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A Few Thoughts On Food!

by PAC Staff on 07/10/14

 Growing up as a kid, I liked watching “Eight is Enough” but as a veterinarian I don’t quite understand how Dick Van Patten is the go to guy for some people when they buy dog food. I tell my clients all the time the pet food industry is a billion dollar industry, so there’s a lot of time and money spent on creating perception. Terms like “all natural” and “holistic” drive me nuts---they’re meaningless when it comes to describing pet food, but create a perception like “green” might for a person searching for cleaning products or a pest control company. Organic is different—you actually have to meet criteria to use this label.

So be honest with yourself when you look at why you’ve chosen a food----are there objective criteria and science behind your choice?  Or are you buying based on  a perception created by the art on the bag or the vague terms referring to the wilderness, a harkening back to dog being distantly related to wolves? In reality wolves and dogs are genetically different— over time wolves became domesticated and evolved into modern day dogs that now do far better metabolizing carbohydrates.  A dog is not a wolf and a modern day human is not a caveman. Or how about the “grain-free” craze? This is not a new discovery or even anything groundbreaking. These diets have been around longer than the 23 years  I have been a doctor of veterinary medicine. It just means the carbohydrate in the diet is peas or potatoes rather than rice, grain, oats or barley. And don’t even get me started on raw diets—owners, as well as dogs are getting foodborne illness from these---there’s a reason we invented cooking, refrigeration, pasteurization and preservatives! People love to rag on corn, but how many people want to make an impassioned defense of potatoes? I once read a post where someone made fun of corn by asking if farmers ever complain about dogs raiding their corn fields. But how many dogs are fishing for salmon or raiding sweet potato or pea fields?

If you think a diet is “all that”, do two things: go to a search engine and type in that diet’s name and the word “recall”. Many many diets are recalled for various reasons; inadequate sanitary practices where the food is manufactured, harmful if not toxic ingredients, bacterial contamination and so on. Next, find out who makes this diet. I always get a kick out of doing this with clients when they find out that the same large company that makes Ol’ Roy (Diamond)makes Dick Van Patten and Taste of the Wild.

In summary, be informed. Look in to what you’re feeding your pet. Don’t be swayed by pretty packages or marketing fads!

  • Dr. Mike Lent

Flea & Tick Products: Actions, Use and SAFETY!

by PAC Staff on 01/23/13

Ingredients in Flea & Tick Control Products: Mode of Action, Use, and Safety
Jack E Quick, DVM


Perhaps no area of veterinary medicine has grown as rapidly as the field of flea and tick control. Fleas have become resistant to many products and with the explosion in flea numbers, there are huge efforts aimed at controlling them. Ticks can transmit a number of diseases, including ehrlichiosis or tick fever that is common in Arizona, so tick control is also receiving more attention. Today's insecticides for pets have made great advancements and a wide array of different compounds have been formulated. The goal of this article is to explain some of the common, active ingredients listed on the labels of various shampoos, dips, sprays, powders, foggers, etc. and our recommendations for our pets here in Tucson.



Products with Pyrethrin - BioSpotPyrethrins are one of the most widely used insecticides in today's flea and tick products and have been used as insecticides for over 100 years. Pyrethrins are natural extracts made from flowers of chrysanthemum plants. These plants grow naturally in the Middle East, Europe, Japan, and most importantly, Kenya. There are six different pyrethrins: pyrethrin I and II, cinevin I and II, and jasmolin I and II. All six are found in flea and tick products, but generally, the label only reads 'Pyrethrin,' regardless of which of the six types is actually present.
Mode of Action: Pyrethrins affect the nervous system of insects and result in repeated and extended firings of the nerves. They do this by affecting the flow of sodium out of nerve cells.
Use: Pyrethrins are used to control ticks, fleas, lice, Cheyletiella mites, and mosquitoes. They are mainly found in products applied directly on the pet. Household products generally contain either pyrethrins, a combination of pyrethrin and permethrin (see below), or pyrethrins plus a synergist. Synergists are chemicals that enhance the performance of other drugs. The synergist most widely used with pyrethrins is piperonyl butoxide.
Safety: All pyrethrins are easily hydrolyzed and degraded by stomach acids, so toxicity following ingestion by pets is very low. Toxicities, although rare, do occur. A cat or dog with pyrethrin toxicosis generally will salivate, tremor, vomit, and may seizure. Generally, signs of toxicosis will be gone after 24 hours.

