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Tuesday, May 31, 2011

Figuring Out Urinary Problems

Cindi sent this to me...

This is a crystal question.  Cindy has a puppy, Hottie, but we're now calling her Hot Pants. 
We believe that HP is suffering from bladder crystals of some sort.  All of the tests that her vet has done have shown nothing.
Are there any home remedies that we can try to help this little girl?
This is only one lab result, there are many more, but all with the same negative conclusion.
Anti-biotics helped when administered, but when stopped, the symptoms returned.

Let's start at the beginning and look at the cause of urinary problems and how we diagnose them.  The first symptoms that are reported are normally an increase in drinking and/or urinating, straining to urinate, or abnormal appearance of urine.  The first test we run is a basic urinalysis.  This test analyzes various chemical parameters of urine, such as pH, protein levels, glucose, and other things.  We also look at a urine sample under the microscope to view any red and white blood cells, bacteria, and crystals.  If we see crystals, we can usually identify which kind they are, which helps determine the best form of treatment.

Now in many cases it's not as simple as finding crystals or not.  Some bladder disorders never produce crystals.  In other cases stones can form without releasing any noticeable crystals in the urine.  So just because crystals aren't seen by the vet doesn't mean that there isn't a stone.

My first question is why do you think there is a urinary problem?  If the urinalyses were completely normal, this pretty much rules out an infection.  In an infection you'll see abnormal cells, bacteria, and so on.  If there is a suspicion of stones in the bladder, there are two ways to easily find them.  The first is abdominal x-rays, which can clearly show the most common types of stones.  However, there are some stones that x-rays pass through and therefore cannot be seen with this form of imaging.  There are various contrast studies that can be performed, but it's often easier to have abdominal ultrasound performed. With ultrasound you can see any stone, sediment, or sludge in the bladder as well masses, thickness of the bladder walls, and so on.  Blood tests won't detect a bladder abnormality but will determine if there are problems with the kidneys (the beginning of the urinary tract).  And all of this leads to my second question...what tests were run?  You mentioned that many were run, but none showed crystals.  Did they show other problems?

To summarize, here is my normal order of testing for urinary tract disorders:
1.  Urinalysis with sediment analysis.  Some vets will also do a urinary culture as part of the initial diagnostics.
2.  If this doesn't give the answers or if the problem doesn't resolve with initial therapy, do abdominal x-rays.
3.  If there still isn't a resolution of the problem and the specific cause hasn't been identified yet, do abdominal ultrasound.
4.  If there are no signs of bladder abnormalities, stones, etc., yet symptoms still persist, I will certainly do a urine culture.  In some cases I may do this step earlier (such as if we find rod-shaped bacteria).

Also, difficult urinary infections may require 4-8 weeks of continual antibiotics.  Treating for 1-2 weeks and then stopping may not be sufficient.  I normally treat for a minimum of 2 weeks, and if this doesn't work I'd look at possibly doing a urinary culture.

Cindi, I hope this helps.  Obviously there is more information that is needed before finally figuring out what is going on with HP.

Friday, May 27, 2011

Broken Chip?

Post 501.  Let's keep going!

Here's a question from Esther...

I found your microchip blog posts and have a question for you:
Have you ever had seen or heard of a case of a chip (AVID) breaking up into two parts and one part migrating?

I just found a tiny lump on my cat halfway doen his back (about 5 inches from the original implant between his soulderblades, which is still detectable) and it feels just like a microchip! I took the cat to the vet and she agreed that it felt like a chip. Also, both sites scanned and displayed his AVID#!(NOT two different numbers, so it does not appear to be a chip that might have been implanted into my cat before I found him, when he was an unneutered, hungry stray.) Now, I suppose the scanner could have picked up the chip located 5" away from the site of this new-found lump.

My vet did not have any other idea what the lump could be ("I have never felt anything like it.") and recommended having it surgically removed to find out. (The lump is too small and too movable for a needle biopsy to make much sense.)

I will porbably follow her advise and have his teeth cleaned while he is under anesthesia. Still, I would like to find out first if there is a possibility of this being (part of) a migrated chip. Would it still scan if it had broken in two?

Thanks for your thoughts on this (if any)!

Yes, I know this is more fodder for the anti-microchip crowd, but I thought it was worth bringing up.

