Veterinary Burnout, PTSD, And Life Balance

Recently I received a very interesting email from Tim.

 

I ran across your blog when I did a research for my own blog post on veterinarians and depression/PTSD. I had a recent conversation with a woman who used to be a vet tech and had to give it up because of too much exposure to sick and suffering animals.

 

I started thinking about the veterinary industry and how it may be a segment of the population that may suffer from PTSD due to occupational exposure. PTSD is an important topic to me because this past year I have been treated for the same due to my 20+ year career as a firefighter/medic. Do you know of any studies or resources that discuss PTSD and veterinarians?

The blog I write is called Self Care and Fitness Education where I discussed my own experiences as well as holistic means to return to a more balanced life. I want to raise social awareness about your profession and PTSD, as well as give my readers food for thought.

 

I'm not a psychologist and will have to defer to official definitions of Post-Traumatic Stress Disorder (PTSD).  I'll also admit that I'd never really given much thought to experiences in my profession as leading to PTSD.  When I think of that disorder I think of military, police, and other first-responders who frequently end up in sudden and violent situations.  I've never applied it to veterinary medicine.

 

Depression and emotional burnout is most certainly an issue in this job.  I've faced it myself many times.  Emotional fatigue hits us from time to time since daily we deal with often emotionally charged situations.  One of my most popular recent blog posts was on the emotional toll of the job, and I have been very surprised at that particular post being read 4-5 times as much as my average ones.  It's obvious that this topic resonates with people.

 

Personally I wouldn't think of this job as creating PTSD, but someone more familiar with the disorder may define it more broadly than myself.  Is there emotional and psychological trauma in veterinary medicine?  Absolutely.  Virtually every day I am faced with pets that need to be muzzled or sedated due to aggression.  Recently my hospital manager was bit severely by one of our patients and had to have her hand bandaged and put in a brace.  People outside of the profession can develop fear of animals due to the experiences of being attacked, which probably falls within a spectrum of PTSD.  I personally think that most of us in the field learn how to handle that since we face it so frequently, just like not every soldier or police officer is going to have true PTSD.  But is it possible?  Sure, especially if the attack is severe.  I know that the times I've been badly injured I'm more nervous than normal around aggressive pets.  If I was mauled, I'd probably be downright terrified by the idea of another vicious dog.

 

Burnout and depression is much easier for me to understand, having faced both issues over my career.  Think about our situation.  We make a fraction of what our human colleagues do, and have at least as much training and work the same weekly hours, if not longer.  It's tough for many vets to make ends meet, especially newer graduates.  We have the highest debt-to-income ratio of any medical profession.  Every day we have to almost bargain with clients to let them allow us to treat their pets.  Daily we face situations where we know what to do to diagnose and treat problems, but the owner can't or won't pay for the necessary tests and medications.  We are often physically attacked by our patients, and sometimes yelled at by their owners for things that are beyond our control or because we didn't fix the problem the first time (and those people never seem to understand that they keep denying our treatment plan).  We are in this job because we love animals, especially pets, and often become emotionally attached to our patients and clients.  This attachment helps us do our job, but it can make it especially hard on us when despite our best efforts we can't figure out a problem and lose the pet.  We are physically stressed, often working long days, sometimes coming in after hours, rarely getting full lunch breaks, and are having to get up and down off the floor after restraining and sometimes "wrestling" with pets (my large animal colleagues have even greater physical challenges).

 

To summarize....long hours, comparatively low pay, daily risk of physical injury, emotional roller-coasters, not being able to freely do what we were trained for....

 

Yes, depression and burnout are a concern.

 

It's also difficult to balance our work and home life.  I can't tell you how many times I've driven my wife crazy because I fret over a case for days, especially if it went poorly.  My worry over the clinic's revenues sometimes dominate my thoughts on my days off, affecting my interactions with my family.  I don't do emergency work anymore, but when I did my planned evening could be ruined by a sudden after-hours call.  It can also be hard for me to participate in plays and other outside activities because I can't say that I'll leave exactly at closing time every day.  Balancing personal and professional lives is a huge concern among veterinarians, and one that we're likely doing a poor job handling.

 

Tim, I'm not aware of any specific studies on these issues in veterinary medicine.  I may have seen an article or two on depression and burnout, but I can't remember where or when so I can't give you a specific reference.  In writing this I'm hoping that some of my readers will know of specific studies and can direct you to them by writting in the comments.  If there haven't been many studies, there certainly should be, as my personal experience is that these are common issues.  But more important than simply knowing the extent, we need to have good solutions on how to handle the problems.