Pyrethroids (e.g.; Permethrin, Phenothrin, Etofenprox)

Products with Permethrin - CutterPyrethroids are synthetic pyrethrin compounds. That means they are made in a laboratory and are not natural plant extracts. Common synthetic pyrethrins are allethrin, resmethrin, phenothrin, etofenprox, and permethrin. Allethrin and resmethrin are commonly used as flying insect killers, while phenothrin, etofenprox, and permethrin are used to control fleas and ticks. These may be slower in action than the natural pyrethrins, but have a longer effect.
Mode of Action: Pyrethroids, like pyrethrin, affect the nervous system of the insect, causing repetitive nerve firings.

Use: Pyrethroids are used for the control of ticks, fleas, lice, Cheyletiella mites, and mosquitoes. In addition to killing these parasites, they also repel them. Because permethrins last longer than natural pyrethrins, they are commonly found in premise sprays and in products intended for slower, but sustained action. Permethrins are soluble in oils, but not in water. This is used to advantage in products that use an oil carrier to enhance distribution of the pyrethroid over the animal's body and prolong his activity, e.g., once-a-month BioSpot Spot On for Dogs, Defend, and K9 Advantix
. Permethrin should NOT be used on kittens or cats. Bio Spot-Spot On for Cats, which contains etofenprox, is labeled for use in cats.

A pyrethroid that is often used in the environment is fenvalerate.

Safety: Pyrethroids are less easily broken down than pyrethrin, so this makes their toxicity, though low, higher than that of pyrethrin. As with any pesticide, some animals may show a temporary sensitivity where the product is applied. A patient with pyrethroid toxicity will salivate, tremor, vomit, and may seizure. If these signs occur, consult your veterinarian.

When pyrethroids are used in the outdoor environment, there is virtually no leaching into the soil, and when used properly, pyrethroids are very safe. The World Health Organization states fenvalerate 'will only cause a problem if spilled.' Permethrin and most other pyrethroids should NOT be used on kittens or cats.

Organophosphates (and organocarbamates)

Do NOT use pyrethroids, organophosphates, organocarbamates, or amitraz in cats.
Organophosphates and organocarbamates are another class of drugs that have had wide usage as insecticides both in agricultural settings and for pet animals. Commonly used organophosphates and organocarbamates include dichlorvos, cythioate (Proban tablet), diazinon, malathion, carbaryl (Sevin), fenthione, methylcarbamate (Adams Flea and Tick Collar), and prolate.

Mode of Action: Organophosphates function by blocking nerve inhibition, i.e., when organophosphates are present, a nerve that is firing will continue to fire. They do this by inhibiting acetylcholinesterase, an enzyme necessary for normal nerve function.

Use: Organophosphates are used in termite control and have many agricultural uses including the control of corn rootworms and cattle parasites. They are also present in various ant and roach control products.
Organophosphates, should NOT be used on cats.

Safety: Organophosphates and organocarbamates are the class of insecticides most likely to cause toxic reactions in pets. If toxic levels are applied to the pet, (or the pet ingests them), the pet will experience nerve abnormalities. A pet suffering with organophosphate poisoning will salivate, tremor, stagger, and may seizure. An antidote is available to counteract its effect. At our hospital, we have seen two cases of organophosphate poisoning in pets. Both were accidental ingestion of large quantities of the chemical, and fortunately neither patient died. NOTE: Greyhounds and Whippets can be overly sensitive to organophosphates so use a different product in these breeds.

