Navigate New Antibiotics Guidelines with Veterinary-Client-Patient Relationship

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Kenny Coogan: Good day everyone, and we appreciate you for joining us on another exciting Mother Earth News and Friends podcast.

I am Kenny Coogan, and joining me today are veterinarians Katie Estill, Michael Marricle, Oberlin McDaniel. At Mother Earth News for 50 years and counting, we have been dedicated to [00:02:00] conserving our planet’s natural resources while helping you conserve your financial resources. Today we are going to discuss Guidance for Industry (GFI) No. 263, which is part of a broader effort by the Food and Drug Administration to combat antimicrobial resistance, also known as AMR, a serious threat to animal and public health. This means that over-the-counter sales of specific medically important livestock antibiotics in the U.S. will end June 11th, 2023.

Dr. Katie Estill is a mixed animal veterinarian in rural Northern Nevada and an on-call advisor across the board for many of our titles, including Countryside, Goat Journal, and MOTHER EARTH NEWS. She helps fact check our publications and writes one article per issue in Goat Journal.

Dr. Michael Marricle practices veterinary medicine through his [00:03:00] ambulatory livestock and equine practice in central Arizona. His days are spent seeing routine and emergency calls for horses, cattle, small ruminants, mini pigs, and other backyard livestock.

Veterinarian Oberlin McDaniel is the owner of North Carolina Mobile Veterinarian Service, a rural three doctor livestock practice. They provide medical services to equine, bovine, swine, small ruminants, camelids, and poultry. Welcome to the podcast, doctors.

Guidance for Industry, also known as GFI No. 263, is not limited to animals that will enter the food chain, but applicable to all livestock and companion animals. GFI No. 263 was written and created by the FDA to combat antimicrobial resistance to drugs also used in humans. We posted a post on our social media asking, uh, people, farmers, [00:04:00] hobby farmers, their take on this. And Desert Oaks Plantscape says, “Great news. The overuse and improper use of antibiotics is driving scary antibiotic resistance bacteria. Now they need to stop allowing unfettered use of CAFOs,” which stands for Concentrated Animal Feed Operations.

FDA Guidance on Antimicrobial Resistance (AMR)

Kenny Coogan: All right, so veterinarians, uh, maybe we’ll start with Katie. How common is antimicrobial resistance? Why do you think the FDA is implementing this guidance?

Dr. Katie Estill: Um, so their biggest concern is antimicrobial resistance in humans, obviously.

So we have resistant infections in people and their concern is as we build resistant bacteria, that those, we build resistant bacteria in animals and those cross over to people. Um, and I think one of the biggest concerns, um, In terms of the FDA is, you know, mass treatment of animals. Um, previously, antimicrobials were used to promote [00:05:00] growth, um, in livestock animals. Um, so their goal is to reduce the risk of that crossover of resistant infections into people.

Kenny Coogan: All right, so Dr. Michael, how dangerous is it to have antimicrobial resistance in the, you know, in the far future, near future?

Dr. Michael Marricle: So, we’re not coming up with new antibiotics every day or every week, or even every year. So I like to approach the meds that I have in my truck, or the ones that are on the shelf are probably the antimicrobials that we will have for the foreseeable future. So every time one stops working, we already have a pretty small toolbox or short list of antimicrobials, so we need to make them last as long as possible.

I’m biased towards my pasture, livestock, and equine, so, you know, I’m boots on the ground. I see it in front of me when I have animals that should respond to certain therapies that aren’t. And then we send samples in, [00:06:00] uh, for susceptibility to see what antibiotic might work on this bacteria, and it’ll come back as nothing, nothing will work on. And then what’s the doctor do in that position? And then how long is it until these bacteria jump over into humans or they’re already there? So, yeah, the, as far as the question that’s, it’s, it’s pretty important.

MRSA and Staph A in Mastitis and Bumblefoot

Kenny Coogan: Yeah. So the FDA said that they’re concerned about the antibiotic resistance in not only livestock, but also horticulture and the practice of human medicine.

Dr. Oberlin, can you talk about MRSA and other strains of staph A? And this is the primary bacterium responsible for mastitis and dairy animals and bumblefoot and poultry.

Dr. Oberlin McDaniel: Yeah, this is definitely a huge issue, you know, in our field and in human medicine. And it’s just one example of many organisms that are providing to be a pretty big issue to [00:07:00] treat.

They build a lot of local, you know, they cause a lot of local, huge amounts of inflammation and sometimes it’s not treatable at all in, in the dairy field and bumblefoot either. Um, there’s a lot of things you can read about on the backyard poultry forums on how to treat bumblefoot, but you probably should call your vet.

I might lend this question over to another, a doctor. I’ve actually never personally had to treat a MRSA infection in my, in my own practice, but I do routinely culture, you know, all my mastitis cases, um, and haven’t had to, uh, jump through that hoop yet. But I’m very aware that the issue for sure. So has anybody else had to treat that?

Kenny Coogan: Yeah, Dr. Michael or Dr. Katie, any, uh, information about MRSA or staph A?

Dr. Michael Marricle: Uh, yeah, so I was primarily dairy for my first four years of practice and so we, we would send, I mean, routine testing of milk right off the bat, just, um, just to see even when the cows went fresh. And [00:08:00] it’s pretty standard to send samples in and see what we’re dealing with before it’s a problem.

And the cattle that come back with staph aureus and not gonna respond to therapy, they typically get to find a new career. They don’t get to stick around the dairy. And it’s kind of, you know, as a doctor, I wanna prevent these cattle from even ending up in that boat. And a lot of it boils down to, uh, treatments that took place before we even saw the animals.

So I guess just getting in front of the issue. But yeah, it’s definitely present. It’s kind of sad for the, the critter when they come down with this issue that, that we caused. I don’t mean, but just us, the, the livestock population by less than judicious use of these antimicrobials.

Kenny Coogan: Dr. Katie, anything else to add?

Dr. Katie Estill: No, I think, I think Michael covered it. It’s, it’s, um, you know, we, we don’t have a lot of choices when we encounter that in livestock or in poultry, and especially poultry. There’s just not a lot of options for [00:09:00] antimicrobials you could use than them.

