Sometimes You Lose

Remember recently my entry titled "Sometimes You Win"? Well, that isn't always the case. As a vet, sometimes unexpected and unpleasant things happen.

This afternoon I saw a small parrot who had been acting sick for a few days. His symptoms were vague, just acting "fluffed" and breathing a little heavy. Unfortunately, birds hide their illnesses very well, not acting sick at all in the earliest stages. This is an instinctual behavior, as in the wild the weak or sick are usually the first preyed upon. What this means for pet owners is that when birds start acting sick, they actually have been for a while and have now become so ill that they can no longer hide it. For Duke, that was not a good thing.

I began my exam as usual, carefully holding him while I looked him over. Birds have very different anatomies than dogs and cats, so restraint is also quite different. I've worked with exotic pets all of my career, so I'm used to those differences, and am comfortable handling birds of all sizes. So I thought things were okay at first. But as I was going over his body I noticed that he was breathing very rapidly. When I put my stethoscope to his chest, I heard a raspiness in his breathing that wasn't obvious on the initial exam. That's when things went bad.

As I was listening to his lungs, I noticed that he wasn't moving as much. Then I couldn't hear his heart. I quickly started to look at the rest of him and he wasn't moving at all. It didn't take me long to discover that he had passed away. I took a deep breath and had to tell his owner what had just happened. She was obviously surprised and shocked, but took it better than I had expected.

Birds are pretty fragile creatures. Sudden death under stress when they are sick is not rare, and is something that avian vets dread. We are taught that we need to examine a bird as quickly as possible, and do as much as possible in a single handling because the entire process is very stressful. Even board-certified avian specialists have this happen. But it doesn't make it any easier. When you have a pet suddenly and unexpectedly die in your hands before you have done much to it, it's very jarring and your stomach just drops.

The owner allowed me to do a necropsy (terminology lesson...."auto" means self, "necro" refers to death, and "opsy" means to study or examine. "autopsy" means to do an exam on "self", or the same species. "necropsy" means to study death, and is the term used for post-mortem exams on animals). I found that the air sacs (part of the avian respiratory system) had some foam in them, and the right lung had some yellowish fluid. My conclusion was that he had developed an infection of the air sacs that spread to his lungs. Duke's body was already extremely stressed, and the exam was simply too much for his system.

I can't say that situations like this ever get easier, but most of us learn how to deal with it. And this is just one more of the things that vets experience and have to deal with.

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Being The Boss

Here's another insight into the life and times of a vet that many people never realize. Though I don't own the practice I work for, I do manage one of the locations. Much of the daily duties I delegate to my Office Manager and Director of Pet Nursing (DPN), but I keep track of things closely and put my hand in when needed. Tomorrow I have to help fire someone.

The person in question has had a problem with repeated tardiness, coming in late regularly even up to 30+ minutes. My DPN and I have talked to her repeatedly about it and have given her warnings. That didn't seem to correct it. So we had written discussions outlining what she needed to do to improve (very simply, show up on time). Even that didn't seem to help. So a little over a month ago we had a final discussion, basically stating that if she was late even one more time by even one minute, she was going to loose her job. Today she was 38 minutes late because she didn't turn up the volume on her cell phone and relied on that as her alarm clock. She has been given multiple opportunities and well over a dozen "second chances", and the problem has persisted. What is sad is that she actually does a good job when she is at work. Unfortunately, allowing this would set a bad precedent, and it does interfere with the flow of work.

This is not the first time that I have been involved in terminating someone's employment (to use "nice" terms), but it doesn't really get easier. My DPN is going to be the one to talk to her, but I'm going to be there for support and authority. I know that there is a high likelyhood of begging, pleading, crying, etc., as I've seen it before. However, she knew that this could happen, and in fact WOULD happen if she was late again, so she shouldn't be completely surprised.

This is another of those things they don't teach us in vet school. I have had to learn how to be a good manager through seminars and experience. I have made many mistakes over the years, and realize that I've been a poor manager in several situations. But I have tried to improve on that and believe I do a pretty good job overall. Confrontation is never easy, but as a manager it's something you can't get away from. You have to learn to steel yourself to it, be firm but fair, and not let someone's emotions influence your better judgement. Letting a problem fester and build not only makes the work environment suffer, but it becomes harder to deal with the longer it exists.

So any vets-to-be out there, keep this lesson in mind. You're likely going to be managing staff at some point, even if it's because you're the only doctor on duty that day. Your success as a veterinarian will often depend on your ability to handle people and manage conflicts and difficult situations. This is not the right profession for someone with poor people skills. Start to hone them now.

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Cute AND tasty?

I could almost hear the collective "awwwwwwwww..." after the country learned of the piglet that wiggled its way from the confines of a transport truck onto the shiny asphalt of North America's busiest freeway, the 401, to then be saved by a good Samaritan who brought the pretty porcine to the THS. The piglet was examined by veterinarians there and will be treated for a broken leg.

Though admittedly adorable, I cannot but think of the piglet's fate, had it not fallen from the truck: it would have arrived at a pig farm, to grow and be fattened up over a few months or more, to then be slaughtered and used for our consumption, the beings so willing to wolf down menu items of pork chops, bacon, and pancetta, and yet with hearts so warm as to rescue this pre-fab menu item in order to alleviate its suffering. This story should be both heart-warming and also a reminder of the thousands, no, millions of adorable piglets and pigs being led to slaughter at this very moment.
Is this blatant hypocrisy or rather a more innocent manifestation of our contemporary human condition?

Humans eat pork products willingly. Our hearts also warm when seeing images such as this.

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Cesarian Questions

My story about the Cesarian section a few days ago sparked some questions that I thought would make an interesting discussion.