Imidacloprid (Advantage)

Imidacloprid is another new insecticide, which is in yet a different class of chemicals. The product Advantage contains imidacloprid.

Mode of Action: Like most insecticides, imidacloprid interferes with the nerve conduction system of insects. Imidacloprid acts by blocking the nerve receptors. It kills fleas, but does not have activity against ticks.

Use: Imidacloprid is most commonly used as a once-a-month topical insecticide on cats and dogs to kill fleas. Imidacloprid is mixed with an oil carrier and the drug collects in the hair follicles from which it is slowly released.

Safety: Imidacloprid has a wide margin of safety, but as with all other pesticides, some pets may develop sensitivity to the product.

Arylheterocycles (e.g.; Frontline)

Fipronil is the most commonly used product in this relatively new group of synthetic insecticides, such as Frontline Top Spot.

Mode of Action: Arylheterocycles block the passage of chlorine through cells in the insect's nervous system and this results in paralysis.

Use: Fipronil is most commonly used as a once-a-month topical insecticide on cats and dogs to kill fleas and ticks. Fipronil is generally mixed with an oil carrier and the drug collects in the hair follicles from which it is slowly released.

Safety: As with any pesticide, some animals may show a temporary sensitivity where the product is applied. Some animals may also develop more severe sensitivities, and if so, a veterinarian should be consulted.

Insect growth regulators & development inhibitors

Spot OnInsect growth regulators (IGRs) and insect development inhibitors (IDIs) are relatively new components of flea and tick products. Insect growth regulators include methoprene (Precor), fenoxycarb, and pyriproxyfen (Nylar). Insect growth inhibitors include lufenuron and diflubenzuron. Products containing IGRs and IDIs include Program, Sentinel, Bio Spot, Adams Flea and Tick Spray.



 Preventic Plus Flea and Tick Collar, and Frontline Plus.

Mode of Action: IGRs and IDIs differ from traditional flea product ingredients in that their main activity is against the immature forms of the flea. The IGRs mimic the juvenile growth hormone of fleas. The juvenile growth hormone is what keeps the fleas from developing into more mature forms. When the levels of juvenile growth hormone decrease, the larva form matures. The IGRs keep this development from occurring and the immature forms of the flea fail to molt and death occurs.

The IDIs inhibit the synthesis of a substance called chitin. Chitin is necessary for the formation of the hard outside skin (cuticle) of the flea. No chitin, no adult flea.

Use: Note that the IGRs and IDIs do not kill the adult fleas, so to be most effective, they should be used along with a product that does kill the adults (adulticide). If there is little risk of flea infestation, the IGRs and IDIs may be enough to prevent a flea infestation. However, if flea problems already exist, or the risk is high, it is best to also use an adulticide.

Many IGRs and IDIs are used in the environment as ingredients in foggers and sprays. They are also applied topically to cats and dogs, given orally, or by injection.

Remember, at this point there are no effective IGRs or IDIs for ticks.

Safety: Because IGRs and IDIs mimic insect hormones or alter a unique insect process (the making of chitin, which mammals do not make), they are extremely safe.

Amitraz (Preventic collar)


Amitraz is an ingredient that is used as a dip to treat demodectic mange. Amitraz has also been shown to be highly effective when used as an ingredient in tick collars for dogs. It has little or no effect on fleas, so is used in control of ticks only. Do NOT use Amitraz on cats.

Mode of Action: Amitraz belongs to a group of drugs called formamidines and is an ingredient in Preventic Collars. Formamidines kill ticks by inhibiting their nerves.

Use: Amitraz has been proven to kill ticks, which have become resistant to more traditional compounds such as organophosphates. Amitraz is a lipophilic drug, meaning it distributes well over the entire skin, even in large dogs. Most ticks are killed by Amitraz prior to attachment or if they do attach, they are killed in less than 24 hours, thus preventing the transfer of Lyme disease. Tick collars containing Amitraz can be used at the same time with many other flea and tick products such as Bio Spot-Spot On for Dogs (check the labels, or with your veterinarian, first). The concentration of Amitraz in the collars may not be high enough to kill demodectic mange.