 

And I have no magic answers on how to do so.

 

Low Risk Doesn't Mean No Risk

Jessica emailed me this recently and I thought it was a good way to open up to a larger topic of discussion.

 

I came across your blog posts on tail amputation while doing some research. My 3 year old bulldog had her tail amputated yesterday after a year and a half of trying to manage her chronic infections and skin irritation conservatively. I got more than 1 opinion and I really thought we were doing the right thing. It was obvious that her tail was sore more often than not and she hated having it cleaned. I was told of the risk of incontinence postoperatively but was unable to find anyone who actually experienced this. Our surgeon assured the risk was very, very low.

 

Well now 2 days after surgery, we are at home and our poor girl has been unable to control her bowels. At first I hoped it was just diarrhea from anesthesia & antibiotics, but twice now she has passed 2 small formed stools while sleeping. Otherwise it has just been constant small dribbles.

 

She has gotten in the poo position twice outside but only a very tiny bit came out.

 

I did speak with our surgeon who said he was confident that there was no damage to surrounding nerves or muscles but that it was a known risk of this procedure. He said that her whole backside is sore and irritated. She also had an anal purse string suture to prevent her from having a bowel movement during surgery which could be causing additional pain for her. He said to keep her on a bland diet and wait it out.

Have you ever seen this before in your practice? Is there a chance it could be temporary?

 

Let begin by addressing the specific condition.  I've performed several tail amputations in bulldogs as well as other breeds.  The closer you are to the rectum during the surgery, the higher the likelihood of damaging important nerves or muscles.  Tail amputations in bulldogs are normally done because of deep folds that lead to significant irritation and infection, and with their short tails you're very close to the rectal area.  Even though the risk is low, damage can happen despite the best surgical skills, and there is no way that even the most experienced surgeon can 100% predict every outcome. 

 

There is also the consideration of temporary post-operative trauma.  Sometimes damage is transient due to localized inflammation of the nerves or muscles.  You can have short-term problems that will resolve with a bit of time and rest.  If this dog had significant irritation there could be a situation where the tissues will heal and return to normal.

 

How do you determine which outcome will happen?  Time.  Really, that's it.  Temporary "damage" due to surgery should resolve within 1-2 weeks, if not sooner.  If it goes on longer than this there may be permanent damage.  Once initial healing has taken place (usually 10-14 days) your vet can check some of the reflexes and nerve responses around the anal area to see if there is a concern.  You can also consider taking her to another vet for a second opinion, though I would give the doctor who performed the surgery the first opportunity to assess her since he is most familiar with the case.

 

This topic brings up a bigger issue that I also want to touch on.  "Low risk" never means "NO risk".  No matter what the procedure or treatment is, there is always some degree of risk involved.  I've done several thousand spays and neuters so far during my career.  Once I had a puppy die due to problems with the anesthesia equipment, and once I had sutures slip internally during the night after surgery, requiring a trip to the ER and emergency surgery.  But those are the only serious complications I've had in thousands of cases, which are pretty darn good statistics.  Most vets consider routine spays, neuters, and dental cleanings to carry very little risk, especially with proper monitoring, pre-anesthestic blood tests, and modern anesthetics.  Even so, there is always the risk that a pet will have an unexpected reaction to a medication or something else will go wrong.  There will NEVER be a way to reduce the risk to 0%, just due to the nature of how surgery and anesthesia affect the body.

 

Sometimes complications happen that are beyond a doctor's control.  A pet has an unexpected allergic reaction to a drug.  Suture material fails.  The pet's body reacts severely to the sutures.  The anesthesia equipment malfunctions.  There are hidden health problems with the pet that we don't notice on our initial work-up.  I could go on and on but you get the point.  There are situations that even the best doctor and best preparation can't prevent.

 

Sometimes complications happen because of the fault of the doctor or technician.  Maybe a suture wasn't tied properly.  The tech may not have been monitoring properly to catch the arrhythmia.  A drug may have been overdosed.  The surgeon may have cut a little too far in one direction.  Yes, these are things that shouldn't have happened.  I hate to break it to you, but doctors and technicians are human, and we can make mistakes.  I've said it before and will say it until my dying day.  If a doctor tells you they've never made a mistake or missed a diagnosis, they are lying to you.  It is simply impossible for any human to be 100% perfect at our job 100% of the time.  If anyone challenges this idea, I will ask you to do some serious reflection on your own life and career and honestly tell me that you've never made a mistake that somehow could have been prevented. 

