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Sunday, June 26, 2011

The Other Side Of Pet Ownership

There's often something that pet owners don't consider when they get a pet, especially if they have multiple pets.  Cleaning!  Pets can be loving, fun, interesting companions, but they can't pick up after themselves.  Which means that we the owners get to do that.  And yes, I had a big day of doing that today, which is why this came to mind.

Today I had to clean a betta tank, remove and replace bedding in a rat tank, clean the cats' litter box, and clean out the bearded dragon tank.  Doing all of that took me the better part of an hour, and wasn't the most pleasant work.  However, in the mini-zoo we have in our house it's a necessity and one you can only put off for so long before conditions get unhealthy.

I'm not sure many people consider this less-than-pleasant aspect of having animals in the home.  You have to clean up waste, keep them clean (I had to give my beardie a bath today), and pick up messes that they may make with chewing and scratching around the house.  Pets are still less maintenance than children, but they aren't completely maintenance-free.  This is especially true with caged pets such as birds, rodents, and reptiles where you have an enclosure that must be cleaned and you can't train them to eliminate in a specific place.

Still, it's an acceptable trade-off as far as I'm concerned, and the price we pay to have the joy of pets around us.

Thursday, June 23, 2011

No More Declaws

One of my earliest posts on this blog was on the pros and cons of declawing, posted back in November 2008.  At the time I had a good discussion, partially by email, with one of my UK readers on the good and bad of it.  At that time, I didn't like the procedure but was willing to do it.  Well, I have to say that since then my opinion has changed.

It's interesting how you can think about things differently as you get older and have different experiences.  When I first graduated from vet school I had no problems with declaws, seeing it as a routine procedure and not harmful to cats.  I even had my own cat declawed before I started vet school.  As I practiced and performed this surgery, I started to realize that it was uncomfortable and had a higher risk of complications compared to other surgeries.  However, I continued to do it, though I started to more openly stress the potential problems.  Fast forward a few more years and I had read more articles on how cats don't walk the same afterwards (even though it may not be noticable to the naked eye), pain control was more important, and it was illegal in many countries.  So I started really trying to talk up the bad parts of declaws and convince clients not to do it without just saying "don't do it".  I still saw it as a better option than ending up at a shelter because of destructive clawing.

My first major turning point was just after my blog post in 2008.  In the discussion with the reader, she pointed out that we don't de-bark dogs that are constant barkers because it is unethical.  Clawing is a natural behavior of cats just like barking is a natural behavior of dogs.  If we de-bark dogs, we're treating a behavioral problem with surgery, and the veterinary community as a whole has a consensus that doing that surgery is unethical.  It was a bit of a surprise as I realized the hypocricy of my declaw position...I was okay with doing it, yet I was ethically opposed to a comparable procedure in dogs.  I was using surgery to correct a behavior, and this went against my views as someone with a strong interest in behavior.

Even then I didn't stop doing declaws, though I was increasingly uncomfortable with them.  Over the next couple of years I starting having more post-operative complications in this surgery, mostly with cats getting their bandages off and the paws bleeding.  It was never life-threatening blood loss, but it certainly looks horrible and is a mess to clean up, and I hated thinking how my patients felt that would make them uncomfortable enough to really pull at the bandages.  I modified my technique, trying every method I knew of to remove the claws and seal the incision, short of a laser (which I've never had access to).  Almost 12 years of doing declaws with minimal problems and then it seemed like every second or third surgery had issues.  I began to really, really dread whenever I had to do the surgery.

Finally, about four months ago I decided that I had simply had it.  The more I thought about it the more I had problems with the "necessity" of declawing cats.  Yes, I know they can be destructive.  I have three cats of my own, all with claws, and we have claw marks on furniture to prove it.  However, I would never de-bark a dog because of barking, or declaw a dog, rabbit or other animal because of destructiveness.  I would never do a full-mouth tooth extraction in a pet to prevent damage when biting.  There are serious ethical problems with each of these.  So why would I be comfortable doing a declaw?  I decided that I wasn't.  And I told everyone that I would never do one again.