Safety: Collars containing Amitraz are very safe in dogs, if used correctly. The collar needs to be placed so you can get two fingers between the collar and the dog's neck – no more, no less. If the collar is placed too tightly, irritation can occur. Be sure to cut off any excess portion of the collar so the dog (or other pets) cannot chew the end of it. If ingested by a pet, contact your veterinarian.

Selamectin (Revolution)

Mode of Action: Selamectin kills parasites by blocking nerve signal transmissions. Revolution enters the bloodstream through the skin. It then stays in the bloodstream protecting against heartworm disease, passes into the gastrointestinal tract where it can kill certain intestinal parasites, and passes into the sebaceous glands and then onto the hair and skin providing protection against fleas and certain mites and ticks.

Use: Selamectin is a topical insecticide used for the treatment and prevention of fleas, ear mites, some internal parasites, and some types of mites and ticks; and the prevention of heartworm disease. Over 98% of fleas on the pet are killed within 36 hours of application. Once in contact with Revolution, fleas will not lay viable eggs.

Safety: Selamectin is safe to use on collies, breeding males and females, and pregnant and nursing females. Do not use it on kittens or puppies less than 6 weeks of age. Use caution in using it on sick, weak, or underweight animals, or animals with broken or irritated skin.

Nitenpyram (Capstar)

Nitenpyram (Capstar) is approved in cats and dogs to kill fleas.

Mode of Action: Nitenpyram interferes with the nerve conduction system of insects, blocking the nerve receptors.

Use: Nitenpyram in Capstar, an oral flea control product, is approved for use in cats and dogs over 4 weeks of age and 2 pounds of body weight. Nitenpyram starts killing adult fleas that are on the pet within 30 minutes. The peak effect after administering the medication is about 3 hours for the dog and 4 hours for the cat. It will be very useful in certain circumstances such as prior to surgery, boarding, or grooming. It will also help prevent pets from bringing fleas home from shows, trials, or trips to the park. The pet could be given the pill before leaving for the park or before heading home from a distant show. Any fleas on the pet will be dead within several hours. It will not work for on-going control as the medication is out of the pet's system within 24 hours.

Safety: Capstar appears to be very safe. It is safe for kittens and puppies 4 weeks and older, weighing 2 pounds or more, as well as for pregnant or nursing cats and dogs.

Citrus extracts

Citrus extracts are now being termed 'the all natural way' to control fleas and ticks. The best known of the citrus products generally contain d-Limonene or linalool. These are extracted from the peelings of citrus fruits. We basically have found these all natural citrus products to offer no advantage over traditional products, except perhaps in the pleasant citrus fragrance they impart to the coat.

Mode of Action: Citrus extracts affect the flea's nerves.

Use: d-Limonene and linalool are used in dips, sprays, and shampoos. In heavily infected flea regions, citrus extracts are probably not effective enough as an insecticide unless used in conjunction with more potent products.

Safety: Even though all natural, citrus extracts can be toxic to the pet and should be used in strict accordance to the label. Poisoned pets may salivate, stagger, and lose body heat. Some animals may have hypersensitivity and develop skin rashes, especially on delicate tissue such as the scrotum or vulva. Some citrus-extract products have been fatal to cats. Remember, 'Natural' does NOT necessarily mean 'Safe.'

Herbs & vitamins

Brewer's yeast, thiamine, garlic, citronella, rosemary, and other herbs have been advocated as effective flea control substances. There have been no clinical trials to prove their effectiveness. This does not mean they may not work in some situations, but their reliability is questionable. As with citrus extracts, these 'natural' products are not without potential harm. Use them carefully.