 

Let me also be clear in saying that "we're only human" doesn't excuse mistakes.  If a serious mistake happens, that professional is certainly held liable, as is proper.  We're going to make mistakes, but they should be rare and we should face the consequences and try to make ammends.  There is a difference between a rare mistake and repeated mistakes of the same kind.  The former will happen and the latter needs to be investiaged and handled differently.

 

Now that I've said all of this I need to go back and reassure everyone, as I know that there are people reading who have been freaked out and won't have surgery done on their pet, even routine procedures.  Don't let my comments scare you.  Every day of our lives we take risks, and usually don't even realize it.  The National Safety Council produced a nice little graphic that gives the odds of dying from various causes.  Here are a few choice bits of that data.

 

Motor vehicle incident:  1 in 112

Falling:  1 in 152

Assault by firearm:  1 in 356

Car occupant:  1 in 492

Exposure to fire, flames, or smoke:  1 in 1,418

Choking from inhalation and ingestion of food:  1 in 3,649

Air and space transport incidents:  1 in 8,357

 

I've seen data that shows that surgical risks are about 1 in 10,000 if proper pre-anesthestic work-up, monitoring, and drugs are used.  This means that your dog or cat is far more likely to die as a passenger in a car accident on the way to the vet than they are while undergoing a routine anesthetic procedure!

 

Worry sometimes is misplaced.  The average American is 3 times more likely to be killed in a car accident than by being shot with a gun, yet we casually get in our cars and drive every day without worrying much.  We hear so much about plane crashes around the world, yet we're about twice as likely to die by choking on our dinner than in such a situation.  Pet owners routinely fear anesthesia for their pets, yet the risk is low.

 

So what does all of this mean????

 

First, there is minimal risk of your pet undergoing an average anesthetic procedure and the huge majority of the time it is safe and uneventful.  The risks of complications with surgery are highly dependent on the kind of surgery, with some carrying far greater risk than others.  Whenever a pet (or person!) is undergoing surgery the doctor should make you aware of the potential risks and how likely they may be.  If they don't come out and tell you, be sure to ask!  But also be aware that if the complications you were warned about do happen, sometimes everything can be done right and the outcome is still not what you wanted.

 

Remember....low risk doesn't mean no risk, but low risk does mean complications are rare.

NDV To Treat Canine Distemper......Hogwash Or True?

One of my readers passed on this link and question....

 

Does your office employ the treatment discussed in this link? http://www.kindheartsinaction.com/about/report-on-the-effectiveness-of-ndv

I'd like to know if you've heard of this and if so, what is your take on it and why aren't more vet offices using this treatment?
 

My first thought when reading the website was "well, this is new..."  As I continued to read I was scratching my head in confusion, especially with some of the statements.  Several red flags were raised in my mind and I was at the point of writing it all off as "snake oil".  But I wanted to give a more informed opinion and really break things down, hence this blog post.  I'll warn readers that I may get technical with some of the discussion, so if you're not into virology you may want to skip this one.

 

Let's start with a quote from the website:

 

We have received reports from 21 vets who have used NDV to treat distemper dogs. Of those, 12 vets used NDV-induced serum in the early stages of the disease, and in 86 percent of those cases, the distemper dog survived. Dog caregivers — owners, fosters and rescuers — tell us that 63.39 percent of distemper dogs were saved by one of the treatments developed by Dr. Sears using NDV — Newcastle Disease Vaccine.

 

Okay, that sounds pretty promising!  So what's the issue? Why isn't this being used more?

 

Let's begin by talking about what these viruses are.  Canine distemper (CDV) is a RNA virus that affects a wide variety of mammalian carnivores, including canids (dogs, foxes, wolves, etc.), raccoons, skunks, and even seals.  It is highly contagious and spreads through aerosol droplets or contact with infected bodily fluids.  Puppies less than six months old are the most common pets affected.  The diseases typically starts out with fever, respiratory signs, and diarrhea.  With prolonged infection it can invade the nervous system, causing inflammation of the brain and spinal cord.  The early symptoms may be subtle and only appear as diarrhea and a runny nose, though the disease progresses quickly over a week or two.  About 50% or more of dogs will die from this disease once symptoms develop, and even if they recover some of them may have long-term neurological problems.  Diagnosis can be difficult, and typically is based on isolating the virus in cells collected from the conjunctiva around the eye.