As a vet-in-the-making with an unending string of questions, do you mind if I ask you a couple of things?
Is it normal procedure to spay after a caesarian, or were there specific reasons (eg the difficult birth or the pregnancy was accidental) that you chose to do it on this occasion?
Presumably removing the ovaries affects the bitch hormonally - does this have an effect on her maternal instincts towards the puppy? (Or even affect her physically, eg reducing lactation?)
Thanks, just interested :)

C-sections usually happen because the mother can't give birth naturally, often because the puppies are too big. In English bulldogs this is routinely done since they have such large heads. Certain selective procedures such as this can involve a breeding bitch (proper medical term, folks!) worth thousands of dollars. Her reproductive future is important so you don't spay them. However, certain dogs have litters accidentally, or have serious complications, and future litters could be a risk to their health or life. These dogs should be spayed. In my particular case the father was apparently smaller than the female, yet the puppies were too large. At three years old this was her first litter, and the owners didn't have her for the purpose of breeding. I discussed with them the future risks of other litters, and they agreed that it wasn't worth this happening again and wanted her spayed.

Ovaries produce many hormones, all important to the reproductive cycle. Removing the ovaries obviously affects hormonal production, but not immediately. There are already in the blood stream, and you're just affecting continued production and not what is already present. It can take days for those levels to go away, and longer for the affects on the body to reverse. So spaying her had no effect on her rejecting the puppy a few hours later. Estrogen levels drop immediately after birth anyway, and so have little to no influence on behavioral or physiological responses. Lactation after pregnancy is primarily controlled by prolactin, and after this point the milk production is mostly controlled by whether or not there is nursing occurring. Unfortunately, maternal behavior in pets or people aren't completely under the control of hormones, otherwise it would be easy to make humans and animals better mothers merely by a supplementation.

Good questions!

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For Those Who Have Gone Before....

When I was in 10th grade I had to do a special project for my American History class. I had two uncles who fought in World War II in the Pacific, and thought that it would be interesting to interview them on their experiences. They had a friend of theirs who was a prisoner of war in Germany and included him in the interview.

My Uncle James was in the Merchant Marine and saw combat on ship against the Japanese. My Uncle Dan was a mechanic in the Air Force and stationed in the South Pacific. Though he wasn't a direct combatant, he was still in combat situations. Their friend (whose name I'm sorry to say I don't remember almost 20 years later) was in the Army and was captured in Europe. All three had extraordinary stories. The POW talked about interaction with the Nazi guards at the prisoner camp. Uncle Dan had to jump into ditch when a Japanese fighter strafed his camp. Uncle James saw a nearby ship destroyed by a Kamikazi fighter. These men risked their lives to preserve freedom for all people, not just Americans.

I have had other friends and relatives serve in the military, including the recent conflicts in Iraq and Afghanistan. The personal relations and stories hit the closest, but I have incredible respect for anyone who chooses to serve our country this way. And I have such admiration and debt to those who have died in service.

Today is Memorial Day in America. This holiday was first started to commemorate the people who died in our Civil War. Since then we have expanded it to honor all men and women who die in military service. The phrase "Freedom isn't free" is a bit overused nowadays, but that doesn't make it less true. We owe our current society not to the politicians and presidents, but to the average soldier, marine, sailor, airman, and guard who have sacrificed their families and lives to preserve what we know and love. We need to remember them today, and also remember those they left behind. Our idea of modern civilization throughout the Western World would be quite different without them. We forget that at our own peril.

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Sunday Cesarian

I don't normally work on Sundays, but today was filling in for a doctor at one of our hospitals (the practice I work for has multiple locations). The day started off pretty slow, which wasn't surprising for a holiday Sunday. Late morning a very pregnant maltese came in. She had been seen over the last couple of weeks for assessment as she came closer to full term. A week ago x-rays showed that there were two large puppies, and that they were possibly too large to give birth to. We found this to be true today, as a repeat of the x-rays showed slightly larger puppies than a week ago. She had been actively contracting for at least six hours without any puppies being born. My usual rule-of-thumb is that if there are contractions for more than an hour without any birth, the dog may be in trouble.

The owner agreed to the cesarian section, and we began rescheduling appointments and preparing for surgery. As we began to induce anesthesia part of the fetal sac started coming out. I quickly felt her belly, and I could feel the puppy's head near but not in the birth canal; I knew I had to get in there immediately.

The next several minutes were pretty fast and furious as I hurried through the abdominal incision, brought the uterus out of the belly and cut the first puppy out. I handed it over to one of my techs to begin stimulating it to breath. For those who haven't been involved in this, it involves vigorously rubbing the puppy, then carefully but firmly slinging the puppy head-first almost between your legs. This helps to force the fluid from the lungs and mouth. While one person was working on the first puppy I quickly removed the other one and handed it off to the next assistant. While they worked on recovery of the puppies, I spayed the mother (removing her uterus and ovaries), and quickly closed her up. For the mother's part, the surgery from that point was quick and uneventful.

The first puppy did very well, began breathing, and was very strong and vigorous. Unfortunately, the second puppy did not do as well, and never breathed on its own. With my instructions (I was the only doctor on duty and was busy in the middle of surgery on the seven-pound mother) they tried hard to save the second one, but in the ende we lost her.

The mother recovered quickly and well, but never seemed to accept the puppy. We tried putting them together, but the mother simply ignored her (it's a little girl). That means that the owners are likely going to have to bottle-feed this newborn for the next five weeks. But thankfully both the mother and puppy went home in very good condition. As long as the puppy can be fed well, I anticipate both to do great.

Not bad for a Sunday afternoon, huh? Oh, and this another reason to spay your dogs. Malteses don't commonly need cesarian sections, but anything can happen. The owner's total bill was a little over $1000, and they would have lost the mother if they hadn't agreed to the surgery. It's much cheaper, easier, and safer to simply have your dog spayed. This kind of problem is one of the risks that anyone takes when they breed dogs.