First, this is not a common problem.  Chips migrating are known, though uncommon, but a broken one is much less common.  Theoretically a broken chip could continue working, though it would be much more susceptible to damage.  The outer shell of a microchip is essentially protective, allowing it to be inserted without the inner workings making direct contact with the tissues. It's usually a sterile, non-reactive glass and has small holes for fibrous tissue to adhere to, therefore reducing the risk of migration as scar tissue "locks" it into place.  The smooth surface makes it slide into the tissues easily, allowing less trauma during implantation.

Since the outer casing serves no direct function in the chip's working once implanted, I could see a situation where it breaks or comes apart.  The casing and the inner parts could migrate to different locations, resulting in two different "lumps".  If there isn't too much trauma in the area, the actual working parts could continue functioning without the shell, allowing it to broadcast the chip number.  However, it would be much more likely to fail in the future as those parts would be much more easily damaged.  It's also very possible for a microchip's broadcast to be picked up several inches away (especially with 134 kHz chips), so you may be getting one signal from the chip and not in two locations.

I would agree with your vet's advice that it's worth surgically exploring this.  If it is the chip, I would recommend removing it and have a new one implanted (yes, I still advocate microchips and use them in my own pets).  Leaving it in place could lead to tissue irritation in the future or the chip could stop working.  If it's not the chip it sounds unusual enough to be worthwhile removing.

Good luck, Esther!

Wednesday, May 25, 2011


Today is the 500th post I've made on this blog!  For me, that's quite a milestone, as when I started blogging in September of 2008 I really didn't know where it would go or how long I'd be able to keep it up.  Truthfully, I worried that I would eventually run out of things to blog about.  Yet here I still am!

So where have we gone during that time?  Lots of placed I never thought it would.  I've been interviewed for different web sites, have gotten to do live webshows, and have even made a little money here and there.  What is more interesting to me is that I've developed an international readership and this site has been viewed on every continent except Antarctica.  Here are a few other interesting tidbits about this blog.

*  For some reason, the most popular entry I've made was on March 28, 2009, about whether or not something is stuck in a pet's throat.  That entry has been viewed almost 13,000 times and had 23 comments.  The next closest has only a fration of that!  (Dachshund Back Problems, August 8, 2009, 2756 pageviews).  Apparently lots of people are worried about things in their dogs' throats!  And two years later I stand by every one of my comments on the subject.

*  As of today this blog has been viewed over 83,600 times.  And last month alone there were over 13,000 views!

*  Most of my readers are in the United States (not a surprise just based on population).  The breakdown of top 10 countries from high to low is:
     1.  United states
     2.  United Kingdom
     3. Canada
     4.  Australia
     5.  Germany
     6.  Netherlands
     7.  Saint Kitts and Nevis
     8.  Russia
     9.  India
     10.  Ireland

*  Internet Explorer is used by 47% of readers and most readers (76%) are using a Windows-based operating system.

And these are just the stats that Blogger tracks.  In the grand scheme of things I know this is still a small blog, and my lifetime pageviews is less than what major blogs will get in a single day.  But I'm happy with it and it's become bigger than I ever imagined.

It's been an interesting journey over the last 2 1/2 years, and I've discovered that I have a lot of fun with it and am not planning on stopping anytime soon.  Let's see where we can get in another 500 posts!

Tuesday, May 24, 2011

A Worthy Adventure, Over

Sometimes you never know what life will bring you. A couple of months ago I started doing online veterinary web shows with GabCast.TV, a new site that was working on doing live, interactive shows from experts as well as anyone who wanted to do their own show.  The pedigree behind the site was impressive, with major Emmy award-winning television executives and some big-name supporters.  As part of the promotion for the site they even had Jimmy Kimmel Tweeting about it.  The site started off on a trial basis until they could get long-term financial support.  It all seemed really good and promising.

Unfortunately things don't always work out as they are planned.  I received notice today that GabCast hasn't been able to find permanent funding and won't be able to support the hosts.  So as of the end of this month I won't be doing webshows through them anymore unless something changes in the future.

It's been interesting doing this, and I got more exposure than I ever thought I would.  There's still the possibility that bigger things could come of this, but only time will tell.  I'm certainly not sorry that I pursued this and feel that it opened me up to new opportunities and new possibilities.

So for now it's back to normal with this blog and the way things have been going for the past couple of years.  If anything else happens, I'll be sure to post it here!

Monday, May 23, 2011

Coughing Kitty...Or Is It?

