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Friday, February 27, 2009

Preanesthetic Blood Testing

Remember yesterday's post? Well, we did get the disc and the analyzer worked well today. Surgeries were able to proceed normally, and we got through the day without any further technical difficulties. But the whole thing made me think of another topic of discussion.

Many people might say "well, you're dealing mostly with young, healthy pets. Would it really have been that big of a deal to do the surgery without the blood tests? Isn't it really unnecessary? After all, vets used to do surgeries without anything like this." All of these are great questions. To answer them in short...yes, it would have been a big deal, yes it's necessary, and yes vets used to do without it but also had a higher complication rate.

When we do an exam on a pet, we can only evaluate certain things. One of the things we cannot evaluate is the function of the various internal organs. We can't just look at a pet and tell if the kidneys or liver are working properly. These are very important when it comes to anesthesia, as the body eliminates the drugs through these two organs. If they're not doing their job, then the drugs may not be eliminated properly, leading to prolonged anesthesia or other complications. To give you an idea of how misleading an exam might be, you have to loose 66% of your kidney function before you will have any abnormalities in lab tests, but have to loose 75% of the function before you act sick. So there is a window between 2/3 and 3/4 kidney failure where you look, act, and feel perfectly fine, but there are detectable abnormalities.

Well, what about the fact that many patients are young? Doesn't that lower the risk? Yes, it does. The older a pet is, the more likely we are to see organ dysfunction. However, there are numerous abnormalities that we are more likely to see in young pets, such as kidney cysts or a liver shunt (where blood flows around the liver rather than through it). No, we don't see these things often. But I have diagnosed many young, apparently healthy pets with various diseases that we detected in a pre-anesthetic blood panel. Older pets are even more likely to have problems detected. If we did anesthesia without knowing for certain, we would potentially be placing the pet at risk for complications.

It all comes down to knowing or guessing. Do you want your doctor to make a guess about whether or not your pet's organs are normal, or do you want him/her to know for certain? If the preanesthetic testing isn't done, then you are doing nothing more than making a guess, and in a way gambling as surely as rolling dice in a game of craps. Personally, I don't like guessing when I have other alternatives.

Thursday, February 26, 2009

The Best Laid Plans

Some days things just don't seem to work out like you expect them to. Today we had a busy surgery schedule, with a total of eight procedures. For us that's a very busy day, and doesn't include any of the other patients we see. I even came in about 45 minutes early this morning to make sure we got started and stayed on schedule.

With every surgery or dental cleaning we require pre-anesthetic blood testing. This involves a simple blood chemistry panel and blood cell count, and doesn't take very long to run. We do this as a screening for any hidden organ dysfunction, and consider it an essential part of the procedure. In fact, we won't do the procedure if we can't run the tests. Like today....

I walk in and my head tech says that the chemistry analyzer is on the fritz. I then take a look at it, and the LCD screen is merely a bunch of lines of pixels, and never changed. Turning it on and off several times didn't work, so I called the tech support number. Apparently the disc in the machine was an older version, and that may be why the machine wasn't working. So basically, we were totally unable to do any lab tests at all, and had to cancel ALL of the procedures. Thankfully the pet owners took it well, and we were able to reschedule the surgeries.

My only concern is tomorrow morning. We have five surgeries scheduled, three of them postponed from today. We're supposed to get the replacement disc in the morning, and I hope it comes early enough. I also hope that's the actual problem and there isn't a bigger issue that would delay us further. That would be frustrating for us, but extremely inconvenient for the clients.

Ah, the joys of running a business!

Wednesday, February 25, 2009

The Christian Ninjate

What the heck is a Ninjate, and how does that relate to Christianity? If you read my profile, you'll see that I am a big geek, as well as a Christian. Though I do touch on these subjects in this blog, I also concentrate primarily on life as a vet. I've been having a growing desire to have a forum for more pointed discussions of faith and fandom, so I have started a second blog.

What is a ninjate? There is a popular argument/discussion on which is cooler: ninjas or pirates? Sometimes it's phrased as who would win in a fight. Recently I gave a message on this subject, and ended up coining the term "Christian ninjate". I've Googled the phrase, and can't find it anywhere else, so I think I'm the first to use it ("ninjate" has been around a little, but it's not common). A ninjate is the ultimate combination of a pirate and a ninja, having characteristics and abilities of both. It's sort of a geek fantasy, merging the best of each. Yes, it seems kind of strange to relate this to Christianity, but believe me, it works!

So if you're interested or just curious, come on over to The Christian Ninjate site, and see what it's all about. I doubt it will be boring, and it might just cover a unique spin on the Bible, Jesus, and God.

And don't worry, I still plan on having some fun with veterinary medicine right here!

Tuesday, February 24, 2009

How Often To Breed

It seems like breeding questions are popular. Here's another one.

I have two yorkies, the female is almost four and the male almost two. They have had two very successful litters of puppies no health problems from parents or puppies. They have sold asap and I have had several request from people wishing to purchase a puppy from me. My question is should I allow these two dogs to bread at will or should I space the breeding apart? Thank's for the help.

Definitely don't breed at every opportunity. Pregnancy and nursing take their toll on a dog's body, and breeding too frequently can adversely affect their health. Without proper rest, the body may not be able to handle another pregnancy and you may increase the risk to the mother and puppies.

