Crooked Beak

One of my fairly regular patients is a blue and gold macaw with a deviated beak.  This is commonly called "scissor beak" and happens most commonly in larger parrot species.  At some point when they are young, part of the beak grows abnormally, pushing the beak away from the normal middle position.  Over time this becomes worse and worse as the normal wearing of the beak happens abnormally as the upper and lower portions do not meet up properly. Improper beak shape can lead to difficulty eating as the bird cannot grab its food properly.  Here's an example of what this can look like.

In mild or early cases an experienced avian vet can reshape the beak with a Dremmel hand tool, wearing down the long portions to a more normal position.  Though somewhat distressing to the bird, this is actually a painless procedure.  However, when the problem continues for long enough even regular trimming won't be a final solution.  In these cases surgery may be needed for a permanent fix.  Another method is to use acrylic on the beak to gradually force the beak into a normal position.  Once normal positioning is achieved, the shape should be self-sustaining over time.

The macaw I see, Alex, has been coming to me for over a year now, and he's only three.  Though I'm good with birds and other exotics, I'm not a specialist and have been trying to get the owner to go to a local board-certified avian vet to have more advanced procedures done.  Alex has a lifespan comparable to a human, so taking care of this now will help give him a better life in the future.

If anyone knows someone who has a bird with a beak growing like this, make sure they see someone skilled in avian medicine right away.  The earlier that treatment starts, the more successful it can be.

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Caution In The Heat

It's been pretty hot where I live, with temperatures in the upper 90s (Fahrenheit), and heat indexes in the low 100s.  Being of Scandinavian blood, I try to avoid being outside at all in this kind of heat, as I quickly feel the effects.  Any yard work is done first thing in the morning before the day has a chance to heat up much.  I also make sure to drink plenty of water and take breaks.

It's in weather like this that veterinarians start to see cases of heat stress or stroke, especially in dogs.  In most cases the pet was left outside in the heat without shade or an ability to get out of direct sunlight.  Access to fresh water is vitally important, but it's the direct, unrelenting sunlight that causes the most harm.  If a pet is kept in an enclosed environment, such as a car, the risk is even greater.  In most cases outside temperatures won't get out of the low 100s to 110s.  However, in a parked car the temperatures can heat up by 40 degrees F within an hour and can get up to 150 degrees; 80% of the increase is in the first half-hour.  And cracked windows don't significantly decrease the temperatures or slow the rate of increase.

Heat stroke can be deadly.  Whatever the cause (lack of shade, being in a parked, car, etc.) core body temperature can rise quickly, getting into critical ranges within minutes.  Very old, young, or debilitated pets are at the greatest risks, as well as those who have dark-colored fur (remember, darker colors absorb more sunlight).  When body temperatures get above 105, proteins can begin to break apart and brain cells can die.  I've seen pets come in with temperatures that are above the normal range for a thermometer (generally meaning 106 or higher); most of those didn't survive.  When body temperature get this high, even if a pet survives there can be permanent brain and organ damage.  Besides the immediate danger of brain damage, there can be other serious concerns that may not show up until a day or two later.  Simply put, overheating can be deadly.

This is an entirely preventable problem!  Don't EVER leave your pet in a car.  There have been cases of death when outside temperatures are as low as in the upper 60s (remember...around 40 degree increase means that at 67 outside the inside temperature can get to 107).  I don't care if you crack a window, put the sun shade up, or take other measures.  DON'T leave your pet outside in a car for even a few minutes.  If you come back and your pet is dead or in serious condition, YOU are the one who did that.  Also, don't ever leave your pet outside without any way to get in the shade and out of direct sunlight.  If you have a shade-free yard, don't leave your pet outside for more than a few minutes, and keep checking on them regularly.

Take care of your pets in hot weather.  They may be in situations that they can't control but we can.  Be aware of these circumstances and you can prevent serious harm or death.

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Rules For Visiting The Vet

I saw these posted on a work-related forum, and thought that I would share them here. All veterinary staff will immediately understand these things. For the non-vets reading this, you may see some of yourself in this. It's all in good fun.

