A sad case

A young, two year-old cat presented to me in severe and acute respiratory distress, severely hypotensive (low blood pressure), and vomiting clear fluid. The cat's gums were extremely pale and his temperature was a freezing 34.5 degree C (94.1 degrees F), indicating that the cat's extremities were very poorly perfused (no/little blood flow). The owner brought the cat in immediately after hearing the cat suddenly screech. There were no toxins to which the cat was exposed.

On examination, the cat's veins were hair-thin, so tiny that it was difficult getting an iv catheter in one of them - but we did. After giving the poor gasping cat a tiny dose of a sedative to calm him down, I administered a shock dose of iv fluids, which was touchy, as chest x-rays indicated that the lungs were full of fluid (could be blood, infection, edema, whatever), but I had to get his blood pressure up.
A presumptive diagnosis of anaphylactic shock or pulmonary embolus was made (the latter very difficult to diagnose in animals and people ante-mortem). I administered oxygen, injections of dexamethasone, epinephrine, famotidine (an antihistamine/H2 blocker for all you meddies out there), and Benadryl). Epinephrine was repeated twice in the next two hours.
Within ten minutes, the cat improved clinically with this treatment. The fluid rate was dropped, an injection of a diuretic was then given to relieve the fluid in the lungs, all the while the cat had watery fluid coming up from his lungs and pouring out from his mouth and nasal cavities.
Soon afterward, the cat turned blue indicating hypoxemia (low blood saturation in oxygen), so we gave him a low dose of milk of amnesia (propofol), intubated the cat, and manually ventilated him for over two hours. Watery fluid continued to pour from his nose. His gums returned to a normal pink with us manually ventilating him, but every time we extubated him to seet how he would do alone, he turned blue - not good.
We continued to intubate and extubate him but he could not ventilate on his own.
I advised the owners that he would need mechanical ventilation but such therapy in the ICU at the referral practice would have cost thousands, which he understandably didn't have. We extubated the cat, his breathing became severely labored so we put him out of his suffering and humanely euthanized him.
One of my technicians broke down crying... we were all so upset. I like to think that our efforts were noble. As vets, though, we always question ourselves: "Was my diagnosis correct?" "Did I do something wrong?" "Could I have saved this kitty?"
Fudge, this case didn't end well... but we tried.

Not the cat in question, but a cat receiving oxygen therapy.

Happy Birthday

It's Christmas day, and the kids got up early to see what Santa brought them.  My wife and I exchanged some additional presents, and we have cinnamon rolls baking in the oven (a tradition in our house).  We're enjoying some relaxing family time, as well as the gifts we were given.  It's a pretty typical traditional Christmas.

I don't regret the secular aspects of the season, but sometimes we have to be reminded of the rest of it.  Did you know that today is a birthday?  How many of you have forgotten this?  Okay, yes, I know that Jesus was likely born in the Spring and that many "traditional" Christmas beliefs and decorations are related to pagan celebrations.  Christmas is a celebration of the birth of Jesus, and that is the focus of the holiday.  People many centuries ago chose this time to recognize His birth, and we continue that tradition today. 

The birth of Jesus Christ was one of the most defining moments in human history (and arguably THE most defining moment).  For Christians this is one of our most special celebrations, where we recognize the humble earthly beginnings of God's son.  And even if you're not a Christian, the coming of Jesus defined human civilization from that point forward.  A baby's birth is a joyous time...this is even more true when it is the birth of the Savior.

Part of my family's Christmas tradition is to recognize that this is a birthday.  We will read the Christmas story from the Bible, and make a birthday cake for Jesus.  It is important to us as parents to make sure that our children don't get so lost in the presents and decorations, and that they keep in mind the REAL reason for the holiday. 

So happy birthday to Jesus!  He is the greatest gift we could ever receive.

The Night Before Christmas

It's Christmas eve, a day of excitement in our house.  It's our tradition, based off the Swedish customs, to open family presents on Christmas eve (Santa's presents are for Christmas morning).  Today is also special for our kids because we're going to see the new Alvin & the Chipmunks movie, which they have been anticipating for months.  Like most people, this day is about being together as a family.

I've taken this week off work to relax and have time with my family, and am so glad for that.  I can't remember the last time I've had this much time off to be at home.  Honestly, I probably needed it.  It's been so nice to relax and sleep late with my wife and spend more time with my kids.  We get so busy going hither-and-yon to get ready for Christmas that we often loose sight of what the holiday is really about.