I received this email from Dan:

I came across your blog while looking up a possible diagnosis for my cat. He's a big-un, at 20 lbs, and he seriously flipped out when we took him to the vet for his peculiar cough. I've filmed a video of it and uploaded it to YouTube

Any idea what this could be? He's eating fine and going to the bathroom, has plenty of energy. Normally when he coughs like this it's six or seven times in rapid succession, and we caught him at the tail end of it here.

Any help you can provide would be welcomed. We are poor (my wife hasn't been able to find a job for a year) and really can't afford to take him to the vet again.

Thanks if you can give any assistance.

Thanks for sending the video, Dan.   Being able to see something like this is invaluable for a vet since we don't always get to watch what is going on in our clinics.

When I watch your cat, I don't actually see a cough.  I'm also not hearing what is a typical cough.  To me this looks like a type of swallow or regurgitation.  Coughing involves a sudden and forceful expelling of air through the trachea, usually exiting the mouth.  In his case he doesn't actually open his mouth and there doesn't seem to be an expulsion of air.  Additionally it seems like he's involving his abdomen as much as he is his chest.  Maybe my veterinarian readers will have seen something like this and would offer a different opinion.

I would be more concerned about something in his esophagus rather than something in his trachea or lungs. I've seen similar motions from cats when they have a string or blade of grass stuck where they can feel it in their esophagus but cannot swallow it.  My recommendation would first be to show this video to your vet if you haven't already.  If you were in my clinic I would want to sedate him and get a very thorough look at his tongue and the back of his throat.  If this didn't show the problem, I would first make sure there were no signs of pulmonary disease and then look at having endoscopy to look deeper in the esophagus.

Good luck with your kitty and I hope you find the problem.

Friday, May 20, 2011

Not Just A Vet

I think that when many people see their doctor, veterinarian, or other professional, they can easily forget that being in such a career doesn't completely define a person.  To me being a vet is what I do, not who I am.  I have a great job and am good at it, but it's what I do to allow me to spend time with my family and in other pursuits.  I consider myself "Chris" first and "Dr. Bern" second.

However, it can be difficult for many vets to realize this themselves.  I've struggled with work-life balance for years, and now after 14 years in practice I think I'm starting to get a small handle on the issue.  My associate doesn't seem to have mastered this yet, and she's been practicing longer than I have.  I'm struggling with her being willing to take time off, take a vacation, or even go home early when we're slow and both of us are there.  I've had days when we only have a couple of appointments and I offer for her to go home and I'll cover the rest of the day, yet most of the time she'll hang around.

This is actually a difficult topic for vets (and I'm sure other doctors) to handle.  We spend so much blood, sweat, tears, effort, money, and time getting our education and training, and then we have to work really hard to make ends meet and pay off our debts.  With that much invested, it's hard for us to turn away and realize that we not only deserve, but NEED to have time away from work to relax, have fun, and connect with our families.  If we do nothing but work and stay "on duty" even in our minds, we'll burn out quickly and then be good to nobody.

So I encourage any vets to work on this balance, and any students to realize this when you graduate.  It IS okay to have a life outside work and enjoy it!

Wednesday, May 18, 2011

Reluctant To Tell The Hard Truths

One of my idols is Dr. Gregory House from the long-running TV show "House".  Though he is quite a jerk, unfeeling, and conceited, he can say things that nobody else can, and is usually right.  In the real world he would have likely been fired long ago despite his brillance, so you're not likely to find many people like him.  But I really wish I could be as blunt with my clients as he is with his.

Many to most veterinarians are very non-confrontational, introverted people (myself included).  It takes a lot for us to reall sit down and say the hard things to people, even if they need saying.  When I was a new vet, I was more likely to be direct.  Then I started realizing that I actually needed to improve my diplomacy and communication skills, and learned how to be very politically correct in my speech and writing.  Now that I'm entering my 14th year of practice, I think the pendulum is swinging back the other way and I'm getting tired of having to be "PC".

I often think that clients shouldn't have a pet because they can't afford basic care, or simply won't do it.  Rarely have I ever actually said anything to them in a direct way.  Why?  We're vets, but we're human, and it's hard to confront someone in this way.  Also, we don't want to drive people away from our clinic and want to have a good reputation as sympathetic and caring.  So when I see those people I normally go back and complain along with the rest of the staff, or come online and blog about it.

Not today.