For our animals here in Tucson we are mainly concerned with preventing tick infestation especially during the monsoon season. The most common tick in southern Arizona is the brown dog tick (Rhipicephalus sanguineus). High levels of infestation can cause skin irritation and damage in dogs, and the population can reach pest proportions in houses and kennels. In the U.S., R. sanguineus is a vector of disease in dogs; canine ehrlichiosis (Ehrlichia canis) and canine babesia (Babesia canis). These rarely cause disease in humans; only a few cases are known. In dogs, symptoms of canine ehrlichiosis include lameness and fever; those for babesiosis include fever, anorexia and anemia. Both have been found in Arizona. In parts of Europe, Asia and Africa R. sanguineus is a vector of Rickettsia conorii, known locally as Mediterranean spotted fever, boutonneuse fever, or tick typhus. Rhipicephalus sanguineus has not been shown to transmit the bacterium which causes Lyme disease.  The brown dog tick, Rhipicephalus sanguineus Latreille, is unusual among ticks, in that it can complete its entire life cycle indoors. Because of this, it can establish populations in colder climates, and has been found in much of the world. Many tick species can be carried indoors on animals, but cannot complete their entire life cycle inside. Although R. sanguineus will feed on a wide variety of mammals, dogs are the preferred host in the U.S. and appear to be required to develop large infestations.


Infestations in houses can explode to very high levels quickly. Typically, a few ticks are brought into the house or kennel, often on a dog which has been away from home. The early stages of the infestation, when only a few individuals are present, are often missed completely. The first indication the dog owner has that there is a problem is when they start noticing ticks crawling up the walls or curtains! The best management strategy is prevention of infestations in the house or kennel. Please feel free to discuss tick control with any of our staff or veterinarians. Preventing engorgement of the ticks on dogs is critical to management of the tick and the well-being of the dog. Treatments with fipronil Frontline Plus (in sprays and spot-ons), amitraz (often in flea and tick collars), permethrin (sprays and shampoos) and deltamethrin (shampoos) have been reported as effective. Regular treatment will minimize the chances of a dog picking up a tick and the tick successfully feeding. Treatment will also reduce attachment by other species of tick, such as the American dog tick or the blacklegged tick. Once an infestation has started, thorough treatment of the dogs is critical and may need to be repeated several times. Follow your veterinarian's instructions and the directions on the any tick control product you use. Dogs should be examined regularly and attached ticks removed and disposed of. It may be necessary to treat the house or kennel, paying particular attention to cracks and crevices. Pest control operators should be consulted. Other mammals should be monitored and treated if necessary, but be careful about treatments used on cats. Some tick and flea treatments for dogs are poisonous in cats. People should check themselves regularly; although rare in the U.S. this species will bite humans. DEET (found in many insect repellents) does repel these ticks, but may not be practical if an infestation is inside a house. Use according to label directions.


Our first choice for both flea and tick prevention for both dogs and cats is Frontline Plus. This product is easy to apply to the skin and has very few if any side effects and is effective for at least one month against ticks and up to 3 months for fleas. Frontline for cats is safe for cats. Frontline is non-prescription and can be purchased from numerous retailers. Please follow the package instructions for proper application especially with cats. If you have any questions please feel free to contact any of our staff we are glad to help.



Summer Safety Tips for your Pet!!!

by PAC Staff on 06/28/12







If kept outside, make sure your pet has plenty of shade. Remember that doghouses are not good shelter     during the summer as they can trap heat.



Make sure your dog has access to plenty of cool, fresh water 24 hours a day. If your dog travels with you, bring along water and a bowl.



Never leave your dog in a vehicle on a warm day. Even with the windows open the temperature inside a car can rise to over 100 degrees in a matter of minutes.



It’s fun to take your dog with you to run errands, but if you can’t bring your dog inside the store, it’s best to leave him home. Tying a dog outside a store is dangerous because he is exposed to the hot sun and strangers who could be unkind.



Avoid strenuous exercise on extremely hot days. Take walks in the early mornings or evenings, when the sun’s heat is less intense.



Make sure your dog’s vaccinations are up-to-date. Dogs tend to stay outdoors longer and come into contact with other animals more during the summer months.



