We require 2 business days notice for all prescription refills. This includes medications from the clinic and approvals of prescriptions from online pharmacies, compounding pharmacies or local pharmacies in Santa Fe. Keeping ahead of your animal’s medication refills is your responsibility. Please plan ahead.
We cannot refill medications for animals who we have not been seen by one of our doctors in over 12 months. In this case, if you need a refill of a medication you will need to schedule an appointment to be seen by one of the veterinarians.
Some long-term medication refills (including but not limited to pain medications, thyroid medications, heartworm medications) require regular lab testing in order to assure the animal’s health and that the medications are being given at the appropriate dose. Please plan ahead when needing refills on these medications as there will be additional delay while awaiting lab results.
Providing your animals with prescription medications at an affordable price is becoming a challenge. Keeping all of the medications that your animal may need in stock in our clinic pharmacy leads to increasing costs for us and for you. In order to continue to provide you and your animals with the best care at affordable prices, we have made some simplifications in the way we provide medications and prescriptions for your animals.
We will continue to stock those medications not readily available at the human pharmacies as well as those medications that we commonly need to begin giving without delay.
Many of the medications that we use are also used for people and are available at a local pharmacy. Most of them are now available from an online pharmacy. We cannot compete with the prices offered by these large national pharmacy chains who use some medications as loss leaders and who get huge volume discounts from suppliers. For these medications will provide you with a written prescription that you can take to the pharmacy of your choice.
We will not call in prescriptions to pharmacies. Our experience with the chain store pharmacies in Santa Fe has become quite frustrating over the past few years. When calling in your prescriptions and refills, we’ve discovered that customer service and record keeping are lacking, leading to hours spent on the phone by our staff repeating and verifying prescriptions that have been mis- recorded, mis- understood or lost by the pharmacy staff, and leading to repeated visits and long waits for you to pick up your animal’s prescription medications. Refill requests from these pharmacies need to be faxed or emailed to us for approval.
Some of the medications that we use are not available in doses or forms that are easy to give to your animal patients. In these cases we turn to compounding pharmacies to mix the medication in to the appropriate dose and in a form (chewable, liquid or transdermal) that is easier to give. These compounding pharmacies typically bill you directly and ship the medications to you at your home.
Supplements, Nutraceuticals and Unapproved medications?
There are an increasing number of over-the-counter supplements and medications available for every ailment for your animal. These are advertised heavily in trade magazines and on the internet. Why don’t we commonly use these medications in our practice? Let me provide some answers here.
Many of the medications that we use for your animals are approved by the FDA specifically for that use. For example a drug called KinaVet is FDA approved to treat Mast Cell Tumors in dogs. What does this FDA approval mean? It means that the drug has been tested in a species and for a specific disease and has shown to be effective at treating that disease in that species. It has also been shown to be safe, the doses, side effects and adverse effects are known. So generally, we know the good and bad of what we are getting.
Approving every drug for every use in every species of animal that we treat would be cost prohibitive and take an endless amount time. Veterinarians have the ability to use a drug in an “extra-label” manner, meaning that we can use a drug in a species or for a disease that it hasn’t been approved in if we have reason to believe it will work for the intended purpose and that it will be safe. Most drugs that we use in an extra-label fashion have been researched and tested in clinical trials by veterinarians at research centers or in clinical practice. These trials are important, as they help us know that a drug will work on a specific disease in that species and that it will be safe for that species at the established dose.
What about these life-saving supplements that you read about in the back of your horse magazine or find on the internet when searching for a solution for your dog’s illness? Those who sell them may be well-intentioned. The supplements may actually be effective. They may be safe. But we don’t know.
We have had the personal experience of using such compounds on a few patients after nothing “tried and true” was working. In one case, we were assured by the maker that “there were no side effects!” With some trepidation, we proceeded to use the treatment, but with stipulations to the client. We were going to administer the substance in the clinic. We were going to monitor the patient closely and stop administration if we felt it was unsafe. The animal’s heart rate rose significantly and his temperature rose above pre-treatment levels. We stopped administration and the vitals would return to normal. Every time we restarted administration of the substance they would again rise. Eventually, he got the whole treatment but it did have side effects, which could have caused a real problem for the animal had we not recognized them and let them resolve. It did not cure the condition as the maker said it would.
Some supplement makers are using laboratory “bench chemistry” to make a compound and a claim, not doing trials in the species or diseases they intend to treat. Some are using research into past publications as a basis for their new claims. Some are simply conjecturing. Some do have good science behind their treatment but are looking to you to finance their research and clinical trial on your pet.
