Apoquel

 

Oclacitinib

Immune modulator

(Apoquel)

By Dr. Karen Burgess

 

Brand name and formulations

Apoquel

Tablets

What is Apoquel used for?

Apoquel is labeled for the treatment of itch associated with allergies.  It is in general a very effective tool in the management of allergies for pets.  There are many other immune modulatory uses for Apoquel that are being discovered daily.  Apoquel begins controlling itch within four hours of administration and can be used short or long term safely.

What is Apoquel?

Apoquel is an inhibitor of a specific mediators of inflammation, JAK1 and JAK3(Janus Kinase).  JAK1 is one necessary component in the cascade of events that lead to an allergic response, typically “itchiness” and inflammation in dogs.  By using Apoquel this process can be safely interrupted.

How is Apoquel given and what if a dose is missed?

Apoquel is typically prescribed for once daily dosing after an initial two week course of twice daily administration.  If a dose is missed and it is less than 12 hours late, go ahead and give the missed dose.  If it is within 12 hours of the next dose, skip a dose and resume regular schedule with the next dose.

Are there any side effects associated with Apoquel use?

In rare instances pets may experience vomiting, diarrhea, loss of appetite, or lethargy.

Who should not take Apoquel?

Apoquel should not be taken by pets being given immunosuppressive or immunomodulatory drugs.  Examples of this include prednisone and cyclosporine.  Apoquel is not approved for animals less than one year of age, pets with cancer, or generalized demodex infections.

What follow up is necessary with Apoquel use?

Laboratory work should ideally be done prior to use and then annually thereafter.

 

 

 

 

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public domain

1/2017

Ear Meds- How To

How to Administer Ear Medication
By Dr. Karen Burgess

ears

Understanding the Ear

  • Always remember that the ear is a delicate structure. When inflamed or infected it may be very painful.ear pinna
  • The ear is really just a canal or tube lined by skin. If a pet has underlying skin disease it is common to also have ear issues and it is fairly uncommon for a pet to just “get an ear infection”. Instead it is often a sign of underlying skin disease or systemic allergies.
  • The anatomy of some breeds can affect the ear’s ability to stay healthy. Whether it is a too narrow passage or an ear with excessive secretions these are typically lifelong issues.
  • The ear canal is L-shaped with a vertical and horizontal portion. The vertical portion is visible to the naked eye, the horizontal portion is visible only via a veterinarian’s otoscope. The tympanic membrane (TM) lies at the end of the horizontal canal.  Often a pet owner may see a normal appearing vertical canal while the otoscope may reveal a completely occluded horizontal canal.  To address ear disease both the vertical and horizontal portion of the ear must be treated while protecting the TM.  The TM or eardrum can be damaged by disease, medications, or objects placed into the ear (i.e. Qtips).  While the eardrum can heal, damage can also potentially affect hearing longterm.

Medicating 101

  • If you feel you are not able to safely treat your pet’s ears, do not proceed. Ear cleaning can be scary and painful which could potentially make a normally docile animal become aggressive.
  • Before starting, gather supplies: ear medication, towels, treats, old clothing.
  • Location, location, location-find an area where your pet can be confined. An elevated surface or corner of a room often works well. Having an extra pair of hands is often helpful.  For smaller animals a towel can be used to “burrito” wrap and better control the process.

Process

  • Find an appropriate area to work in. Flooring with good grip or the ability to have your pet sit with their bottom against a corner or wall may be helpful.
  • Hold the ear flap up vertically with your non-dominant had allowing visualization of the ear canal.

ear 1

  • Holding medication in dominant hand, place the opening of the ear medication (often a spigot or long slender dropper) over the opening into the ear canal and gently squeeze instilling ointment or liquid into canal.

ear 2

  • Hold the ear flap (also called the pinna) closed like a resealable bag. Massage the base of the ear briefly as long as not too uncomfortable for pet.
  • Allow pet to shake head, medication may come out but some will stay in. Wipe inner ear flap if necessary to clean off any residual debris.
  • Give treats and verbal praise throughout process.

 

 

 

 

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Travel, Plane

Plane Travel with Pets
By Dr. Karen Burgess

plane travel, pet travel, crate, air plane, flight, travel

Restraint while flying and at the airport
Safety for your pet during a flight is of utmost importance.  It is best to avoid extreme outdoor temperatures when flying a pet in cargo.  Many airlines will not allow cargo shipment of pets below 40 degrees or above 80 degrees.  Animal crates are shipped in cargo, but they may sit on the tarmac or in holding for some time before and after flight.  Double check with the airline to insure that your pet is being shipped in a climate controlled region of the plane.  Airports will often have designated areas that dogs can be walked outside of the terminal.  Pets are usually not allowed out of their carrying cases once within the terminal.  It is strongly discouraged to remove your pet from their crate if at all possible as the sights, sounds, and commotion of an airport may frighten them and cause them to act differently than in the comfort of the home.  Using a harness instead of a collar is in general more reliable for travel.