I normally recommend breeding no more often than every other heat cycle. That means breed on one heat cycle, rest her on the next one, and then breed on the one after that. You can wait longer between cycles, but I wouldn't do it sooner. Keep in mind that your bitch is a living creature, and not simply a puppy factory. You shouldn't let market demand force you to breed her more frequently than is healthy.

Also keep in mind my previous discussions about whether or not you should breed in the first place. Just because the parents are healthy doesn't mean that they're good breeding quality.

Friday, February 20, 2009

Zoonosis Week: Leptospirosis

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.

When your dog receives his or her "distemper-parvo" combination vaccine, there is usually a list of letters that you'll see on your receipt or medical record. If there is an "L" in the list, this stands for "leptospirosis". Commonly shortened to just "lepto" when talking about it, this part of the vaccine protocols is actually controversial. There is a belief among some in the veterinary community and many breeders that the leptospirosis vaccine has a high risk of causing an allergic reaction, potentially leading to serious consequences for the dog. Since it's not the focus of my topic today, I won't get into all of the specifics of this discussion, but for now I will just state that the controversy is unfounded. Studies have shown that there is no statistical difference in reaction rates between vaccines with lepto and those without it. Those who believe that lepto vaccines are highly reactive are using outdated information and merely passing on what was told to them.

Leptospirosis is a bacterial organism that can infect many wild animals and is passed through their urine. If a dog (or even human) drinks water contaminated with this urine, or licks ground or grass also contaminated, they can become infected. Transmission can also occur through broken skin or open wound, as well as through mucous membranes in the mouth, nose, genitals, and so on. The more rain and wet ground in an area, the greater the risk of transmission as it survives in these wet conditions. How many pet owners have been urinated on by their dogs, or had to clean up urine from the floor? If your dog is infected, you have just been exposed to lepto.

In dogs, liver and/or kidney failure is the most common consequence. In humans this disease may begin with flu-like symptoms and go undiagnosed until it is far advanced. Meningitis can also be a consequence of advanced disease. As you can imagine from this list, leptospirosis is a serious disease with the potential to be fatal.

Once diagnosed, the disease is potentially treatable with several kinds of antibiotics, but some of the damage done may be permanent. The best option is prevention. That means for humans to be careful when being exposed to water sources that wild animals have been around, and washing hands carefully after being in these situations. For dogs this means being vaccinated against lepto. Talk to your veterinarian about this vaccine, and realize that there are several opinions on it and no consensus across the profession.

Thursday, February 19, 2009

Zoonosis Week: Scabies

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.

From rabies to scabies! You'd think I planned my alliteration.

Today I saw a pair of dogs, one with scaly patches on her ears and the other with extremely itchy skin. One of the main things I considered in this case was scabies, also called sarcoptic mange. The name comes from the microscopic mite that causes the disease, Sarcoptes scabiei. This mite burrows under the skin and will usually cause a localized allergic reaction and intense itching. As the mites grow and spread, the itching can be severe enough for the pet (or person) to cause sores because of self-trauma, as well as reddened or scaly skin due to the mites' effects.

Skin mites such as scabies can affect many types of animals, though each species of mite is usually specific for a single or a small group of species. Even though a host such as a human or a dog might not be its preferred environment, mites aren't always picky and will invade whatever is close that may be used as a meal. The mites are mostly transmitted through close contact with an infected animal or person, as they do not live long off their host.

Diagnosis is normally made by performing a superficial scraping of the skin in several locations, and then looking under the microscope to identify the mites or their eggs. Because the mites can cause such an intense reaction, it is possible (and not uncommon) for the vet to not be able to find them even if they are present. Sometimes we do a "therapeutic trial" in cases that are highly suspicious, giving treatment and see if it helps.

There are several accepted treatments. One of the easiest and most common is a series of 2-3 injections of an antiparasitic medication called ivermectin. Special medicated dips can also be used. There are also a few topical flea and tick medications that have been used for treating this mite. Your vet can recommend the treatment that he or she feels is best.

So the next time you bring an itchy pet to your vet and they want to scrape the skin for mites, don't ignore the recommendation and refuse the service. If it is scabies, it can affect not only your pet, but the whole household.

Wednesday, February 18, 2009

Toxic Onions

This is a topic that most pet owners are likely unaware of, and an event today reminded me of that.

My receptionist came back from lunch, and almost in passing asked me if onions are dangerous to cats. She had taken an onion off her hamburger and laid it on the counter since she doesn't like onions. Her cat jumped up and quickly ate it. She didn't think anything about it at the time, and almost didn't ask me. I had her immediately go back home, get her cat, and bring him in.

As soon as she arrived back at the hospital, I placed a feeding tube down his esophagus and gave him about 48cc of hydrogen peroxide. This is what we commonly give to induce vomiting, which he did within a few minutes. When a toxin is ingested, if you can get to the pet within about 60 minutes, you can often get them to throw it up and prevent absorption. You should never do this with caustic substances, but for many poisons and objects it works well.

Goober (yes, that's his name) threw up the food he had eaten, as well as several large pieces of onions. He was acting perfectly normal, though he was VERY unappreciative about having a rubber tube forced down his throat. We were able to get what appeared to be all of the onion out of his stomach before it passed, and I think he will be fine. If she hadn't brought him in quickly, we could have been dealing with a serious or fatal situation in a few days.