Keep dogs off lawns that have been chemically treated or fertilized for 24 hours (or according to package instructions), and away from potentially toxic plants and flowers.


Visit http://www.akc.org/pdfs/public_education/hazardous_plants.pdf for a list of toxic plants.



Mosquitoes (which carry heartworm disease) along with fleas and ticks are more prevalent in warmer months. Ask your veterinarian for an effective preventive to keep these parasites off your dog.



Many dogs like swimming, but some cannot swim or may not like the water. Be conscious of your dog’s preferences and skills before putting him in the water. Always supervise your pet while swimming.



Chlorine from pools and bacteria from streams, lakes and ponds can be toxic for a dog’s system. Always rinse your dog with clean water after swimming. Beware of the wildlife that may pose a danger to your swimming pet. Some catfish are known for attacking small dogs.



Many airlines will not ship animals during summer months due to dangers caused by hot weather. Some will only allow dogs to fly in the early morning or in the evening. Check with your airlines for specific rules. Shipping policies can be found at http://www.akc.org/pdfs/canine_legislation/airline_chart_0605.pdf.



If traveling by car, keep your dog cool by putting icepacks such as frozen water bottles in his crate. DO NOT use freezer ice packs which contain poisonous materials. Make sure the crate is well ventilated. For more traveling tips visit http://www.akc.org/public_education/travel.cfm.



Be aware that asphalt can quickly get hot enough to burn the pads of dogs' paws. In hot weather, walk your dog on the grass or dirt where is it cooler.


Summer Safety 2012

by PAC Staff on 06/05/12

Summer is a fun time for people and their pets but as the temperatures rise, so do the risks of summer hazards.  Here are a few summer dangers and the precautions you can take so you and your four-legged family members can have a happy and safe summer.

 Desert Dangers:  Rattlesnakes are active from early spring to late fall in Arizona.  If you believe that your pet has been bitten by a rattlesnake, seek veterinary care immediately!  We strongly recommend enrolling your dog in rattlesnake avoidance training; please contact us for information on trainers in the Tucson area.  Colorado River/Sonoran Desert toads also become active in the summer months and are toxic to dogs.  If your dog licks or bites a Colorado River toad, flush its mouth with water (with the dog’s nose pointed towards the ground so the water cannot flow into the lungs or be swallowed) and seek veterinary care.  Avoidance training for Colorado River toads is also available.

 Heartworm Disease:  Heartworm disease is a serious and potentially fatal disease that is caused by parasitic worms that live in the heart and the vessels of the lungs.  Heartworms are spread by mosquitos and as the summer heats up and the monsoons arrive, the numbers of mosquitos increase.  Unfortunately, the numbers of heartworm positive dogs are increasing in Arizona and we have already diagnosed 4 heartworm positive dogs at Pantano Animal Clinic in the last year.  Luckily, heartworm disease is preventable!  Year-round heartworm prevention is easy, safe and inexpensive (especially compared with expensive and complicated treatment).  In addition to preventing heartworm disease, the year-round monthly heartworm preventive also treats and controls roundworms and hookworms.  Roundworms and hookworms can spread to people (causing serious diseases, especially in children) so year-round heartworm prevention protects all members of your family!

 Heat:  Never, ever leave a cat or dog alone inside a parked vehicle!  Even with the windows down, the temperature inside the car will rise to fatal levels within minutes.  Our pets are prone to heatstroke, so be sure to schedule exercise and walks in the early mornings or late evenings and be sure to have plenty of water available.  Don’t forget that hot pavement can quickly burn the pads of your dog’s paws.

 Travel Dangers:  Pets that travel with their families can easily become lost in unfamiliar surroundings.  If you are traveling this summer, be sure that your pet has an up-to-date tag (with at least two phone numbers) on its collar.  If your pet is not already microchipped, please be sure to get it microchipped!  Please contact us at Pantano Animal Clinic with any questions about microchipping your pets.  If your pet is already microchipped, be sure that all your contact information is up-to-date with the microchip company.  If you are traveling outside of Tucson, we recommend becoming familiar with the veterinary hospitals in the locale you are visiting so that you will be prepared if the need arises.