Selecting and preparing a crate
While on the flight, whether in cargo or the passenger cabin, pets should be confined to an airline approved carrying cage that allows them to stand up, turn around, and lay down comfortably.  Contact your airline prior to travel to confirm acceptable crate size and weight; typical requirements include waterproof bottom, spring locked doors, disabled wheels, no handles, adequate ventilation, and metal hardware.  As an added level of security plan on cable tying the crate door closed on the day of travel.  Crates will need to be labeled with stickers designating live animal and direction of crate.  You should also include contact information and general information about your pet in a protective sleeve (ex. medical or temperamental issues, picture of your pet).

Preparation for airplane travel
The more effort made to prepare for airplane travel the better likelihood of success.  Determining well in advance that a pet experiences motion sickness or is frightened by travel can allow ample time to address and even correct these issues.  When making flight arrangements research your airlines pet policy clarifying weight, size, and temperature limitations.  Avoid flights that have layovers, connections, or a high likelihood of delays.

Now, even if future travel is not anticipated, get acclimated to the crate and car rides
Acclimating your dog or cat to their carrier or crate in a stress free time can lay the groundwork for potential future travel.  Leaving your carrier out for general exploration is a good idea.  Periodically put a treat or special toy in the crate for your pet to discover.  Feeding your cat or dog in the crate can also help create positive feelings.  Acclimate to car rides by periodically take your pet to the car and allowing them to get in and out giving verbal and treat rewards simultaneously.  Assuming your pet is not showing signs of distress start taking them for short rides (ex. pull out of the garage and then back in, pull out of the driveway and then back in, drive around the block, etc.) always providing rewards.  If your pet becomes nauseous, contact your veterinarian to discuss potential treatment options moving forward.

Month prior
Continue desensitizing your pet to the vehicle.  Ensure that you have proper identification in the form of a secure collar and tag.  Contact your microchip company and confirm that all contact information is up to date.  Schedule an appointment with your veterinarian to update vaccinations, obtain health records, and a health certificate if required.  Check supplies of medication (flea/tick, heartworm, etc.) and obtain any necessary refills.  Research your destinations finding appropriate lodging.  Determine where emergency veterinary hospitals are on your route in case urgent care is required.  Contact your airline and confirm necessary travel information for your pet and carrier size.

Week prior
Check supplies of dog food necessary for travel.  Consider whether bottle water would be helpful to bring.  Pack your pet’s carry bag including food, dishes, leashes (bring an extra), plastic bags for cleanup, toys, bedding, litter and pan for cats, medications, medical records, and first aid kit.  Print out airline pet policy information to have on hand in case there are any issues on arrival at the airport.  Ensure that all supplies and paperwork required by the airline are in order.

Day of travel
Do not feed your pet six hours prior to travel.  Plan on taking a break prior to entering the terminal to allow your pet to stretch, eliminate and drink.  Always leash your dog prior to opening the car door.  Identify pet friendly break spots and always clean up after your pet.  Provide fresh water in the crate if allowed by the airline (hanging water bottle or non-spill crate crock with frozen water).

What if a pet experiences motion sickness?
Motion sickness can have medical and psychological origins.  Slow desensitization can dramatically help.  In addition there are several over the counter and prescription medications available for motion sickness that can be discussed with your veterinarian.  Sedation for flights is typically not recommended and may even be prohibited by the airline.  It is better to allow your pet to cope as they normally would in their crate.

 

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Conjunctivitis

Conjunctivitis
By Dr. Karen Burgess

conjunctivitis, dog, cat, eye, sick

What is conjunctival tissue?
The conjunctiva is the pink fleshy tissue that covers the eye and tissue surrounding it.  In a cat or dog with healthy eyes this conjunctiva should not be easily seen.  In cases of conjunctivitis where the conjunctiva is inflamed owners will often notice angry red tissue near the eyelid.  The conjunctiva is made up of mucous secreting cells similar to that found in the mouth and nose and serves to help protect and lubricate the eye.

What are symptoms of conjunctivitis?
Mild cases of conjunctivitis may appear as increased tearing that is clear or colored in nature.  More severe cases can develop swollen pink or red bulging tissue that appears to almost cover the eyeball.  The eye may become increasingly painful causing a pet to hold it shut or paw/rub at eye.  In severe cases it may be difficult to see any part of the normal eye.