Getting Vets and Antibiotics to Rural Farms

Kenny Coogan: So owners have remarked that it is already difficult or impossible to source antibiotics used to treat their livestock, and a couple of comments came in. Twin Raven Natural says, “Not everyone has access to a large animal vet, so this will just lead to more unnecessary suffering of animals in many instances.” Twin Pine Farm says, “Totally ridiculous. I don’t need a vet to tell me I can buy penicillin or ivermectin. I know what to do.”

So the FDA’s, um, guidance. Part of the problem is supply issues. Many of the medications have been on back order while issues beginning, uh, during the onset of COVID-19, when livestock owners can’t get one antibiotic because of back order issues, they opt for a suboptimal medication. They might not treat those specific bacteria, what the original medicine was intended for. @JoeMarie73 says, “In our area, it is next to impossible to get a vet to visit [00:10:00] farms. How are we going to get a prescription without vets who are willing to do farm calls?” And then Colorado Burial Preserve says, “Yeah, the timing of this is awful because of the shortage of vets, especially large animal and rural vets. In the short term, it is going to cause animal deaths and raise prices.”

So right now I’m talking to three rural vets. Do you believe that there are enough large animal and livestock vets to prescribe medications currently? Dr. Katie, what do you think?

Dr. Katie Estill: No, I, I think there, there are, um, and I do think a lot of it is, is a lack of support. Um, certainly. So a lot of people call me in a rural area only for emergencies. Um, so I, they don’t, they don’t, uh, call me for routine care at all. So my ability to treat routine things for them is, is limited.

But I think in some areas I think there are gonna be difficulties finding a veterinarian. But if you’re supporting that veterinarian by choosing to have them help you with routine care, they can afford to stay in that area.[00:11:00]

Kenny Coogan: All right, Dr. Michael, by going through a vet, do you think this will cause the drugs to cost more to the farmers?

Dr. Michael Marricle: No, not necessarily. It’s a little more complex than that, but a lot of, I can only go off of my own experiences with the number of patients that I see, that they’ve already spent a lot of money on the wrong medications, on the wrong dosages, and these animals are sick for an extra week or two or three. There’s money lost there. There’s money lost if you’re a livestock, you know, if you’re, if you’re raising cattle for beef, you’re losing pounds. Again, if you’re trying to get milk from your backyard, dairy cow, you’re losing milk if she’s sick longer.

So that’s all, that’s all cost to the owner. If they call their vet sooner, and the sooner the animal’s healthy, the more money they’ll save. If, if we’re looking at it from a, you know, livestock dollars left [00:12:00] on the table standpoint, so I, I think it’d be pretty even, and the animals would be sick for a period of time.

Kenny Coogan: According to Anne Norris, uh, FDA health communications specialist, the FDA intends to allow unlabeled inventory remaining in distribution channels to be depleted rather than recalled. So that’s good. But many of these medications are already on back order, so they haven’t yet been manufactured with the over counter labeling.

So though this rule allows sale of inventory, there may not be available inventory on many of these medications.

When to Use Antibiotics

Kenny Coogan: So, Dr. Oberlin, can you talk about some specific conditions which one should be using antibiotics?

Dr. Oberlin McDaniel: So one condition that comes to mind would be, you know, a respiratory outbreak in a pen of calf.

We do a lot with beef cattle personally, um, in my [00:13:00] practice. And so that’s something that, you know, is an issue. You know, when, when calves are weaned and, and housed with amongst, um, other animals that are kind of new to their herd, it’s similar to daycare and they get all sorts of nasty, you know, viruses that lead to bacterial pneumonia infections, and, and that would be an instance that antimicrobials and using the appropriate antimicrobial at the appropriate time and frequency patient, um, would for certain be warranted.

Another thing that would come to mind would be for like a backyard person, no matter what kind of animal they had, no matter, like a goat, a, a pig, or a horse, that they had a nasty laceration, you know, if they got cut on a dirty piece of tin or whatever, animals find themselves into pretty funny predicaments sometimes that those wounds may need antimicrobial therapy.

And I just wanna add a little bit to what we were talking about prior, um, [00:14:00] specifically, you know, the concerns that you know of, of penicillin. It seems you’ve been getting a lot of concerns about, you know, penicillin and, you know, animals dying because these products won’t be available and there’s not gonna be vets available. And I do think that there’s vets available, um, and that we are here to help you. You know, we’ve, this is, this is why we’re here, we’re here to help you.

Um, but penicillin and some of the tetracycline, those, those aren’t the, the drugs that we would likely use for most of these cases. Those, those two, those two drugs, um, I use very sparingly, um, just because of the amount, um, and the frequency that they have to be given. And they’re, they’re given inappropriately a lot of the time.

They’re also penicillin, particularly is mislabeled. So if people are following the labeled instructions on the bottle, they’re usually drastically underdosing their animal and contributing to antimicrobial resistance.

Kenny Coogan: [00:15:00] Dr. Katie, can you discuss penicillin procaine for listeriosis? Because it crosses the brain barrier and how animal owners may resort to LA 200 Oxytetracycline, not knowing that they’re prolonging the suffering.

Dr. Katie Estill: Yeah, so, uh, I mean especially with penicillin, cuz it’s one of the medications that has been on back order, a lot of people are then resorting to the other, um, more common over the counter LA 200. But like Dr. Oberlin was saying, with penicillin I see a lot of, a lot of people not giving it at the appropriate dose and and timeframe.

Um, so most people just, you know, for ease of of use give it once daily and penicillin procaine should be given twice daily, every 12 hours. Um, so, um, using it appropriately for listeria cuz it, you know, it will treat that. Um, I see a lot of people not giving it frequently enough.

Establishing a Veterinary-Client-Patient-Relationship (VCPR)

Kenny Coogan: In order to follow the guidance to get these medically important antibiotics [00:16:00] going forward, animal owners will be required to establish a veterinarian-client-patient-relationship known as a VCPR. The definition of VCPR varies from state to state and can be obtained by contacting your state’s veterinarian medical board. Some states require, at a minimum, an annual onsite visit. So, uh, Dr. Michael, what are some of the best ways to establish a veterinarian-client-patient-relationship? And I’m assuming this is before you encounter an emergency with your livestock.

Dr. Michael Marricle: Yeah. I would rather meet you and get to know your operation and examine your animals before they’re sick. But yeah, for establishing a VCPR, just pick up the phone or like us, our, our website has an email submission form.

You select days that are most convenient for you, and we show up for 30 minutes or an hour. We [00:17:00] talk, we walk around, we consult, and I always try to give people the most bang for their buck cuz we were talking livestock. So can I update you on vaccines? Can we trim your goats? Um, we’ll talk nutrition, we’ll talk husbandry.