I'm actually very comfortable with my decision, and haven't seen it affect my practice at all.  It makes me feel more comfortable as a vet in how I care for my patients, and gives me a sense of relief that I never have to deal with the complications in my own patients.  I also have swung to the other side of the debate, and wonder how others can easily do the surgery without consideration for all factors and without considering the stance on similar procedures that we won't do.  I think that declawing in the US has become so commonplace that many vets never really think about the ethics behind it and what we're really doing to the cats.  I'm not going to condemn my colleagues who still do the surgery as I remember what I thought years ago and I want people to come to decisions themselves.  But personally I would have no problem at all with it becoming illegal in the US.

Sunday, June 19, 2011

Career Choices Know No Borders

Let's close out the week with another international reader...

My name is Aina Kamaruzaman and I'm a veterinary student of the newly vet school in Malaysia (the 2nd vet school apparently) and are moving to third year this september. I've been following your blog and I read your post about foreign graduates. I have no intention to work overseas rather than study (because I want to serve Malaysia due to the shortage of vets here) and I have few questions for you since you are the senior vet and probably can understand a typical vet student like me.

1) We are the smallest vet faculty in Malaysia (established in 2008) and we are the pioneer batch for the faculty. How to get ourself in the same level as other vet students in the more established universities because some people (even in Msia) probably wouldn't notice us as vet students. And how do we can promote ourself being recognize internationally so that people worldwide know our existence?

I'll admit to not having a clue on this part, though perhaps my readers might.  Also, this is more the duty of your school's administrators than it would be for you and your fellow students.  As students, you don't have ways to get connected within the international academia community as easily.  One possibility might be to talk to students in vet schools outside of your country and work out an informal exchange program, spending a week or two with them and then having some of those students come to Malaysia to see your facilities.

2) I am moving into third year but still do not know which field I'm going to be involved with when graduated. I've been exposed to field work, ruminants, non-ruminants, horses, small animals, zoos, clinical and laboratory works but still couldn't make up which to choose. Is it normal for a third year student like me have this problem?

Now this I can answer!  Aina, this is actually a very common situation for many students, regardless of where you're going to school.  When I was a veterinary student I considered cardiology, surgery, exotics, and lab animal medicine as possibilities.  I was even the first president of our school's Student Chapter of the American College of Laboratory Animal Medicine and wrote an article on a career in lab animal medicine.  I ended up going into general small animal practice and developed side-interests in surgery and exotic pet medicine.

It's also not uncommon to change your focus over the years.  I had several professors who started out their careers in one field and ended up doing something completely different.  One of the great things about a veterinary degree is that you have a lot of flexibility in where you work and what you do, and you can change that as you gain experience.

Now you'll need to have a basic idea by the time you graduate so you can figure out where to apply for your first job.  But if your school is a standard four-year program, you still have a couple of years to determine what you want to do.  When you start your clinical rotations, you'll learn what things you really like doing daily, and that should help your decision.

Best of luck!

Saturday, June 18, 2011

Hope For The Fainters

Y'know, if I had known that I'd get so many questions from outside of the US this week, I'd have put it up as a theme week!  Here's a question from Lauren in the UK, with a situation that is applicable regardless of your country of origin.

Sir, I am a 16 year old student based in the UK. The thing is, I have a passion to become a vet and have spent 7 months volunteering at a small animal practice. I find the surgery to be extremely interesting, and quite frankly, I love it! Only on one occasion I did actually faint, and I'm now worried that it will be of a regularity. I am just seeking your honesty, and wondering if you have any experience or advice for this? I have a fear of this holding me back from my dream! Kindest regards, Lauren

When I read this I knew that I had to answer as soon as possible because of what happened to me when I was young.  I started working for a veterinarian when I was 14, and my job was to help clean the kennels and take care of the pets in the back.  My parents didn't think I would last long, even though I had wanted to be a vet since I was nine years old.  The problem was that one of my chores at home was to clean the dog poop out of the yard, and every time I went through to do this, I would gag and almost throw up.  Yet here I was with a job that not only had me doing it, but doing it with my hands (gloved, of course)!  I quickly got over the problems I had with the idea of messing with dog and cat waste, and it stopped bothering me.