Why do cats and dogs develop conjunctivitis?
There are numerous reasons for the conjunctiva to become inflamed.  Infectious causes include viruses and/or bacteria.  In some cases infections will develop secondary to some other underlying cause of conjunctival inflammation.  For cats viral conjunctivitis is extremely common and closely related to upper respiratory viral infections they are exposed to at a very young age.  In several of these situations the cat may recover from the initial infection but the virus remains dormant in their body reappearing later in life at times of stress or illness.  Non-infectious causes of conjunctivitis are typically related to the anatomy (size, shape, and location) of the eyeball itself.  Dogs often develop a condition where they stop producing tears which then leads to a “dry eye” and secondary conjunctivitis.  Some breeds of cats and dogs are more prone to having flat faces or bulging eyes which can change how the eyelid sits against the eye.  In these cases eyelashes or facial fur may rub against the eye and conjunctiva causing inflammation.  Allergic disease, foreign material caught in the eye, tumors, and immune disease are all additional causes of conjunctivitis.

How is conjunctivitis diagnosed?
A veterinary examination will typically reveal the presence of conjunctivitis.  Additional testing of the cornea and tear production may also be necessary.  If systemic disease is suspected bloodwork may be recommended.  In complicated cases referral to an ophthalmologist may be recommended.

What are treatment options for conjunctivitis?
Definitive treatment of conjunctivitis involves diagnosing the underlying cause for treatment and controlling secondary bacterial infections.  This may involve topical drops or ointment, oral medications, eye lubricants, or surgery.  It is important to protect the eye from self-trauma by using a protective collar or Elizabethean collar.  Pain medication may also be prescribed to help with associated discomfort.

What is the prognosis with conjunctivitis?
Prognosis is directly related to the ability to treat the underlying condition causing the inflammation.

 

 

Photo credit-none required

Cats 411

Cat 411
By Karen Burgess, DVM 

cats

What should be considered before getting a cat?
The introduction of any pet should first be discussed with all family members or potential human housemates.  Cats are a long-term commitment living up to twenty years. If unsure, ensure that no family members have an allergy to cats (typically to their saliva or dander).  If uncertain or unfamiliar with cats in general, it is a good idea to first visit and interact with cats in an animal shelter type setting.

What should I look for in a cat?
Ideally one would have the chance to spend at least an hour observing a prospective cat’s behavior.  Ensure that they are willing to be handled by humans and seem comfortable with all family members.  Cats that have been handled by people from a young age and raised by a mother cat tend to be better options (bottle raised kittens may have more issues with behavior in the future).   Observe for any signs of a respiratory infection (sneezing, nasal discharge), has solid stools, uses the litterbox, and has a good overall appetite.

What do I need to own a cat?
It is best to have the following supplies before bringing your new cat home.

  • Cat carrier, some shelters may provide a cardboard variety, plastic versions are typically more convenient and durable and are often available second hand at garage sales etc.
  • Litterbox, purchase the biggest available (even consider a concrete mixing container from Home Depot, often more affordable and larger than real litterboxes), avoid uncovered versions
  • Litter and scooper, clumping, non-scented preferable, commercial scoopers are typically most durable
  • Water and food bowls, separated
  • Cat food, try and find out what your new kitty is already eating and obtain a small amount of this to start with, having some additional cans of tasty cat food may also serve as a nice treat
  • Scratching post, horizontal and vertical, many types available, taller the better as cats typically want to scratch while in a full stretch, ask Healthy Paws for additional recommendations on scratching in general
  • Cat toys, various types available, favorites tend to be wand toys, balls, food dispensing balls, catnip products
  • Cat bed, covered often preferred
  • Cat hair brush and nail clippers for grooming
  • Cat collar, breakaway type (one that if a cat jumps and is caught by the collar will break away thus preventing choking), bell can be helpful in keeping track or your new friend

sleeping

Where should my new cat stay?
In the beginning it is best to have a small room (laundry room, bathroom as example) set up as the cat room.  Put food, water, litterbox, bedding, scratching post, and toys in this room and use it as a home base.  Fill the litterbox with 2 inches minimum of litter and place food and water bowls as far away from the litter as possible.  Cats like hiding spots.  Keeping a carrier, covered cat bed, or even a box with one open side in the room may provide added security.  Use of the scratching post can be encouraged by sprinkling it with catnip or hanging a toy from the top.  As your cat and you feel more comfortable, gradually allow more access to other areas of the house.