I hope all of you around the world have a wonderful Christmas to celebrate with your own families!  Be joyous and show the spirit of love to each other!




Facebook Follies

I've avoided joining Facebook for a long time. I'm not a highly social person, preferring a small circle of friends. For the most part I've kept in contact with those I wanted to (some better than others), and have no great desire to meet random people. I also saw how many people were clamoring to join Facebook, and didn't want to go with the crowd. I often said that I wouldn't join just out of principle.

Ooops.

A few days ago I joined. Most of it was due to my wife's gentle pressure, talking about how I could get in touch with some of my old friends better. Partly I also saw there were some interesting games, and I could put my pages in pirate lingo! So in the end, I did finally join. Little did I know what I was getting myself into.

Now I'm playing eight different games, have 41 mateys (errr...friends...pirate language y'know), and am madly loading pictures onto it. My wife tells me that this is typical when someone first joins, and it will calm down in a week or two. I hope so, because I don't think she realized what a monster she may have created.

Now I'll go ahead and forewarn any of my readers here that I likely won't accept any friend requests from people that I don't know personally. I'm pretty private with parts of my life, so please don't be offended if you read this blog and I don't take you as a friend on Facebook. It's nothing personal, just my way of compartmentalizing my life a bit.

I still can't believe that I finally went and did this....

Time for Muppets

I grew up watching the original Muppet Show, and have never stopped loving Jim Henson's creations.  I have watched every movie and incarnation of the muppets since they first came on TV.  No matter how many times I see them, I still laugh at the same things.  Though all of them are great, I think that Animal is my favorite.  Just about everything he does makes me bust a gut.

Did you know that the muppets have their own YouTube channel? I just recently discovered this!  So here's a couple of my favorite clips from their MuppetsStudio (notice that both prominently feature Animal!).



The Humor In A Vet's Life

For all of the hardship, heartache, and difficult decisions in a veterinarian's day, there can be a surprising amount of humor.  Some of it happens naturally.  For example, a year ago I blogged about a particularly funny incident involving a canine University of Tennessee fan.  Some times the humor is completely incomprehensible to others, such as when one of my techs had his pants slip a little while handling a dog, exposing his "crack" a little.  One of the other techs stuck a catheter cap into the space.  Yeah, a bit childish and weird, but we all had a good laught about it.  Other times the humor is forced as you try to find ways to cope with a particularly difficult situation.

I certainly don't consider myself a humorist, though I would love to be.  I'm simply not witty enough to come up with anything funny on a regular basis.  But there are certainly vets who can and do.

Probably one of the kings of veterinary humor is Dr. Robert Miller.  He is currently retired but had a great and varied experience on just about every species imaginable.  He is most well known for his cartoons based around veterinary medicine.  Here's a link to his cartooning site.

Dr. Michael Obenski has been writing humorous columns for DVM Newsmagazine for over 30 years.  When I get that journal every month, his is the first article I look for.  His insights are spot-on (though may be not quite as humorous to the clients he is describing) and based on experiences that every small-animal vet can relate to. You can read some of his articles here.

Then there's Dr. Bo Brock, a mixed-animal practitioner from Texas.  Working on livestock and farm animals as well as pets, he gives a completely different perspective.  Also published in DVM Newsmagazine, you can read his articles here.

So does anyone else have any good resources for veterinary-specific humor?

Coming out...

...as depressed may be more difficult than coming out of the closet. As some of my regular readers may know, I have not posted very recently in many months, since the rupture of a long-term relationship. Since then, I have entered into a "circumstantial" depression, call it what you will...
Right now, I am actually on my way out of it.
My life from the outside is fully functional, I continue to work, and to love work. In fact, in all modesty I don't think I have ever been a more caring and empathetic veterinarian, and have never felt like such a good diagnostician.
A part of me is hiding, though. A significant part of me hides behind a very thick veil of diversions, activities, and (sometimes) feigning of happiness. Another part of me is truly happy, truly functional, truly "me."
My friends and family in whom I can confide have been nothing but supportive, loving, and caring, though there is only so much they can do. It goes without saying that I am also receiving professional help...
I am discovering that my true purpose is not to be someone's better half, though I must confide I don't always buy this. Then what is my true purpose? There must be something, someone, waiting for me, and for whom I am also waiting.
I have decided to "come out" so that perhaps others may realize they are not alone, that we are all human, and that through suffering we can achieve greatness.