The first surgery I ever witnessed was a ferret descenting.  I was watching over the doctor's shoulder as she was closing up, and the ferret started to move slightly (different kind of anesthesia back in the early 1980s than we have nowadays).  She asked me to hold the hind legs while she finished a few stitches, and I was glad to do so.  All I could see was a little pink tissue through the open skin near the anus, and I didn't think much about it.  When she was done I walked out of the surgery room and had the most strange experience.  The floor came up to meet me!  Yes, I almost fully passed out.  But the strange thing is that it felt like the floor rose up to me rather than me falling to the floor.  I didn't stay out long, but yes, I did pass out from watching a surgery.

Over the next two years I slowly started getting used to surgeries.  When I was 17 I had my first girlfriend, and she was also interested in veterinary medicine.  I brought her in to watch my own dog being spayed. During the procedure I had to help her out of the surgery room as she was about to pass out.  I had her put her head between her legs to keep from fully collapsing.  As she was doing this, I passed out myself!  I had seen spays before without problems, and yet I passed out watching my own dog.  And in front of my girlfriend!

Over the next few years I continued to have sporadic luck with watching surgeries. I never passed out again, but I came close several other times.  I began to learn how it felt just before I would pass out:  bright lights, tunnel vision, a certain lightheadedness, etc.  As I discovered the signs, I learned how to walk away from the surgery, sit and put my head between my legs, and prevent it from going all the way to unconsciousness.  I was determined to get past this weakness and go on to be a veterinarian.

And I did.  I developed a strong interest in surgery, and am now asked for surgical advice by other vets in my multi-location practice due to my expertese.  I have seen every part of a dog or cat during surgery or during a necropsy.  Just about every day I have blood on my gloves.  And I never come close to passing out anymore.

So, Lauren, you see that I can completely relate to your situation!  And there is indeed hope for you.  It is possible to get past any queasiness and pursue your dream.  If I did it, so can you.  Best of luck!

Thursday, June 16, 2011

Getting A Start...Foreign Graduates

For some reason I keep getting questions from vets outside of the US about getting licensed or work in the US.  I answer them as best as I can, but I'm not a policy or licensing expert.  Still, here's a question from Mehmet that I actually know!

I am a foreign veterinary graduate who is dreaming about being a licensed veterinary medicine in US. I will follow the steps of ECFVG but i am curious about if i can work as a veterinary technician before taking the practice exam or is there any way to improve my clinical skills in US before taking the practice exam.

It's actually very common for foreign (non-US to me) veterinarians to work as technicians prior to licensing. In fact, I've known a few vets who practiced outside of America, moved here and stayed working as techs because of the cost and hassle of getting their license. While working as an assistant or tech doesn't give you a big advantage in going through the ECFVG program, it does keep many of your skills honed and gets you experience with the common American practices of medicine.

There are a few things to keep in mind, though.  Even if you're a vet in another country, you don't get the designation of being a licensed technician or are even able to sit for that exam.  In some states you are very limited in what you can do unless you are licensed.  For a skilled veterinarian, this can be frustrating.  Also, without your veterinary license you can't make diagnoses or prescribe treatment, no matter how certain you are of what you're doing.  It can sometimes be difficult to sit back and let someone else do the work you know you can do.  Still, it's better than working a desk job if you like veterinary medicine.

Good luck with your dream, Mehmet!

Wednesday, June 15, 2011

Outnumbered...A Vet's Home

A few days ago my wife came to a rather interesting revelation about our household and family.  The pets outnumber the people by a ratio of almost 3-to-1. Here's how it breaks down:

4 People
3 Goldfish
1 Betta fish
1 Bearded Dragon
1 Rat (new addition, more on this soon)
3 Cats
2 Dogs

That makes 11 pets total if you count the fish individually.  A lot of pets for two kids and two adults!  Yet that's par for the course for a veterinarian.  We work with pets who are often orphaned, abandoned, or sick, and most of us like a wide range of pet species.  Most vets have hard-luck cases that they've taken into their own homes.  One of my own cats was found in a dumpster behind a pet store.  Vets also can care for difficult medical situations or simply afford more pets than your average owner.  So with all of these factors, it's not surprising that most vets have multiple-pet households.