I had a client come in to get a rabies vaccine for her dog.  The only reason she was doing this was because her other dog has supposedly bit someone and was under quarantine from Animal Control because the rabies vaccine wasn't current.  These dogs weren't current on any vaccines, didn't take heartworm or flea prevention, and hadn't seen a vet in years.  The owner admited it was because she didn't have the money, and couldn't do anything further for them.  As I was talking to her, something shifted in me, and I braved my non-confrontational nature to say what I really wanted to say.

I talked to her about the severe and life-threatening risks of heartworms, distemper, and parvo.  I told her that she was allowing her dogs to be at risk for disease and potentially even die.  And then I did what I have never done in a situation like this.  I suggested that maybe she should find homes for them with someone who actually can do basic preventative care.

Many reading this may wonder why it's so hard to talk about it.  "They shouldn't be having pets if they can't afford it!  You're a coward if you've never talked to clients about this!"  And you'd probably be right on both counts.  But it's different to talk about it with friends and colleages compared to actually confronting someone.  In your own lives think to difficult things you've had to say to people.  Most of the time we avoid it for as long as possible, if not forever.  Is that wise?  Certainly not.  Avoiding this discussion only hurts the pet, and denies the client needed truth and a reality check.

Now this doesn't mean that you need to be cruel or argumentative.  I was careful to be as polite as possible.  But I did see the client get a little wide-eyed at the suggestion that she give up her pets, which made me cringe inside.  However, it needed to be said, and I don't regret doing so.  In fact, I'm now more likely to do it again in the future.

In our modern society there seems to be too much emphasis on "being nice", or being "politically correct".  It seems that everyone has to be careful never to offend anyone else, like somehow people have an inherent right not to be offended.  But tip-toeing around issues often keeps necessary truths from coming up, and doesn't really get to the heart of the issue.  You can be more polite than Dr. House and still say what you need to say.  When you do so you're actually doing the person a favor as well as helping yourself.

So I'm going to start being more direct with people from now on, and work on my diplomacy skills in telling them what they need to hear, not what they want to hear.  The longer I practice the less tolerance I have for ignorance and foolishness.

Or maybe I'm just getting a bit crotchety as I get older!

Tuesday, May 17, 2011

A Hair Chewer

Here's a question from Becca....

In the past few months my cat has been eating my hair while I sleep. I tried just telling him no and batting him on the head but when I fall back asleep he starts at it again. I tried kicking him out of the room but he spends the entire night crying and throwing himself against our door and I do enjoy our snuggle time. I am starting to lose my mind from lack of sleep. Do you know what could be causing this or how I can get him to stop?

Well, this is a bit of a strange case, and I can't think of hearing about a problem like this before. But I'll see what I can do to help.
First, have you changed shampoos recently, especially just prior to this starting? There might be a possibility that with the various plants and fruits used in certain shampoos that he is finding something appealing in the scent or taste. A cat's appetite is driven as much by scent as anything, so a good odor may stimulate him to chew on it.  Consider going to a shampoo that doesn't have any strong odors.
I'm not sure if this is possible, but have you considered putting your hair up in a cap or hairnet when you sleep? Keeping him from having access to it may be one solution. Alternatively you can get a bitter spray (such as Bitter Apple brand) and spray your hair just before going to bed. Try it on a small section of your hair at first to make sure you won't damage it, but these sprays are non-toxic to people and pets...they just taste bad. You do run the risk of getting some of your own hair in your mouth so be warned. Also make sure you wash it really well after getting up in the morning.
What you have to do is make any deterrent greater than the reward he gets from chewing at the hair. Negative reinforcement needs to follow the "ICE" rule. It needs to be Immediate, happening just after the unwated behavior (within 20-30 seconds). It needs to be Consistent, happening every single time the behavior is exhibited. And it needs to be Effective, actually stopping the behavior for even a short period of time. Failure to meet one of these three criteria may result in the pleasure and reward from chewing the hair outweighing any punishment.
If none of this works, you can try putting him out of the room just before bed. In this case get some Feliway, which is a pheromone analog that helps reduce stress in different situations with cats. You can get this from a vet, major pet supply stores, or online and it comes in several forms. Put a plug-in diffuser near the door, or use a spray on the floor and door frame to see if this helps with his anxiety of being locked out.
Good luck!

Monday, May 16, 2011

Playing With Poo. Really?!?!

Some things I just don't get.  I just saw a commercial for a new kids' game, "Doggie Doo".  Apparently in this game you feed the toy dog a Play-Doh-like substance, and have to collect it when it comes out the other end as poop. No, seriously! Here's a picture...