And this also illustrates one of the hallmarks of veterinary medicine. You really never know what will come through your door or what you will need to be doing at any given time.

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Age Is Not A Disease

For whatever reason, many people seem to think that pets don't need any care beyond a certain age. I've had people decline vaccines, heartworm prevention, and other routine services because their pet is "too old". I've also had clients who don't want to do dental cleanings or other simple anesthetic procedures because their dog or cat was geriatric. It's interesting that different people have varying definitions of "old". The "magic age" might be 8, 10, 14, or just about anything. And perceiving their pet as old often has nothing to do with the pet's actual health. Just today I saw an 8 year-old boxer that the owner didn't want to do more than a rabies vaccine because he was too old. However, the dog was in excellent health and acted half his age.

Age is NOT a disease! Honestly, a pet's age is irrelevant to whether or not it should get certain procedures, or even survive anesthesia. The reason why there seems to be such concern is that historically older pets haven't done as well with surgeries or dental cleanings. But keep in mind that years ago we didn't use the same types of anesthetic drugs, didn't do as much monitoring, and didn't do pre-anesthetic blood testing routinely. As a pet ages, it has a higher likelyhood of stress on the organs, potentially leading to heart problems, liver disease, or kidney failure. However, a likelyhood of a problem does not equal a certainty. People and pets don't die from "old age", but from system or organ failure.

When I'm evaluating a pet, it's age is often a minor concern, especially for routine care. I may pay attention to it if I'm considering certain diseases or disorders that are more commonly in older pets. But otherwise I concentrate on evaluating the health. I have seen four month old puppies with fatal illnesses and 16 year old dogs that acted like they had no problems at all. I have done dental cleanings on 18-20 year old cats and dogs without any concerns or complications.

So keep all of this in mind when making decisions about your pet. Just because they are senior or geriatric doesn't mean that they should be prevented from receiving needed care. And if they're otherwise healthy, their age alone will not cause concerns for their survival. Look at the condition of their health, not how many birthdays they have had.

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Do What The Doctor Says

In the last couple of years a major topic in veterinary medicine has been owner compliance. Surveys have been done and have shown that pet owners don't follow the doctor recommendations far more frequently than vets believe. And that's not with whether or not they authorize services. The surveys looked at how compliant owners have been with giving prescribed medications or following treatment directions. And surprisingly, half or less of owners follow veterinarians' instructions. Often times they don't give medications as often as recommended or for as long as recommended. They also don't manage bandages, restrict exercise, and otherwise do what the doctor has said.

Why does this happen to this degree? Part of it is that people have busy schedules. It can be very difficult to give medications three or four times per day. Heck, I've forgotten to do that myself on my own pets and kids. Sometimes it may be because certain pets don't allow you to give medications easily. A lot may be that owners don't understand the necessity of proper medication. Whatever the reason, it's a frequent topic of discussion in veterinary journals. Most vets assume that the directions will be followed exactly or closely, and it's a real eye-opener when we find out it isn't happening. So let me try and help out a bit and explain some things to you pet owners.

Medications take a certain amount of time to reach effective levels in the body. This can be minutes to days. The body also metabolizes and eliminates medications at different rates. And the medications must stay at therapeutic levels for an adequate period of time to be effective. For medications that are given twice daily, you must give it this often to keep the blood levels high enough. The reason why some medications are given once daily and others are given more often has to do with how each chemical is metabolized. They are NOT all the same.

Antibiotics must be given for a long period of time to be fully effective. Many people stop giving the antibiotics as soon as the symptoms go away. Time and time again I have seen infections return because the owners didn't finish out the course of antibiotics. As the medication works, it will reduce the population of bacteria. There will be a point where the numbers of bacteria are low enough that you don't see clinical signs, yet the bacteria are not eliminated. If you stop the antibiotics too soon, you could see a quick return. Some infections require antibiotics to be given for 1-2 weeks after the symptoms have resolved! Just because you no longer see the problem doesn't mean that it is actually gone.

Many treatment plans are difficult, such as keeping an active dog on restricted activity. Some are time-consuming such as most behavioral therapies. Some are inconvenient, such as feeding a special diet to one pet in a multi-pet household. But your vet is going to recommend what is best for your pet, and you as a pet owner have a responsibility to do what is best for your pet. If you have questions or concerns about the treatment plan, bring it up before you leave the vet's office. But if your vet tells you to give a medication on a certain schedule for a given length of time, please do it. Failing to do so could prolong problems with the pet.

Don't contribute to this epidemic of non-compliance in pet owners. And don't complain if a problem doesn't go away because you didn't follow directions.

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Carrying your dog around

I've blogged about this before: how inappropriate it is to conduct your day with your dog in a purse or other semi-capacious item not normally used to tote living things.
How it has come to incense me so, I do not know, but that I feel sorry for the dogs is clear.
Humans had it right millenia ago. Their behavior towards humans has changed little since then, while ours towards them has inexorably led to the very many doggie behavioral issues that need to be eschewed from the development of our intimate human-canine relationships.
I will continue to bring this topic up, as I would like to drill it into the minds of as many people as possible, in an effort for all of us to achieve the healthiest human-canine bond possible.
It's work, but well worth it!

The skull of what may be the earliest known dog, which dates to 31,700 years ago. The prehistoric skull was excavated at Goyet Cave in Belgium ( photo: Mietje Germonpre).