Why the big worry? Onions are very toxic to cats. Potentially fatally toxic, in fact. They cause abnormalities in the red blood cells leading to their destruction and severe anemia (called Heinz body anemia due to the structure created within the blood cells), and can also cause kidney failure. This can happen relatively quickly, and with only a small amount of onion. It has been known to happen after cats ate baby food with onion powder as an ingredient. Garlic is in the same plant family, and can cause the same toxicity. Cats have died from people giving them garlic tablets as a way to prevent fleas (which garlic does NOT do, and has been studied scientifically). These plants are also potentially toxic to some dogs, but the risk is nowhere nearly as serious as with cats.

So keep all of this in mind. NEVER give your cats anything with any onions or garlic in them. This is a very serious toxicity, and requires intense hospitalization and even blood transfusions once symptoms begin.

Tuesday, February 17, 2009

Zoonosis Week: Rabies

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.

I'm starting to realize that I'm on an "R" pattern with these diseases. Don't worry, it won't stay that way.

Rabies is one of the "big baddies" of zoonotic diseases. In fact, it's such a concern that in the US and many other countries, animals are required by law to be vaccinated for it. This disease is treated so seriously because there really is no treatment once symptoms are evident, and it is almost always fatal. So let's learn a little more about it.

Rabies is a virus transmitted through saliva. The virus replicates in the salivary glands of an animal with advanced disease, and can then become infective through either a bite or through contact with mucous membranes (mouth, nasal passages, etc.) and broken skin. Most people think of the infection through being bitten by an infected animal, but this is not the only way. There have been many stories in vet school of veterinary students and faculty examining a horse or cow with excessive salivation, even sticking their hands in its mouth, and then having to be treated for rabies exposure. If the person had a cut or other wound on their hand, the saliva could get into the body through that injury. Rabies cases have also been documented in people who have gone into caves with numerous rabid bats, inhaling the aerosolized saliva and becoming infected through the membranes in their lungs.

Once through the skin the virus will eventually migrate to the peripheral nerves. How long this can take is variable, and is not really predictable. Once it reaches the nerves, it quickly spreads to the brain where it causes encephalitis and eventually death.

Symptoms can vary, but are almost always neurological. This can include confusion, behavior changes, paralysis, uncoordinated movements, and seizures. In fact, we are taught in vet school to include rabies as a possibility in any case that shows neurological signs. Symptoms usually begin within a few weeks of exposure, but can take as many as a few years.

Prevention is a matter of vaccination and avoidance. Since any mammal can potentially become infected with rabies, mass vaccination of wild animals is impossible. There have been programs where bait is laced with an oral vaccination in hopes of reducing the cases, but these many not have wide-spread efficacy. Vaccinating pets and livestock is the best way of avoiding transmission of the disease through animals commonly in contact with humans. There is also a vaccine for humans that many of us veterinary staff receive since we are at highest risk. Other than vaccination, the average person should avoid direct contact with wild animals, especially ones showing odd behaviors.

If someone becomes exposed to the disease, receiving post-exposure injections can prevent the disease from spreading. This has to be done quickly, as the end is pretty much a foregone conclusion once the virus reaches the nerves. This speed of spread is why treatment is often started when exposure is suspected but not yet confirmed.

Here are a few other tidbits for you...
* Rabies kills around 55,000 people each year world-wide, mainly in Africa and Asia.
* There are only six known cases of people surviving rabies once symptoms began.
* Louis Pasteur and Emil Roux developed the first rabies vaccine in 1885.
* It is also sometimes called "hydrophobia" because of the victim's inability to swallow water.
* In the Stephen King novel, Cujo is a rabid dog.
* Old Yeller (from the movie of the same name) had to be killed because he contracted rabies.
* Infected bats, monkeys, raccoons, foxes, skunks, cattle, wolves, dogs, mongoose, or cats provide the greatest risk to humans.

Monday, February 16, 2009

Zoonosis Week: Ringworm

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.

One of the first misconceptions that I have to clear up with some of my clients is that ringworm isn't actually a worm. It's a type of fungal infection of the skin and is related to other fungal diseases such as jock itch and athlete's foot. The name comes from the ring-like progression of the lesion once it becomes established in the superficial layers of the skin. Many kinds of animals can get ringworm, including dogs, cats, rabbits, and guinea pigs.

The fungi that cause ringworm can be found contaminating the environment, and this is usually how humans and animals become infected. Once infected, that animal then becomes contagious, and can transmit the disease by contact. On animals the lesions look like scaly, hairless areas, most commonly on the head (though they can appear anywhere). Most of the time these areas do not cause itchiness, but if it progresses far enough they can be irritating.

Luckily, this is not a serious disease. In pets we most commonly make a definitive diagnosis by collecting hair from an affected or suspicious area and growing a culture to identify the organism. There are other, quicker methods of diagnosis, such as using a blacklight, but they are not as accurate as the culture. Once diagnosed, there are several methods of treatment, depending on how wide-spread the infection is and how long it has been going on. Most of the time treatment will consist of topical lotions or antifungal shampoos, though severe cases may require oral medications. Long-haired pets may also need to be shaved to reduce the numbers of spores on the skin.