Do I need to cat-proof my home?
Cats by nature are inquisitive animals often preferring vertical surfaces to allow a better view the lay of the land.  Small areas are also favorite hiding places for cats.  Take a look around the house before introducing your new cat to look for any potential areas that might require blocking off.  Look at all surfaces, including tops of cabinets/higher surfaces to ensure nothing will be harmed if your cat starts exploring.  Some common safety concerns for cats include…

  • Recliners
  • Washers and dryers/piles of laundry that unwittingly contain a sleeping cat
  • Doors left open to the outside
  • String, yarn, rubberbands, and hairties that may be ingested causing life-threating intestinal blockage
  • Trash cans that do not contain lids
  • Dangling electrical or window blind cords
  • Breakable objects that may fall during cat exploration (look for museum or earthquake wax to secure objects)
  • Household plants
  • Fireplaces, ensure have a screen
  • Boxes that are unintentionally thrown out with a cat inside
  • Burning candles
  • Closed closets or drawers that a cat may have hidden in

What about the first day at home?
Once home, take your new cat into their special room in their carrier.  Close the door, get situated sitting on the floor, open the carrier door, and wait patiently kitty decides how they want to explore.  Some cats will come bounding out and be excited about their new surroundings, others may hide for hours in the crate only coming out to explore when left completely alone.  Be patient, even shy cats can make wonderful pets; they just may require a bit more time to adjust.

When should the first veterinary visit be?
New cats should have a complete examination by a veterinarian within a week of coming home to ensure their overall health.

What are some good general cat resources?

tips

 

 

 

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Labwork, Urine Testing

Urine Testing
By Dr. Karen Burgess urine

What is a urinalysis?
A complete urinalysis is made up of chemical (commonly called a dipstick) and microscopic or sediment examination.  The dipstick portion looks for the presence of red and white blood cells, glucose, ketones, protein and bilirubin in the urine.  It also quantifies the concentration and acidity of the urine.  The sediment portion of a urinalysis involves physically looking at a sample under the microscope in search of red blood cells, white blood cells, crystals, bacteria, and abnormal kidney or bladder cells.  The urine is one of the first ways that kidney disease can be identified in pets.  If a bacterial infection is suspected a culture and sensitivity (C&S) may also be performed to identify specific bacteria and the appropriate antibiotic choice for treatment.

Labwork, Blood Chemistry

Blood Chemistry
By Dr. Karen Burgess

chem

What is blood chemistry testing?
Blood chemistry testing uses the serum or non-red blood cell portion of blood to evaluate how a variety or organs and systems work in the body.  Often a variety of tests are combined to form a profile that is specific for a pet’s age or medical situation.

What tests are commonly performed in a blood chemistry profile?

  • Glucose-often also referred to as blood sugar, glucose provides energy to all of the body including the kidneys, brain, and muscles. Low blood sugar can cause seizures or collapse while persistent elevations of blood sugar may be indicative of diabetes.
  • Kidney testing-the kidneys are responsible for filtering the blood and regulating sodium (salt) and water concentrations in the body. Ultimately the kidneys produce urine.   BUN (blood urea nitrogen) and creatinine are waste products that are filtered by the kidneys and elevations can occur with kidney disease or dehydration.  A sample of the urine is necessary to fully evaluate kidney function.  Electrolyte values are also often performed and further help determine kidney function.
  • Liver testing-the liver serves many functions in the body including waste removal and nutrient breakdown. ALT (alanine aminotransferase) is a direct measurement of liver cell damage.  This value goes up and down very quickly allowing real time evaluation of damage to the liver.  ALP (Alkaline phosphatase) is a less specific test and can be elevated with liver disease, stress, or secondary to hormonal diseases.  GGT, AST, and bilirubin are all additional tests of liver function.
  • Protein values-the body requires protein as building blocks and in fighting off disease. Albumin, globulin, and total protein are all measures of protein in the body.   Low values of albumin in particular can lead to life threatening fluid accumulation in the body.
  • ElectrolytesNa (sodium), K (potassium), Cl (chloride), TCO2, and anion gap are all related to electrolyte balance. The body keeps electrolyte values in very narrow ranges.  Abnormally high or low levels can lead to collapse, heart failure, or other signs of disease.
  • MineralsCa (calcium) and Phos (phosphorous) are minerals that are tightly controlled in the body. Elevation in calcium can be associated with cancer and elevations of phosphorous with kidney disease.
  • Thyroid testing-thyroid hormone impacts the metabolism of a pet. Elevations, commonly seen in cats, can lead to heart disease, weight loss, and eventually death.  Abnormally low levels, more common in dogs, can cause abnormal weight gain, behavior changes, and skin disease.