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Snake Bites

A week ago Saturday one of my regular patients came in for an emergency situation. Little Brandi is a 5-6 pound Yorkshire terrier, so she's not very big. Her owners witnessed her walk right up to a rather large snake, sniff at it, and receive a bite right on her muzzle. The husband quickly killed it and they were able to identify it as a copperhead, a common venomous snake in our area. They rushed her right up to me for treatment, and had her to me in a matter of minutes.

Right now most of you are probably thinking that a little dog like Brandi is lucky to have not been killed instantly. And that she probably needed life-saving hospitalization and treatment that cost the owners thousands of dollars. After all, a bite like that is pretty serious and usually fatal. Right?

Actually, that's pretty far from the truth. Believe it or not, venomous snake bites are rarely fatal. Sure, they will make the victim very sick and feel bad, but it takes a lot of venom to kill something larger than a small rodent. In North America people rarely die from a single bite from snakes like this, and the ones that do die usually fell into a nest and received numerous bites. The same situation applies to pets. A single bite from a copperhead, water moccasin, or even most rattlesnakes is rarely fatal.

When Brandi came in she had an obvious bite on her muzzle near her eye, and it was already a little swollen. I gave her injections for pain, inflammation, and an antihistamine, and sent her home with pain medications and antibiotics Over the next few days she became more bruised and had difficulty eating as the pain and swelling worsened. However, her owners were very careful with their care and watched her closely. Thought the first few days after the bite were rough, she pulled through without problems, and when I saw her this past Saturday she looked great.

Now don't misunderstand me. Snake bites can be serious, and some pets can have allergic reactions to the venom. Any person or pet who has been bit by a venomous snake should seek immediate medical care. However, I don't want people to worry that their pet will die. Brandi is actually the second Yorkie I have treated for a copperhead bite, and both did very well. If you get veterinary treatment, your pet should come through without any serious problems.

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Human rights

Unrelated to veterinary issues, I am ashamed by the most heinous violations committed by Russia against the gay community during a pride rally in Moscow. Activists were arrested during this peaceful rally, hours before the all-inclusive Eurovision finals were to take place (which was won in 1998 by Dana International, an Israeli transsexual). As GPOC writes on his blog: an attack on the liberties of one group is an attack against us all. Where are Toronto's lefty protests now? We must all decry Russia's devolution to barbarism.

It's 2009 and this is still occurring on this planet.

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Sometimes You Win

Being a doctor can be hard, and unfortunately you can't help every case. Sometimes the diagnosis itself is pretty difficult. Sometimes there isn't a good treatment available. And sometimes the patient doesn't respond to your best care. So when you get the difficult cases that turn out well, it makes it all worthwhile.

Tucker is an 8 year-old golden retriever that I have been treating. Several months ago he came to me with a swelling around his right eye. I suspected an allergic reaction, and we treated him with short-term anti-inflammatories. He responded well, but then a short time later it came back even worse. This time that side of his face swelled and he started having pain eating or opening his mouth. An aspirate of the swelling didn't show any signs of cancer or abscess. Based on the location, I suspected an inflammation of the muscles involved in chewing (a condition called masticatory myositis). So we put him on fairly high doses of steroids (glucocorticoids) for a few weeks. That helped, but the problem started to return. In cases like this you may have to treat for a longer period of time, or you may have to keep the patient on steroids for life. Hoping for the best, I put Tucker on the medication for a couple of months.

I saw him a few days ago and he has been off his medications for almost three months. Thankfully, he is doing great! No more pain or swelling, and he is such a happy dog. Tucker is a great dog, and his owner is very nice and willing to do what is needed. This is one of those cases that you are greatful to see come back. And this is one of those happy endings.

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The True Value Of Pets

Can you place a monetary value on pets? Many people do. "I paid $1200 for my labadoodle!" "This was a free cat, so I ain't spending much money on her." "It's just a guinea pig. Your office visit is more expensive than buying a new one." Lawyers also put a specific value to a pet's legal worth, which normally isn't much. Here in the US pets are considered a special form of property, and therefore people aren't entitled to settlements for more than the replacement value, or possibly the future breeding revenue. However, I don't think this really give the true value on pets. Whether or not somebody finds "value" in a pet is more a factor of emotional bonding, and may not have anything to do with how much they paid to get that pet.

Back in march I saw a hamster for a lump on its chest. It ended up being an abscess, which I drained and then put the hamster (Bob) on antibiotics. The way abscesses form in rodents, the material is very thick and doesn't come out easily. This means that there is a pretty decent chance that the infection will return and will have to be surgically removed. That happened with Bob. When they brought him back in for a recheck, the abscesses had fuly returned and I told them we were going to have to do surgery. After some discussion they agreed, and on Tuesday we had him back in to take them off. Once I had this 39 gram hamster anesthetised I noticed tha the abscesses were more wide-spread than I had first thought, and some of them were small but inoperable. I called them and said that I did not recommend going through with the surgery because of the high likelyhood of more cropping up at a later time. However, they insisted on it so I proceeded. That little guy underwent extensive surgery to remove as many abscesses as I could, taking longer than a large dog neuter, and using more suture material than I use in an average spay.

The first time I saw Bob the visit cost the owners about $60. The follow-up was $35. The surgery was $210. A total of a little over $300 over two months for a $15 hamster. And this isn't the first time that I've seen this. I had a client spend close to $400 for diagnostics and amputation of his hamster's food because of an unusual tumor. I had a client spend $80 on a skin problem for a mouse that she had originally purchased to feed her snake and ended up becoming attached to. And I've seen people who bought dogs for $800 that wouldn't spend $30 twice a year for heartworm prevention.

A pet's "worth" or "value" has little to do with their price tag, and more to do with the bond and emotional attachment. People consider something valuable for reasons other than money, and pets are no exception. Someone can be willing to spend much more or much less than what they paid to get that pet. And someone may be willing to spend hundreds to help a very small hamster. Personally, I think that bond between a person and a pet is invaluable, and I strongly admire anyone who sees a pet's life as worth more than what they have in their bank account.