If your pet has any sores that sound like this, make sure you visit your vet for a proper diagnosis. Doing so can not only help the pet, but can help the humans in the family with quick prevention or treatment.

Sunday, February 15, 2009

Zoonosis Week: Roundworms & Hookworms

Zoonosis: An infectious disease in animals that can be transmitted to people. The natural reservoir for the infectious agent is a animal.

I thought that I would go back to a theme, doing an informational one this time. Zoonotic diseases are something that we don't talk about as much as we should, and are extremely important. There is much misinformation out there, and human doctors are often not as knowledgeable about these topics as are veterinarians. That's probably because we vets are the most likely to be exposed to them! So we're going to make darn sure we know what we're at risk for and how to prevent it.

So let's begin by talking about roundworms and hookworms. These are common intestinal parasites in dogs and cats, especially kittens and puppies. When we do a fecal exam, one of the things we look for is the eggs of these parasites. Both of these worms normally live in the intestines of their host, shedding eggs into the feces. These eggs can contaminate the environment, adhering to the animal's fur, the grass and leaves, or basically anywhere that feces have been touching. This includes the floors of our homes, which is not uncommon as we are trying to housebreak our new puppies. When an animal (or human) swallows anything contaminated by the eggs, the can become infected themselves.

Puppies and kittens are very commonly infected because the larvae of the worms migrate through the host's body. They can form cysts that are impossible to detect and are a dormant stage that are resistant to antiparasitic medications. During pregnancy, the cysts open, and the worms migrate through the uterus or into the mammary glands, providing two sources of infection for the babies.

Humans are most commonly infected through poor hygeine. Sandboxes can be a good place for stray cats to defecate, potentially contaminating a child's environment. Stray dogs and cats will sometimes eliminate in the soft ground cover of playgrounds. A pet's fecal materials can get into the grass in which children roll around and play. You can likely think of similar situations in your own lives. In any case, the people touch the area that has been contaminated, and then touch food or their mouths without washing their hands first. Suddenly, the person (often a child) has swallowed the eggs, and will become infected. Other sources of infection include being licked in the face by an infected pet (the eggs can be in saliva), and migration through the skin (in the case of hookworms...their larva can get into a person through bare feet).

In pets, both kinds of worms can cause diarrhea and poor body condition as the worms upset the intestinal tract and interfere with food absorption. Hookworms drink blood from the intestines and can cause life-threatening anemia in small pets.

In humans, these worms can cause the most serious disease through "larval migrans". The larvae move through a person's body, and can end up in unusual places, such as the lungs or the eyes. This can lead to pulmonary disease and blindness.

Thankfully, these worms are easily preventable and treatable. A veterinarian can detect these parasites in a fecal sample, and it is recommended to perform these checks twice per year. Routine heartworm preventions in both dogs and cats also include preventions for roundworms and hookworms. If an infection is detected, there are several very effective medications that a vet can use to eliminate the parasites.

For human risks, you can take the following simple steps. Any time a child has handled a dog or cat, make sure they wash their hands immediately afterwards. Pick up any feces from the yard at least weekly, if not immediately. If a pet has defecated in the house, clean and disinfect that area as soon as you notice it. Keep your pets on heartworm prevention to help with intestinal parasites as well. If your vet detects parasites in your pet, try to avoid anyone being licked in the face until the infeciton is cleared.

It doesn't take much to protect your family against potentially serious parasitic disease.

Friday, February 13, 2009

Training Secrets For Any Situation

Several years ago I attended a management class to help me be a better leader at my hospital. One of the main principles I learned there is a phrase that has really stuck with me.

"Behavior that gets rewarded gets repeated."

This was intended as a way to manage people in the workplace. The idea is that you reward the behaviors you want people to do, and they will continue to do them. Sometimes this is also called "positive reinforcement", but I like the other statement better. What is really interesting to me is that this phrase is appropriate to pretty much any situation involving people and pets.

Talk to any good pet trainer, and they will tout the benefits of positive reinforcement as the best method of training. When you're trying to discipline a dog, train it for a certain behavior, or correct bad behaviors, you want to look for the behaviors you want them to do, catch them in the act, and then reward them for it. So when you're housebreaking a dog (like I'm doing with Inara), you watch them going to the bathroom, and immediately praise them and give them a small treat as a reward. They learn what it takes to get rewarded, and try to do that same thing again.

This idea extends to raising children as well. With my own kids I have learned to take the same approach. I often tell them "when you do something good, good things happen to you." A few nights ago after supper my son decided to pick up everyone's dishes and cups and take them into the kitchen. He did this on his own without any prompting. We praised him and said what a good boy he was, and then allowed him an extra dessert. He responds well to this kind of a reward, and looks for more opportunities to get them. Which is exactly the point!

My Masters Degree is in animal behavior, and I have continued to be fascinated by it as a veterinarian. One of the things that I have learned is that humans and animals share many behavioral traits, and that similar training methods will work across species. All species like to receive rewards, even though it may not be obvious ones. To a dog, the pleasure of chewing on a shoe may be enough of a reward to keep it performing this behavior. To a cat, getting to taste people food after jumping on the kitchen counter is a similarly positive reward. To a child, getting to stay up late is a great reward for finishing their homework on time. To a receptionist, a special certificate and recognition for consistently excellent client service will help to make sure they want to continue performing that way.