An Allergic Vet?

Here's an interesting and excellent question...

My name is Jennifer. I am a student at West Valley College in Saratoga California. My assignment is to write a paper on a dream career or mine. I picked becoming a veterinarian, and found your site. My question is, Will having my allergies to certain animals (dogs, cats) affect me being a veterinarian? It would be greatly appriciated if you could get back to me Asap. Thank you so much. 

Jennifer, this is more common than you might think. As you mention, allergies tend to be to specific animals and not to all animals.  And there are ways around this problem.  If you have been working with an allergist, talk to him or her about desensitization medications or other ways you can medically handle the allergy.  In some cases regular antihistamines will control your disorder.  Allergy specialists routinely deal with similar situations and would be best suited to help you.

If your allergy is too strong for antihistamines but not problematic enough to see an allergist, you can choose not to work on certain species.  One of the great things about veterinary medicine is the great variety of things you can do with your training.  If you're allergic to dogs and cats, you can choose to limit your practice to horses or other livestock.  You can also choose to go into pathology or public health medicine where you're not actually working with patients. 

Sometimes your allergy will desensitize on its own.  I used to have a fairly strong allergy to cats until I got one of my own when I was in my early 20s.  Now I only have to worry about it if my hayfever is acting up and I touch my eyes after handling a cat.  My allergy is much less severe than it used to be.  However, sometimes the opposite happens.  My associate developed a severe allergy to rabbits as she got older.  It's bad enough that we can't have one stay in the hospital when she is working.  We see few enough rabbits that she simply doesn't see them, we put them in the farthest exam room when I see them, and if one needs to have surgery we schedule it on a day she is not there.

So don't give up on your dream if that's what you really want to do.  There are certainly ways to be a vet and deal with any allergies.

Practice Makes Perfect

Being a doctor isn't easy, and I don't think anyone would disagree with this comment. One of the hardest things to learn is how to take the information from the classroom and textbooks and apply it in a clinical setting.  This is why experienced doctors tend to make better clinical judgements than new graduates (everything else being equal).  It may not seem like it, but there can be a bit of disconnect between what is reported in the texts and what you may actually see.

It's common for doctors to talk about whether or not a patient "reads the textbook". This means that some cases present exactly like is described in the textbook.  For example, a hypothyroid patient would have a thinning coat, weight gain, and persistent skin infections.  However, some cases don't have classic characteristics, such as a diabetic patient without an increase in drinking or urinating.  It's easy for a doctor to read symptoms and lab results in a book or class notes and figure out what the disease is and how to treat it.  However, if the patient doesn't have all of the symptoms, or has some conflicting lab results, it can be difficult to make conclusions.  That's where experience and learned clinical judgement comes into play.

There is an art to medicine.  It takes experience to learn how to interpret lab results, determine what treatment is best, and how to implement that.  Lab results do not stand apart from the patient.  Two patients can have the same lab values but look and act differently. Conversely, you can have two patients with the same basic symptoms but radically different lab results.  You can have the same disease that presents in several different ways.  A newly graduated doctor has an incredible amount of "book knowledge", and knows a lot.  But they haven't learned how to apply that knowledge.  There is absolutely no way to teach this.  It only comes from seeing enough cases to learn the wide variety of presenting symptoms and clinical outcomes.

Believe me, this isn't disparaging newly graduated doctors.  Every single doctor was a "new grad" at one point, myself included.  I have had to learn many lessons of the years, and am a better doctor for it.  At the same time, I enjoy mentoring newer doctors as I always learn something from them. 

One reason for this entry is to caution laypeople about reading journal articles and text books and then interpreting their cases.  Yes, many times you can learn a lot and I don't discourage.  I also encourage people to be well-informed, ask their doctor lots of questions, and keep copies of lab results and medical notes.  But you have to be cautious in interpreting this information in light of your particular case. There is a reason why becoming a doctor takes years of intense education and why an experienced doctor's judgement is so critical.  Now, this doesn't mean that a given doctor will always be right...we're only human after all, and it's impossible to make perfect decisions every time.  But in general, an experienced doctor will know more than a new graduate and both will be able to handle cases better than a layperson.