Oh, and Bob is doing well and was runing around like nothing was wrong the next day. Now we have to hope that his antibiotics clear up what I couldn't remove and he continues to have a normal life.

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Training Tips

I knew Twitter was good for something: I would never have found this page with 12 excellent tips (I think they're essentially mandatory) every dog owner should follow.
Click here for an obedient dog.

Lookee the photo I found online.

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A Father's Milestone

As this is a blog about a veterinarian's life, and not just one about veterinary medicine, I'm going to step away from what I do and talk a bit about who I am. In this case, my role as a father.

Yesterday my son had his first baseball game. He just started minor league a few weeks ago, and this is his first time in organized sports. When I was growing up I was never really "into" sports, and neither was my father. However, I played soccer for many years, and swam competitively, doing very well in both sports. In fact, if I had pursued it into high school, I probably could have gotten to the point of earning sports scholarships. I was never interested in baseball, basketball, or football, the main US sports endeavors, and remain disinterested to this day. My pursuits are more in the "geek sports" than traditional ones. So supporting my son in a sport I never played was pretty interesting.

Watching a group of 8 year-olds play baseball was pretty funny. There were some good hitters on both teams, though the opposing team had more of them than my son's. Fielding was pretty poor on both teams, so for the most part of someone hit the ball they ended up on base. The coaches also called a team's half of the inning done when the batting team accumulated five runs.

As much as I hate to say it, Lucas wasn't a star performer. He struck out both times at bat, and one time just kind of watched a ball go by him when he was in the outfield. But he had a really good time, and I know he will get better. What was great for me was to see my boy out there on the field.

On my way home from work this evening I was talking to my father on the phone, and telling him about the baseball game. We compared notes to when I was playing soccer and he was on the sidelines watching. One memory that we shared was my own experiences with being a bit distracted on the field. Just like Lucas was staring off into nothing when a ball came near, I also had moments when I was picking at grass or otherwise not paying attention while the ball was on the other end of the field. I guess it's something that all kids do at one point.

So now I've reached that particular milestone of a father, and have watched my son play his first sports game. It was a bit surreal, but I was very proud of him, and look forward to even more games. Hopefully he will get on base next time.

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Moving An Elderly Cat

Here's a tough situation sent in by Jackie.

I have an elderly cat,17 years old, and showing signs of her age - cataracts, vomiting, limping, dull coat, but she still has an appetite. She has always been a very anxious cat, does not like to be touched, but will lay next to you. I am moving from a home in Florida to an apartment in Colorado and fear the 3-day trip, by car, will be too hard for her and then the adjustment there, as well. She has never been outside except for the necessary vet appointments. I feel that euthanization would be more humane and would like your view on this. Thank you.

I know this is a hard situation for you Jackie, and I'll try to help you out. But realize that this may be a discussion to also have with your personal vet, as he or she will know your cat's health status better. If there are some strong health-related reasons for a poor quality of life, then euthanasia may be a valid option regardless of your situation with moving.

As I've mentioned in previous entries, I believe that euthanasia is an option of last resort, and should never be done for convenience. Seventeen is very elderly for a cat, and most don't make it to this age. What you have mentioned of her condition is not uncommon for a cat of her advanced age, but also doesn't mean that she is at the end of her life. Your vet may be able to help you with supplements, diets, or medications that can help with any digestive, arthritis or coat problems. Simple things may help improve her quality of life.

Most cats don't adjust to new situations easily, and a long move to a new location can be difficult even for a young cat. An older cat may have a harder time with this situation. However, the key word here is "may". We don't know how she will react to the trip or the move. She may completely freak out and begin having behavioral problems. Or she may settle in and make the adjustment just fine. We don't know what will happen until it happens. And to me, making the decision to euthanize her based on a "maybe" is not the right decision if she is otherwise in good condition. Euthanization is an irreversible decision, and not an easy one. Even if she hasn't been the most overtly friendly of cats, she has still been your companion for almost two decades, and I don't feel you should give up on her just yet.

You asked for my thoughts, so here they are. I would recommend getting her used to the cat carrier for several weeks prior to the move. Leave it out all day and night, and put her food and water bowls in the back of it. This way she has to walk in and out throughout the day, and learns to see it as just another piece of furniture. About a week before the move go to your local pet supply store and buy spray and plug-in Feliway (often under the brand name Comfort Zone). For the last week prior to the move, spray the carrier with the Feliway every couple of days. Once you get to your new place, plug in the diffuser in an area she will likely spend the most time. Feliway is designed to help reduce stress in cats, and can help in situations like this.

If you get to your new apartment and see that she has become frantic and is showing a complete mental breakdown, you can always make the decision to euthanize her later. But if she turns out to make the move easier than you thought, you will be able to keep her in your life for a longer period of time.

Good luck, Jackie!

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Twitter

I joined Twitter yesterday in order to boost readership of this blog. I have many great followers and readers (for which I am grateful), but I would love to reach out to more people out there in the blogosphere. Is it egotistical to want this? To want thousands and thousands of people following what I have to say? My training as a vet has helped bring me to this: a practitioner, a blogger... someone who is opinionated and isn't afraid to share it.
By joining this ultra-popular networking site, I, too, have been introduced to some spectacularly interesting blogs - there are some darn incredible writers out there!
My quirkiness notwithstanding, there are important things to bring to the forefront and I hope that this blog, my writing, my opinions, will evolve towards something more important, more intelligent, and of course, remain relevant to all of us.

Tweet.

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To Specialize Or Not

Here's a recent comment that I thought warranted further discussion.

