, of course, but the point is even more true for pill, capsule and caplet antibiotics, which have proven shelf lives that extend for YEARS past the manufacturer-contrived or pharmacy-invented expiration date printed on the side of the bottle.

As Dr. Francis Flaherty, Director of the U.S. FDA's expiration testing program noted a few years back:

"Manufacturers put expiration dates on for marketing, rather than scientific, reasons. It's not profitable for them to have products on a shelf for 10 years. They want turnover."

In short, short expiration dates are, for the most part, little more than a scam.

The fact that potent pill antibiotics are being stored for YEARS past the manufacturer's made-up expiration date is not a closely held secret. As the White House web page on the Strategic National Stockpile notes:

[Strategic National Stockpile] efficiency measure is focused on reducing the cost of replacing inventory by extending the shelf life of products that remain efficacious after their original manufacturer's expiration date through a Shelf Life Extension Program (SLEP). By extending the shelf-life of a product, the program does not need to spend money to replace that product as quickly or as often. The program's assets now include large amounts of antibiotics that cannot be rotated back into the market and chemical/nerve agent with no commercial use. Where possible, the program rotates stock in the market to avoid expiration of supplies through its vendor managed inventories. ... The program's annual efficiency measure is dollars saved per dollar invested in the Food and Drug Administration's Shelf Life Extension Program (SLEP) for available projects.

The Shelf Life Extension Program (SLEP) has found that cipro, a common pill antibiotic, is good for more than seven years past its putative expiration date.

Doxycyclin, amoxycillin, penicillin, and cephalexin are similarly long-lived if kept in a medicine bottle at normal room temperature.



It's not just Uncle Sam that stores Tamiflu and antibiotics for years at a time. The City of Los Angeles, for example, notes that its pre-positioned antibiotics have a shelf life of approximately four (4) years.

The National Institute of Health notes that the U.S. Department of Health and Human Services has a contract with Bayer, the maker of Cipro, to rotate its stock every three years -- two years longer than the expire date you will find on the same drug if you buy it at your local pharmacy.

This last point is not a small matter.

I find it hard to believe that Scott Weese does not know the difference between a manufacturer's expiration date (2-3 years) and the even more bogus date put on by dispensing pharmacies (typically 6-months or a year) which are designed to get patients to toss good medicines down the drain even faster.

I am going to be charitable here, however, and assume ignorance rather than malevolence.

After all, as pharmacist and U.S. Army Colonel George Crawford has noted:

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

And clearly no one tells you in veterinary school either. Scott Weese is living proof of that!

Bottom line: Just because a guy is a veterinarian does not mean he knows anything about drug expiration dates, generic drugs, drug manufacturing, or drug marketing.

No doubt Mr. Weese got into veterinary school by blindly regurgitating everything he was told.

If that's the case, I suspect there a few more medical mysteries he has yet to discover.

What? You say vaccinating every dog and cat every year is not needed and increases immunity disorders? How can that be true?

What? Branded drugs are no different than their generic analogs? That cannot be right!

What? A pet's generic drug needs can be filled for a few dollars at the local WalMart or Costco? There's no need to get your meds directly from the vet? Can that possibly be true?

What? Manufacturers have a financial reason to suggest you should toss out perfectly good drugs and buy more? Dispensing pharmacies have this same incentive? Unbelievable!

The good news is that on this last question, at least, the U.S. Government has voted with its wallet and with its eyes wide open.

As a consequence, perhaps a few lives may actually get saved this Fall. And wouldn't that be nice?!

A final note: A flu vaccine is the best way to make sure you stay healthy this Fall. If you are unlucky enough to come down with the flu, antibiotics will NOT help as the flu is caused by a virus.

Tamiflu might help to alleviate symptoms. That said, rest, a lot of hot fluids, and chicken soup will generally work wonders in a week or so. Give that a try.

• Related Posts and Information:
  ** Harvard Medical School Fanmily Health Guide: Drug Expiration Dates - Do They Mean Anything?
  ** Johns Hopkins Health Alerts
  ** The Medical Letter On Drugs and Therapeutics: Drugs Past Their Expiration Date
  ** The Wall Street Journal: Many Medicines Are Potent Years Past Expiration Dates
  ** Medscape: Do Drugs Really Expire
  ** Is the "Worms and Germs" Blogger Incompetent?
  ** Antibiotics for Less Without a Prescription

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Is the "Worms and Germs" Blogger Incompetent?

Is the author of the "Worms and Germs" blog incompetent?

That's the uncomfortable question I was left wondering after reading a recent post about antibiotics for dogs in which the author, Scott Weese, parades out his ignorance of antibiotics.

You see, it seems to come as a complete surprise to him that expiration dates on antibiotic pills, capsules and caplets are, essentially, a scam.

It also seems to be a complete surprise to him that most of the common antibiotics prescribed for humans are exactly the same as the ones used for dogs.

How can he not know this?

The fact that expiration dates on pill antibiotics are a marketing fraud has been widely know for years.

All you have to do is Google "expiration dates antibiotics" and the first citation given is from a Harvard heath letter entitled "Drug Expiration Dates - Do They Mean Anything?"

That post summarizes a 20-year study done by the FDA for the U.S. military:

"It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

"Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.... So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use.... Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way."

The Wall Street Journal put this story on their front page a few years back.

But don't take my word for it: You can read the article, in its entirety, right here.