For the educated layperson, this means that you should ask even more questions.  Like I mentioned last time, there is nothing wrong with respectfully questioning the "whys" of your doctor's decisions.  But a little knowledge can be a dangerous thing, and you should realize that no matter how much you read, this information can never compare to a doctor with the same information and years of experience.

Never Be Afraid To Ask

In her comments to my last post, Stefani made these statements....

I get records every time I leave, and I go over them. I review bloodwork. I ask lots of questions about anesthetic protocols and monitoring. I go a place that uses licensed techs. I make specific requests. 

I wanted to bring these up for those who don't read the comments because they are great words of advice.  While I think that the average professional deserves some degree of initial trust (or you would never follow any recommendations the first time to went anywhere), I also think that full trust needs to be built.  Part of that depends on the professional you see acting in an appropriate, open, and ethical manner.  But a large part of that  depends on you as the client to do your part. 

A common bit of advice you will hear about medical treatments is to ask your doctor questions.  While I have mostly heard this in relation to human physicians, I also believe this holds true for veterinary doctors.  We as doctors understand what we're talking about, and try to explain it to people.  Unfortunately, some clients are afraid to admit that they don't know what in the heck the doctor is talking about.  And unfortunately some doctors (or other professionals) aren't good at communicating (though this doesn't make them incompetent).

Whenever I see a pet and I'm getting ready to leave a room, the last thing I always ask is "do you have any questions" or "is there anything else I can help you with."  I deliberately and actively make a point to ask something like this whether it's a well pet or a sick one.  I want to make sure that my clients always understand what I'm talking about.

I also strongly believe that any professional should be able to explain rationally, logically, and with evidence why they are doing or recommending something.  I certainly do so in my own practice.  That's why I don't mind when a client questions me or asks for more clarification.  I also have no problem with clients wanting copies of their medical notes or lab results.  If your doctor/vet/professional can't explain their rationalle or isn't willing to give you copies of the records, you most certainly should wonder why and possibly consider switching. You may or may not agree with your doctors reasons or conclusions, but medicine isn't always 100% certain.  Disagreement is okay, as long as the disagreement is for legitimate reasons.

Many doctors don't explain something further not out of a lack of caring, but because silence from a client is often interpreted as comprehension.  Always be willing to respectfully question your doctors, and never be afraid to ask questions.  Taking this attitude will only help you.

A Few Bad Apples

Over my lifetime (all 40 years of it so far) I have seen many people do reprehensable things.  Professional businessmen and CEOs who embezel and drive companies into the ground.  Ministers who steal or hire prostitutes.  Teachers who seduce and sexually abuse their students or other children.  Police officers who abuse their charges, physically beating them.  Respected officials who abuse their power.  Celebrities who are supposed to be role-models falling to drug and alcohol addiction.  And don't even get me started on the problems with politicians.

There's the old adage that a bad apple will spoil the whole bunch.  And I guess that it's human nature to see a prominent figure as a representative of their "type".  But is that really fair?  In recent news we're seeing a barrage of apparent infidelities performed by Tiger Woods.  Does this mean that all professional golfers are likely to be adulterers?  Remember Debra LaFave, the Tampa teacher who slept with her 14 year-old student?  Does this mean that all of my son's teachers secretly want to have sex with him?  Back in the '80s the televangelist Jimmy Swaggart infamously was outed over a relationship with a prostitute.  Should we assume that all preachers are secretly hiding scandalous behavior?

My recent discussion on the potential ramifications of increased legal awards in veterinary malpractice suits has brought this home to me because of similar views of my profession.  Most of the commenters on that entry appear to have a very strong view against veterinarians.  Reviewing some of these people's web sites makes it appear that veteriarians as a whole should not be trusted (and please forgive me if I'm mischaracterizing anyone's comments).  One web site seems to proudly boast that they have received "hundreds" of similar reports of horrible veterinary malpractice from around the world.  Reading these sites you would almost never want to take your pet to a vet again.  And I'm sure these people probably feel that way themselves, as the circumstances they describe seem particularly and legitimately heinous.

But let's put a bit of perspective on this.  Okay, so there are "hundreds" of reports.  Can we assume 500?  Just for the sake of numbers.  And that's from just one web site, so we can assume that only a small number of people contacted that webmaster.  It's also a safe bet that only a small percentage of malpractice concerns are ever reported.  So we need to increase that number many times.  Do you think that a 10-fold increase (5,000) is to small?  Let's go with a 100-fold increase, and say that there are 50,000 malpractice cases that happen. In the US alone there are approximately 200,000,000 veterinary visits annually by all pet owners.  So our 50k malpractice cases represents 0.025% of veterinary visits.  Well, maybe only 1 in 1000 malpractice cases are reported, so there are actually a half-million horrible and malicious veterinary visits annually.  Pretty big number, right?  But that's still only a fraction of one percent of all visits in the US alone, let alone the world.  Suddenly "hundreds" of reports from around the world is a prety miniscule number.