And I, I can’t think of any instances where I don’t walk away from a brand new client on a nice little VCPR establishing consult where we haven’t found something that will probably pre, that will prevent, uh, some kind of emergency in the future. With horses, it’s always looking in their mouth to see if their teeth need to be done. If, if it’s, they haven’t vaccinated in 10 years and it’s time, or really husbandry, we like husbandry livestock vets looking around, talking nutrition. How are we gonna prevent parasites, proper housing. So I, I could go on for a while, but as far as establishing VCPR, you just pick up the phone and call your vet and schedule an appointment.

Kenny Coogan: [00:18:00] Legally or ethically, if you’ve never met the animals or the farm and they say, “Hey, my animal has blank,” do you, and we can go around, do you send them medication without seeing the animal? Can you do that? Uh, what, I guess it’s ethical and legal. So Dr. Uh, Oberlin, what, what’s your stance? How, how do you weigh, “oh, this animal’s, you know, sick, but I have never met this farmer.”

Dr. Oberlin McDaniel: So I actually ran into this, um, issue quite a bit, um, in my practice career just because, uh, you know, when I started five years ago, I was the only vet that had been around ever in about five counties. Um, and so almost everybody that was calling in was new. And, um, the way, the way I approached it, especially, you know, if, if we are available and we can get out there, you know, in a timely manner to, to help an animal need like that for sure is what needs to happen and is the requirement, but, we went into, um, in some instances, and I’m sure that, uh, [00:19:00] I’m sure that the other vets can speak to this too, where either somebody says, “Hey, you know, I really do not have the money right now to pay you, but I would really, really, really appreciate, you know, some helpful advice.”

As much as that gets on my nerves a bit, being a free solicitor of advice, I’ve never said no to anyone. If they said, I said, “Hey, you know, send the office a video of your animal. Send me a few pictures of the discharge that you describe coming out of your goat’s nose per se. Please take a temperature, snap a picture of you taking a rectal temperature in your, in your pig.”

And I’ve helped work with those people or point them to extension agents who could either, uh, get out there. As far as like management nutrition, what their environment is like, I have handouts that are now easily extractable for, you know, my office staff to, [00:20:00] you know, send out that, that doesn’t require a heck of a lot of extra energy, but people find really helpful.

And then as far as, um, dispensing antibiotics, usually we do require actually being on, at an on farm visit, but there are circumstances where they used to be over the counter drugs where, you know, I could at least prescribe the appropriate dose of penicillin at the appropriate frequency or LA 200 and say, this is something that you can try.

But I rarely run into, I rarely, rarely, rarely run into the cases now where people are not willing for us to, to come out. That that’s a rare, that’s a rarity now. And usually people, um, and, and we’re, we’re, we’re affordable and, and worth it. So what I will say about that is your animal does need to be seen, but usually a veterinarian will work with you and your time of need, but you also have to be willing to get to know your vet. If we don’t, we don’t know. If we don’t know you and we don’t know your animal, there’s no way that we can help you. And it’s [00:21:00] the same in the medical field. You don’t call, um, you know, a random doctor and say, “Hey, I think I got strep throat . You think you can call me in?” If it’s somebody that doesn’t know you, they just, it’s not gonna happen.

So this, I think the same respect should be paid forward to, to veterinarians.

Kenny Coogan: Dr. Katie, do you have anything else about, uh, how to establish a veterinarian-client-patient-relationship?

Dr. Katie Estill: Uh, no. I, I think they covered it. It’s, it’s pretty easy. You just give us, give us a ring.

Should I Stock Up on OTC Antibiotics Now?

Kenny Coogan: Very good. So, Dr. Katie, legally and ethically, this has been a very large, uh, question and comment. Can you share your livestock antibiotics with your farmer friend? And can, if you see them available, can you buy the entire shelf and hold on to them?

Dr. Katie Estill: Oh. So if you see your current over the counters, just grab them? Uh, well I will say, so they do have an expiration date, so just mass buying them, they’re gonna probably go bad before you need them.

And also, you know, the goal is to, hopefully not. [00:22:00] So should you have 12 bottles of penicillin? I mean, I would, hope not. Um, cuz the goal is to use as, you know, use them as appropriately as possible. Um, so I don’t, I don’t think you should, especially while penicillin’s on back order some, you know, some do need that to be treated with it. Shouldn’t go hogging it. It’s not toilet paper. We don’t need to hoard it cuz it will be available.

And I, there is no reason why you shouldn’t be able to develop a relationship with your veterinarian and they don’t need to come out every month. They can come out once a year, establish, you know, go over your concerns like Michael said, and kind of establish protocols and then they’re gonna be able to help you when you have an issue.

They don’t have to show up on farm for every little thing. Once they get a feel for your operation, they can consult with you over the phone or via email, um, and help you without having to pay a call fee and show up.

Kenny Coogan: All right, we’re gonna take a quick break, but before we started recording, Dr. Oberlin was mentioning you shouldn’t have 10 bottles of penicillin. You should probably have some [00:23:00] preventative, uh, measures to keep your herd healthy. So we’re gonna talk about that after the break. And we’re going to also, uh, learn the specific drugs that fall under GFI No. 263 and in what circumstances they should be used. So now we’re gonna take a quick break to hear a word from our sponsor.

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What Antibiotics are Covered by FDA GFI No. 263?

Kenny Coogan: All right, we are back with veterinarians Katie Estill, Michael Marricle, and Oberlin McDaniel.

Dr. Michael, can you list a couple of the drugs that you use or you implement that fall under the GFI No. 263 and in what circumstances they should be used?

Oxytetracycline

Dr. Michael Marricle: So there’s a couple on the list that I encounter often that come to mind. It’s the oxytetracycline and penicillin procaine that I don’t actually use those much, but it’s the most common med, the two most common meds that have been given to my patients or new patients or non-patients, when people are calling in that they’ve treated with before calling me. The both are great meds. They just need to be used for [00:25:00] the appropriate disease at the appropriate time after a nice talk with your vet.