I'm quite surprised they don't offer more specialization since as a vet it seems you can go into a variety of different speciality areas (my neighbor is a large animal vet). Do you think if they retained the basics for every major area, but included more specialization it might increase the productivity of vets?

Veterinary medicine has changed a lot in the last 100 years. When our society was more rural, veterinarians were mostly working on the farm animals, and would see the dogs and cats while they happened to be on the farm. In the last 50-60 years, our culture has dramatically shifted to animals being pets and family members, not livestock and workers. This has also changed the focus of veterinarians and where you find most of them. In 1909 most vets will have been found working the farms. In 2009 most of them will be working on companion animals.

Almost every veterinary school in the US started with an agriculture land grant and that bias still shows. Vets are also the leading experts in diagnosing emerging serious diseases in animals, especially those transmittable to humans (swine flu, avian flu, etc.). By having the knowledge of all species, we have a better ability to observe and report these diseases, thus upholding the part of our veterinary oath that involves protecting the public health. As a secondary point, having the training we receive in school allows us much more flexibility to pursue a myriad of career options, often different from where we thought we would be when we graduated.

On the flip side is the argument that we simply have to know too much. Think about everything a MD has to know about human anatomy, physiology, and medicine. Now take that same depth of knowledge and apply it to a dozen different species that have radical differences. Cram all of this training in the same time it takes human medical students to learn their one species, and you get an idea of the difficulty involved in obtaining a veterinary degree. Many people argue that because the nature of veterinary practice has changed, there should be a "limited licensure" that allows vets to practice on certain species to the exclusion of others. For example, I would have a license that allowed me to practice on companion animals and pets, but not livestock.

There are good arguments on both sides of the issue, and it has been a hot-button topic in the field for several years now. On one side I can understand the historic and current need for vets to monitor all kinds of animals for diseases and general public health (including food inspection). Yet on the other side I remember only tiny details of my training in livestock, and can never see myself working with those animals again. I'm not sure that that part of my training has ever been useful to me.

So back to the comment...we already get basic training in all major areas, and do have the opportunity for certain amounts of electives to direct part of our interests and education. For example, I took electives in ultrasound, avian medicine, and exotic pets because I had interests in these areas. Some of my classmates took extra classes on equine or large animal medicine and surgery. I can't say that any of this "specialization" is really going to increase our productivity greatly, though it did help me start off with more knowledge in the areas I thought I might practice.

By the time I retire in another 25-30 years, I fully expect the profession to be radically changed from what it is today. We'll see what changes happen and how future veterinarians are trained.

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Vaccinating Sick Pets

Here's a common scenario that many vets face. A pet comes in for an illness. Sometimes it may be for something relatively minor like a skin or ear infection. But more likely it will be a potentially serious problem such as profuse vomiting, not eating, being extremely lethargic, and so on. Chances are good that this problem has been going on for a while, and it seems that these cases happen in pets that rarely get veterinary care. So there we are with a pet that might have a very serious illness when the next question comes up.

"Hey, doc. While we're here could you give him his shots?"

Sometimes I can't completely understand some people. Their pet is sick and I'm talking about having to do a battery of tests to determine if it may be life-threatening. Yet they seem more concerned about the fact that they haven't brought this pet to a vet for vaccinations in a few years. These people seem to find the lapsed vaccines a greater concern than the illness that just happened to motivate them to come through our doors. So let's have a little lesson in immunology.

The immune system in a living creature is a truly remarkable and complex thing. When an animal or person becomes sick there is a cascade of events and chemicals within the body as the organism tries to correct or heal the illness. Antibodies may be produced, inflammatory mediators are released, white blood cells are released from the bone marrow, blood vessels become leaky, and many other things can happen. All of this is a normal response whether it's due to an injury or infectious disease. However, this normal response can lead to adverse effects on the body depending on the severity of the response. The immune system is also not limitless. There are only so many white blood cells that can be produced at one time. There are only so many resources the body has. And there is only so much a body can take at one time.

This is where vaccines come into the picture. When we give immunizations, we are stimulating the immune system to have many of the above effects. However, if the immune system is already "busy" trying to fight off another problem, it may not respond properly to the vaccine. This might mean that the body doesn't develop proper immunity and the shot ends up being worthless. Or, the stress of this secondary response on the immune system may make it harder to fight off the primary infection.

Put simply, we don't vaccinate seriously ill pets or people. It's simply not a good idea. A minor, local illness (such as an ear infection or small wound) isn't a big deal and we can still immunize. But vets aren't going to do this if there is a serious or wide-spread problem.

So the next time you take your pet to the vet for an illness, please don't ask them to vaccinate him or her until the problem is corrected. And make sure to visit your vet regularly so that you don't get behind on vaccines and physical exams to put you in this situation.

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Preparing To Enter Veterinary Medicine

Emily has asked a series of questions, and I'm going to answer each in turn.

So why am I considering becoming a vet? I have been an animal activist for years, lost hope in people and kept it all to myself. Until I met the vet for my two dogs who inspired me to look into the Vet programs as a way for me to help animals. I believe that not enough owners are properly educated about nutrition and care for their animals- their front line for information is from their Vets. No other job field inspires me quite like this one...yet no other scares me as much. Ergo, I have questions....if you'd be so kind to answer?

Emily, I think it's great that you've found a vet that inspires you so much. However, if you lost hope in people beforehand, you may be in for a rude awakening as a vet. If you've followed some of my discussions (especially my pet peeves) you'll see that there are a lot of people out there who don't do what they should with their pets. This will frustrate you incredibly, and you will need to learn how to deal with it. This is NOT a profession to get in if you don't like people or can't handle them well. You'll be talking to people and trying to get them to do your recommendations. The owners make the decisions, not the pets, and you'll have to face that.