Please understand that I'm not trying to belittle the people who have had truly horrifying experiences with their pets, or who have to deal with someone who should have their medical license stripped from them.  I honestly feel regretful that someone with the same title as I have caused them and their loved ones so much unnecessary pain.  But let's not throw the baby out with the bathwater.  I fully agree that anyone (regardless of profession) who behaves abusively and unethically needs to be fully prosecuted and probably deserves anything they get in the process.  However, it's wrong and unjust to assume that all members of a given profession are automatically guilty of the same behaviors. 

I can honestly say that the huge majority of veterinarians that I've known and worked with are honest, ethical, compassionate, and thorough people.  Yes, there are bad apples in my profession, as there are in EVERY profession out there.  Unfortunately, some people fall victim to laziness, greed, anger, and any other sin.  That most certainly does NOT excuse their behavior, and they need to be faced with the consequences of such actions.  However, I would ask people to exercise some common sense and discretion and not let these people spoil their view of the whole bunch.

Caffeinated Happiness

I have discovered a very important thing about myself.  I am a much happier person when I am full of caffeine.  I'm not much of a coffee drinker, but I drink sodas almost daily (diet only...trying to keep at my goal weight).  Yes, too much caffeine is bad for you, especially with some diseases.  But I'm otherwise healthy so I don't worry about it.  Caffeine doesn't really hype me up too much.  It does get me energized when I'm dragging, but I normally don't get hyperactive on it. 

Does that mean that I'm addicted?  Probably.  But I'm not as bad as some people I've known.  I don't keep an energy drink around, and rarely even buy them (y'know, Red Bull and similar drinks).  I have at most 2-3 sodas per day, and if I have coffee it's no more than a cup.  I know people that need 2-3 cups of coffee just to get going in the morning!  But I definitely do better and am more pleasant with caffeine in my system.

My wife has learned this also.  When I'm feeling frustrated or depressed, she tries to talk me into pumping up on caffeine.  And I can't say that this is a bad thing.  I never realized it until recently, but I feel happier and joke around more when I have had caffeine.

I guess there are worse things to be addicted to.  At least this particular addiction is legal!

Phosphorous Problems

This question comes from Barbara...

My question is what is the highest abnormal phosphorus level that a canine has ever been successfully treated for without total loss of kidney function and maintained on diet & medications. And is there a citable article in any journals?

First, a little bit of explanation on what abnormally high phosphorous levels mean.  There are several things that can cause the phosphorous levels in the blood to increase. The most common reason is for renal (kidney) disease.  As the kidneys fail in their function, phosphorous is retained in the body rather than being expelled.  Other causes can include low parathyroid hormone levels, increased intestinal absorption, acromegaly (a growth disorder), destructive bone lesions, and normal bone growth (mainly in puppies and kittens).  The main thing to keep in mind is that high phosphorous is NOT a disease.  Phosphorous levels don't increase without another reason, and therefore this value is used as an indication of other disease rather than a marker of a specific disorder.

Now let's talk renal disease specifically.  There are numerous reasons why the kidneys may quit functioning, including toxins, genetic tendencies, cancer, and age.  We use several values to assess renal disease, most commonly creatinine, blood urea nitrogen (BUN), and phosphorous.  It is common to have increases in creatininine and BUN with phosphorous remaining normal.  In my experience, if the phosphorous is also eleveated, it indicates a more severe renal insufficiency.  Once the kidneys are damaged, they do not heal.  This fact makes renal failure difficult to treat in pets, and often leads to euthanasia.

Treatment for renal failure is multi-modal.  Special diets are required to help reduce protein stress to the kidney and minimize certain minerals (such as phosphorous).  Fluid therapy may be used to help increase the flushing through the kidneys, helping to prevent build-up of toxic chemicals in the body.  With increased phosphorous levels, medications may be used to bind the phosphoruous and reduce its absorption in the intestines (usually with common antacids!).  Depeding on the cause, other medications may be used to try and more directly treat the underlying problem.