For most of my career I've been able to avoid most of the pity adoptions we are presented with.  I've never taken home a parvo case like many of my colleagues that I know.  I've been willing and able to pass on most abandoned dogs and cats I've seen.  But somehow of the last few years we've slowly accumulated more pets than I realized, and now have 11.  And my kids want more!  They keep trying to talk us into another dog, with the logic that we have three cats, so we need three dogs to make it even.  So far my wife and I have adamantly resisted.

If you don't see any blog posts for a few weeks and I haven't announced a vacation, it means that the pets got together and staged a coup!

Saturday, June 11, 2011

Sometimes It IS Just A Coincidence

My associate recently had a sudden and tragic thing happen with one of her patients.  The dog was a geriatric basset hound that I had also seen previously, and had even done surgery to remove several large skin tumors.  This time she was seen for a routine checkup and vaccines.  I briefly looked at her because the owner wanted some smaller skin masses removed and wanted me to do it in the near future.  My associate is a very good, experienced doctor who has been practicing a few years longer than I have and has done a good bit of emergency work.  The dog appeared in good condition with no obvious serious problems, and walked out of the clinic with her tail wagging and in good spirits.

About eight hours later the owner rushed her to the emergency clinic, where she presented deceased on arrival.  The emergency doctor noted a lot of free blood in her abdomen and a softball-sized mass palpable.  The owner declined a necropsy, so nothing definitive could be determined about the cause of death.

The owner is concerned that my associate missed something on the exam.  However, as I said, she is a very good, experienced doctor, and would be unlikely to miss something as large as the other doctor noted.  Also, there was nothing done to her that would have caused sudden internal bleeding, even a vaccine reaction (which doesn't cause spontaneous hemorrhage).  I can see some of the owner's concern, as she brought in an old but healthy dog, we did some services, and several hours later her dog suddenly bled to death.  I would be asking questions myself, and wondering what had happened.

Really, this appears to be a case of bad timing and coincidence.  Yes, coincidences do happen, and an event like this doesn't mean that a doctor was negligent or caused the problem.  A previously unknown splenic tumor may have ruptured, filling part of the spleen in the bargain, or the spleen may have suddenly twisted.  Conditions like this can happen and are generally unpredictable.  Often the only sign of such a disorder is sudden death, as tragic as that may be.  I know it's easy to blame the last person to see the pet, and most certainly that should be investigated, but that isn't the only answer.  Unfortunately in this case we have only speculation as to what happened, as the owner declined the necropsy.  But I'm convinced that my associate didn't miss or cause this problem.

If something like this ever happens to you, talk to the doctor about it and listen to what they have to say.  Also, feel free to ask opinions of other vets, making sure the first vet isn't covering something up.  But be willing to accept that such events can happen through nobody's fault, and it likely would have happened without any visit or services.  It was just bad luck and happenstance that it happened on the same day.

Friday, June 10, 2011

It Happens To Us Too

One of the goals I had when I started this blog almost three years ago was to show the human side of a veterinarian's life.  I'm happy to discuss pet-related medical issues, but I also want to show what it's like to be an average veterinarian.  Today is one of those days.  Problems that happen to other people happen to us too, because we're also "other people" to someone. 

My wife had picked up our kids, some nieces and nephews, and a neighborhood girl from vacation Bible school.  She was dropping one of them off, backed out of the driveway, and suddenly the minivan wouldn't go into reverse.  That was worrisome, but she tried to turn around and get to the street through the yard in forward.  She managed to go a few dozen feet when it wouldn't move anymore.  The engine was fine but something had disconnected from the gears and it wouldn't engage with the drive train.  After fiddling around we realized it wasn't going to be an easy fix and we called a tow truck to take it to a local mechanic. 

But it got worse.

I drove my car over to the mechanic to be there with the minivan and talk to them about the problem.  As I was driving over I started having some weird electrical problems with the car, losing power in acceleration.  By the time I pulled into the mechanic's parking lot the car was having some serious problems.  I turned it off and then couldn't get it started again.  That was two cars dying in less than two hours!  Our ONLY two vehicles!!!