(1) I know a science background is preferred for acceptance. Is there anything I can do to improve my odds and show that I am a smart potential candidate?

Veterinary school is VERY competitive. You have 400-500 applicants for about 100 openings in an average school. Having a science background isn't essential. In my own veterinary class there was someone who worked for IBM and a school teacher. The vet who took over my hospital near St. Louis had previously been a magazine editor. However, you will need to have very good grades in the necessary classes, at least a B average and an A is more preferable. You will also need to send in recommendations from veterinarians as part of your application, so you will need to make good friends with your local ones.

(2) If I become a vet tec, does that certification translate into becoming a vet, ie: would I have to take less classes? Thought that being a vet tec first might be a good way to ease myself into the profession.

Whether or not you are a veterinary technician has no bearing on veterinary school. Having that certification won't reduce the classes one tiny bit. You may find some of the classes easier than your fellow students, but you'll still have to take the same ones as everyone else. Being a tech doesn't keep you out of medical training any more than being a human nurse keeps you out of part of human medical school. If you truly want to be a vet, I would recommend skipping the tech degree and going straight for the doctorate.

(3) In the school part, how important would you say math/chemistry skills are? If it doesn't come naturally to you, perhaps extra studying involved, is it possible to succeed?

Both are extremely important. Most veterinary schools require algebra and calculus for admission. You will also need enough chemistry classes to almost qualify you for a chemistry minor. Once in practice you will use basic math and algebra every single day as you calculate drug dosages and fluid rates. You will also need a very good grasp of chemistry (especially organic) to understand how drugs work on the body. Math isn't natural to me, so I'm an example of how hard work and study can get you through.

(4) Are there any resources available which might give me a sense of what material will be covered during Vet school?

Veterinary school will cover every possible subject related to an animal's health: anatomy, physiology, internal medicine, infectious diseases, toxicology, pharmacology, parasitology, embryology, cardiology, dermatology, nutrition, neurology, soft-tissue surgery, orthopedic surgery, and classes I probably can't even remember. You'll also have to learn all of this for more than one species: dogs, cats, reptiles, birds, horses, cattle, sheep, goats, pigs, and pretty much EVERY species except humans. It will be the most incredibly challenging four years of study you can ever imagine. Once you get to know your vet better, ask to borrow some of his or her texts and look through them to give you an idea of the detail that we have to know.

Good luck with your studies, Emily!

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Spring is here!

Spring is a time when many people take their pets to the vet for their yearly check-up. The snow has melted - in areas that receive snow - and pets become exposed to different things, like plants, dirt, baseball fields (and therefore baseballs), fossils, fault lines, fleas, ticks, and trolls (where they're indigenous).

Ok, jokes aside: dogs (and cats - cats are more complicated with respect to heartworm disease) require heartworm testing, monthly flea, tick and heartworm prevention, and possibly vaccines/boosters.
You should always your vet which vaccines are being administered to your pet and why. Ensure that a rabies vaccine is not given more frequently than what is labeled by the company (i.e., 1 year vs 3 years for rabies) or less frequently than required by law (which often correlates with manufacturer's recommendations. "Core" vaccines, like distemper and parvovirus (for dogs) and panleukopenia and rhinotracheitis (for cats) have been shown to provide immunity for at least several years, if not lifelong immunity. That's right: lifelong protection. I am confident that my patients are protected if their titers are sufficient. Vaccine titers are therefore becoming ever more popular. This entails the measurement of antibody against a certain disease (virus or bacteria). My recommendation is to check titers every year (if affordable - remember, the more people ask for this service, the more vets will offer it, and certainly vice versa - prices should go down as a result). I do not subscribe to yearly vaccines - this practice is outdated and medically unsound.
This does not mean that I don't believe in vaccines! In fact, the opposite is true. I would convince every owner whose puppy/kitten or naive pet (naive in the immune sense, meaning never vaccinated) that their pet MUST be vaccinated and booster a year later.
Dogs living in areas where Leptospirosis and Lyme disease are endemic should discuss these vaccines with their vet.
Not all dogs are candidates for all vaccines. So ask your vet, you've got the right to know!

Which one is right for your pet? Find out more by reading the American Animal Hospital Association (AAHA) canine vaccination guidelines here.
Guidelines for cats can be found here.
Lotsa reading, folks and may be complicated - my apologies!

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More Fat Cats

My recent entry on how to talk about fat cats brought up a couple of other questions from readers that I thought I would address.

Is it more common for a cat to be free feeding? I thought this was discouraged in dogs, but is it more acceptable in cats?

This is an area of a lot of discussion among veterinarians. In the wild, cats are considered to be "grazers", meaning that they tend to eat small prey throughout the day rather than one large prey once or twice per day. Therefore, pet cats should have the opportunity to eat throughout the day as well. The problem is that many people equate "free feeding" with keeping a bowl constantly full, which promotes obesity. The main issue to look at is not really how often they feed, but how much they eat.

Cats should get a certain amount of calories per day based on their size and activity level. Just like humans, less active cats should eat less because they are burning fewer calories. More active cats can get away with eating larger amounts. To me, how often they feed is irrelevant if you control the calories. If you have a single cat, you can put a measured amount of food in a bowl and leave it out for the entire day. However, DO NOT refill the bowl if the cat eats it before the next feeding time. Doing so will give them more calories than they need.

If you have multiple cats it gets more difficult. Invariably you will have one cat that eats more than another, finishing the food more quickly. If you then refill the bowl, at least one cat will become overweight. In cases like this, I recommend feeding only 1-2 times per day, and possibly separating the cats to feed. Now before anyone says "I just can't separate them", let me bluntly say in response "bull-hockey". At one point I had three cats on three different foods (weight loss, adult, and kitten). I put each in a separate room, put the food down, and after 20 minutes took any leftover food up and let them back out. If someone says that they "can't" separate their cats to feed it really means that they don't want to take the extra five minutes it takes to do it. And I don't understand that mindset. It's something very achievable.