Polymyxin B

One that is on the list that I use a lot is the, um, polymyxin B look like it was on the list. I think that’s the one of the eye ointments. I use that a lot for conjunctivitis or eye ulcers. And that one, I like that it’s on the list because it, it’s one that seems to often fall into that category of not administered appropriately. It’s on the list. You know, I have people putting it in a horse’s eye once a day when it really needs to be put in there eight times a day, and they just end up prolonging the disease that suffers longer. And then by the time I get there, we have to pick some other med. It probably would’ve worked if we use it appropriately from the get-go.

Penicillin

Penicillin, I will jump back to that just for a second. I mean, I, I had an owner just last week that had a whole pen of calves. He had, they’d been sick for two weeks. He’d been treating with penicillin. He was [00:26:00] treating once a day when it was supposed to be given twice a day, and he was giving like a 10th of the dose that I would’ve used. So it did nothing. Um, the animals got sicker. It probably contributed to AMR. And then by the time I saw them, we had to pick, uh, a much bigger, more expensive medication to treat these animals.

We, we brought them around, but he ended up costing himself more in the long run and, that’s kind of a classic example of why this is on the list.

What is Antimicrobial Resistance? (AMR)

Kenny Coogan: All right, so, um, many years ago, Harvard Medical Institute or researchers, they came up, they built a two foot by four foot agar petri dish. Did any of you see this?

So it’s a two foot by four foot petri dish. And on the far ends, like it’s the end zone, they put some bacteria in it and then they put some, uh, antibiotics that were like one time what the bacteria could handle and like the next zone. And then they did 10 times, [00:27:00] and then they did a hundred times, then they did 1000 times. And then in the center they did 10,000 times. And within I think 10 days or maybe seven days, the, uh, bacteria was able to spread and live within that middle threshold of 10,000 times stronger than what the original strain of bacteria could originally live in. Because the bacteria evolved. You know, it killed 99% of it, but that 1% had that random mutation and that allowed it to like jump that hurdle.

So I think Dr. Michael, that’s kind of what you’re implying. If you’re not using enough, that bacteria’s gonna live and reproduce and then it’s gonna be harder to take care of.

Dr. Michael Marricle: Yeah, I think every vet here, that’s what we think about every time we pull up an antibiotic is, you know, how’s this gonna affect us down the road, this producer, how’s it gonna affect them?

How’s it gonna affect the whole population? So, yeah, that’s exactly how it works.

Kenny Coogan: And it’s true for human use. Even if you’re feeling good [00:28:00] after, you know, you’re supposed to take it for seven days, if you’re feeling better on day five, you really need–

Dr. Michael Marricle: You stop.

Kenny Coogan: Yeah, yeah.

Dr. Michael Marricle: You stop. And you just, you just trained, you know, that was like a workout session for those area and next time they’re gonna come back, they’ll be able to lift even more.

Yeah, I mean, I, I have friends. I think growing up, everyone grabbed their amoxicillin. Just, just seemed like I knew people that were on it. Every two months I’m like, holy cow. Like what are these people growing in their bodies.

More Antibiotics are Covered by FDA GFI No. 263?

Kenny Coogan: All right, so, uh, there’s about 20 drugs listed under GFI No. 263. Dr. Katie, could you maybe list a couple more that you encounter?

Erythromycin

Dr. Katie Estill: Yeah, so, um, some of the ones on there are the inframammary antibiotics, the cephapirin, the today, the tomorrow, um, mastitis medications that you’d see lots of people using. Um, there’s also a erythromycin that’s a, um, inframammary infusion for mastitis.

And I think having those used appropriately, um, and especially [00:29:00] as they’ve been on back order. So today is supposed to be used in fresh cows, tomorrow at dry off, um, to help prevent mastitis. Um, having those be used appropriately, even though, you know, I’ve seen people starting to use them interchangeably because of back orders and not having the availability, making sure that they’re using them appropriately.

Kenny Coogan: Dr. Oberlin, is there any other drugs that you wanna mention?

Sulfas (Trimethoprim Sulfa)

Dr. Oberlin McDaniel: Yeah, I’m gonna group into the sulfas. So I use quite a bit of sulfas, um, trimethoprim sulfa or we call ’em SMZ. They treat, you know, upper respiratory infections, UTIs, pretty broad spectrum antibiotic, which means it does both gram- negative and gram- positive. It’s usually, it has to be given twice a day for pretty long duration. So sometimes we, we choose another drug, uh, because of that.

Tylosin

Another one was Tylosin. Tylosin is kind of an older beta-lactam antibiotic, more similarly to [00:30:00] penicillin, but a smaller dose and for less duration. But it’s older and I think it’s, there’s a lot of resistance to it and personally I don’t use it in my own practice, but it was primarily used in poultry, um, and cattle.

A few other ones, you know, that I see on the list that I think are, are worth mentioning. Lincomycin, Lincomycin, uh, we use in swine for lameness issues. Um, it works pretty well, again, using it very sparingly and only, you know, when necessary.

Gentamicin

And then Gentamicin. Gentamicin is something that is actually we’re very limited with. Um, in food animals particularly, you have to be very careful with species in age with, with Gentamicin. We can use it in, in nursing piglets for diarrhea cases, specifically for myself. And then Gentamicin might be used for like in a horse for regional limb perfusion.

Treating Infectious Vs. Non-Infectious Mastisis

Dr. Michael Marricle: One thing. [00:31:00] So Dr. Katie mentioned those inner mammary tubes. When an owner calls for that kind of issue or other issues, the cool thing about calling your vet is they might give you some, some more information. For instance, with our mastitis cases and you know, cattle producing milk, there are studies out there that show 50% of the time they’re non-infectious.

And there’s other, other studies that show that we can take a milk sample today, test it, get a 24 hour read and a 48 hour read, and it won’t change. Waiting one extra day or two extra days to pick the right antibiotic will not negatively impact uh, the results. So I have so many of my backyard Jersey milking cow people trained to as soon as that calf freshens, or as soon as they think there’s an issue, which they– and I will talk about what to watch for– they’ll just drive the sample down to the lab for [00:32:00] very low cost. We’ll take an extra day or two and get the right answer. Half the time it’s non-infectious. We’re just treating that animal with supportive care and then it gets better and we got to side pass antibiotics altogether, or we picked the right antibiotics so we didn’t end up hitting this animal with six different tubes.

And I could think of similar stories for all kinds of, you know, infectious disease, respiratory cases or wounds. Like I’m sure every, all three of us here could think of similar stories and that that’s why having the vet’s perspective, the person who sees this stuff every day is, is, is pretty handy.

You’ll get better medicine.