Enjoy the summer months ahead!  Please don’t hesitate to contact us for any advice on keeping your four-legged family members healthy and safe this summer.

Author: Dr. Erika Hartle, Pantano Animal Clinic

Valley Fever and Your Pets

by PAC Staff on 05/22/12


Valley fever is a disease caused by the fungus Coccidioides immitis.  This fungus grows in the soil of the desert southwest because it does well in alkaline soil, low elevations and a warm, dry climate. It is very easily aerosolized—blown up into the air as dust—and spread via the wind. Construction or animals digging can disturb it, but even indoor cats are susceptible to it being pulled in through the air conditioning. A previous study done by the geology department at the U of A showed that valley fever infections have been found all over the Tucson area with a very slight increase in areas that have higher rainfall (which allows more fungal spores to grow).   It can affect most species of domestic animals, but  this article will focus on valley fever of dogs and cats.

The most common site of the body infected by valley fever is the lungs. However, it can disseminate—or spread to other parts of the body—and infect the bones, skin, eyes, brain, or spine/spinal cord. In very rare cases, it can affect the heart muscle, scrotum/testes, or the gastrointestinal tract.

The most common clinical signs are fever, lethargy, decreased appetite, coughing, and weight loss. These correspond to the most commonly infected primary site, the lungs. Other clinical signs correspond to the body system infected: limping for bone infections, open/weeping sores in the skin, inflammation in the eye, seizures or other neurologic abnormalities in the brain, neurologic abnormalities (weakness of the limbs, knuckling over, etc) and pain over the spine if the spine or spinal cord are affected. It is so common in our area that for any animal that is acting sick, especially ones with more vague signs, I put valley fever on the list of possibilities.

Valley fever is most commonly diagnosed by a combination of history, clinical signs, blood work and x-rays (in some cases, direct sampling of the tissue, especially the skin or bone, may yield organisms). The classic appearance on the white blood cell count (WBC or leukogram) is an increased white blood cell count because of the inflammation characterized by two different types of white cells. The valley fever titer is an antibody test, so it only checks for the body’s response to the disease, not if the disease is actively present or not. Elevated titers are usually indicative of disease, but the “art of practice” comes in with lower titers---are these exposure to the organism but not infection or true disease? These titers have to be considered in light of clinical signs, supporting lab tests, x-rays, etc.  However, we do occasionally empirically treat dogs (and cats) that we have a strong suspicion have the disease, but may test negative, with fluconazole and an anti-inflammatory.

Treatment most often consists of fluconazole. This is the safest and most effective antifungal medication. In my experience, it also seems to be the best tolerated. In rare cases where valley fever does not respond to fluconazole, we will refer dogs to internal medicine specialists for liposomally encapsulated amphotericin B treatments. This is quite expensive and can often require many treatments.

It is important to realize with valley fever that unless an infection is confined solely to the lungs, valley fever, in my opinion, can never be completely cured. In infections in any other site of the body, these dogs must be on some lifetime maintenance dose of medications. In bone cases, this can commonly be as little as three times a week or as often as once a day. So it is important to never stop the drug in those cases, as it can come back worse and disseminate or spread to other parts of the body.

It is also important to track the progress of treatment success by repeating valley fever titers (as well as other supporting clinical lab data if that was initially abnormal) to ensure they are declining. I also recommend rechecking annual titers in lung cases, because I have seen a few of these turn out to have valley fever in other sites that were not initially apparent.

Also, immunosuppressants such as prednisone should be avoided in these patients (especially if someone has stopped the fluconazole), as it could allow the infection to more easily disseminate.

Please don’t hesitate to schedule an appointment to discuss valley fever concerns with myself or any of our doctors here at Pantano Animal Clinic.