Labwork, Complete Blood Count

Complete Blood Count
By Dr. Karen Burgess

cbc

What is a CBC (complete blood count)?
A CBC quantifies the number of red and white blood cells and platelets a pet has.  It also describes the cells qualities including how they physically look (ex. too small, too large)

What are red blood cells and what tests are done on them?
Red blood cells make up almost half of the blood’s volume.  They give blood its red color and contain hemoglobin which is responsible for carrying oxygen from the lungs to all of the cells in the body.  Common tests performed include:

  • RBC (red blood cell count), HCT (hematocrit), Hgb (hemoglobin)-measures red blood cell mass and quantity. A decrease in these counts would be suggestive anemia, a potentially serious medical problem.
  • MCV, MCH, MCHC, RDW-measurement of red blood cell size. The size of the red blood cells can give clues about specific disease processes.
  • Retic-quantification of reticulocytes or immature red blood cells. Helps determine whether the bone marrow is working properly.

What are white blood cells and what tests are done on them?
There are five types of white blood cells.  These cells respond to bacteria, viruses, and foreign material in the body.  White blood cell types include:

  • Neutrophils-most common white blood cell, typically fight bacterial infections. Can also be elevated with stress.
  • Lymphocytes-components of immune system
  • Monocytes-are involved with damaged tissue typically
  • Eosinophils-often involved with parasitic and allergic disease
  • Basophils-also related to parasitic and allergic disease, uncommon.

What are platelets and what tests are done on them?
Platelets are the body’s first line of defense in the body’s clotting process.   Low platelet counts can be indicative of potentially life threatening bleeding problems in a pet.

Labwork, FAQ

FAQ’s About Laboratory Work
By Dr. Karen Burgess

FAQ

Why should laboratory work be performed on a pet?
There are many reasons to perform testing on a pet, some of the more common include:

  • As part of a wellness examination-our goal with annual labwork is to prove that a pet is healthy and not find abnormalities. The idea is to establish a baseline so that if and when a problem develops there is a “normal” reference point to refer back to.  This becomes increasingly important with age, thus why it is recommended that senior pets have labwork done twice a year.  In some situations a pet may seem healthy and an unknown medical condition may be identified thus allowing earlier intervention and possibly a better prognosis.
  • With illness-labwork allows further evaluation of the sick pet in an effort to further isolate the problem, assist with treatment, and provide prognosis.
  • Prior to anesthesia-the key to safe anesthesia is to plan ahead. A key component of this is preanesthetic labwork which helps to determine safe drug and dose selection.

How are labwork samples obtained?
Bloodwork is performed on a blood sample.  This sample is drawn from a neck or leg vein using a syringe and needle.  Urine is either collected in a clean container while a pet is naturally voiding or while being restrained using a syringe and needle.

Where are blood tests performed?
Bloodwork can be done either by an automated analyzer in the hospital providing results within the hour or at a commercial laboratory yielding results within a day or so.  Urine evaluation is done by automated analyzers and under the microscope visually.   Some samples are also evaluated by trained personnel under the microscope.

 

 

 

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Canine Influenza – Update

Update- Dr. Burgess on Canine Influenza
in the Crystal Lake, Algonquin and Lake in the Hills area

This week new information has become available concerning the current Influenza outbreak.  Cases of this upper respiratory infection (symptoms may include fever, lethargy, cough, nasal discharge, pneumonia) have been reported now in various locations outside of the city.  The strain of Influenza causing most of these cases has not been previously diagnosed in the United States which is making testing and treatment more complicated.  The current Influenza vaccination may not have any efficacy against this new Asian strain.  This Influenza virus while not contagious to humans is highly contagious to dogs and possibly cats (no reported cases as of yet) staying alive on surfaces for forty eight hours, clothing for twenty four hours, and hands for twelve hours.  Current recommendations include:

  1. Be aware that any exposure to any other dog that is infected may put your pet at risk.  Dogs are able to spread the infection several days prior to showing any symptoms.
  2. If planning to board, use doggie daycare, visit a dog park, participate in group dog classes, or attend dog events, be aware that your pet may be at greater risk for contracting this infection.
  3. Contemplate vaccination for Canine Influenza.  While the currently available vaccine may not prevent this strain, it does still prevent the original strain which has also been found in some affected Chicago pets.  Bottom line is we just do not know enough yet about this new strain, but vaccination for Bordetella and Influenza is what we have available at this point in time.
  4. Avoiding exposure is the number one preventative.

Below is the American Veterinary Medical Associations thoughts on Canine Influenza:

https://www.avma.org/KB/Resources/Reference/Pages/Canine-Influenza-Backgrounder.aspx