Rules For Visiting A Vet
1. Do not make an appointment. Just walk in, because they are going to be there anyway. Demand to be seen immediately! Become irate if you have to wait for anyone who was there ahead of you.
2. Bring your children, bring your neighbor's children. If you have no children, borrow some from a friend.  Toddlers who have been walking for less than a year are best. If they are talking let them run around all over the hospital to ask everyone on the staff questions.
3. Place your pet on the exam table, then sit down. Please do not hold it. Emphasize that "It won't jump down!" and "It NEVER bites!"
4. Please ensure your mobile phone is turned on when you enter the consult room. Get as many people to phone you to find out what is happening to your dog/cat. Spend at least 10 minutes discussing this with them as well any other personal matters that come to mind.
5. Do not remove your sunglasses, especially if you have a hearing problem.
6. If you have a concern, YELL at and abuse the receptionist, then when you see the doctor, be as sweet as possible.
7. As you leave, let your un-neutered dog urinate on every stationary object until you get outside. Do not tell anyone.
8. Please tell us if there is a problem, but wait at least 3 weeks to do so. Remember, continuous diarrhea for four weeks or more is considered "An Emergency Situation!". This is especially true at closing time on the weekends.
9. If your pet is in really bad shape, tell the doctor that you have been on vacation. If you haven't brought your pet in to the hospital in two years, always tell the doctor the problem started RIGHT after the last visit and hasn't gone away.
10. Have your record under as many last names as possible. For your pet, have a registered name, a baptized name, and a nickname for each family member. Use a different one each time you come in for a visit.
11. When leaving your pet for boarding or any other procedures, never tell anyone in the office that you have changed your phone number since your last visit.
12. Never say anything important until the doctor put his/her stethoscope to their ears.
13. Always say, "Cost is not important! Just save my pet!" until you get the bill, then deny that you said it was OK to treat. Make a big fuss over every item even though you are not going to pay anyway.
14. Always bring your checkbook without any checks in it or leave home without your wallet. Only carry hundred dollar bills when you do bring it, especially if you are only buying one can of food.
15. If possible, always send your pet to the clinic with your children under 18 years of age with no money or credit cards. Never tell them why they are bringing the pet in.
16. When in consultation with the vet, do not talk to them directly, but rather baby talk to your pet about their symptom-wymptoms.
17. Always dismiss anything the vet nurse tells you regarding your pets treatment plan because "you're not a doctor". Argue intensely, use as many curse words as possible. When the vet comes and tells you the same exact thing, deny that the nurse told you anything or tried to explain something to you.
18. If you can come in wearing a negligee and fluffy slippers, full hair and makeup at 5am (after making vet wait an hour so you could do said hair and makeup), we would be really appreciative.
19. Make sure to emphasize that you used to breed German Shepherds...pause...and then say with great emphasis...WHITE German Shepherds. Then stand back and wait for the nurse to fall over because she's so impressed.
20. Complain about the cost of EVERYTHING. Stating that if you went to your doctor, you could get such and such procedure done for $100. Or that you will have to just "put your pet down" because you can't afford our prices.
21. Make sure you call an hour before closing to ask about having something done quickly (ex: express anal glands). Then, when you come in 20 minutes before closing, mention the huge list of other things you want to have looked at "since we're here anyway."
22. Make sure to never bring your dog in on a leash. It is best to let them run arround the parking lot and lobby without one. There is no need to be concerned about injury by cars or other pets.
23. Our Doctors' recommendations should not be heeded under any circumstances. They are just trying to con you out of your hard earned money. Feel free to waste an hour of out time and then decide you will take your pet home and "observe" him/her because you definitely know what is best.
24. When you believe that your pet may be in need of medication, it is not necessary to bring him/her in. Just call us on the phone and describe the injury/symptoms and we would be happy to diagnose the problem and prescribe medications for it. Of course, there will be no cost to you for the medicine, since your pet is not even our patient.
25. If your pet has eaten any type of contraband item that was within it's reach in your home, it is best to lie to the doctor to avoid having anyone know that you were in posession of said item. The doctor will still be able to save your pet's life without knowing exactly what is wrong.
26. Our Doctors have no need for a lunch hour, nor do they have any desire to spend time with their families after business hours, as our Doctors are not human but lifeless robots. Feel free to come in or call any time of day and expect the doctor to spend any amount of time you desire to talk to you about your pet's new accessories, new hairdo, or her latest outing to the dog park.

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Is It Worth It?

Jessica sends in this timely question...

I came across your veterinary blog the other day when I was searching the internet, and I happened across a post discussing if you could do everything over again would you go to veterinary school again? From the post it sounded as if there were many times when you regretted your decision for various reasons. The reason I am emailing you is that my situation is unique, I had planned on being a veterinarian most of my life (I love animals and come from a family of professionals), but ended up switching for various reasons (e-calls and long hours being one reason) to optometry once I got to college. To make a long story short I got accepted to optometry school and not long after decided that it wasn't everything I thought it was, and thought that I would really miss not having any animal interaction. Unfortunately I was already in the middle of a large amount of school debt and decided I better finish my degree so that I would have a way to pay off my debt in case vet didn't work out for some reason. I am now in my last year and will graduate this coming May. I am in the process of deciding if I want to apply for vet school this application period. I am now spending time shadowing vets on the weekends to try to make a decision about if veterinary is something that I really want to pursue. (I don't want to get another expensive, time-consuming degree, if I am not 100% sure this time). I am trying to get all the opinions and viewpoints on the career I can, which is why I am emailing you.

Unfortunately when I was shadowing optometrists before I applied, they all made it sound like the perfect career, and didn't talk about any of the downsides. As with any job optometry has plenty of downsides, including e-calls and a very repetitive nature. If you get a chance I would be interested to hear why you often regret your decision. I know in your blog you said that you wouldn't be the person you are without the career. I can understand that, but disregarding everyone you've met etc. because of the career, would you still become a vet again?