Now back to the question...Barbara, focusing on the phosporous level is not looking at the whole picture.  In your case it sounds like the elevated phosphorous was due to kidney failure.  You need to look at all of the renal values and the urine values and not focus on a single lab value.  If the kidneys are being treated well and phosphate binders are used, the blood phosphorous levels should be controllable.  If the BUN and creatinine are normalized but phosphorous is still high, then more testing is needed to determine why this value is not falling.

The "highest level ever treated" is simply not something that is recorded or even important to doctors.  Journals don't track this data and truthfully it isn't clinically relevant.  Normal phosphorous value can range from 3.0-8.0 depending on the lab or equipment used.  I have seen phosphorous values in the upper teens to low 20s in my own cases.  But truthfully whether a value is 15, 20, 25, or higher doesn't really matter to me.  All of these are significant elevations, and I'm going to treat them all in the same way:  phosphate binders and try to address the underlying cause.  Diagnostic laboratories do keep track of these values to determine what a "normal" range is, but a "highest ever" would be what is statistically called an "outlier" and is insignificant in the analysis of normal ranges.  Therefore these values aren't reported to the profession at large.  Journal articles also don't focus on these extreme values, but instead discuss clinical relevance, especially in the larger picture of the disorder as a whole.  So I hate to say it, Barbara, but your question isn't something that can be answered. 

I hope this at least explains things a little better.  Feel free to ask any follow-up questions.

Sue For Emotion?

It happens from time to time that people will threaten to sue for one problem or another.  Here in the US, as well as in many parts of the Western world, there are people that are ready to jump into the legal system to solve their problems.  Often, this is because of money rather than a true need for justice.  When human medical malpractice settlements and judgements can easily be in the millions of dollars, it's easy to see why some people would be tempted.  But it is quite different in veterinary malpractice claims. 

Pets are considered a special kind of property by the legal system.  Due to this status, a pet owner can only sue for the actual value of the "property" and any medical costs incurred.  For a breeding animal this dollar figure can be in the thousands of dollars due to lost potential revenue.  For a stray it may be less than $100.  Currently people cannot sue for emotional damages due to the loss of the pet, similar to how they cannot sue for emotional damages due to the loss of a car or television.  But this attitude may be changing.

Over the last century the status of pets has changed.  We have allowed them into our homes, families, and beds, and now consider them a part of our extended family.  We have closer bonds to them in ways that were very uncommon 100 years ago.  Our emotional ties have grown as our societies have moved from rural to urban and we have brought our pets in closer contact to our daily lives.  These stronger bonds mean that we often feel the loss even more acutely.  The loss of a pet can generate genuine emotional distress.

And vets are encouraging this.  We celebrate that human-pet bond, calling pets "furry children" and the owners "parents".  In my own practice we delierately call our patients "pets" rather than "animals" to help enhance and recognize this bond.  As medical professionals, we want our clients to care about their pets as much as they do about their children, and get upset when the people don't seem to care as much as we think they should.  Many vets and pet stores sell clothing and other things for pets that make them seem like little people.

As vets we have very low malpractice insurance costs.  I have to pay less than $300 per year to get a $1 million coverage policy.  The same level of insurance for a human physician can be anywhere from $20-40,000 per year.  Someone in a higher risk field such as obstetrics may have to pay $100,000 to get adequate coverage.  Truthfully this has become a crisis in human medicine.  There are more and more doctors getting out of higher-risk fields and specialties due to the outrageous insurance costs.  Doctors are also leaving certain parts of the countries where the courts have historically allowed extremely high settlements.  And a large part of the reason why human health care is so expensive is due to the multi-million dollar settlements and the insurance necessary to cover the doctors.

Now here is the dilemma.  As veterinarians we see what has happened in the human field, and don't want that to happen to us. We pay literally 1/100th of the insurance costs of human doctors, and we don't have to deal with outrageous lawsuits.  Yet we want people to have strong emotional ties with their pets and strongly promote these bonds.  In essence we want to have our cake and eat it to.  We want people to be emotionally attached to their pets but don't want them to be able to sue for damage to this bond. It is also hard for the pet owners, because if we have to start paying higher malpractice insurance costs, these costs will be passed on to the consumer, meaning higher charges on veterinary services.  It also means that we are going to need to be running more diagnostic tests to cover ourselves much like human physicians have to do.