They looked over my car and managed to get it started again.  However, they couldn't figure out why it had died.  There was something with the electrical system or the battery where it wasn't charging.  However, my alternator was replaced about eight months ago and shouldn't be bad.  The battery checked out fine, as did all of the other systems they looked at.  I finally drove away with the car acting fine, but without an idea of what had happened or whether it would happen again.  For a while things seemed okay, but less than an hour of driving later and I started having more issues.  I was able to make it home, but I'm not sure if it's drivable anymore.

Another thing with my car...It's a 1995 Chevy Lumina that has a very long list of problems.  The cost of even a single repair on it will likely be more than the car is worth, so we had previously determined that we wouldn't fix it when it finally ran out of steam.  However, we have been hoping that it would last several more months until we could afford a new car payment.

So let's recap.  Vehicle #1 is currently at the mechanic with an unknown problem related to the gears or transmission.  Vehicle #2 is having an unknown electrical problem and may not start in the morning; if it does, I don't know how far it will go.  And I'm scheduled to work tomorrow!  Saturdays are very busy for us, so it would be bad if I can't make it in.  Thankfully, my father-in-law may let me borrow his car tomorrow so I can make it to work.

So does this sound familiar to anyone?  Few veterinarians are wealthy, and things like this hit us just as hard as they do anyone else.  The next time you see your vet, remember that they have problems and challenges just like you do.

Thursday, June 9, 2011

Egg-citing Cases

Much of the workload for a veterinarian is pretty routine.  We see numerous cases of vaccines each day, do spays, neuters, and dental cleanings almost daily, and even see the same kinds of medical cases over and over.  I can't tell you how many skin problems and ear infections I see every single day this time of year!  To the clients it's a big issue, but to us it's just another day at the office.  Even the species and breeds can become routine and rather boring.

But every once in a while you get something different.  And because I'm willing to see most species of pets, I tend to get some more exciting cases.  It's especially fun for my staff, as they get to see things with me that they haven't seen with most of the other vets around them.  For example, I neutered a rabbit last week.  To me this was mildly exciting, as I only get to do a few of these per year (as opposed to the hundreds per year of dog and cat neuters).  But most of my staff had never seen surgery of any sort on a rabbit, so it was fun for them.

Today was another case.  I saw a sun conure for sudden lethargy.  Anyone who knows birds quickly learns that a sick bird is REALLY sick because early symptoms are often difficult for the owner to notice.  It didn't take me long to feel this bird's abdomen and realize that she was "egg bound".  She had laid several other eggs recently, and apparently one had become stuck inside her.  This can happen in birds who have a calcium deficiency in their diet, or are laying too many eggs in a short period of time.  The oviducts loose their ability to contract and the egg becomes stuck.  This is a very serious and life-threatening situation.

Thankfully, most of the time it can be treated, at least in the short term.  I anesthetized the bird and tried to milk the egg out of the cloaca (the shared urogenital opening that birds and reptiles have).  Unfortunately, it wasn't budging.  So I stuck a needle into the egg and extracted most of the contents.  This allowed me to compress the egg to make its diameter smaller, allowing me to gently pull it out.  The bird recovered well, and will hopefully be doing much better over the next couple of days. 

I've done this procedure before, but not often and not in a few years, so it was interesting to me.  But my staff were really egg-cited about it!  (Yeah, sorry, couldn't resist the pun).  In fact, my staff was so engrossed in watching me that I had to remind my techs that there was a room ready for them to start on.

It's always nice when something different comes through the doors.  So much of what we do is SSDD (Same Stuff, Different Day) that some variety helps to keep us interested.

Wednesday, June 8, 2011

Getting Rid Of Ticks

It's warm weather, and so we're seeing an upswing in parasites.  Most of the ones we see are fleas and ticks.  I've talked many times about flea control but haven't really discussed ticks.  So let's do so!