Kenny Coogan: Dr. Oberlin?

Dr. Oberlin McDaniel: Well, you know, to, just to add to that, you know, we’re so blessed that as large animal vets say, we get to see so many different farm schematics. Several different pig operations, several different cattle operations, horse farms, sometimes daily and weekly, you [00:33:00] know, and so we know what is prevalent in the area, the issues that come to the forefront and area. We know what works too as far as management nutrition in the, in the area and, you know, genetics and, and also like, no, it, it just, it helps to, to know people. You know, we sometimes we serve as like a link between other farmers. Like, hey, you know, you might visit this person farm and just see how they do things. I think you’d really benefit from just seeing the way that facility works. And so we don’t wanna be perceived as like, this something to be feared, you know? Uh, we’re here to help and we wanna look at the, the big picture as far as your management scheme. And we take it to see a lot of different places and all the pieces of the puzzle together.

When Should You Consult with a Vet

Kenny Coogan: Very good. So, Dr. Katie, can you talk a little bit more about the veterinarian-client-patient-relationship, VCPR? When should [00:34:00] you consult with the vet? So let’s say your state law says the vet has to come on site once a year, and then four months later your cow has one sneeze or it has 20 sneezes, or your pig starts limping, or it’s hard to, you know, boil this down, but is it when it is limping? When is it completely lame? When can, when can you reach out to a vet? Are vets mad when somebody calls and says, oh my cow coughed, sneezed once? Go ahead, Katie.

Dr. Katie Estill: No, I would, I would much rather always hear from people sooner rather than later. Um, I would rather show up to the, to the party right when it starts, uh, rather than after it’s been going on for a while and we’ve tried multiple things that haven’t worked, um, and it’s gotten worse.

So I would much rather always tell people to call me when they’re concerned. You know, having that relationship where I can say, Hey, you know, uh, say you’re an hour away from me. Um, cause my service area is [00:35:00] fairly large. Can you take a temperature? Can you, can you tell me what’s going on with your animal? Um, and I can assess it from afar and say, yeah, we need to, you know, we need to head over there. Or, Hey, you know, this doesn’t sound serious at this point. Here’s the things I want you to watch for. Um, and we can make a plan versus having to rush out. But I would always rather have people reach out to me when things are beginning rather than things have been going on for two weeks and now they’ve gotten worse.

Kenny Coogan: All right, vets, any other, uh, Dr. Oberlin and Dr. Michael? Anything to add about that?

Dr. Michael Marricle: No, that was good. Sooner rather than later. And that once a year visit is gonna be the one where we talk about preventative medicine, so we’re not having the really scary tetanus talk or what have you. Or flu in your horse. So once a year to have our preventative talks and then, yeah, as soon as you notice something.

Those are my favorite clients and, and we have a great relationship. We, we talk, there might be some texting with videos to, to really help assess the [00:36:00] situation and, and, yeah. My least favorite, it’s because it’s, it’s hard as a doctor to, to walk in after this animal’s so far gone, like we’re gonna have to put them through a lot to bring them back, hopefully.

So sooner rather than later. I think about like the mechanic shop. If you don’t have the right tool to take the lug nuts off. So you’ve tried your crescent wrench, you’ve tried your hammer, you’ve tried everything. By the time you take that vehicle to the mechanic, like they’re gonna have to use the torch to get those lug nuts off. Cause you’ve tried everything except calling the mechanic first .

Kenny Coogan: Great analogy. All right, Dr. Michael, because you said it, this is the next question. What preventative methods do you recommend to keep your animals– and when I say animals, Just a reminder, GFI No. 263 is for animals destined for feed, but also for companion animals.

Keeping Herds and Flocks Healthy with Preventative Methods

Kenny Coogan: So, Dr. Michael, what are some preventative methods to keep your herds and flocks healthy that you like?

Dr. Michael Marricle: Yeah, I live in the desert, so [00:37:00] husbandry, we always start with husbandry. For us here, it’s about shade, clean, cool water. I wonder about the number of heat stress cases I’ve prevented in the area simply by recommending people move their water trough to the shade.

Or you can actually bury it like two feet in the ground and it’ll stay 20 degrees cooler, and then your animal drinks more. And then you don’t have to call me to give an IV. Um, immunizations are high on the list. I know people have different opinions on that, but, uh, a lot of my clients, we just, we have the talk on immunizations. And if give ’em, if they’re convinced, which they usually are, we go with it. Cause it’s all about perspective. I’m, I’m the guy that drives around seeing the ghosts that have tetanus cuz they didn’t get vaccinated through tetanus. And I’m the one who inevitably gets to put them down. And we could talk about vet burnout, but that’s definitely something that, um, something to think about.

But immunizations. Husbandry, yeah. [00:38:00] I mean, husbandry is all encompassing. We’ll, we’ll talk about nutrition enrichment, how to keep your animals from getting bored. But it, it’s just, it’s all a conversation with somebody like myself or the vets here that have perspective. They might bring ideas to the table that, that will keep your animal from getting sick and maybe just live a fuller life period.

Livestock Vaccinations by Region

Kenny Coogan: Dr. Oberlin, can you talk about some of the vaccinations that you recommend and. Can you also, this is a question from a audience member. Can you talk about the vaccination for staph A in goats, but it isn’t labeled for sheep?

Dr. Oberlin McDaniel: So first off, as far as vaccines go, that’s really gonna be, you know, we do have core vaccinations that are recommended by species, by region.

And so you have, uh, exposure levels depending on where you are. You know, I’m sure, um, Dr. Michael has a different vaccine [00:39:00] protocol that he uses, um, in Arizona than I do in North Carolina. We have all the ticks, all the varmints, you know, so we have a lot of the tickborne diseases and we have a lot of rabies.

So my vaccine protocol may be quite a bit different. But as far as vaccines go, I just wanna touch on a few things because we work with people with all types of opinions. . And like Dr. Michael was saying, you know, we have a conversation, an educated conversation about immunity and the exposure level to those specific animals at that specific farm, at this specific location for what their purpose is and what they do and what would be best for them moving forward as far as, as far as the vaccine protocol. And a vaccine protocol is gonna look very different from a goat farm, you know, uh, a dairy goat farm here that travels and goes to shows to just a backyard goat farm over here that, you know, these, these are just pets. So it’s customized [00:40:00] and that’s where, uh, veterinary-client-patient-relationship goes is, is everything is customized as far as your healthcare preventative protocol.