Newcastle disease is also a RNA virus, but it affects wild and domesticated birds.  The symptoms are similar to what we would see in dogs:  upper respiratory signs, conjunctivitis, diarrhea, neurological signs, and problems with eggs.  The virus can be isolated from swabs of the trachea and cloaca of affected birds.  There really isn't a treatment in birds, and the main concern is the disease spreading among flocks and causing massive bird death.  It can pass to humans, but isn't considered severe in our species, only typically causing short-term conjunctivitis and flu-like symptoms.  Interestingly, Newcastle disease virus (NDV) has been studied as a potential treatment in certain kinds of human cancer.  Apparently a modified version of it can target and kill cancer cells, though there is variability of the result between strains of NDV and types of cancer.

Both viruses are in the family Paramyxoviridae, with NDV in the genus Avulavirus and distemper in the genus Morbillivirus.  As a point of reference, human measels is also in the genus Morbillivirus, while mumps and human parainfluenza are in the genus Rubulavirus.  For those who don't know a lot about taxonomy, "family" can include a fairly broad variety of organisms, though there are considerable similarities.  For example, the family Canidae includes domesticated dogs, wolves, jackals, foxes, and bush dogs.  The family Hominidae includes humans, chimpanzees, bonobos, gorillas, and orangutans.  As you can see by the examples, members of a family have a lot of close similarities, but also some pretty big differences.  Nobody is going to confuse the skull of gorilla with that of a human, or look at a fox and think it's a wolf.

Okay, now let's get into the specifics of this supposed treatment for canine distemper.  Here's quotes from the website again:

The basic principle of the treatment is to use the NDV as an inducer to prompt a reaction in the dog’s immune system that can create a material to kill the distemper virus.....Today, the NDV treatments include the NDV-induced serum, the NDV as an IV injection to the body and the NDV spinal tap, which is for dogs in the neurologic stage of distemper.

Okay, so vets who are doing this are giving NDV vaccine to dogs, something that is not approved and not tested, as well as being a vaccine for a disease that only affects birds.  They they collect serum from that vaccinated dog, inject it into a dog with distemper, and somehow the NDV vaccine will "create a material to kill the distemper virus".  Someone might think that because NDV is a paramyxovirus like CDV that there would be some benefit of giving it.  But if that was the case, why wouldn't giving serum from a dog vaccinated for CDV help even more, since it's the same disease?  Or a measels vaccine, since that's in the same genus as CDV?  Stop and think about that for a minute...would we use serum from someone vaccinated against mumps as a treatment for measels?  Because that's basically what these vets are doing (go back to the taxonomy above).

"Yeah, but Dr. Bern, you already said that NDV has been studied because it kills cancer cells.  See, it's got something in it that helps cure diseases!"  Okay, granted, NDV may attack certain cancer cells.  But cancer cells are quite different from a virus, and these vets are claiming that NDV destroys the virus.  Even if it attacked the cells containing the virus, those cells are still very, very different from cancer cells.  You can't assume that something that destroys cancer would also destroy viruses.

The website presents data from a study they did.  Let's look at some of the comments about that "study" (yes, the quotation marks are intentional). 
 
The data for the report comes from two sources:

1. Veterinarians using NDV
2. Dog owners, caregivers or rescue groups.

Every case reported to us has been included in our statistics. We are not selective in compiling our information.

 

 Okay, there's problem #1.  This is in NO WAY a scientific study, based on these statements alone.  In any true medical study it's common for cases to be omitted for a number of reasons:  different diagnosis than expected, incomplete records, improper documentation, and so on.  So this was one of the big red flags to me.

For this survey, the diagnosis of distemper relied on the judgment of each vet. Very often, the dog owners did not want to pay the additional expense of a lab test. So, the vets would make the diagnosis based on their experience, the apparent symptoms and in the context of whether they were in the midst of a distemper outbreak.