Honestly, they freak me out a bit.  Yes, that's strange coming from a vet, but they really do creep me out!  I can't bring myself to touch them and always have to use instruments to remove them.  Put me with a hissing cat or snapping dog and I'm okay, but don't make me touch a tick.

But in all seriousness ticks are pretty nasty critters and can carry some bad diseases.  The most common ones I worry about are Lyme disease, ehrlichiosis, and Rocky Mountain spotted fever.  Each of these can cause serious illness and even long-term effects and have relatively vague symptoms so often are overlooked initially.  Thankfully, most of these diseases can be effectively treated if caught early enough and don't have to be fatal.  Also, studies have shown that ticks normally have to be attached for at least 18 hours before transmitting disease, so early removal is important.

So how to you prevent removal?  There are many good tick preventions on the market, including Preventic collars, K9 Advantix, Vectra, and others.  The best ingredients against ticks are permethrin and amitraz, so these are the ones I would look for.  However, keep in mind that a single exposure to a tick-infested field or area can result in 600-800 ticks trying to attach!  If a product is 99% protective, that means that you can still have almost 10 ticks attaching.  So just because you still see a few, just realize how many you prevented.

What about if a tick does attach?  Here are some hints on removing them.

*  Grab the tick with tweezers or hemostats as close to the skin as possible.  Fine-tipped tweezers work much better than blunt-tipped ones
*  Pull it straight up with steady, even pressure
*  Clean and disinfect the site after removal
*  Don't twist, jerk, or crush the tick as you remove it
*  Whatever you do, do NOT use a hot match or grease to remove it!  Also avoid petroleum jelly, nail polish, or other substances.  None of these work well and all can potentially cause harm.

Thursday, June 2, 2011

Talking About Allergies

Very rarely will I ever rant about my colleagues, but I feel that I have to get on a little soapbox today.  Bear with me as I get it out of my system.

Today I saw a 9 year-old Weimaraner with chronic skin and ear infections.  This dog had been affected most of its life, and the owner had always taken it to the vet.  The vets had treated the problems with appropriate medications, but then the problem would return.  Now to me this is a prime suspicion for allergy problems.  But apparently in all these years no doctor had ever even mentioned the possibility of allergies to the client.  Just an hour or two later I saw a golden retriever with chronic foot irritation.  This dog's previous vets had done various alllergy treatment, but apparently had never talked about food allergies.

I hate to say it but these aren't the first times I've run into situations like this.  Several times per year I'll see a pet for the first time and learn that they have had chronic or recurrent problems with skin and/or ear.  The dog will have had treatments at vets, but those vets have never discussed allergies.

Why is this a concern?  Because ear and skin disorders, especially infections, don't "just happen".  When they occur several times per year there is an underlying cause that must be determined.  Yes, the infection/irritation needs to be treated, but doing that and nothing else is like putting out a house fire but never figuring out what started the fire.  When problems are recurrent, the infection is only a symptom and is not the main problem.

Allergies are the most common reasons for these disorders, and can include seasonal allergies (pollens, grasses, etc.), flea allergies, dust mite allergies, and food allergies.  Unfortunately most allergies in pets affect the skin in similar ways, regardless of the root cause or allergen.  So several causes can have the same appearance and it can be difficult to quickly figure out which is the culprit.  If we can determine the allergen we can often prevent the infections from happening in the first place.

None of this is new information, and veterinarians have known about allergies for decades.  I was taught all of this back in the mid-90s, and frequently see it brought up in journal articles and continuing education meetings.  No vet should be surprised at allergies as a cause of skin or ear infections, and every vet should be considering this as a possible diagnosis when they are recurrent.  This is why I'm surprised when owners come in and say that their vets have never talked about this.

I know that clients don't always pay attention to what we say or remember it well, so there may be some cases where the vet did mention it, but the client didn't pick it up.  I also have seen plenty of clients where the previous vet DID do a thorough work-up and treatment, considering all aspects of allergies.  But this situation happens too frequently for me to believe that it's always the client not listening to the vet.

Here's the bottom lines....Vets, make sure you are talking to clients about allergies with recurrent dermatitis and otitis.  Clients, if your pet has ongoing skin and ear problems, ask about environmental and food allergies.