And that brings me to last month's survey.  I asked if pet owners should be able to sue for pain and suffering even if it increased the costs of medical care.  And it seems like people aren't really sure. There was an even split for and against the idea, with 27% each.  And 44% simply didn't know.  As you can see this is a complicated issue.  If people can sue for emotional suffering for themselves or their pets, medical costs will rise. Yet the courts recognize awards for similar suffering in humans, and we are encouraging such bonds and ties with pets.


There are already movements in certain districts in the US to allow pain and suffering awards, though so far only up to a few thousand dollars.  As pets become more integral in our lives, we will likely see this legal trend continue.  And if it does, expect to pay more at your vet.

Fun With Words

Here's a weird thing about me (one of many)....there are certain words I just love to hear and say.  I don't know why, but some words simply sound interesting to me, or I love the specific meaning that they give.  Here are some examples....

Plethora
Ubiquitous
Purulent
Borborygmi
Ornithology

Language can be fun, and I enjoy learning about the origins and underlying meaning of words and phrases.  The English language is such a hodge-podge (there's another good one!) of words from other cultures and languages and is constantly evolving that some people spend their lives studying it.  Unfortunately, people often butcher words, usually unintentionally.  I have learned to live with these mistakes, but it still bothers me sometimes.  For example, there is no such word as "irregardless".  It's simply "regardless".

Anyone else have this quirk?  I'd love to hear other words that people find interesting/alluring/gripping/intriguing/etc.

Cat Vs. Fan Belt

As the weather in the Northern Hemisphere gets cooler, everyone needs to be aware of a very tragic possibility.  When temperatures drop, cats will often dry to find warm, dry places.  This all too commonly includes a car's engine.  The cat will climb up into it from underneath and make themselves cozy.  The person doesn't notice the cat there until the engine is turned on and the cat gets caught in the fan belt or other moving parts.  And this can be a very, very bad thing.

Today I saw a cat unfortunate enough to have this happen to her.  She was an indoor cat that had somehow managed to sneak out without the owner knowing.  He got into his truck and drove to his mother's house.  He never knew that she was in the engine until he turned the motor off and heard her screaming.  They had to literally take apart the engine to get her out, and they're not sure if it will ever run properly again.  She was rushed into my clinic and brought straight back to me.

As soon as I saw her I knew it wouldn't be good or easy.  I have heard of cats that have literally been cut in half in situations like this, and thankfully that wasn't the case here.  But part of her tail had been chopped off and her left hind leg was a mess.  The tibia (long bone in the lower leg) was shattered and completely exposed, with marrow missing from the center.  The skin and muscle was stripped from the bone from the upper leg down to the ankle, and I could see the bones in the ankle joint.  Several of her teeth were chipped, likely from her chewing at the engine.  The claws on all her paws were torn and bloodied by her attempts to escape.  There may have been internal injuries, but I couldn't see anything else at first glance.

Even given all of that there was a chance of saving her.  She would have had to be stabilized first, as she was in shock, and then had her leg and tail amputated.  If there were no other injuries, she could have ben okay.  However, she was looking at close to $2000 worth of medical care in the next 24 hours, and this wasn't a financial possibility.  In the end, we elected to euthanize her, as there was no way she could survive without extensive care and surgery.

This is a tragic accident, and one that is difficult to prevent.  It's hard to check your engine every time, but try to be aware of the possibility.

Never Work With Children

An adage in Hollywood is that you should never work with kids and animals.  I'm finding this out all too clearly.  My family is currently involved in a production of The Best Christmas Pageant Ever.  Most of this cast is children, about 20 in total.  And oh, my gosh this is crazy! 

I wasn't planning on being in another play so soon, but got talked into it by my darling wife and the director.  Thankfully I only have five lines in one scene, so it's a pretty quick and easy appearance.  Unfortunately, that means that I spend most of my time backstage, trying to wrangle a couple of dozen teens and pre-teens that don't seem to understand the meaning of the words "keep quiet". There is constant chatter and noise, which can be heard in the theater if we're not careful. So I am constantly "shhhhh"ing the kids, snapping my fingers, and otherwise trying to get them to understand that a true whisper can't be heard across a room.  All of a sudden I feel like I have 20 kids of my own!

The first show is this Friday, and we'll have a total of seven performances over the following week.  Hopefully we can get through this without me duct-taping some of the kids to their seats.

 
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