And there's problem #2.  Remember that in the early stages there is diarrhea and signs of a sinus infection.  These symptoms may not be severe.  The only way to truly diagnose the disease is by doing swabs of the conjunctiva or the inside of the urinary bladder (rarely performed for obvious reasons).  So there may have been puppies that had diarrhea and runny nose, the vet suspected CDV, treated with the NDV treatment, and the puppy got better.  But it's very possible that many of these cases of unconfirmed distemper actually were not distemper.  A simple case of corona virus can cause diarrhea and be self-limiting.  There are several mild viral and bacterial infections that lead to sinus problems, but again may be self-limiting, with the pet resolving without treatment.  If these cases "responded" to NDV treatment, but were never confirmed to actually be CDV, how do we know that they are not animals who would have gotten better without any treatment because they didn't actually have distemper?  It's very possible that many of the dogs in the study who "responded" never actually had CDV in the first place.

There's also an issue with the variety of treatment protocols.  Some vets are using NDV serum intravenously, some are giving it into the spinal colum via a spinal tap, and some are giving the NDV vaccine directly IV.  Each of those methods is going to affect the body very differently, stimulating different responses.  This lack of consistency makes any conclusion difficult, as a scientific study would be limited to a single method.  In discussing the reports the website says that several vets gave NDV serum but never got follow-ups with the pets.  Are those cases still included in the data?  That's a prime example of the type of information that you delete from a study, yet they state that they didn't delete anything.

Here's a quote from the conclusions section of the website:

As to why these treatments work, our theory is that the NDV causes a reaction within a dog’s immune system that produces a previously unknown material or group of interacting materials, that is able to neutralize the invading virus. However, finding the answer would require extensive scientific research.

If that statement doesn't raise some serious red flags, you may want to go back to science classes.  We certainly don't know everything about the immune system, but postulating a "previously unknown material" that somehow neutralizes the virus is a rather bold statement.  Scientists have a pretty good idea of how viruses affect the body, the defenses the body has against them, and what "materials" are present.  I find it rather suspicious to propose a completely new and previously undiscovered immune system response with a vaccine and diseases that have been studied extensively.  It might be different if it was a completely new drug, but it isn't. 

Essentially vets using this protocol are saying "Well, it does something in the immune system and somehow that counteracts the virus, but we don't know how, where, or why."  Does it affect the cell membrane?  Does it affect antibodies?  Are there special proteins generated?  Does it strengthen the cell nuclear membrane?  I would be very, VERY hesitant to use any form of treatment where the method of action isn't even theoretically outlined.  The people developing this treatment are certainly not acting as responsible scientists, and are certainly not using proper scientific method.  Where is the control or placebo group?  Have they done double-blind studies to prevent bias on the part of the participants?

All of the above is my opinion and analysis.  I'm certainly not a specialist or a virologist, just someone who can look at the data analytically and without bias.  Feel free to ignore my opinion.  But here are some thoughts on this treatment by specialists in the field, as posted on the Veterinary Information Network (VIN).

From Dr. Melissa Kennedy, DVM, PhD, Diplomate American College of Veterinary Internal Medicine.  She is a clinical virologist at the University of Tennessee College of Veterinary Medicine, so with a double-doctorate and a speciality in internal medicine, she spends her career studying and teaching about viral diseases.....

"No cure yet.  There are a number of urban myths out there, like the Newcastle Disease serum."

Dr. Alice Wolf, DVM, Diplomate of the American College of Veterinary Internal Medicine and Diplomate of the Amercan Board of Veterinary practitioners is even more blunt and vocal.

"He doesn't have to 'prove' that it works.  It's not a USDA or FDA product.  He can say anything he wants.  His argument would be for us to prove that it doesn't work."

"If it sounds too good to be true, it probably is."

When asked how he gets away with it she replied "A la P.T. Barnum... There's a sucker born every minute?"

So let's summarize.....We have vets using a treatment for one virus, stimulated by a vaccination for a completely separate virus, and neither virus affects the other species (birds and canines).  There are more closely related viruses that could be used (measels), yet aren't.  The treatment "works", but the people using it don't have an inkling about even how it possibly could, other than some vague and mysterious "unknown material".  The "study" performed has numerous holes in it that significantly calls into question any so-called results, and would be soundly refuted by any scientific publication.  Reputable experts in the field, including at least one virology specialist, have clearly stated that this is a "myth" and should not be considered a valid treatment.

I know that people really want there to be a cure for canine distemper.  So do I.  But based on what I can see from this information, the NDV treatment is not a valid one.

 

 

 

 

Do Indoor Pets Need Rabies?

