1. The First Visit to the Veterinarian dr. Ákos Máthé Department of Internal Medicine

2. A golden chance To examine the new patient To bond a new client to your practice ~Health examination - congenital defects ~Vaccination programs ~(Parasites: flea control and deworming) ~(Nutritional management)

3. Health examination History ~For how long has the owner the puppy/kitten? ~How and where did she/he acquire it? ~Information about littermates, parents ~Previous vaccinations, flea control, deworming ~Patients appetite, any abnormality

4. Health examination II. General physical examination ~Clinical impression: behaviour, grooming, nutritional state etc. ~Rectal temperature ~Skin, ears, eyes, parasites ~Lymph nodes, mucous membranes ~Respiration and circulation ~Mouth and abdominal palpation ~Testicles ~Movement, skeletal deformities

5. Common congenital and inherited problems discovered by physical examination Heart murmurs Abnormal bite Problems with dentition Umbilical hernia Cryptorchidism

6. Congenital heart murmurs „Innocent murmurs” ~Healthy pups/kittens ~Left craniodorsal heartbase, 1-3 degree ~Varies with body position ~Usually disappears at 14-16 weeks of age Pathologic murmurs ~4-6 degree with precordial thrill (fremitus) ~Cyanotic mucosae +/-, abnormal pulse +/-

7. Most common congenital heart abnormalities Patent ductus arteriosus ~Poodle, collie, German shepherd, Siamese, Persian Pulmonic stenosis ~Beagle, English bulldog, fox terrier Subaortic stenosis ~Newfoundland, boxer, golden retriever Atrioventricular valve dysplasia ~Great Dane (Persistent right aortic arch - history with regurgitation) ~German shepherd, Irish setter

8. Abnormal bite Normal bite: lower incisors are just behind upper incisors, mandibular canine occludes in interdental space between lateral upper incisor and maxillar canine Brachygnathic bite (short mandible) ~Lower canines may occlude at level of upper canine ~Can cause palatal trauma  orthodontic techniques recquired Prognathic bite (long mandible) ~Normal in brachycephalic breeds (Bulldogs, Boxers, Persian and Himalayan cats) ~Mild form: level bite (excessive wearing) Rostral crossbite

9. Dentition problems Anodontia ~Absence of one or more teeth Retained deciduous teeth ~Increased plaque formation  parodontal disease ~Abnormal positioning of permanent teeth ~Removal necessary as early as possible ~Yorkshire terriers Supranumerary teeth ~Crowding

10. Umbilical hernia ~Failure of normal closure of umbilical ring ~Contains part of the omentum, sometimes intestinal loop ~Airedale terriers, Pekingese, pointer ~Usually does not cause health problem

11. Cryptorchidism Testicles are not in the scrotum by 8 weeks of age Unilateral > bilateral Testicle is in the abdominal cavity or in the subcutis of inguinal region Hereditary, probably autosomal recessive Poodles, Yorkshire terriers, chihuahua, Pekingese, Maltese, Persian cats In dogs risk of neoplasia in cryptorchid testicle Should be castrated!

12. Vaccination - general considerations Only vaccinate animals in good health Always take temperature Owner should keep puppy/kitten indoors until basic vaccinations are completed, and have taken effects! Select protocol based on patients planned lifestyle ~Cat:- outgoing or indoors? - breeding and show animals ~Dog:- frequent walks/hunts in forrests? - access to rodents - dog kennels

13. Vaccination - general considerations II. Use as few antigens as necessary for patient profile Use multivalent vaccines rather than combine vaccines yourself ~multivalent vaccines are tested for antigen interference  they are safe and effective If you use more than one vaccine at once never mix them, and inject to multiple locations

14. Causes of vaccination failure Host ~Maternal antibody interference ~Immune deficiency/suppression ~Incubating disease at time of vaccination ~Breed: Rottweilers, Staffordshire terriers, Dobermanns, German shepherds are more susceptible for parvovirus

15. Causes of vaccination failure II. Human error ~Improper vaccine handling, storage ~Skin disinfection used ~Early exposure of patient to virulent strain ~Use of passive immunization within 3 weeks ~Wrong vaccination protocol

16. Postvaccinal complications Immunologic ~Type I.: urticaria, anaphylaxis (Leptospira, rabies, FeLV, feline respiratory diseases) ~Type II.: cytotoxic reaction - IHA, AITP (parvovirus, distemper) ~ Type III.: immune complex deposition - uveitis (attenuated CAV-1) Local granulomas or sarcomas (cats) (Leptospira, rabies, FeLV)

17. Postvaccinal complications II. Fever ~Any modified live virus (MLV) Abortion, congenital malformation ~Any MLV, especially parvoviruses Clinical disease ~Cat: calicivirus, herpesvirus ~Dog: parainfluenza virus, distemper

18. Vaccination program for puppies (having colostral immunity) 8-9 weeks:D, A, Pv, (Pi, CoV) 12-13 weeks:D, A, Pv, (Pi, L, CoV, Ly) (14-15 weeks:may go to street/park) 15-16 weeks:Ra, (D, A, Pv, Pi, L, CoV, Ly,) <1 year:Ra D = distemperCoV = coronavirus A = CAV-1 or CAV-2L = Leptospira Pv = parvovirusLy = Lyme disease Pi = parainfluenza virusRa = rabies

19. Remarks for dog vaccinations Use high titer potentiated MLV Pv vaccines in puppies Give additional vaccination for Pv to Rottweiler, Staffordshire terrier, Dobermann, German shepherd puppies at 15-16 weeks of age Only give CoV if owner asks for it or wants „complete protection” Do not give CoV and L simultaneously if possible

20. Remarks for dog vaccinations II. Boosters: D, A, Pv, (Pi, L, CoV, Ly) yearly, Ra every 1-3 years depending on law Do not use MLV-s in pregnant bitches Colostrum deprived puppies ~Vaccinate at 3, 6, 9, 12 weeks with D, A, Pv using inactivated Pv first, then potentiated MLV Pv ~(Pi, L, CoV) are optional at 9, 12 weeks

21. Vaccination program for kittens (having colostral immunity) 8-9 weeks:P, Rh, C, (Ch, FeLV) 12-13 weeks:P, Rh, C, (Ch, FeLV, FIP, Ra) 15-16 weeks:(P, Rh, C, Ch, FeLV, FIP) P = panleukopeniaFeLV = Feline leukaemia virus Rh = rhinotracheitisFIP = Feline infectious peritonitis C = calicivirusRa = rabies Ch = Chlamydia

22. Remarks for cat vaccinations If inactivated P is used, give it 3 times, MLV P is enough twice P, Rh and C also exist as intranasal vaccines ~but parenteral P is more effective ~intranasal Rh and C are more effective, but may cause mild disease Give inactivated P, Rh, and C to pregnant queens and immunosuppressed cats (FeLV +, FIV +) FIP is intranasal, only useful for seronegatives

23. Remarks for cat vaccinations II. There is no benefit and no harm if you give FeLV vaccine to a positive cat FeLV vaccination does not provide complete protection FeLV vaccination does not cause test positivity Boosters: P, Rh, C, (Ch, FeLV, FIP) yearly Ra every 1-3 years Colostrum deprived kittens: ~P, Rh, C at 3, 6, 9, 12 weeks (use inactivated P for first time) ~(Ch, FeLV) at 9, 12 weeks ~(FIP, Ra) at 12, 15 weeks

24. Microsporum canis vaccine Killed vaccine Useful as part of treatment regimen against ringworm Three times with 3 weeks intervals Only IM to dogs, IM or SC to cats Local reactions