Just wondering, what do you feed your cats? I have 2 cats- 1 is overweight and we have gone from free-feeding to measuring "indoor" dry food twice a day for the last 9 months with only a 1lb weight loss-the other cat has maintained her healthy weight. My friend swears that feeding canned food would help with weight loss. Thanks for your help.

Personally, I feed my cats either Nutro or Royal Canin indoor formulas, and the two adult cats get 1/2-2/3 cups once daily (they're not very active). Tristan (the kitten) currently gets 1/3 cup daily of Royal Canin Babycat.

You may not realize it, but the indoor formulas and low-calorie formulas of foods are not intended for weight loss. They are designed to help manage a lower weight on less active cats. To achieve significant weight loss on these foods you'll have to feed such small amounts that you may also give too few vitamins and other nutrients. Instead, you should talk to your vet about using a food designed for weight loss (Science Diet R/D, Royal Canin Calorie control, and several others).

Canned food actually can help weight loss, but again you need to feed the proper amount and the right kind. The principle is that canned foods have more protein and less carbohydrates than dry food. A cat's natural diet is strictly carnivorous, with a high-pro, low-carb balance. There is evidence in human medicine that this kind of diet can help promote weight loss. Taking the name of this human diet, veterinarians sometimes jokingly refer to this in felines as the "Catkins" diet. There is good evidence that this kind of food can help promote healthy weight, as well as improve blood glucose management in cats. So your friend is actually right. However, that doesn't mean that you can feed as much canned food as you like. You should still follow the recommended amounts.

Good questions, everyone. Keep them coming.

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Anal Gland Answers

Dan sends in this scenario.

Hello there, I have a small Terrier who is about to turn 9 years old. He never had anal gland issues until about 6 months ago, when I noticed him scooting. I have taken him to my vet and the techs expressed his glands (one was impacted and came out like paste). Since then I have returned monthly and had them expressed, no problems.

My question is this….

His normal defecation isn’t nearly as large and firm (not runny but soft). I asked the vet tech if he needed more dietary fiber to increase his stool volume and if that would help his glands. She told me no but in my research of the issue it appears that many vets do believe that fiber seems to help. What is your opinion of fiber offering any aid in anal gland maintenance and also will it help his loose stools?

Anal sacs are normal structures in dogs and cats, one on either side of the anus. In wild canines and felines the secretions from the sacs normally express onto the stool during defecation and are used for scent marking. In pets there really is no purpose for them. Most animals never have any problems with them at all. Small breed dogs tend to have a much higher chance of impaction or difficulty expressing the material than other dogs, and anal sac issues are very rare in cats.

The most obvious sign of full anal sacs are when a dog sits on their hind end and "scoots", or drags their bottom along the ground. Many people have the impression that this indicates worms, but this is rarely the case, and "scooting" is a classic sign of full anal sacs. In most cases having them expressed at the vet is a very simple and straightforward procedure. However, sometimes the secretions can be unusually thick and cause impactions. In very severe cases infection can occur, and can then cause the sac to rupture through the skin next to the anus.

Truthfully, there are still a lot of unknown things about why pets have problems. We do know that it happens almost exclusively in dogs, and most commonly in small breeds. Overweight pets seem to have a higher tendency for issues, so losing weight may help. Anatomical differences can cause the sac opening to be malpositioned, making natural expression difficult. And some pets naturally begin to produce unusually thick secretions, making it diffcult to express on their own.

There really aren't any good and accepted ways to prevent or reduce problems. Like you found, Dan, many vets (myself included) do believe that increasing the fiber in the diet may help. However, there are no studies to support this belief and it's purely anecdotal. I do think that I've seen cases in which it has helped, and it surely doesn't hurt to try as it the fiber doesn't cause any harm. Most often I recommend adding some canned pumpkin to the dog's food, usually anywhere from a few teaspoons to a few tablespoons (there isn't a generally accepted amount) depending on the size of the dog. Canned pumpkin is cheap, easy to obtain, and they like the taste of it. Another option is adding a few teaspons of Metamucil or similar fiber supplements to the food. The fiber may or may not help with the soft stools, so you may want to ask your vet about special foods to help with digestive issues.

The only other options are regular expression (most commonly by a vet or their staff), or surgical removal of the glands. Surgery is an option of last resort, and usually only recommended when there are repeated impactions or infections, or you have to have them expressed monthly or more frequently. The reason it's not done more commonly is that there is a slight risk of permanent post-operative complications with fecal incontinence. It's probably in only 10-20% of the cases, but there can be some damage to the muscles or nerves of the anal sphincter, making it difficult for the dog to hold feces inside, potentially leading to stool coming out at any time without any control.

If you want to discuss this further, I would recommend talking to your vet rather than the tech. My own techs normally do the expressions also, so it's not necessary for the vet to be involved in routine expression. However, if you want to discuss the surgery and other options, you'll need to talk to the vet.

Good luck!

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Voracious cat

As you now know, my cat is acromegalic and diabetic. This means his diabetes is difficult to control and his high levels of circulating growth hormone (and uncontrolled diabetes) means he's constantly hungry. As I blog, he is bothering me for crackers and peanut butter, and is slowly making his way towards the New York style banana pudding (courtesy of Red Rocket Coffee).
Aside from a lick, which he now and then steals, I do not let him eat these things.
While slightly humorous, I must remember that not long ago, he would never have wanted to eat these things. Isaac, I must remember, is sick. This fact I have accepted.

Not Isaac, but I haven't ruled this scenario out.

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