Connie asks this question:

 

How important is it for a small house to get a rabies vaccine. I know it's a law in Florida but since my dog is rarely outside alone except for walks, I feel it is not necessary.

 

In every US state rabies is required by law.  In every country I've ever had a client take their pet to, it is the one vaccine that must be given.  To enter some countries you have to be very specific in the timing of the rabies vaccine and even have titer levels run.  This is the one vaccine or preventative care that government officials don't joke about or give any leeway.

 

The reason for the strictness has to do with the very serious, incurable nature of the disease.  If a person is infected long enough and starts developing clinical symptoms, they will die.  It's that simple, as there is no treatment or cure.  Transmission requires direct contact, but the virus particles can go through the smallest opening.  For example, infected saliva contacting an abrasion or small cut is enough to transmit the disease.  It doesn't take a full bite wound.  People have been exposed by having a stray kitten lick them, or removing something from a horse's mouth.  Symptoms don't show up immediately, sometimes delayed by many months, so it may not be immediately obvious that an animal is rabid. 

 

This is a deadly, incurable disease.  And humans can easily catch it if exposed.  We have significantly reduced the number of human cases through wide-spred vaccination of pets and livestock, as well as control of animals entering certain countries.  There are even programs to leave vaccine-infused bait in endemic areas to help prevent transmission in wild carnivores.  If people stopped vaccinating, this disease could easily become much more wide-spread.

 

Now you hopefully understand why the laws were established and why the governments are so strict.  But what is the real risk of exposure? 

 

Certain parts of the country are definitely at higher risk than others.  There are also different wild animals that are typical carriers (reservoirs) of rabies in different areas, though any warm-blooded animal has the potential to carry it.  Here are some graphics from the Centers for Disease Control.

 

Most common reservoirs for rabies.

 

Number of rabies cases, 2009.

 

And since Connie lives in Florida, here is specific data for part of 2013.

 

As you can see, this is a wide-spread problem.  And just because a certain area doesn't have any "dots" doesn't mean rabies isn't there.  It just mean that specific cases weren't diagnosed, but can still be in the wild population.

 

So what about the dog who pretty much lives indoors and goes out only a leash?  That's where the situation gets tricky.  That particular pet indeed has an extremely low risk of being exposed to the disease.  But it's not impossible for a dead or dying bat to be found by the dog, giving exposure.  Rabid animals don't behave normally, so an infected raccoon could possibly attack the dog.  What about a dog wandering the neighborhood that attacks?  Sure, I'll admit that these things are pretty rare, but they're by no means impossible. I've seen plenty of dogs attacked by wild animals, or even stray dogs, and in those situations you have no way of telling the rabies status of the attacker without killing it and having the brain examined.  Do you want to take that risk?

 

There's also the bigger issue of legality.  When a pet bites someone or punctures the skin with their teeth, it gets reported to local animal control.  They then look into the case, and if the pet isn't current on the rabies vaccine it will be quarantined at the owner's expense and a fine charged.  After 31 years in this profession I can assure you that even the best, nicest dog or cat has the potential to bite, especially if they are scared, sick, or injured.  If that happens and the dog isn't current on rabies vaccine, the owner is in for a world of trouble from law enforcement.

 

I know this has been a long answer for a simple question, but I wanted to take the time to go into the details and "whys" of the situation.  The short answer is yes, it's important even for mostly indoor pets to get rabies vaccines.

Big Dogs Mean Big Costs

Many of my clients have very large dogs.  Most of them are under 100 pounds (45kg), but some are quite a bit larger.  Dogs like Great Danes, mastiffs, Saint Bernards, and Great Pyrennes are really nice dogs and there is a differen kind of happiness when you have a "giant" breed that you won't find with a toy breed.  However, that joy can go away when something goes wrong and there are veterinary bills.

 

Owners of big dogs know that feeding costs are high because of the sheer volume of food the dogs eat.  But prospective owners don't always think about the medical costs.  In veterinary medicine we dose based on weight.  A 150 pound human is typically going to take the same dosage of antibiotics as a 300 pound human.  This is not the case with animals.  A 40 pound dog and an 80 pound dog are going to get radically different doses of pretty much everything.  This includes antibiotics, pain medications, heartworm preventative, flea preventative, anesthesia, and so on. 

 

Today a client came in with her 120 pound Great Dane.  As part of her annual physical we ran a routine urinalysis and discovered an infection that hadn't been obvious to the owner.  We talked and it did seem like there were some emerging clinical signs that supported our lab results.  The decision was made to put her on antibiotics.  The owner was fine with all of this until we added up the costs and the medications alone were nearly $200. 