First, what kid would want this game?  "Ooh, ooh, mommy, mommy!  I REALLY just HAVE to have this game where I get to pick up DOGGIE POO!"  And second, what parent in their right mind would want their kid to have it?  "Here, Johnny, it's a game all about picking up Play-Doh poop!"  What kind of "fun" would this be, and what kind of lessons would it teach?

Obviously as a vet fecal material doesn't bother me.  I've been picking up dog and cat poop most of my life and I'm very used to it.  But at no point have I ever thought "Hey, let's make a children's game of this!" while doing so.  Frankly, I've always been glad to get the job done as quickly as possible, regardless of the odor or consistency.  My son is particularly sensitive to smells, and even the thought of having to pick up our dogs' doo-doo makes him gag.

But fecal humor is becoming more common.  Has anyone seen the "sooper dooper pooper" series where cartoon animals dispense jelly beans out their *ahem* backside?

Ummm, yummy!  Just what I always wanted to eat! Animal jelly-poo!  Of course, in the recent movie "Hop" it is revealed that jelly beans are really Easter Bunny poop, so the trend is definitely there.

I simply don't get it.  If any kids out there want to play with animal poo, I'll be happy to let them come to my work or my backyard and do so for free!  And when they're done I'll even give them a free white plastic disposal bag!  No charge!


Thursday, May 12, 2011

A Licking Problem

When I first posted about things stuck in a dog's throat back in March, 2009, I never knew that particular topic would be so popular. Even over two years later I'm getting comments on it and questions from it. Here's the latest one, sent in from Frankie.

Thumbelina the pit bull loves to eat grass. Occasionally, she will eat some grass, and it will either 'get stuck', or something that was in the grass will get stuck in there, and she will go insane trying to eat anything on the ground, trying to push it down. She snatches sticks, rocks, twigs, in a frantic effort to remove the feeling of something being stuck in her throat (and I know it's probably a blade of grass that's tickling her in there and feeling bad). And she licks and flicks her tongue incessantly in a weird way and gulps (flick flick flick, gulp). I usually help her by giving her water or a piece of bread or something that will sweep her throat and push it down. It always works.

Until now.

Something got in there. She did her frantic thing of trying to eat more grass, dirt, rocks, whatever might push the thing down. I quickly got her home and fed her bread, watermelon, soft rice, soy milk, anything to flush her throat. Nothing works. She is not trying to frantically eat everything in sight anymore (I have seen her even try to eat her blanket in the past when this happens!), but she keeps doing the incessant flicking of the tongue/licking her chops thing. She's looking at me with worried eyes. I gave her benadryl in case there was any inflammation. I was thinking that either a) she swallowed something harsh and it scratched her throat and she THINKS there is something in there, or b) she ate a bee or a hornet (they are all over the grass here in Los Angeles, hovering around), and it stung her as she swallowed it and the stinger is stuck in there.

I took her to the vet. He felt around. Nothing. Did a quick check. Nothing. Evidently. He never took a flashlight or looked inside her throat. He said there was a very slight swelling in her throat and gave her a shot but felt no obstruction, something to keep the swelling down (Dexameth 2mg/ml/ml). But he basically looked unworried. But I am. She is not coughing. Just doing the weird licky thing.

Have you seen this? Any suggestions?

Frankie, I would agree that it sound like something may be stuck, but not just in the throat.  Certainly something abrasive in the throat or even a stinger would cause irritation to the esophagus, but this would result more in difficulty swallowing than the repeated licking you've noticed.  A steroid injection (dexamethasone) would help with this, so hopefully it's not a problem anymore.  I would actually be more concerned about something in the back of the mouth or behind the soft palate.

When we as doctors talk about "throat", we are more specifically talking about the area of the neck past the back of the mouth.  However, objects can also lodge in what we call the pharynx, which is the back part of the mouth past the tongue.  Something lodged on the roof of the mouth or pharynx could cause this kind of licking.  The soft palate covers the back part of the nasal passage, which opens into the pharynx.  If something was trapped behind the soft palate, it could tickle the pharynx and cause the licking and irritation.  An object such as a blade of grass could be inhaled and migrate through the nose and towards the pharnyx, projecting past the soft palate (see a similar case on my blog here).  Alternately, something in the pharynx could possibly work its way up and get stuck around the soft palate.