 My main thing is that I like the science etc. behind optometry ( I like diagnosing, treating, ocular disease etc.), I just miss the fact that there is no animal interaction, and optometry tends to get very repetitive/boring very fast. I know its a good career overall, but I know as an optometrist I will never look forward to going into the clinic everyday, and will count down the hours until I get out at the end of the day. Do you enjoy going into work as a vet everyday, or is it just a job? I get annoyed if I have to stay late for patients in optometry, and I know that every pet has an owner and that there is a lot more people skills involved in veterinary that most people think, but I feel like staying late for an animal would be much more tolerable.

I would really appreciate if you wouldn't mind giving me your insight into the career without any sugar coating. Any viewpoints help, since I don't want to put myself into more debt and take 4 more years of my life getting a degree that I just find mediocre once I'm done.

I've actually been putting off answering this letter because I wanted to make a more objective reply.  However, this week I've had cranky clients and aggressive pets and haven't reached that point.  So I thought rather than delaying further I'd give an honest answer.  Now there are several points to reply to, so I'll take each one in turn.

First of all is the financial reality.  Jessica, if you're already in a lot of debt, it wouldn't be a good idea to go straight into veterinary college.  The average debt load of a newly graduated vet is quickly pushing $90-100,000, and the average starting salary is around $55,000.  Now total your existing debt from ophthalmology school and see if you can live off that salary.  You'll be spending thousands of dollars each month in loan repayments, making basic living a challenge.  In fact, this is one of the biggest problems facing veterinary medicine right now, as we have a higher debt-to-income ration than any other medical professional and it's only getting worse.  Veterinarians make about 1/3 of what a physician with the same experience will make.  You have to be realistic about this and decide if you can make your loan repayments after graduation, keeping in mind that even a bankruptcy filing won't eliminate student loans.

Staying late for animals can be just as annoying as staying late for humans.  When you've been working a 10+ hour day, you just want to go home, relax, and spend time with friends or family.  No job is more important that your loved ones, and a veterinary career can interfere with it just as much as any other medical job.  Believe me, you'll get tired of those clients who come in at the last minute for "sudden emergencies" that have been going on for a week and could have waited until the next morning.  As you stated, you'll be dealing with people just as much as you would in any other aspect of medicine, and they're the ones that will annoy you regardless of what field you're in.

Being very honest and blunt, this is a job to me.  Almost every day I'd rather be anywhere else than at work, and enjoy the days when I don't need to be there.  Now there are certainly things I enjoy about being at work, and it's not like every single moment is dreadful.  I started feeling this way about three years into practice, and it hasn't improved in the 10 years since then.  I still get excited about certain things, and do have fun with my staff.  But yes, this is a way to pay bills and put food on the table, no longer a calling or something I'm very passionate about.

Taking away every other aspect of my life and who I am?  Well, that's hard to do, as I am who I am today because of what has happened in my life, including my job.  But if I could wave a magic wand and keep everything the same except for my job, would I still be a vet?  Truthfully, no.  I have discovered that my passion lies much more in teaching than in practicing medicine.  If I had to do it all over again, I'd likely take a course to being a college professor.  Yes, I know this had its downsides also, as I've actually taught at a local college.  But that job was the best one I've ever had, even with the challenges and hassles.  I hated leaving it and going back into practice.

Jessica, please realize that I am very much in the minority in my opinions.  I read a study several years ago that looked at job satisfaction among US veterinarians.  Only about 20% didn't like their career choice, and 80% were satisfied or very satisfied with their job.  There are a lot of great things to be said about being a vet, and it can be an excellent career choice.  I wouldn't want you to avoid becoming a vet on my opinion alone if this is your true passion.

Pros:  Good salary compared to many professions.  Respect from most people (surveys have ranked vets in the top 5-10 professions that people trust most, and above any other medical professional other than nurses).  Interesting and varied cases.  Great interaction with animals.  Lots of career options.  Most vets find it to be a true calling and a satisfying job choice.  Great intellectual challenges.  Opportunities to own your own practice (if this interests you).

Cons:  Low salary compared to debt load.  Often long hours.  Risk of physical injury every day from aggressive animals.  Having to be responsible for life-or-death decisions.  Having pressure to be perfect every time in every case.  Sometimes difficult clients.

Jessica, I hope this helps in your decision, though I strongly advise you to continue to get lots of opinions.  I'm sure some of my veterinary readers will chime in with their own opinions, which are always welcome.  And hopefully I haven't tarnished my image to my readers, as there are still many interesting things to share about the realities of life as a veterinarian.