So do you want me to give examples as far as what vaccines I’ve personally used in my practice?

Kenny Coogan: Absolutely.

Dr. Oberlin McDaniel: For, um, a horse in North Carolina, a basic, you know, uh, somebody who’s on our, um, our routine call list and on our healthcare prevention program, they would receive minimal. If they’re not going anywhere and gonna be around any other horses, they would get rabies because they could definitely get exposed to rabies just sitting in the pasture on the farm.

They would get West Nile because we have a ton of mosquitoes around. EEE or WEE, which is Eastern or Western encephalitis, those are both mosquito borne illnesses and also rampant in the area. And tetanus. Those are all super duper important. Did I miss any, Katie and Michael? Tetanus, rabies, West Nile, EEE, WEE. Yep. Okay. Those are the core. And then [00:41:00] beyond the core, uh, protocol, we would add in maybe flu and rhino. Those would be diseases that would be spread nose-to-nose contact. So for horses that are going to shows or, you know, doing a lot of traveling, um, and things like strangles too. Strangles will be something that we would add. And in specific instances where it’s warranted, um, Potomac Horse Fever is something we’re also adding in, which is something we’re seeing more of.

And then goats, we usually use CDT, which is, which covers clostridials, and then we use rabies. Cause again, rabies is rampant our area. So those would be the two that we primarily use in, in goats and sheeps.

And then as far as, uh, staph A, I have not been asked this question, so this may be a question, Michael or Katie, are you guys familiar with this? I don’t do a lot of dairy in my area. I just don’t have a lot of milkers in my area. I, I service primarily, um, beef and then my, my goat producers are, are mostly pets or, or meat.

Have you guys used this vaccine [00:42:00] before?

Dr. Michael Marricle: I don’t. There are goat dairies in my area, but I don’t hear from them often. And the other vets in the area that I talk to don’t hear from them often either. So I wonder are they just using a vet that I don’t know, are they in need of a vet? Like who’s doing these conversations with the goat dairies in my area?

Like I drive around a lot and look at properties and I wonder, I’m like, you know, their animals need preventative care. They’re gonna get sick, but they’re using, cuz I know most of the vets in my area, they’re not going there. So that, that, I think that’s kinda the spirit of this whole thing is, is just trying to open communication.

Like just connect the appropriate parties, the people with the animals to the folks who know how to treat them, or know other ways to help treat them.

Kenny Coogan: You might be hearing from them after June 11th.

Dr. Michael Marricle: Yeah. [00:43:00] Yeah.

Dr. Oberlin McDaniel: So just to add about staph A thing, cuz I’m, I’m not familiar with that. And one thing that I’m kind of an open book about is, you know, with my clients and stuff, I, I, I don’t claim to know everything.

Um, you know, I’m a constant learner, and new things come on the market all the time. And, you know, if somebody were to phone in and ask me about that specific vaccine, I would make sure that, you know, I educate myself and call the necessary people to kind of understand it a little better and see if it’s appropriate.

It’s just not something that I’ve, I’ve been asked about. And um, like I said, I’ve never diagnosed a case of staph in my area and I don’t really work predominantly, um, with dairy animals. So I work with my clients on all levels. And if I don’t know the answer, I ask somebody who does. I’ve asked somebody with gray hair who’s done it before, and I have those contacts.

And so, yeah, I don’t have the answer to that question, but if we do another podcast, I’ll, I’ll have it then. [00:44:00]

Kenny Coogan: Anything else, Dr. Katie?

Dr. Katie Estill: No, I would say I, I have not used it either, just due to lack of, of dairy goat experience, but, um, I would assume it’s, it’s fairly similar to other vaccines for small ruminants, and then it’s not labeled for both.

So there’s a chlamydia vaccine labeled for sheep that’s not labeled for goats. In terms of usage of things that are used off-label by the FDA is, you know, you can use it off-label species, but you have to do so with a valid veterinary-client-patient relationship.

So if you’re having an issue with your milk sheep, which are significantly less common than milk goats, but they’re around. With staph aureus, you know, you can assess whether that’s gonna be useful for you with your veterinarian.

That’s the person you need to talk to if, if the product is to be used off label because a lot of, uh, medications, antibiotics as well, um, in sheep and goats are used off-label by your veterinarian because they’re using them appropriately.

Other Alternatives to Antibiotics

Kenny Coogan: All right. We have a couple of more messages. One is from Maria, [00:45:00] and she says this has been in effect for California for a few years. “I needed some antibiotics for my birds and was told that I had to seek an avian veterinarian, which did not exist in my area. I resorted to home remedies like apple cider vinegar, activated charcoal, and vitamin C.” So veterinarians, we’ll start with Dr. Michael, do you recommend herbals, high tannin feed stuffs, rotational grazing, specific bedding techniques, or any other holistic strategies to avoid the need for antibiotics?

And I, you know, I, I gave you some specifics, but is there husbandry that can prevent the use of antibiotics?

Dr. Michael Marricle: Yeah, no, I, I love this question. Yeah, that all falls into husbandry. There’s, uh, I said there aren’t antimicrobial, or we’re not developing new drugs every week or every day or every year, but there’s a lot of stuff is already around us that we’re studying more and every year we’re finding more [00:46:00] uses, more appropriate uses for some of these substances.

But as far as, like you said, high tannins, I had a goat producer in New Mexico that grew specific weeds cuz they would grow, they were safe for the goats and it cost him nothing. He had to water ’em and he never had to worm or deworm his goats because grazing on these high tannins kept all the parasite load extremely low, non-existent. Abetting, uh, you said herbals. There’s, I could think of a few things that I use in conjunction with medicine. You know, when you call a vet, it’s not just somebody that’s gonna draw something up in a needle and give it, you’re, you’re getting somebody with all kinds of advice and you’re getting a detective.

You know, we, we talked about when, if there isn’t an appropriate treatment or whatever your critter’s going through. We’re gonna stop at nothing to find the right treatment. And there are avenues if there’s not a, a listed medication or that medication exists, but it’s not labeled for [00:47:00] specific animal, we have routes we can go through to figure out what is the most appropriate.

So we’re also detectives. As far as like Maria, talking about not having a bird vet. I think of myself here in, in Arizona. I work on the most potbelly pigs of anyone in the state. I did not go to school for that, and I had no intention of doing that. But people kept calling and it’s supply and demand. And you, you call me enough times with a sick animal, usually just once, I’m going to do what I can.