In these cases, a thorough throat and soft palate exam would be necessary, and this can't be easily done with an awake pet.  If this is persisting I would recommend having the pet sedated to allow a more thorough exam of the throat, pharynx, and soft palate.

Good luck!

Wednesday, May 11, 2011

Looks Prevail Over Health

Anyone in veterinary practice knows "those" clients.  Okay, there are many types of "those", so let me be a little more detailed.  The clients who care more about their pet's appearance than they do their health.  Such clients usually manifest in one of two ways.

First are the clients who would rather get them groomed than do any basic preventative care.  I know I've ranted about this before, but now is the time for a good reminder.  We offer heartworm testing and prevention and they say "Oh, I can't afford that right now."  Then as soon as they leave the clinic they end up at the grooming salon spending $60+ on a professional trim for their dog.  Forget the fact that the dog only has a rabies vaccine and they aren't using any other preventative care.  That dog NEEDS a good hair cut. 

The second situation is like a client we had in today.  She would rather see her dog have dental disease than have it's leg shaved.  Seriously!  When we do dental cleanings the pets must be anesthetized to do the procedure safely and effectively.  Our anesthesia protocols require an IV catheter be placed, and we usually do that in one of the front legs.  This dog is a schnauzer with typically long "feathers" on the legs.  Several years ago when we did the first dental cleaning the owner threw a fit because the leg had been shaved and she wasn't expecting that.  Ever since then she won't do dental cleanings because we have to shave a leg.  In the meantime, dental tartar and gingivitis are growing worse and the dog will end up with full-blown periodontal disease if it doesn't have a dental cleaning.

Unfortunately you can't say much to these kinds of people.  They have something set in their mind and you can't convince them otherwise.  It frustrates me to no end because I'd rather see a dog shaved but have healthy gums, or be matted and not have heartworms.  Still, as I've practiced I've grown to learn that there is only so much you can do with some people, and the pet is the one that ends up suffering because of their lack of understanding and caring.

Tuesday, May 10, 2011

Xylitol Is Safe??? Yep, It Can Be.

Last month I talked about dental disease and had this comment on that post.

Have you heard of this product:

It contains xylitol, which I've read from several reputable sources as very dangerous for pets.. But I also know it's a good dental disease preventative.. Huh?

Being a bit surprised by this, I decided to look into it.  For those who aren't aware, xylitol is an artificial sweetener used mainly in sugar-free gum.  It has the potential of being very toxic to dogs and can lead to sudden hypoglycemia and seizures.  I first posted about it back in 2009. Knowing the toxicity potential but not being aware of its use in dental products, I contacted Virbac (the manufacturer of C.E.T. pet dental products) and asked about this.  I want to thank Alyson Bentz, a veterinary technician in their technical services department, for providing me with several articles and some great information.

Back in 2006 two veterinarians associated with the ASPCA Poison Control Center produced a paper, Risk Assessment  of Xylitol in Dogs and Cats.  According to the data, the lowest acute oral exposure that resulted in acute hypoglycemia is 150-200 mg/kg.  Liver toxicity happened at >1600 mg/kg.  Keep in mind that there isn't good data on cats, and these numbers are based on studies in dogs.

A product like the C.E.T. Water Additive contains 5 mg/ml of xylitol, or total of about 4g total per bottle.  The solution is supposed to be mixed at 10ml (2 tsp) per quart of water, giving a final concentration of 0.05 mg/ml.  A 2 pound (0.91kg) dog will consume about 123ml of water per day, which would result in ingestion of xylitol equivalent to about 6.8 mg/kg per day.  The larger the dog, the lower the concentration (a 100lb/45kg dog would drink about 2.3L daily, for a concentration of 2.5 mg/kg per day.  The estimated amounts in cats are similar.  So with this data, it should be quickly obvious that even at the highest concentrations (remember, these are daily accumulated totals) we are factors of ten below the lowest toxicity level.

Okay, so let's say the pet drinks the concentrate straight (maybe it spills).  To reach hypoglycemia toxicity levels a 5lb/2.3kg pet would need to drink a minimum of 68ml.  A 55lb/25kg dog would have to drink 3/4 of a liter!  So even though the toxicity risk is obviously greater with the concentrate, there still needs to be a relatively large amount drunk to be a problem.

Why even risk it?  Xylitol has been shown to have anti-bacterial properties on oral bacteria as well as prevents calculus formation.  The data seems to suggest that low doses of xylitol are beneficial for oral health without any significant risk.