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The Other Half Of A Vet

For the past couple of years I've talked about life as a vet.  However, there is another half to me...my wife.  Most vets are not married to other vets and those spouses have to put up with a lot of things that they probably never expected.  I've been married to my sweetheart for almost 12 years, and she's had to deal with some pretty odd things.  She also isn't a science-based person, having majored in English and minored in Drama.  She has a pretty weak stomach and doesn't like "creepy-crawlies".  In fact, when she saw the cuterebra picture from last week she became nauseous, and couldn't even come close to watching the videos.  Here are some other things my wife has had to deal with....

*  Trying to get blood, feces, urine, and other unseemly things from my clothes.
*  Hearing me casually talk about abscesses, surgeries, and other gross things while we are eating dinner.
*  Coming to visit me at work and seeing me in the middle of a surgery. (Remember that weak stomach of hers?)
*  Seeing me struggle with life-or-death decisions and worry about it the whole time.
*  Having me call at the last minute and say that I won't make it home for dinner because of a last-minute emergency.
*  Having me leave in the middle of the night because I was called in for an emergency.

Veterinary spouses often have to put up with even more things, especially those married to large animal vets.  There's nothing quite like having to help give birth to a calf or see your spouse carried away in an ambulance because they were kicked by a horse.  Spouses also have to give support and comfort when things go wrong and a patient dies.  I know that my wife has helped me on untold occasions.

So I just want to give a big "shout-out" and thanks to the husbands and wives that support their veterinary spouses.  It's not an easy job and we're glad that you do it.

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Aggressive Dog Problem

Reader Rockjdog asked this question...

Question for you. One of my dogs is very aggressive. When I first got her from a rescue a little dog (off leash) got in her face and she bit the dog. The dog died on the way to the hospital. (Severed artery).  So I have discovered she is very aggressive to all animals. She goes bonkers when she sees another dog. Last week she caught a full grown ground hog. She carried it and shook it for a good 20 minutes. No matter what I did she would not let go.

She is 125 lbs and my other dog Rock is 175 lbs so it is very hard to walk them together. Rock is fine but Molly can get very excited.  I have been to two trainers and have done the work they suggested but she still remains very hyper when it comes to other dogs.

She has had blood work done and she is fine.  Do you think it might be helpful for her if I approach my vet about trying some SSRI's for her? Do you think they work on dogs? I have not heard too much about them with animals but it seems to be an over-looked drug fro behaviour or fear issues.

This is a pretty serious problem, and one I would really look into.  You could be at risk for a lawsuit, as you are legally responsible for any harm your dog does.  Be very careful with Molly because of this.

Animal behavior is a very strong interest of mine, and I consider myself good at it.  Even so, I will often refer cases of aggressive pets to specialists because of the liability and potential danger involved.  I would highly recommend that you seek out a veterinary behaviorist and not just a trainer.  Follow this link to the American College of Veterinary Behaviorists where you can find a diplomate near you (sorry, I don't have references outside of the US).  As big as your dog is, a veterinary behavioral specialist is going to be your best resource.  A trainer is the equivalent of a therapist, or perhaps even a psycologist.  A board-certified behaviorist is the equivalent of a psychiatrist, as they are doctors and can prescribe medications.

Any therapy for behavioral problems always requires behavioral modification therapy.  Such treatment is the cornerstone of changing a pet's behavior.  Medications can be added to the regimen to help alter the behavior but should never be used alone.  Veterinarians who aren't well trained in behavior will sometimes prescribe medications and not talk about modifying the behaviors or other training methods.  If you talk to a vet and they only discuss medical therapy, I will be blunt in saying that I would not fully trust their judgment on this topic.  Every specialist I have ever heard speak, as well as every article that I have ever read, have always emphasized drugs as an aide to therapy but not the sole part of therapy.

There are two broad categories of behavioral medications:  selective seratonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).  A few medications may fall outside of these classifications, but most can be broken up into one of these two fields.  Researchers are still trying to understand all of the ways that these medicines work, so there are still some aspects that are not understood about their mechanisms of action.  Simply put, these drugs generally help reduce anxiety and increase the feeling of "well-being" in the patient.  They don't necessarily reduce aggressive tendencies, but instead can work to lower the anxiety, stress, or fear that leads to aggression.  If a drug out of one category doesn't seem to work, a choice from the other category may be more effective.  It's also important to remember that these medications can take anywhere from 2-4 weeks to show effectiveness, so a few doses won't make a dramatic difference.

Take care of this as soon as possible.  I hope these suggestions help!

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Spammers Must Die

Over the last few weeks I've been having more and more spammers post comments with links to outside web sites.  Up until now I've simply deleted these comments as soon as I noticed them, but my frustration has been building.  I already have the comments set up where you have to manually enter a code to help prevent bots from posting automatically.  Apparently the bots have found a way around this or some of the spammers have determined that they should spend their time hunting down small blogs like mine and posting links to unrelated and sometimes offensive sites.

Well, I'm going to have to put a stop to that.  For the time being I'm going to have to approve all comments posted here.  I'm not a fan of censorship and welcome any opinions contrary to mine (as long as they are posted intelligently and respectfully), so I'll continue to make all non-spam comments public.  But be aware that any comments made will have to go through my email so I can better weed out (and hopefully report) spammers from this blog.