Behavior that gets rewarded gets repeated. Look around in your work, family, and pets and see how you can use this principle every day.

Wednesday, February 11, 2009

A Kid's Perspective

One of the things I enjoy doing is talking to children and young adults about veterinary medicine. I have done presentations to all age groups from pre-k to pre-vet college. Last Friday I spoke to some preschool students about pet care. Today I went to my own children's school and talked to six kindergarten classes about what it's like to be a vet.

When we practice for a long time, we sometimes loose some of the awe of what we do. We have seen and done so many things that we forget when it was all new to us. And we have so many clients that don't seem to listen to us or respect our medical judgment that we forget that most people highly respect veterinarians. Being around children can remind us of the "cool" factor of our job.

When I was talking to the classes today I explained that vets do surgery. The kids were 5 and 6 years old and didn't know what that was, so I proceeded to explain. I told them that we would make them be asleep, then cut them open with a small knife called a scalpel, and the put our fingers inside. Most of the kids would go "eeewwww!", but I could tell that they were kind of excited by that. Of course, my daughter was the only one in the class that said "cool!" when the other kids were grossed out. Yes, we think she's going to grow up to be a vet.

A program I have been involved with is FutureVet. They provide online or purchaseable materials to use in making pet care and veterinary presentations to kids and students, all broken down by age groups. I brought play stethescopes to the classes, enough for each child to have one of their own. These are inexpensive toys, and aren't really functional. But they absolutely loved them. To me it's a simple and necessary piece of equipment that I use dozens of times every day and have on my person for about 10 hours a day, so I tend to take it for granted. To the kids this was something amazing and magical. When she came home, my daughter wanted to use one of my real stethescopes so she could actually listen to our pets' hearts.

Days like this help to balance out days like Monday, and remind us that we do have a pretty cool and interesting job.

Monday, February 9, 2009

One Of Those Days

Everyone has had "one of those days". You don't really need to elaborate more than that, because regardless of your profession or interpretation, we all know that this phrase means that it wasn't a good day. Well, today I had one. Let me give you some insight into what "one of those days" might mean to a vet.

Firstly, I am not kidding when I say that the majority of dogs I saw today needed to be muzzled in order for me to examine them. I was almost bit at least three times. It's not unusual to have a patient or two in a day where this is needed, but pretty rare for it to be most of them. All of us in the profession have to deal with aggressive, fearful, or otherwise "difficult" patients, but we always hope that most of the pets we see will be pretty tolerant of our services.

Secondly, I was having a hard time getting people to agree to treatments. I had several sick pets, including one dachshund who hadn't been eating well for a week and had difficulty walking for the last couple of days. She appeared to have a partially slipped disk on her back, leading to some neurological dysfunction. The owner couldn't afford any diagnostics at all, even though I told her that this was very serious. Oh, and this was one of the dogs I had to muzzle. I had more clients than average who were like this. I ended up seeing a lot of patients, but didn't have much to show for it. It was one of those days when you really spend much of the day working hard, but don't bring in enough revenue to feel like it was worth it, and don't feel like you helped many pets.

Thirdly, I had several "stupid" clients. Yes, I'll use that word. One had a pomeranian who had previously had problems with vomitting. The owner gave her some eggs and potatoes from an egg salad, and then was surprised and worried that she had a little vomiting and diarrhea. Another person wanted ear medications for her cat, even though she was last seen at a vet in Oklahoma in Novemeber, and never followed their directions. She beame upset when we talked to that vet, they wouldn't authorize further medication without an exam, and we refused to sell her the medication.

Fourthly, while trying to handle one of the "difficult" dogs today I slammed my hand against the wall, and apparently have bruised it. Nothing serious, but darn annoying.

To top it all off, I wasn't even supposed to work today! It was one of my days off, but the other doctor I work with was sick, so I came in for her and switched another day off. So this day should have been hers, not mine.

But thankfully I was able to come home to the arms of a wonderful woman and a cute new puppy. The best news of the day is that Inara is slowly but surely starting to get the idea about housebreaking, and hasn't had anywhere near as many accidents today.

Tomorrow I get another try at a decent day, and then have a day off. It's a good thing that every day isn't like this, or few people would be a vet.

Sunday, February 8, 2009

Welcome Home, Inara

For the last few months my family has been talking about getting a new dog. Our lab, Guinevere, is almost 4 years old, and the kids don't really remember her being a puppy (they were 2 and 3 when we got her). So I've been on the lookout for a new puppy to join our family, mostly looking at shelters and rescue groups (yes, I do try to practice what I preach).

Earlier this week a client brought in a very sweet and cute lab mix puppy that I thought was adorable. We were talking, and I found out that she was one of a litter of three that was at a local shelter. I called the shelter (Dog Pack Rescue), and then yesterday we went and took a look at her. It didn't take long for my wife and kids to agree with me that she was so cute and well tempered. And yesterday we took her home.