So there you go!  Thanks to Sheena for pointing this out and giving me the inspiration to look into this!

Sunday, May 8, 2011

Foreign Veterinary Licensing

Most people don't realize it, but becoming licensed as a doctor in a foreign country isn't as simple as showing your diploma. I'll speak specifically about veterinary medicine in the US, but I'm sure the principles are applicable to most licensing. The reason for this topic? An email I received over a week ago from Trisha:

I just read your response to the following question on your blog (from April 13, 2009). My husband is ACVIM board certified in internal medicine. He did a residency in Ames, Iowa after receiving his veterinarian degree in France. From what I understand, even though he's board certified, he would still have to go through the ECFVG program in order to work in the U.S. Is this information correct? Can you provide any information of a way he might be able work in the U.S. (besides in a University setting) as an internal medicine veternarian without the ECFVG program?

For those not in the know, Trisha is talking about the Educational Commission for Foreign Veterinary Graduates, a group established by the American Veterinary Medical Association to oversee the licensing of veterinarians in the US who obtained their degree outside of America. The process is complicated and expensive and requires a lot of steps (outlined here).  But there is no way to legally practice veterinary medicine in the US without jumping through all of these hoops.

Why?  As much as it may sound bad to say, not all veterinary colleges in the world give equivalent training.  Some have less focus in companion animal medicine than others, and some just don't have the resources or quality of education you'll find in many first-world, industrialized countries.  To ensure that all US veterinarians have a comparable training, there are standards that graduates of other veterinary colleges around the world must meet in order to practice here.

Now the confusion may come in that board certification in a specialty area of medicine (such as the American College of Veterinary Internal Medicine that Trisha mentioned).  These specialties are given by boards and groups not directly under the AVMA, and are somewhat outside of standard licensing rules.  You can be a practicing veterinarian without a specialization (such as I am), but there are ways to enter in to a given area of specialty such as surgery, dermatology, cardiology, and so on. 

What is interesting is that the ACVIM regulations specify that the applicants must be legally licensed to practice veterinary medicine, but does not require this licensing to be in the US.  So as best as I can tell you can receive certification by the ACVIM without being able to go and practice in the US.  ACVIM accreditation and a license to practice are handled differently and through different organizations and regulatory agencies.  Universities and government regulatory agencies have ways to have foreign-licensed vets who can work there but not go into private practice.  If anyone knows differently, please feel free to correct me as I've never been through the process myself.  And what complicates the situation further, is a vet must obtain a different license in each state!  There is no license that will allow a vet (or other medical professional) to automatically practice anywhere in the country.  As I've moved around, I've had to obtain a new license in each state (I've held them in six states so far), and each one has different requirements.

So Trisha, your husband will have to go through the ECFVG program if he wants to go outside of a university and work for a privately-owned specialty practice.  Good luck!

Wednesday, May 4, 2011

"Pets" Is A Four Letter Word

Some headlines just grab you. Last week I saw one in my daily veterinary email list: "Calling animals 'pets' is insulting, academics claim". HUH? So of course I followed the link to the article (check it out here).

Apparently there is a new publication, the Journal of Animal Ethics, that discussed the "proper" terminology for animals. They came up with some surprising answers!

“Despite its prevalence, ‘pets’ is surely a derogatory term both of the animals concerned and their human carers,” the editorial claims.
“Again the word ‘owners’, whilst technically correct in law, harks back to a previous age when animals were regarded as just that: property, machines or things to use without moral constraint.”
It goes on: “We invite authors to use the words ‘free-living’, ‘free-ranging’ or ‘free-roaming’ rather than ‘wild animals’
“For most, ‘wildness’ is synonymous with uncivilised, unrestrained, barbarous existence.
“There is an obvious prejudgment here that should be avoided.”

"Pets" is a derogatory term?  Since when????  In my own practice we deliberately call our patients "pets" rather than "animals" because the former has an inherent connotation as a companion animal that shares our homes and is cared for by us.  It's a good term, not a derogatory one.  Frankly, I'd like to see how and why the authors came to think of it in a bad way.

And I'm sorry, but if you look at so-called "free-roaming" animals, I'm pretty sure that they qualify as "uncivilised" and "unrestrained".  Plus, "wild" has meanings other than the definition these authors give.  How many people enjoy a "wild night out"?  How many people describe a thrill ride as "wild", having obviously enjoyed it?