Frankly, I don't see why they do this.  I know it may increase traffic on their site, but this is annoying throughout the internet, and usually results in getting banned or blocked.  Yes, it must be worth their time or they wouldn't do it.  But whatever happened to common courtesy and respect?  Obviously, they don't have it.

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"Holistic"

Merriam-Webster describes "holistic" as the following: relating to or concerned with wholes or with complete systems rather than with the analysis of, treatment of, or dissection into parts; holistic medicine attempts to treat both the mind and the body; holistic ecology views humans and the environment as a single system.
Many pet-food companies have jumped, nay, leapt, on the "holistic" band-wagon, and pet owners cannot get enough of them. Based on my experience, most pet owners do not have a good (or any) understanding of what "holistic" is. That their pets are eating some sort of "holistic" diet is the only thing that many pet owners care about, but don't really understand why.
Example: if I am using an holistic approach to treating osteoarthritis, I would be giving NSAIDS for pain and inflammation, Cartrophen injections to maintain healthy cartilage and joint fluid, omega fatty acids as an adjunct to anti-inflammatories, weight loss to reduce strain and stress on joints, exercise and physical rehabilitation to prevent muscle atrophy and strengthen bones, muscles, ligaments, tendons, etc, and possibly tramadol or gabapentin for pain or concurrent neuropathic pain. This is an holistic approach to treating osteoarthritis. The use of the word holistic to describe pet foods irks me, as much as the word "organic" and "natural." Rocks, twigs, and chicken bones are all "natural," but I don't want your pet eating these things, savvy? Organic foods are those limiting or excluding synthetic ingredients. I will sooner recommend a non-organic food that has undergone studies in animals before recommending an organic pet food having undergone none.
In all fairness, many of these holistic foods seem perfectly balanced, are recognized by the Association of American Plant Food Conrol Officials (AAPFCO), and whose quality of ingredients make me wonder why human beings are not eating half as well as our pets and livestock.
Ultimately, we should be reading pet food labels as if we're eating these foods ourselves. Be curious, ask questions, confirm mysterious ingredients with your veterinarian and don't buy into the hype of "holistic" or "organic" foods unless the proof is in the pudding, or rather in the pet food.

and

both genuinely organic... but don't feed to your pets.

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For The Kids

Today I got to do something fun.  There are groups around the country that a promoting the children's book Martha Speaks in libraries.  They bring in veterinarians and therapy dogs for the kids to meet and hear from, and then spend some time reading the book.  There are six such events being held in the metro area around me, and I'm participating in four of these with today being the first.

There were almost 30 children ranging from pre-Kindergarten to 1st and 2nd grade.  I opened with discussions on what kind of things pets need, where pets live, and how vets take care of them.  Then the therapy dog group spoke for a while and let the kids pet their dogs.  I had some vet-related coloring books, crayons, and stethescopes to pass out to the kids as the left.

I had fun with it and look forward to the next on.  Many of these kids haven't hadn't had pets and may have had bad experiences.  I know that many of their families may not be doing everything they should for  a pet.  If I can give these kids even learn a few things about proper pet care, then they have a chance of bringing it into their adult life. That's a win-win for everyone!  We have a chance to develop kids into responsibile pet owners, the kind vets like to see.

It can be a bit chaotic, but you have to plan for that since these are kids.  When  you get used to it, it can b easy to handle.  And then once you can handle the kids you can go anywhere you want with the discission.

So if anyone in the Atlanta, GA area wants to learn about Martha Speaks and get to meet a vet, check with your local library.  I may just be the one giving the talk.

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Wolf In The Fold

It was like a scene in a science-fiction movie.  The dog had a swelling under its arm with inflammation and a small hole in the center.  Just inside the hole you could see something small moving.  Very carefully we used a pair of hemostats to gently grasp the object and start to pull it out.  We place the object on the table and see a fat larval creature wriggling around.  It was like the ceti eel in Chekov's ear in Star Trek II: The Wrath of Khan.

As odd as this sounds, it's not uncommon to vets, especially those who practice in rural areas.  These "worms" are larvae of a type of fly called cuterebra.  More commonly these are referred to as "wolf bots".  The larva comes into contact with an animal's skin and burrows underneath, or into an orifice such as the eye or the nose.  It remains there and grows, eventually molting into a fly.  While in its larval stage it can get up to over an inch long and can cause a lot of localized inflammation and infection.  They can infect just about any animal, but are most commonly found on dogs, cats, rabbits, squirrels, and other rodents.

Thankfully, once these are noticed they are usually easy to take care of.  A veterinarian is usually able to remove these from the hole, and then it's a matter of cleaning and disinfecting the wound and putting the pet on antibiotics.

Here are a couple of videos I found of cuterebra larvae in animals.  Don't watch these if you're not prepared to be a little disgusted.