So now we have little Inara, a three month old yellow lab mix. She actually looks a lot like Guinevere, enough that it would be easy to mistakenly assume that Inara is her puppy (except that Guinevere was spayed at 4 months old). She is named after a character in Firefly, one of our favorite TV shows that unfortunately didn't make it a full season but did get made into the movie Serenity (I would highly recommend both the series and's one of the best science-fiction shows I've ever seen, and I can't say I've met too many people who disagree with me). The name also means "bright" or "shining", and is the name of an ancient Hittite goddes of wild animals, so it's pretty appropriate.

The kids adore her. Guinevere isn't quite sure what to make of her, and we think she's a little worried that Inara is going to take attention away from her. Thankfully, Guinevere is a very sweet, patient dog. Our cats have taken this addition better than they have any previous one. All-in-all, she already looks to be making a great addition to our family.

However, it's not all fun and games. I'm back to housebreaking, crate-training, and obedience training. I had forgotten how much work all of that was, but I also know how necessary it is. This is the part of puppy ownership that I don't like, but you have to take the bad with the good. This time our kids are old enough that we're making them the primary caretakers, even for cleaning up her "accidents".

So the adventure begins again!

Friday, February 6, 2009

Waxing Loquacious

loquacious [loh-kwey-shuhs]–adjective
1. talking or tending to talk much or freely; talkative; chattering; babbling; garrulous: a loquacious dinner guest.
2. characterized by excessive talk; wordy: easily the most loquacious play of the season.

I have been looking back over some of my previous entries, and have realized that a character flaw I have in person exists in print as well. I enjoy teaching and lecturing, and look for opportunities to do both. Most of my staff over the years have liked this, as I willingly detail to them the "whys" and "hows" of pet care and veterinary medicine. I have also mentored many veterinary students and new graduates, who have commented positively on my explanations. But I do tend to go on at length on many topics, and will give more discussion that what is sometimes needed.

I commonly say that if someone asks me a question that requires a yes or no answer, I will give them that answer and then give them a 20 minute dissertation on why it is yes or no. I have even had receptionists page me on a back phone, ask me a question, wait for my answer, and then hang up on me while I'm explaining it to them. Frankly, I've never gotten upset by this, and we've all joked around about it because everyone knows that I'm a bit of a talker. The receptionist got their answer, and didn't have time for me to go into teaching mode.

Sometimes this can be a good thing. Many diseases or disorders require lengthy explanations for the owners to truly understand what is going on. Just today I was talking to someone whose dog was having severe anxiety when in his kennel. Behavioral issues are never simple or straight-forward, so it was good that I was comfortable in doing a lengthy lesson. The owner thanked me for my thoroughness.

On the flip side, a few months ago I had a client with a different opinion. My tech came back after we were done seeing the pet and was laughing at what the client had said. Apparently she told the tech "That was a very nice vet and I liked him, but he sure can talk!"

What my wife hates is that I'm completely different at home. Though I'm very outgoing in professional situations, and enjoy being with people, when I'm in my private life I'm extremely introverted. Sometimes she can't get two consecutive sentences out of me!

So if I tend to go on a bit long, I do apologize!

Thursday, February 5, 2009

Euthanizing Because Of Cost?

Deciding to euthanaize a pet is rarely an easy thing. Which brings the following question from Scott.

Have you had clients resort to financial euthanasia? I read an article that said millions of dogs and cats are put down each year because their owners won't (or can't) pay for the treatment to save them. How do you fell when an owner makes that decision and you have to carry out the procedure?

I'm not sure that "financial euthanasia" is the best phrasing, but I understand what you're trying to say. This is not an uncommon situation, and in most cases I can't fault the owner. However, that's not to say that I like doing it. Always keep in mind that the veterinarian is the final decider about whether or not the euthanasia will be performed. Most of us try to respect an owner's wishes, but we have our own ethics and are under no moral or legal obligation to perform a service merely because a pet owner wants us to. So to me and most veterinarians, there has to be a justifiable reason for euthanizing a pet, and I take that on a case-by-case situation.

Case #1--An 11 year old cat begins to vomit frequently. The owner pays for lab tests, which show nothing abnormal. The vet repeats the exam a week later and notices a lump in the abdomen in the region of the stomach. X-rays don't reveal anything other than a mass, but it doesn't appear to be something the cat swallowed. The next step is exploratory surgery, which the owners cannot afford. The vet has a strong suspicion that the cat has a tumor, possibly in or on the stomach. The cat continues to vomit, and can't seem to keep food down. The owners don't want him to suffer, and ask the vet to perform euthanasia. In this situation, I would do it because the cat has a high likelihood of having a serious problem, and it isn't going to get better without extensive treatment. Rather than letting the pet suffer and die slowly, I would put it to sleep.

And know what? This happened with my own cat. However, I did the exploratory and discovered that most of his stomach was one big tumor. I knew that I couldn't afford chemotherapy, and it was large enough to be inoperable, so I ended up putting him to sleep. So this is a real situation that I modified slightly for the sake of discussion.

Case #2--Here's another real case. An owner has a 10 year old golden retriever that develops a large mass in the abdomen. Surgery is performed and it is discovered that there is a huge mass involving the spleen. The spleen is removed and the dog recovers well. About 6 months later, more masses are detected in the abdomen, which means that a return of the cancer is likely. The owner can't afford more treatment, and decides to put the dog to sleep when they become big enough to affect the quality of life. I would definitely do this euthanasia, as the owner has already done a lot, and further intervention would likely not help.