"Do drugs really stop working after the date stamped on the bottle? Fifteen years ago, the U.S. military decided to find out. Sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every two to three years, the military began a testing program to see if it could extend the life of its inventory. The testing, conducted by the U.S. Food and Drug Administration, ultimately covered more than 100 drugs, prescription and over-the-counter. The results, never before reported, show that about 90% of them were safe and effective far past their original expiration date, at least one for 15 years past it.

"In light of these results, a former director of the testing program, Francis Flaherty, says he has concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer. Mr. Flaherty notes that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn't mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful."

Medscape has a post here (PDF).

The U.S. Department of Defense has a post here.

The AMA has raised questions about how much medicine is being tossed down the sink.

And on the Government of Alaska's web site, they note that the supply of antibiotics they have on hand is good for five years.

So what's going on at the "Worms and Germs" blog? How can Scott Weese not know this?

The answer, I think, is illuminating.

You see, on some important issues, veterinarians are often taught very little. The entire "course" given on canine nutrition, for example, may be a single lecture from a dog food salesman. The lecture on flea and tick remedies may be a lecture from a Merial salesperson who will detail "the spread" to be made from selling non-prescription Frontline as if it were a prescription drug (hint: it's not).

As for antibiotics, vets will learn by heart the branded and generic names of variouus drugs, and what they treat, but they may not learn other essential information.

And, as alarming as it may sound, that's true for many human doctors too.

Pharmacist and U.S. Army Colonel George Crawford, who used to be in charge of the Department of Defense's pharmaceutical Shelf Life Extension Program (SLEP) notes :

"Nobody tells you in pharmacy school that shelf life is about marketing, turnover and profits."

Right. Apparently no one does in veterinary school either.

You would think veterinarians and doctors might learn about this stuff in a Continuing Medical Education (CME) course, right?

Except there is a little joker in the deck.

You see, those CME courses are heavily subsidized by drug and vaccine makers, who help pay the speaker fees and travel costs for many of the lecturers.

Drug and vaccine makers make money when people throw good medicine down the drain, and they make money when dogs are over-vaccinated.

The business of canine health care is business, and good health and integrity often take the hind post.

Everyone in the system -- vets, pharmacies, and manufacturers -- profit when dogs are over-vaccinated and non-expired medicines are thrown down the drain.

Billions of dollars are wasted every year as a consequence.

The problem with over-vaccination and flushing good medicines down the drain is more than money, of course.

That's what makes the apparent ignorance of Scott Weese at the "Worms and Germs" blog so disturbing.

Throwing good antibiotics down the drain unnecessarily adds to the antibiotic load in our sewers, streams and rivers -- the very kind of thing that can help establish a beach head for real pathology in our own communities.

Surely a "Worms and Germs" expert knows that pathogens are not building up immunity to drugs because people are treating real flesh wounds, urinary tract infections and ear infections with antibiotics given in the proper dosage and the proper duration? It's not that!

Instead, it's because tons of antibiotics are being put into chicken and cattle feed in order to promote weight gain in otherwise healthy animals.

And it's because huge amounts of antibiotics are being tossed down the drain for no reason other than drug companies have "short dated" them with phony expiration dates.

If Scott Weese does not know about expiration dates, how much does he really know about the epidemiology of zoonotic diseases?

This is a fair question.

You see, the military's work on antibiotic expiration dates relates back to the military storage of vast amounts of antibiotics in case of germ warfare, such as Anthrax -- a very serious zoonotic disease.

With over a billion dollars of antibiotics of every type in storage, the U.S. Department of Defense wanted to know if they really had to throw away all that Cipro, Doxycycline, Amoxycillin, Clavamox, and Cephalexin.

The short answer: NO.

For the record (and I trust you will think this is good news) there is also a civilian stockpile of antibiotics.

The CDC's Strategic National Stockpile (SNS) has a vast quantity of antibiotics to protect the American public if there is a public health emergency (terrorist attack, flu outbreak, earthquake) severe enough to cause local supplies to run out.

After September 11th, many states also decided to stockpile antibiotics in case the national supply chain was somehow interrupted.

None of these drugs are tossed out every year, every two years, or even every four years.

As noted, pills, capsules and caplets of antibiotics keep a very long time.

You would think someone who teaches about zoonotic diseases at the University of Guelph (where is that?) would know this basic information.

But you would be wrong.

The good news is that experienced dog men and farmers don't spend too much time listening to Canadian academics.

After all, who would ever go to a vet that was shocked to discover that Southern States and every dog supply catalogue in the country ( see here, here, here, here) and even Amazon.com (see here) has antibiotics for sale without prescription to treat common farm and kennel ailments?

That has been true our whole lives, hasn't it?

Someone tell the associate professor.

For the record, I do not advise using antibiotics thar are four or five years old.

What I do say, however, is that pill, capsule or caplet antibiotics "are going to be fine as long as they are no older than a year or so past the expiration date."

Is that a bold statement? No, not at all.

You see, antibiotic manufacturers typically short-date their drugs with an expiration date that is two years past the date of manufacture, and never mind if the drugs are still fine three, four, or five years later.

Pharmacists, however, short-date the antibiotics even further, putting on a phony expiration date that is only one year from the date of issue.

In short, a two-year time frame is generally within a few months of the pill or capsule antibiotic manufacturer's own recommendation. And it is always well within the full potency of any antibiotic sold in America or Canada today.

Update: 4The High Cost of Veterinary Ignorance

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