Though this is usually simple to fix, don't ever try to remove them yourself.  If the larva ruptures while in the animal, there is a chance of a serious allergic reaction and even anaphylaxis.  If you see something like this on your pet, be sure and seek veterinary assistance.

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Vet For A Vet

New reader Rockjdog made this comment about my recent post on my own dog's illness.

I am sure you have been told this but would'nt the best course of action be to have another vet treat the dog?

That's actually a very valid question, and it's one that we have to wrestle with periodically.  On one hand it does make sense to give the main clinical duties over to another doctor.  As I mentioned when dealing with my own pet, when you have that close emotional tie it's difficult to maintain good clinical objectivity.  The feelings that run through you as you fret and worry can make it hard to keep good judgment.  Last year I had another vet I know have her husband bring her dog to me for a second opinion.  The dog was in congestive heart failure and she was scared that she wasn't making an objective decision because of how close she was to her dog.  She wanted to hear from another vet what she really knew but couldn't bring herself to relate to her own dog.

However, as a vet we don't like to give those decisions over to another person.  We know how to work through a case, and have a hard time letting go of that when it's a personal pet.  It's a corollary to the above point...because were so emotionally invested we have a hard time letting go, as well as a hard time being objective.  We kind of feel like we'd be letting our own pet down if we didn't handle it ourselves.  In my career I've had to euthanize two of my own cats.  Even though it was the hardest thing I've had to do, in both cases I pushed the plunger and put my own cat to sleep.  Yes, that emotionally draining and hurt immensely.  But I couldn't bring myself to let a colleague be the one to do it.  It was my own pet and I felt that I had the responsibility to do the task myself.

So it's not a clear-cut decision.  For a veterinarian, letting another vet work on your own pet may be the best in some cases to allow clear clinical judgment, but it is difficult to completely let go and trust that to anyone else.  I don't think there is an easy way to handle it, but I dare say that most vets would react similarly to me.

So what about my vet readers?  How have you handled similar situations?

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Doing The Right Thing?

Brandie sent in a rather lengthy letter.  For the sake of brevity, I've edited it a bit, though I appreciate the detail I got to read.

When [my lab] was about 8 years old I noticed she was having trouble keeping up and getting tired a lot. Extensive testing only revealed mild hip dysplasia.  At about 9 1/2 years old I noticed she was walking differently, more stiffly, and it would be especially noticeable after she did a large jump. So another vet visit determined that it was merely arthritis and hip dysplasia working against her. She was put on pain meds.  She seemed to continue to worsen gradually, which was expected. But then suddenly she seemed to be worsening more and more rapidly, much faster than myself or her vet anticipated based on what we thought it was at the time (arthritis and hip dysplasia). I prepared myself to have to make the decision to put her to sleep within a couple of years at the rate she was declining.  After a couple of months of rapidly getting worse, she woke up one day much, much worse than she had been, enough that I wondered if she had injured herself in the night. I took her to the vet again, who discovered that it was nerve damage causing this problem, not the arthritis and dysplasia (although those things certainly didn't help matters). She said she figured out it was nerve damage because of the way my lab was dragging her toes when she tried to walk and that she could bend my labs toes under her pads, place them on the ground, and my lab did not correct it.

She was unable to determine exactly what the cause of the nerve damage was, but strongly suspected a tumor in the spine, one that possibly may have been growing for a couple of years and could have been the real cause of her slowing down the way she did. She said that I could take her to the university hospital a couple of hours away and have a test done to find out if it is a tumor and if anything could be done, but that the test would be really expensive.   However, she told me that the test that would have to be done would be very hard on my dog, and might not even discover the cause of the nerve damage but could worsen it. Additionally even if the cause was found, the surgery and recovery involved would also be very difficult for my dog and could take months and would be no guarantee that it would help enough to have been worth it. She said that typically nerve damage does not get better, only worse if there's any change at all. So I decided not to put my dog through the testing for her own sake, since there was little chance that it would really help her without great cost to her.

I asked the vet if she thought that I should put her to sleep. The vet was very ambivalent with her answer. I know she was just being professional but it frustrated me to no end because I was afraid I could not properly judge my dog's quality of life because of bias. I feared causing her to suffer and not knowing it.
 
I got a harness for her back end and helped her walk anywhere she wanted to go, and helped her go to the bathroom for the next couple of months. She didn't mind having to do things that way. The vet told me that there was a 50/50 chance she could either feel nothing or be in excruciating pain.  After those couple of months, I noticed she seemed to just be getting tired, and not just because her front end had to do so much work to compensate for the back end. However, she was still happy and playful and outgoing as ever. I suspected she was started to hurt quite a lot judging by the change in her panting patterns, the positions she slept in, and how she reacted to events in life compared to the past. But, I could never really be sure. As soon as I would decide that she was indeed hurting and was just being really good natured about it, I would second guess myself. No one else would really give me advice about it. The vet refused to say one way or the other. So I had to make the decision completely on my own, and I decided to err on the side of comfort for my dog.