Case #3--A six year old cocker spaniel has a horrible ear infection, and has had frequent infections for the past five years. The owners aren't willing to do any further diagnostics or surgery to help, and are tired of the smell and appearance. The dog is otherwise happy and healthy, but will have life-long problems with the ears. The owners want the dog euthanized because of the chronic problems and impact on their lives. I would refuse to do this procedure because the dog's life is not at stake, and an inconvenience to the owner is not a justifiable reason to me.

Case #4--A five month old labrador puppy comes in with a broken front leg. The owners are young and cannot afford the needed surgery. Simply splinting or casting the leg would be questionable. This is a tougher case, as the dog's life will be significantly impacted, even if the injury isn't life-threatening. I would likely refuse euthanasia, but offer to help adopt the dog out to someone who could help.

As you can see, each case is different, and they aren't always clear-cut. The rule-of-thumb I tend to use is "what is the pet's life going to be like if we do nothing?" If the quality of life would be really bad or fatal, I will strongly consider euthanasia. If the quality of life won't be bad, just inconvienent or less than ideal, I likely won't do it.

So yes, Scott, people do have to make decisions for their pets' health based on finances. This is the reality of the world, and isn't something that I condemn people for. One of my equine professors in vet school taught me a very important lesson. She said that someone shouldn't have to go bankrupt simply to prove their love for an animal. I would agree with this, and have remembered it over 12 years later. I would prefer it if clients could always afford treatment, but that's not always the case. This is why I recommend having an emergency fund just for your pet's care. But in the cases where the owner can't pay for treatment, I try to put the pet's best interests first. Not always a pleasant task, but a necessary one.

Wednesday, February 4, 2009

Should I Breed My Dogs?

I talk to people about spaying and neutering their pets on a daily basis. And almost every day I talk to someone who has an interest in breeding their dogs, and don't want to have them "fixed" because of this desire. However, most of them really shouldn't be breeding, and have misconceptions about breeding. Which brings us to today's question from a reader.

I bought a male teacup poodle and a female tiny toy poodle. It turns out that the male is now 7 pounds at 6months and the female is a very petite 4 pounds - just the opposite of want I thought. Can I breed these two poodles? I really wanted to poodles I could mate.

First, I would recommend and going back in the archives to ready my entries on breeders and spaying or neutering. These posts will give you a good idea about my opinions on this area. In your specific situation, I would first ask if you have experience with breeding. If not, you need to contact a breeder who is or has shown their dogs, and/or is actively involved in a breed club. Good breeding is not merely a matter of putting two dogs together and getting puppies. You also need to consider the quality of the dogs you are breeding. Which brings me to the second point, and that is to assess whether or not the dogs meet breed standards. Your vet and a responsible breeder/shower will be able to help you with that. If the dogs have any common genetic or physical disorders, or simply aren't good breed quality, you shouldn't mate them.

Consider the cost to your dogs. These are living, caring creatures, and not simply dog factories. There are absolutely no medical benefits to allowing dogs to breed, and numerous hazards to doing so. True, health concerns are uncommon, but they do happen. This can included increased risks of cancer, risks of prostate disease in males, uterine infections in females, and so on. Again, go back and read the previous entries I mentioned.

There can be financial cost as well. A couple of weeks ago I was speaking to a groomer I know and found out that she breeds Australian shepherds (which really have nothing to do with originating from Australia). She completely agrees with my opinion of casual breeders, and shares my distaste for them. She also talked about how she has champion quality dogs, shows and competes with them, and because of all of this she is lucky to break even when she breeds puppies. Usually she looses money. This is very typical of the responsible, quality breeders. They enjoy the breed and the hobby, but realize that they make enough money to support it and won't really make anything more than that. So don't start to think that you can make a lot of money by breeding, especially with something as common as poodles.

Now let's assume that you have talked to your vet and a good breeder, have determined that your dogs are good breed standard and are healthy, you wait until the female is 18-24 months old before breeding, and are otherwise doing everything right. These dogs are too young to be bred, and haven't finished growing. They will become reproductively mature at 7-9 months old. However, you SHOULD NOT breed them then, as that's the equivalent of a 13-14 year-old girl getting pregnant. Yes, it's biologically possible, but it's more risky that someone in their 20s. So you have some time to figure out if they're going to grow much more. If both dogs are small like this, differences in size aren't as important. However, whenever the male is significantly larger than the female, there is a chance that the puppies will be too large for her to give birth to. This can lead to problems during labor and delivery, often requiring a Caesarian section. Once these puppies are at least a year old, talk to your vet about whether or not they should be bred. And please go into that discussion with an open mind, being perfectly willing to not breed if that is what your vet recommends. If you have your mind set to breed these dogs and aren't willing to listen to advice from people who know more than yourself, then you are in danger of becoming one of these people that vets and responsible breeders speak against.

Tuesday, February 3, 2009

More Aching Joints

Here is another set of questions that are a good follow-up to my previous discussion about osteoarthritis.

Quick question...have you heard of a procedure where you actually clean the joint? I think it involves removing some of the scar tissue or build up that is causing the pain. I've heard it was a less invasive option. Also, that are your thoughts on giving the animal a cortisone shot?