So because of the demand for pig medicine, potbelly pig medicine in this area, my practice now sees thousands of pigs and we get a lot of bird calls and I do my best to brought in a vet who likes birds and pigs and horses. And so if enough people are calling, then it will be met. An issue, If enough people call in an area, I mean, Oberlin said she moved to an area where [00:48:00] there was no vet servicing five counties, and now she’s got multiple vets working under her cuz people start calling and she was able to grow her practice and that that can happen anywhere.

So yeah. Sorry, sidetracked, but, hopefully that answers the question.

Biosecurity Measures and Disease Prevention

Kenny Coogan: So Dr. Katie, we talked a little bit about husbandry, but I guess maybe a subset of that is biosecurity measures. Can you talk about does biosecurity prevent the need for antibiotics?

Dr. Katie Estill: Not necessarily. So certainly having good biosecurity can help reduce the risk or reduce the need. But not every bacteria is brought in just from outside animals. Some can be shared by wildlife, some can be, you know, just due to environmental issues or husbandry issues. So certainly it’s not going to prevent the need, but it can reduce the need. So you think about small ruminants, um, they have some contagious issue, contagious diseases like Caseous [00:49:00] Lymphadenitis for instance, that if you were to bring in an animal that was infected and the rest of your herd or flock was not infected, you can spread that around and share if you’re not practicing good biosecurity measures by testing or assessing new animals or quarantining them as you bring them in.

So certainly it will help reduce the need, but it’s not gonna always prevent the need depending, it just depends on the disease. And that’s again, one of those things when you have your veterinarian out to establish your client patient relationship, they can discuss with you, you know, what are your goals? Are you gonna bring in new animals? Here’s how I would do that so that we can reduce the need. Are we gonna test them for certain things? Um, cuz what are you gonna do this year with your, with your animals, with your herd, with your flock?

Kenny Coogan: Dr. Oberlin, can you talk a little bit about biosecurity and how it relates to viral issues? Vs., which are not treated with antibiotics, and then bacterial issues.

Dr. Oberlin McDaniel: So I actually get to deal a lot of, [00:50:00] quite a bit with that because I, I work at, um, for commercial hog operations, so we follow the utmost biosecurity before entering and after we leave, just to avoid cross pollination of, of viruses from the outside end.

So I think that, you know, how to make this applicable to everyone on the, you know, no matter what kind of species they have, is knowing what their risks are and the area, knowing how their animals are protected. And obviously I would utilize your vet to do that. You can best know how to keep your place biosecure, cuz that’s gonna look different for, you know, a hog operation as it would to an equine operation to small ruminant operations. And maybe something as simple as just asking people to, visitors to glove up or not petting your animals or going through a boot bath and then maybe as significant or [00:51:00] substantial as to showering before they, they enter, you know, a barn. And, and some of this, as far as viruses go, pig specifically, we can actually give them our viruses.

They can, you know, viruses can manipulate themselves. Just the easiest example would be flu if you’re sick. If I, if I were to be sick, which actually I’m pretty sick, um, right now, and so I actually wouldn’t go into a hog operation because I actually risk transferring the flu that I have to those pigs, which is quite interesting.

So the biosecurity there would be, uh, just reframing from being involved with the animals. There’s no amount of washing that I can do to make myself not sick.

Do Antibiotics Treat Viruses?

Kenny Coogan: Dr. Katie or Dr. Michael, anything else to add about viruses versus antibiotics?

Dr. Michael Marricle: Yeah, so antibiotics don’t work on viruses, but I guess the second you think your animal is not feeling well, the sooner you call myself [00:52:00] or your vet, the sooner we can talk about what else can we do to prevent needing the antibiotics at all?

Cause the viruses can open the body up to secondary antimicrobial infections and, and then that’s when we might need antibiotics. But just like you or myself, the second you start feeling sick, what you probably have to do is go rest and reduce stress in your life and do supportive care like fluids and staying warm.

So when people call me with a, a mini pig that we think is getting, coming down with something, you know, hey, heat lamp, blankets, Gatorade, that kind of thing. And they might be better in a couple days, whereas it would’ve drug on if they, hadn’t provided supportive care.

Or, hey, my horse is, something’s off. All right, let’s do some supportive meds. You know, they’re non-steroidals to make ’em feel better and electrolytes and reducing stress in their environment. Maybe don’t take them on that trailer this [00:53:00] weekend and you can, you can prevent it progressing. So that, um, I think just, just to, in the spirit of that, like having that conversation and, and some of the stuff all it takes is talking to the right person and you tell yourself, wow, I maybe I did know that, or there, I just needed to be reminded.

Kenny Coogan: So one, uh, cause of concern that we’ve seen many times over and over again is that many livestock owners who don’t vaccinate claim that biosecurity prevents the need for vaccination. But I think we kind of all agree that it cannot prevent viral issues. So consult with your vet.

The Importance of a Veterinary-Client-Patient Relationship

Kenny Coogan: And we have one last, uh, question and it’s for all three of you.

What strategies can livestock owners use to cover for staffing issues with their veterinarians? For instance, if they have a good VCPR, but the vet office is shorthanded, Dr. Oberlin is sick. What can the [00:54:00] hobby farmer do during this relationship to ensure that their animals are gonna get the proper care? Dr. Katie?

Dr. Katie Estill: Well, I think it, you know, having that good veterinary-client-patient-relationship is key. Um, and in terms of veterinary shortages, um, I’m a solo practitioner. Um, I don’t have any other veterinarians that work with me. Um, so when I am unavailable, my, my goal is to have an option for those people if it’s an emergency, and it’s not something that I can help them with for one reason or another, um, is to have a, a backup option for them.

And that’s something that I do for my clients to have something available. For instance, I was on maternity leave earlier this year. I made sure that I had veterinarians available and when I couldn’t have someone available, because I live in the middle of nowhere, I had people that they could call that were, granted, two hours away, but they could consult with, and they could talk to

Kenny Coogan: Dr. Oberlin, anything else?