Domestic dogs, cats, hamsters or budgerigars should be rebranded as “companion animals” while owners should be known as “human carers”, they insist.

Okay, I can see a certain sense in getting away from the term "owners" and use "caretakers" or something similar.  I agree that the term goes back to when animals were only seen as property and not as companions.  But at the same time, this term is commonly used with no apparent negative intent or influence. 

Prof Linzey and his co-editor Professor Priscilla Cohn, of Penn State University in the US, also hope to see some of the more colourful terms in the English language stamped out.
Phrases such as “sly as a fox, “eat like a pig” or “drunk as a skunk” are all unfair to animals, they claim.
“We shall not be able to think clearly unless we discipline ourselves to use less than partial adjectives in our exploration of animals and our moral relations with them," they say.

I read things like this and I have to call bulls***.  This is political correctness gone rampant, and will do nothing to improve the perception or care of our pets and other animals.  Such PC thinking really irritates me, as it does nothing to further our society or understanding of animals or each other, and is mostly a waste of time.  I get just as bothered by PC talk and attitudes between humans and in politics as well, and think it can hamper our relationships and discussions more than help them. 

For example, let's take the debate on what to call people with dark brown to black skin.  We can't say "colored people" anymore.  So what about the National Association for the Advancement of Colored People?  We can't say "negro" anymore, but there is the United Negro College Fund.  PC says that we're supposed to use the term African-American (here in the US, at least), yet Africa is a contient and not a country, and most people in Africa don't see them as long-lost relatives.  Plus, many of those people may have come from some of the Caribbean islands more recently than from Africa.  And what about Australian Aborigines?  They have similarly colored skin but we can't exactly call them of African descent.  I guess not many people get upset about saying "black".

We should be respectful to each other and to the pets and other animals in our care.  But if we get over-sensitive about certain terms we are going to be far too afraid to talk to each other or say anything remotely honest or negative.

And I have PETS, thank you very much!

Tuesday, May 3, 2011

Too Late To Necropsy

Gary sent this email....

Hi, My dog died in late febuary  and I'm sure it was from a type of rat
poison due to symptoms found online and I have had the dog refridgerated
until today when I put him into a deep freezer due to warming
temperatures. I was wondering if a liver and blood tests for warfarin or
the other rodenticide bromadiolone would be detected after tissues were
frozen. This poisoning was as I'm almost %100 sure was done by my
landlord. I did not have the funds to have the necropsy done, and won't
untill a few months away from now.Due to the remoteness of my residence
and lack of any other homes in area and prior verbal threats made by
landlord and other proof, i highly suspect intentional  poisoning. I had
read your blog and you offered to answer questions, so Can a necropsy be
done on toxicological tests?

Gary, I'm very sorry that you lost your dog.  Unfortunately, it's going to be impossible to properly determine the cause of death in a situation like this.  Even refrigerated tissues will deteriorate, especially over a few months.  Believe it or not but frozen tissues can have even more damage.  Even though you're preventing rotting of the tissues, the freezing process can cause significant microscopic damage, which is worsened with a thaw.  If you wait another few months, the damage will be worse.  Basically no pathologist will be able to accurately assess the tissues because the refrigeration and  freezing have caused enough damage that it will be difficult to tell what happened as a result of these processes and what happened prior to them. This damage is also visible grossly, making it difficult for the vet performing the necropsy to tell what happened due to death, what was normal post-mortem, and what happened due the prolonged storage.

When we want to submit tissues for pathology review we use formalin, a preservative.  Diagnostic labs always tell us not to freeze tissues due to the likely damage.  If we have to submit a specimen too large to put in formalin, we have to send it same day or overnight and have it cooled but not frozen.  Longer refrigeration or frozen samples will cause significant damage.

A necropsy might be able to see traces of rodenticide in the the digestive tract, as most of these poisons are distinctive in appearance.  However, it can take days after ingestion before you will see symptoms, so there is a good chance that the causative agent already passed through the system and won't be visible.  I'm not enough of a toxicologist or pathologist to be able to say if there will be detectable amounts of anticoagulant in the body, but I would doubt it because of the months-long refrigeration alone.

Even if you could absolutely prove the presence of these poisons, I doubt that you could prove who did it or where they came from.  This would be especially hard considering the time that will have passed between the poisoning and when you may prove the cause of death.  But that would be for a lawyer and not me to determine.