Remember that osteoarthritis is a complex of problems, and is rarely treated or controlled by a single simple option. There are also various degrees of the disease, from mild to severe. The progression of the disease can begin with inflammation and cartilage erosion, and proceed to spurs and remodeling of the bone around the joint. However, it is never just a single factor. Pain comes from several factors, including the mentioned cartilage erosion, lack of synovial (joint) fluid, chemical mediators of inflammation, abnormal bone structure, and instability of the joint. Because it is usually a multifactoral disease, a multimodal approach to treatment is best. A single treatment is rarely the best option.

I have not heard of any surgical option used commonly in the treatment of arthritis in pets. Since this type of arthritis is not merely scar tissue or abnormal bone development, I can't imagine it working. If there is significant enough remodeling of bone leading to spurs, then I could see a rationale for it, but this situation is not going to happen commonly. Also, it might be misleading to think of joint surgery as less invasive. Even if done arthroscopically it is going to involve general anesthesia and an incision into the joint. Depending on the joint, this may not even be logistically possible, especially in smaller dogs. I definitely wouldn't recommend it for most cases.

Cortisone injections have their place in treatment of arthritis, but it is a very limited place. The injections are basically just strong and long-lasting antiinflammatories. Their mechanism of action really isn't any different than giving prednisone or similar steroids. Steroids are great at reducing inflammation and itching, but have limited (if any) effectiveness against pain. That's why steroids aren't commonly used for treatment of arthritis, since NSAIDs are much better at controlling the pain of the disease. There are also side-effects of long-term steroid use, and the injections can't be used indefinitely. In my opinion, there are better ways of controlling the pain and inflammation of osteoarthritis.

As you can see, this isn't as simple as many think. Treating arthritis can be a difficult endeavor, and require multiple types of medications and supplements. It's also a disease that is progressive and generally irreversisble. At some point, treatments that once worked will no longer work as well. But we're learning more about the disease process all of the time, and continue to develop more options, which can give hope for our painful pets.

Monday, February 2, 2009

Pros & Cons Of Pet Insurance

Now that I'm back in town, let's start the week with a question from a reader.

I'm thinking about getting a dog for my mom and concerned about the expense of vet care. What do you think about getting pet insurance? She is resistant to the cost. What are the arguments in favor of it? Do people who have pet insurance tend to care for their dogs better? Are dogs with pet insurance generally healthier?

Pet insurance is actually a very good idea, but it may not be what people expect it to be. Insurance is much more common in Europe than in the US, but even there a majority of pets are not on a program. I can't speak for how insurance programs work outside of the US, so my comments may only apply in my own country.

There are multiple pet insurance providers, and you will need to look around and check what each one provides. In general, they do not cover pre-existing conditions, like with human insurance, so if your pet has existing allergies, arthritis, a heart condition, or some other medical issue you may not be able to get insurance. The plans work very differently than human equivalents. There are no copays and the veterinary clinic doesn't handle any paperwork. You will have to pay out-of-pocket for any services, then submit your receipts to the insurance company. They will then reimburse you according to your plan. In other words, you still need to have the money to pay the vet up-front, and will get a portion of that money back at a later time.

That being said, I think insurance is a great idea. Having the money to cover a serious illness or injury, such as cancer or a ruptured ligament, can be difficult. It will still be hard to come up with the money to pay the vet, but knowing that you're getting a portion of that back can make it easier. I have had clients use it, and they have seemed very happy with it.

If you have been reading my blog or go back through the archives, you will see my discussions on the costs of pet care. Anyone wanting to get a new pet needs to be prepared for the costs involved. If you're not ready to take on those costs, then you shouldn't get a pet, plain and simple. Part of that cost may be insurance. Is the cost worth it? Well, with any insurance you're paying a monthly premium with the hope that you never have to use it. We pay our car insurance and home/renter's insurance every month, but hope that we never come into a situation where we need it. If we need to use our insurance, it means that something bad and expensive has happened, and that's never good. Pet insurance should be looked at in the same way.

Another option is to "self-insure". Set money aside in a savings account just for your pet, up to what you would be willing to spend for a medical issue. Even the most expensive procedures don't normally go over $3000 (US), and $1000 will cover any minor illness and most moderate ones. If you can leave this money alone for your pet, then you really don't need insurance.

Having insurance doesn't make a pet healthier or make someone a better pet owner. A pet's health is determined by how their owner cares for them, and involves preventative care, nutrition, and early treatment of illness. There are plenty of humans with insurance that are still in poor health, and still don't go to the doctor. The same is true of pet insurance. And even if you have the insurance, it is up to you, the owner, to take them in for medical conditions.

Also check with your veterinarian about preventative health programs. Many veterinary hospitals have developed programs where you pay an annual or monthly fee, and the basics of vaccines, routine testing, and office visits are covered at no additional cost. These programs are not offered by most vets, and will vary widely, so you may need to ask around. Some insurance programs will also cover routine preventative care and are not just for catastrophic illness.

In short, I do recommend pet insurance if you don't have the money to self-insure. If your vet offers a kind of "wellness program", consider getting that and supplementing it with insurance.

Hope this answers your question adequately!