I thought long and hard about it and decided that I would rather put her to sleep too soon, than to wait until she was hurting so badly that her seemingly unbreakable happy spirit started breaking, or worse yet, wait until something happened that the only humane choice was to immediately put her down. So I got one last month with her to say goodbye, and in the week prior to the big day, all rules were thrown out the window and she got to eat and do anything she wanted. I spent that entire week making it all about her and doing everything I could to make every hour as happy as I could for her. 

Mission accomplished, she was extremely happy, bouncy (as well as she could be with her back end out of commission), playful, outgoing, etc right until the very end. You'd have never known she was having the problems she was having if you didn't know her unless she tried to stand up and walk. And therein lies the problem for me. I thought that knowing I would rather do it too soon than too late would keep me from regretting the decision, but alas, it didn't work that way. I have since wondered if I did it too soon after all. it has been 10 months and I still cry wondering if I should have waited and given her more time. I wonder if I just imagined all those signs that she was in pain, or imagined the feeling I got from her that she was ready to go if I'd let her even though she was still happy, and constantly second guess myself. I wonder how much longer I could have had with her if I had waited until her happiness began to fade before going ahead with it. What if, just what if, she would have gotten better?

All I've wanted since that day is an objective, educated voice to give me peace of mind by telling me I did the right thing, or be honest by saying I did it too soon and giving me the chance to process that so I can let it go and work on forgiving myself. Some people have told me that I did the right thing, but it doesn't help because I had several people question my decision at the time as well. But it's not like I could really ask my vet if I did the right thing and expect anything but a professional answer, either. As frustrating as it can be I totally respect that.

I am hoping since I am not a client of yours, that perhaps you will disregard the need for professional neutrality and offer your educated, experienced, and objective opinion. You would do my heart a world of good, either way. I think not knowing if I messed up is harder than knowing I did mess up.

Okay, so here goes my response, probably equally as long.

First, Brandie, let me say that based on what you shared your vet did everything correctly and appears to have given spot-on information.  Spinal tumors can be very difficult to discover and usually don't show up on regular x-rays.  Combine that with a breed that is prone to joint problems and some signs of arthritis, and anyone would likely come to the conclusion that your vet did.  Your vet was probably talking about a myelogram, where they inject dye around the spinal column and then look at the pattern of that dye on an x-ray or other imaging method.  Yes, neurological damage is hard to predict and usually doesn't get better, so in this circumstance I can certainly understand not pursuing that option.

I often get asked "should I euthanize my pet?"  This is a difficult question for any vet to answer.  Part of it is professionalism.  We don't want to force someone into a decision that they're not ready for, and ethically we shouldn't make decisions for the client.  Our job is to give the client enough knowledge to make an informed decision on their own.  Even if I'm 100% behind the euthanasia, I ethically and legally can't make that decision for any pets other than my own.  The final decision has to come from the owner, as hard as that can be for them.

Another reason why vets can't make that decision is that we only see the pet for a short period in our hospital.  Even if someone is giving great information and descriptions, we can't really tell how their quality of life is at home.  In these circumstances the owner is the only real judge, and we have to rely on their intimate knowledge of their pet.  The only person who can really determine a pet's quality of life is the family that lives with them.  A vet can guide, educate, and give opinions, but because of the emotional bond only the owner can truly determine the elusive quality of "suffering".

Now with all of that being said, there are some things that a vet can do to help the decision.  I have said in particular cases that I don't think euthanasia is necessary.  When I think it's valid, I'll give the owners all options and include euthanasia in that list, letting them know that if they choose it I would agree with them.  I can say that the odds are and whether a given disorder is likely to be painful.  Again, all of this is merely to help the client make the decision on their own.

But you came to me for some closure and assurance, Brandie, and I'll try to help.  Your vet made sound decisions and gave you solid advice.  Your dog likely had an untreatable and eventually fatal disease.  Before she died, she would have gotten progressively worse and have suffered even more.  You allowed her to pass away when she was still in good spirits and wasn't hurting.  Euthanizing her wasn't a matter of "if", but of "when".  If you had waited, you would have been postponing the inevitable and getting to the point where you would have been more heartbroken at her condition.  By making the decision when you did, you were able to do it on your and her terms, with peace and dignity.

You did the right thing.

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To Catch A Thief

Yesterday I had to do something very unpleasant.  I had to fire one of my staff members.  A few weeks ago we noticed a strange transaction, with another one almost a week ago.  After some investigating we suspected that there was something wrong happening, and there was one common denominator.  Yesterday this person was confronted, admitted to stealing money for several months (much more than we had realized), and was subsequently fired.

Most people don't think about these sorts of things going on in a veterinary practice, but it happens more commonly than most may realize.  I remember when I was in college and working at a local veterinary clinic.  There was one woman who was pretty much the office manager, and very well liked and trusted.  She had everything at that place and had worked there for years.  It happened to be discovered that she was "returning" flea products, taking money out of the register for the refund, and then pocketing the cash.  The whole thing was a scam as there were no actual returns.  Nobody suspected her because of how trusted she was and how long she had worked there.