When it comes down to these supplements and treatments, ask lots of questions before you consider buying them:
Has it been used in this species? (cats’ metabolic processes are very different from dogs’ or people’s.)
Has it been used for this specific condition? (squamous cell carcinoma and not just “cancer”. Acute pancreatitis and not just “inflammation”?)
Is there data to show that it is effective?
Is there data to show that it is safe?
What are the side effects? What are the adverse effects? What is an overdose? (If the claim is “no side effects” that is a red flag. It means they haven’t looked or paid attention. Even water has side effects and adverse effects if overdosed.)
Who is making this stuff?
Where are they making it?
Are manufacturing processes and ingredients consistent, standardized and safe?
What is the maker’ s background, training and experience?
How long has this been out on the market? (Have enough others tried this first to support claims that it is safe and may be efficacious?)
The long and the short of it is, “Let the buyer beware.” We use medications and supplements that we know have been studied, that we know are safe and that we know will provide our patients some benefit.
Joint Supplements for Horses
Arthritis & degenerative joint disease are some of the most commonly diagnosed and treated problems of horses. Treatment of is often done with non-steroidal anti-inflammatories (NSAID) such as phenylbutazone (“bute”), Banamine (flunixin), Equioxx (firocoxib), Surpass (diclofenac) and/ or steroids, hyaluronic acid (HA, Legend) or polysulfated glycosaminoglycans (PSGAGs, Adequan). These medications may be given orally, in feed, topically, intraarticularly (IA, into a joint) or systemically by intramuscular (IM) or intravenous (IV) injection.
Perusing periodicals targeted at horse owners, you will find a few advertisements for the above-mentioned drugs and many more ads for “joint supplements.” These compounds are touted as miraculous, joint preserving, career saving, winner- making compounds that you can order without a prescription. They may claim to have no side effects and be 100% safe.
What are joint supplements? How do they work? DO they work? How do you choose which product to select? All good questions, many without solid answers.
Most joint supplements contain some combination of glucosamine, chondroitin, methyl-sulfonyl-methane (MSM), avocado/ soybean unsaponifiables (ASUs), omega-3 fatty acids, yucca extracts and a variety of other ingredients.
These compounds are thought to be the building blocks of healthy cartilage, synovium (the tissue surrounding the joint) and synovial fluid (the lubricating fluid in the joint). They are thought to be small enough molecules that they will be absorbed from the intestine into the blood and distributed into the joint tissue where they are used to keep the joint healthy, limiting the arthritic process
Joint supplements are considered “nutrient supplements,” not drugs. A drug has to pass FDA criteria for safety, efficacy and consistency of product. In other words it has to be shown cause no harm to the animal that it is administered to, to have the effect that the manufacturer claims, and to be consistent in what it contains and provides the animal.
A nutrient supplement does not have to meet any of the above criteria. It is completely untested and unregulated. As many of you have heard me say, you and I could go sweep the porch, put the contents of the dustpan into a capsule and call it a joint supplement
Some research has been done that shows in general these compounds can get from the GI tract and into the joints. If they make it to the joint, they can modify the arthritic process and provide for a healthier joint
However, most of the joint supplements on the market have absolutely no research into their formulation to back up the claims made on their label about how well absorbed they are or how well they work.
The problems are consistency of quality and function of the commercial products. Since commercial joint supplements do not have to prove their consistent quality, the commercial products can vary greatly from brand to brand and even from batch to batch within a brand, depending on the source that the manufacturer uses for ingredients.
Because the manufacturers do not have to meet any requirements for the efficacy of the product, they do not have to back up the claims made in their ads.
How do you decide which joint supplement to use? You have to do the research. Ask friends which products they have used on their animals and which products they feel have worked. Ask the staff at the feed store which products are more popular and sell more. Maybe these are the products that work
The drugs Adequan (a polysulfated glycosaminoglycan or PSGAG) and Legend (hyaluronic acid) are larger molecules that are made up, in part, of the molecules that are glucosamine, chondroitin or MSM. Adequan and Legend are considered drugs and therefore the companies that make and market them have to demonstrate their safety, consistency and efficacy. In other words, the products have to do what their maker claims they do– protect the health of the joint
While Adequan and Legend are expensive, if you compare what you would spend in a month on either of them to what you would spend in a month on an oral joint supplement, you will probably find that the cost difference is not significant, especially when you consider what we know about the drugs efficacy but don’t know about the supplements.