Vaccines

/ posted in: Work

More thoughts after reading Pukka’s Promise.  The author recommends limited vaccinations.  Vaccines are something that I spend a lot of time thinking about.  First, some background.

For the first 14 years I was in practice I was mainly a relief vet.  That means I went into a lot of practices when vets need time off.  Vaccine protocols vary widely.  There were clinics I wouldn’t go back to because I could not justify giving the number of vaccines that they required.  When we moved last year I started working for a wellness clinic.  One of my concerns was what their vaccine protocols were.  I did not want to be in a position where I was just giving dogs all the vaccines in the fridge.  I have way too many reservations about vaccines for that.  The vaccine policy at this clinic is one of the most sane that I’ve seen in practice.  For dogs it comes down to this:

  1. Dogs under 20 lbs never receive more than one injectable vaccine at a visit.
  2. If your dog is sick, you don’t get vaccines no matter how much you want them.
  3. The staff evaluates each dog’s lifestyle to see what vaccines to recommend.

Seems simple and logical right?  Oh, the wailing and weeping and gnashing of teeth that happens sometimes.  I spend much more time in my day telling people I won’t vaccinate their dog than I do recommending more vaccines.  In fact, for dogs, I never recommend more vaccines.

The under 20 lb rule comes from studies that show that small dogs are more likely to have vaccine reactions than big dogs.  If a small dog is due for multiple vaccines they can come back in 2 weeks for the other vaccine and they won’t be charged an additional office call.  If the dog is sick with something I expect to clear up in 2 weeks (like an ear infection), they can take advantage of that too.  Because of that people can’t claim that we are just trying to take more money from them.

I’m sorry if you didn’t plan ahead and are leaving for vacation tomorrow and your Chihuahua needs a bunch of vaccines to be able to go to the kennel.  I don’t care if he’s had them done all at once before and it has never been a problem.  There are clinics that will do that for you.  We won’t.

People always want vaccines “as long as we’re here.” No.  Vaccines are not benign things that can be given whenever.  If your dog has been vomiting for 3 days I’m not vaccinating it.  Severe allergies and skin infection?  No vaccines.  My all time favorite was the dog who went outside at 4 AM and came back with both eyes out of his head.  They were dangling from the nerve.  The owner popped them back in.  I saw him at noon.  Noon.  Eight hours later.  The eyes were pointing opposite directions and one was obviously blind.  I was grabbing eye specialist referral sheets to try to save his vision and the owner kept saying he just brought him in for a rabies shot.  I made a new rule on the spot that if your eyes have been out of your head at any time in the last 24 hrs, you aren’t getting vaccines.

It surprises me that people think of vaccines as harmless. I don’t expect people to be up to date on veterinary literature but the idea that vaccines can have side effects is in the news a lot.  People often act like this is a new idea to them.  As a profession we’ve done a good job convincing people to vaccinate their animals and it has helped in a lot of ways but I think we’ve gone too far.

Everyone who gets a vaccine at our clinic goes home with a handout listing possible vaccine reactions.  These range from mild things like being tired or being sore at the vaccine site to severe reactions like hives, vomiting, collapse, and death.  What do we actually see?  I ask every time before I give a vaccine how they felt after their last one.  Most owners don’t notice any problems.  Some say they are tired or sore.  Sometimes there are reports of vomiting once but it can be hard to say if that is the vaccine or the car ride and excitement.  If they have hives or any other severe reaction we generally know about it when it is happening.

In the past year I’ve seen 3 anaphylactic reactions to vaccines.  I’ve never seen any before.  They are scary.  The dogs start vomiting over and over.  They are very weak.  They are pale.  Immediate treatment is needed.

What do we do if dogs have had a reaction?  If it is mild and their lifestyle is such that they should continue to have vaccines, we premedicate them with benedryl and maybe steroids.  If they have any more reactions with the premeds they are done.  We don’t vaccinate them anymore.  Obviously, one severe reaction means that they don’t get any more vaccines.

I say “obviously” but it isn’t.  I’ve had people fight me on this.  One of the anaphylactic dog’s owners wanted to give him another vaccine.  I’ve had dogs who have broken out in hives despite premedication with owners almost in tears because I said he shouldn’t be vaccinated again.

There are other dogs that I think shouldn’t have vaccines.

  1. Old dogs. Most of the diseases we vaccinate for are disease of young dogs.  I would rather spend a person’s money on bloodwork for elderly dogs than vaccines.
  2. Cancer patients.  They already have enough problems without adding more immune system stress through vaccination.  I had one owner with a dog who had been through chemo and was now in remission from lymphoma get furious with me for telling him that I thought the dog should not be vaccinated.   He said that I was the only vet saying that to him so obviously I didn’t know what I was talking about.

I think people are concerned that not vaccinating their dogs is a death sentence because they are going to pick up all the horrible infectious diseases that are out there the day after the vaccine officially expires.   The next post will be about what we actually vaccinate for and who should get the vaccines.