It's an unfortunate reality of business that there will be unscrupulous people who will take advantage of their employment.  They will steal and cheat and otherwise try to get things that they didn't earn or deserve.  Thankfully, most people are trustworthy and can be relied upon.  But part of being a business manager is having to watch for and handle situations like this.  Though I've suspected people of theft in the past, this was the first time I was able to directly link something and prove it.  It wasn't something I wanted to do or enjoyed doing, but it really angered me that this had been happening and I was very ready to exit this person from the practice.

Crime doesn't pay, and criminals do eventually get caught.

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Doctor Death

Some days are rougher than others when you're a vet.  One of the hardest things we do is euthanize pets.  Even when we know it's the right thing to do and will end their suffering, it can still be emotionally draining.  The worst part isn't that we're ending a life, it's the reactions of the owners.  Seeing people say goodbye to their loved ones is pretty hard, and no matter how many times I see someone break down in tears it never gets easier.  Frankly, I wish we had more training in grief counseling, as it is an important part of being a vet yet something that appears to be under-appreciated by vet schools.  It can be difficult to make it through some of these cases.

And then some days are even worse than others.  Like today. Most vets would consider it bad if we had to do four euthanasias in one week.  I had four of them in one day. 

Each case was very justified.  The first was a puppy with parvo that we had treated for four days and he began to worsen.  The second was an elderly basenji who had neurological signs and I had strong suspicions of a brain tumor or other central nervous system disorder.  The third was a 15 year-old schnauzer who had stopped eating and wasn't moving around much.  The last one was a dog I had seen for quite a while and who had multiple medical problems that had worsened.  I had no problem with the decision to euthanize each of these pets, but none were easy.  The owners cried with all of them, and like I said that's the worst part.

Days like this I feel like "Doctor Death".  Euthanasia isn't a bad thing, and it allows me to ease suffering and give a quick and peaceful end to an inevitable circumstance.  But I'm very glad to be home from work and trying to decompress from such a day.

Tomorrow I hope I get to see only healthy puppies for their vaccine boosters.

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Smells Like Work

When you're a vet, your nose tends to get pretty immune to most odors.  I regularly deal with diarrhea, blood, pus, rotted tissue, anal gland excretions, and many other undesirable things.  All of these can have some pretty offensive odors, and you simply get used to them.  There are very few scents that turn my stomach anymore.  However, I still can find them offensive and certainly don't like smelling like these things.

The worst part about odors is when they stick with you.  Today I had a severely constipated and impacted cat and had to give it an enema and pull firm feces from its rectum.  There was several days worth of stool backed up in its colon and all of it needed to come out.  So I ended up filling the colon with soapy water and digging the stool out with my finger.  Needless to say, this was not exactly pleasant and had a rather "distinctive" odor.  I did what I had to do and began washing up.  I was rather unhappy to find that odor clinging to me for the rest of the afternoon.

However, that's not as bad as what swine vets have to face.  When I was in vet school I did a swine rotation and had to spend some time in pig barns.  Let me tell you, that was an ordeal.  I would be in a facility for only an hour or two and then take several hot showers once I got home.  Even with repeated washes I would smell like pig waste for a couple of days.  I can't imagine having to deal with that every day, and am glad that other people can put up with it.

Even when I can't smell "work", my pets can.  One of my cats (Perceval, who passed away last year), used to rub all over my shoes after I came home, trying to cover the scent of work with his own.  And my dogs commonly spend great attention to the odors attached to my pants, especially if I managed to get feces or urine on me during the course of the day.

So tell me again what the glamorous part of veterinary medicine is?

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With Clear Vision

Okay, so sometimes I'm a little late to the game.  I'm 40 years old and have just gotten my first pair of contact lenses.  I've been wearing glasses since I was 10 or 11 years old, and in the last 5-6 years my sight has worsened to the point where I have had to wear them all of the time and not just occasionally. Honestly, it's never bothered me to have my glasses.  I'm so used to wearing them that I don't notice them, and I don't mind how they look on me.

So why the change?  Well, I do a lot of costuming at sci-fi conventions and Renaissance faires, and when I'm in costume I don't want to wear my glasses because they don't fit with the theme.  However, without my glasses my vision is more blurred, making it harder for me to enjoy looking at the vendors.  For a couple of years I've considered contacts but finally made the commitment.  For the last week I've been wearing them and have found them surprisingly enjoyable.

My contacts don't give me quite the clarity of vision that my glasses do, but it's still much better than without them.  I'm finding them very comfortable, and have gotten to the point where I forget I have them.  However, I'm so used to my glasses that I find myself in the same habits.  For example, when I go to look at the microscope I still reach up to take my glasses off.  There are benefits though, such as not having to worry about glasses fogging up because of my surgical mask.

So even though I got the contacts for cons and faires, it looks like I'll be wearing them more often than not. 

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