 

Yes, that's a lot of money!  But because of her size and the nature of the infection there weren't a lot of other options.  A 15 pound poodle would have taken home the same medciations for less than $30 because it would have a much lower dosage to achieve the same result.  I've seen this time and time again, to the point where I actually cringe a little when I order up certain medications for these giant breeds.  Unfortunately, I have little control over it, as those higher doses of drugs cost us more to order and stock.  The mark-up is the same, but the larger dogs simply need more.  Believe me, we're not trying to gouge or penalize owners of these breeds.

 

When someone is considering getting a pet of a certain breed, I think it's always wise to research the pros and cons of the breed as well as the costs of medical care.  When you accept responsibility for caring for a pet you also have to shoulder the costs of that care, which are much greater for bigger dogs. Prepare for the inevitable greater costs, especially if that large pet gets sick. 

Merry Christmas

As a Christian this is one of the most special times of year for me.  We shouldn't forget about or ignore Christ the rest of the year, but around Christmas we get to celebrate His birth and what His coming into the world means to all of us.  I pray that all of you have a blessed holiday season and take to heart what the birth of that baby in Israel over 2000 years ago means to us now.  Enjoy your families and Merry Christmas!

The Very Real Dangers Of Tinsel

I don't have tinsel on my Christmas tree and haven't since I've had cats.  I know all too well the dangers of "linear foreign bodies" in cats, and tinsel is a big culprit.  This lesson was driven home this past weekend with one of my clients.

 

I'll call this cat Buzzsaw (not his real name....just his behavior).  He is a rather obese, quite unfriendly cat who came in for a few days of vomiting and not eating.  His exam (what I could get of it without sedation) was unremarkable.  The owner said that he did like to chew on plastic bags, but more importantly they did have tinsel on their Christmas tree.  The husband (let's call him Mr. Toldyaso) had been opposed to tinsel, having heard it was a bad combination with cats.  But his wife and children overruled him, and the tinsel went up. 

 

We sedated Buzzsaw and I took some abdominal radiographs.  With his rather corpulent nature there was great contrast with the fat in his abdomen and I could clearly see a very suspicious part of his intestines.  This confirmed my worries, and I called Mr. Toldyaso that we needed to get Buzzsaw into surgery right away.  Not doing so could prove to be fatal within a few days.

 

Linear foreign bodies are anything long, flexible, and thin within the intestinal tract.  This can include sewing thread, fishing line, ribbon, and yes, tinsel.  If a long section of the material goes into the digestive tract the movement of the intestines acts like a draw cord on curtains.  When your curtains are closed you can pull on a string, which causes them to open.  If you look at them you'll notice that as they close they develop pleats and bunch together.  The same thing happens with the intestines.  The contraction of the muscles moves the intestine but not the string, so the intestines bunch together along the object.  If this goes on long enough it can actually start to cut into the intestine causing severe and life-threatening damage.  The only way to fix it is to go in surgically as soon as possible.

 

We did the emergency surgery and Buzzsaw was very lucky.  I found the affected area quickly and the intestines were healthy with no obvious damage.  At that point it was a matter of making a few small incisions and carefully removing the tinsel.  Closing the intestine and abdomen was routine and he recovered well.  The surgery ended only two hours before we closed, so I sent him to the local emergency clinic for overnight observation.  That was four days ago and he's home and doing well.

 

I had a conversation with Mr. Toldyaso when he picked Buzzsaw up last Saturday night.  He said that he was trying not to be mean about it, but he hadn't wanted the tinsel to be put up in the first place.  I did save most of it and gave it to him in a plastic bag to take home and show his family as an object lesson.  Our charges were around $1000, and the emergeny clinic probably charged around $500 to hospitalize and observe Buzzsaw until he could go home.  Mr. Toldyaso was quite clear with his family.  "You wanted a computer for Christmas.  Instead, you have your cat."

 

While I have tried to instill a little humor in the story, it's one that is completely true and has serious consequences.  Cats have a very, very high tendency to want to chew on long, thin objects, and this can result in disastrous outcomes, including emergency surgery.  Buzzsaw was lucky because we caught it relatively early and there was no damage, but it could have been quite different.  If you have cats, you should NEVER use tinsel in decorating.