Dr. Oberlin McDaniel: Yeah, same actually, you know, as, as long as the VCPR is there, you know, you’re an established client, we know [00:55:00] you, you know, your farm, um, you’re kind of grandfathered in to our practice. There’s always gonna be somebody available. Um, we’ve ensured that through, we have a lot of SOPs that if somebody’s out sick, it goes down to this person. If there’s an emergency, there’s this person, there’s, there’s a primary person on emergency, and then there’s a secondary person on emergency. And when I was a solo practitioner, because I was for three years, like Katie, similarly to her, I transferred my call to a, a neighboring practitioner that was either willing to consult over the phone or allow haul-in. I’ve never, never, ever heard of anyone, nor myself or anybody else, exhausting their opportunities. And there’s always gonna be help for your animal and definitely get a VCPR.

Kenny Coogan: Dr. Michael, any last words about what strategies livestock owners can use to cover staffing issues?

Dr. Michael Marricle: I mean, it’s just, planning ahead goes a long ways. So establishing that VCPR at times of [00:56:00] non-emergency and then also just timeliness the moment you think your animal’s sick, you know, your, your cow sneezes once, if you call me then, then I can plan my day, I can plan my week accordingly so that we can get someone out to you. We’re a multi-doctor practice and for where I’m at, we, I mean we cover the whole state of Arizona, but if the phone was ringing more, there are more people I can hire, supply and demand. So once the phone starts ringing more, I can bring more people in and we will meet the demand.

There’s a lot of vets, uh, vet students coming, getting ready to graduate that would love to go into this kind of practice. The demand has to be there, you know, maybe Dr. Oberlin would hire another vet if the phone is ringing off the hooks more. Maybe Dr. Katie would consider it. I don’t know. We definitely would.

There’s technicians I could bring in tomorrow. I just need the phone to ring more and it to not all be emergencies because it’s hard for me, the staff, when it’s feast or [00:57:00] famine, I dunno, do I need three techs or one? Uh, and when all the calls come in at nine o’clock at night, I mean, we make it happen. We cover it, but the number of those people that noticed their animal was sick that morning, that would’ve been the time to call.

So, call sooner and have that VCPR established.

Dr. Oberlin McDaniel: Just like Michael said, just being able to have a sick animal on our radar. You know, we can make sure that you’re prioritized, if not today, for the rest of the week, and leave you with some tips and tricks to maybe help you avoid an emergency.

Cultivate Kindness with More Mother Earth News and Friends

Kenny Coogan: Thank you so much veterinarians, Dr. Katie Estill, Dr. Michael Marricle, and Dr. Oberlin McDaniel, for speaking with us. Our conversation on Guidance for Industry (GFI) No. 263 has been very insightful. We thank you the listener for joining our podcast and encourage you to share it with your friends, colleagues, and family. To listen to more podcasts and to learn more, visit our website, [00:58:00] www.MotherEarthNews.com/Podcast. You can also follow our social media platforms from that link.

And remember, no matter how brown your thumb is, you can always cultivate kindness.

John Moore: You’ve just listened to our episode, GFI No. 263. You can reach us at Letters@MotherEarthNews.com with any comments or suggestions. Our podcast production team includes Carla Tilghman, Jessica Mitchell, John Moore, and Kenny Coogan.

Music for this episode is “Travel Light” by Jason Shaw. This Mother Earth News and Friends podcast is a production of Ogden Publications. Learn more about us at www.MotherEarthNews.com.

Thanks again to Allivet for sponsoring this Mother Earth News and Friends episode. Get the same pet and livestock prescriptions you get from your vet’s office at the lowest prices [00:59:00] from Allivet.com.

Their fully licensed pharmacy ships only genuine EPA/FDA approved U.S. products, and their exceptional customer service and 100% satisfaction guarantee gives you peace of mind. Do you have a question about your pet’s medication? No problem. Allivet customers can speak to one of their licensed pharmacists or on- staff veterinarian to address any concerns.

Try Allivet today and take $10 off your first autoship order with the code GRIT10RX. This is a limited time offer and some exclusions may apply. Head to Allivet.com to learn more and take advantage of this offer.

Until next time, don’t forget to love your Mother.

About the Veterinarians

Dr. Katie Estill is a mixed animal veterinarian in rural Northern Nevada and on-call advisor across the board for many of our titles, including Countryside, Goat Journal, and MOTHER EARTH NEWS. She helps fact-check for our publications and writes one article per issue in Goat Journal. She greatly enjoys the ability to work with a variety of animals within a day; from dogs and cats to livestock and even the occasional exotic feline from the local sanctuary. After graduating with her doctorate from Colorado State University in 2015, the Nevada native returned, opening her own practice in 2017 with the goal of providing excellent medical care and education to the rural community. In addition to her veterinary clinic, Dr. Estill also helps her husband manage their range sheep operation.

Dr. Michael M. Marricle practices veterinary medicine through his ambulatory livestock and equine practice in Central Arizona. His days are spent seeing routine and emergency calls for horses, cattle, small ruminants, mini-pigs, and other backyard livestock. Dr. Marricle worked as a farrier before attending Colorado State University and after graduating with his doctorate in 2015 he went into dairy medicine. After several years he opened his own practice to better meet the needs of the rural and underserved community with an emphasis on preventative medicine including equine dentistry and herd health.

Veterinarian Dr. Oberlin McDaniel is the owner of NC Mobile Veterinary Service, a rural 3-doctor livestock practice nested in northeastern, North Carolina.  NCMVS provides medical services to equine, bovine, swine, small ruminants, camelids, and poultry. As a mobile service, Dr. McDaniel and her team come straight to your farm equipped to service most of your animals’ needs all out of their trucks.

Additional Resources

Learn more about Guidance for Industry (GFI) No. 263 in our sister publication, Grit magazine.

Watch “The Evolution of Bacteria on a ‘Mega-Plate’ Petri Dish” from Harvard Medical School

Thank you to Allivet for sponsoring this podcast episode!

Our Podcast Team:

Carla Tilghman, Jessica Mitchell, John Moore, and Kenny Coogan

Music: “Travel Light” by Jason Shaw

Listen to more podcasts at MOTHER EARTH NEWS PODCAST.

Check out the MOTHER EARTH NEWS Bookstore for more resources that may interest you.

Go to the MOTHER EARTH NEWS Fair page for an opportunity to see some of our podcast guests live.

The Mother Earth News and Friends Podcasts are a production of Ogden Publications.

Ogden Publications strives to inspire “can-do communities,” which may have different locations, backgrounds, beliefs, and ideals. The viewpoints and lifestyles expressed within Ogden Publications articles are not necessarily shared by the editorial staff or policies but represent the authors’ unique experiences.