Rabies Testing--A Gruesome Job

Rabies is a serious, scary disease.  We have done a great job of significantly reducing the number of cases in the US through extensive, legally mandated vaccination programs, but we haven't eliminated it.  Nowadays most vets and virtually every American will go their entire lives without seeing a case or being exposed to it.  That rarity has the potential to breed complacency about the disease and risks.

 

A couple of weeks ago a young puppy was rushed in for odd neurological signs that had started the night before.  We had just seen him two days prior to that for a routine checkup and vaccinations, and he had been fine at the time.  His history was a bit "sketchy".  The owners had gotten him from someone through a Craig's List add, and the mother had died (the new owner didn't know how or why).  So there were some questions about his background and environment that couldn't be answered.

 

When he came in it was quickly obvious that he was having some kind of seizure activity.  It wouldn't resolve without IV medications, and even then he had one break-through seizure.  He was salivating heavily, wouldn't swallow, and was having some kind of severe neurological disorder.  The owner said that there was no toxin or medication exposure, so the origin of the seizures was mysterious, especially given the severity.  Due to the costs in stabilizing and treating, as well as the strong possibility of something that might not be treatable, the owner elected euthanasia.

 

When we're in vet school we are told to treat every neurological case as possible rabies until proven otherwise.  The vast majority of those cases will not be rabies, but we take appropriate precautions just to be safe.  Rabies is an incurable disease that causes severe, permanent brain damage.  Any animal or person who contracts it will in all likelihood die, and if they somehow live they will probably be in a vegetative state.  It is transmitted through bodily fluids, primarilly saliva, and can pentrate through any wound, abrasion, or mucous membrane.  Because of the severity and incurable nature we are very careful about human exposure.  This is also why the vaccine is legally mandated in every state, and why most countries are so careful about importing animals.

 

The chances of this puppy having rabies were very low, but not impossible.  The symptoms certainly could fit, and the questionable background wouldn't allow us to rule out prior exposure.  Due to the fact that there was human exposure and the owner had children, I made the decision to be absolutely certain and have the puppy tested for rabies.

 

Unforunately there is only one way to definitively test for it.  Brain tissue needs to be examined for the virus.  So there is no way to confirm or rule out rabies in a living animal.  We have to get to the brain.

 

This is one of the worst jobs I've had to do, and I've had to do it several times over my career.  Laboratories won't accept an entire corpse, so we have to submit only the head.  This means that we have to cut off the head.  Putting it bluntly, we have to decapitate the animal.  I can't think of a more gruesome procedure, and when I've had to do it I'm typically more subdued than normal.  I can perform a necropsy without problem and while still cracking jokes, finding the appearance of the internal organs interesting as I search for causes of disease and death.  But there is something psychologically different about having to separare the head from the body, and I try not to look at the animal's face or think too much about what I'm doing.  It's absolutely necessary to do, as part of our oath as veterinarians is to protect the public health, so I can't ignore the risks of disease transmission to families, my staff, or myself.

 

Thankfully the test came back negative.  We still don't know what caused the problems, but we do know that it wasn't something as serious as rabies.

Would You Eat Dog Or Cat?

My staff and I engaged in an interesting discussion recently.  Would one of us eat dog or cat meat?  Most people said no.  I said yes.

 

This may seem very surprising to many people.  How could I as a small animal veterinarian bring myself to eat the very patients that I treat?  Isn't that unethical and inhumane?  Let me take some time to explain my thoughts on this matter.

 

I'm not a vegetarian.  Not even close.  I've often joked that I'm a strict carnivore.  To be truthful, I don't eat as many veggies and fruits as I should.  I really do love the taste of most meats, and think they're perfectly fine to eat.  I simply couldn't survive as a vegetarian because I don't like the taste of most vegetables.  Yes, I know there are numerous health benefits to eating more of these foods and I'm not on a balanced diet without them.  But I've learned to live with this and make the best and healthiest choices I can given my taste preferences.

 

What meats someone eats and doesn't eat is completely cultural.  I don't think there is anything inherently immoral about eating any kind of animal meat, no matter what the species (other than humans, of course).  The shock or revulsion only comes when it goes against cultural norms, and that differs greatly from one culture to another.  What is repugnant to one culture is normal to another. 

 

There are numerous examples we can use.  Pig meat is not allowed by Jews and Muslims, yet ham, pork chops, and bacon are well received by most of western society.  Many Americans have tried to outlaw export of horses if they are used as meat sources, yet horse is considered a delicacy in Europe.  Hindus would never eat cattle, yet hamburgers and steaks are incredibly common in America, where you can find just about any fast food joint serving some kind of beef.  In much of South America guinea pigs are routinely eaten and there are even festivals around this practice, yet they are considered pets in America.  I know someone who raises rabbits as a family meat source, yet that doesn't bother me as someone with four pet rabbits.  Even within a country there are differences, such as pickled pigs' feet being eaten in the southern states of the US, while much of the rest of the country would whole-heartedly reject this food.  In my life I have eaten chicken, turkey, duck, beef, pork, lamb, ostrich, bison, snail, squid, rattlesnake, frog, aligator, shrimp, lobster, clam, and several kinds of fish.  If I took that list around the world I'd easily find countries where at least one of the ingredients was against the local culture and custom.

 

So that brings us back to dog and cat.  No, I could never cook up and eat one of my patients or one of my own pets.  There is an emotional bond in these cases and it would be like eating a family member.  But that bond isn't unique to what we in Western culture consider pets.  I've seen people have the same kind of attachment to pigs, cows, horses, chickens, ducks, and just about every other animal.  If an animal was someone's pet and I knew that, I don't think I could eat it under normal circumstances (other than during a zombie apocalypse, and then all bets are off).

 

That then begs the question "What is the difference between a 'pet' and an 'animal'?"  To me, a pet is an animal that someone keeps for purely emotional reasons and with whom they have an emotional bond to that particular individual (as opposed to the species).  So all pets are animals, but not all animals are pets.  And as far as I'm concerned, any non-pet animal is fair game for the food table.

 

Also, being a vet really doesn't play into the situation.  All animals used in food production are supervised at some point by a veterinarian.  In fact, some vets spend their entire careers working with poultry, swine, beef cattle, and so on.  Those vets don't have an issue with eating a sausage biscuit before going to the hog pens or coming home from work to some fresh fried chicken.  We know that these animals are being used purely for food, and that they exist for no other purpose.  Our job is to make sure they are healthy and treated as humanely as possible until they are killed and turned into food products.  It's really easy for most of us to realize that this is a living creature that one day will sit in someone's stomach.  I know that may sound very harsh, but I'm practical and a realist.  This should only come as a surprise to anyone who really hasn't thought through how meat ends up in the grocery stores.

 

If I was in a foreign country and my host offered a dish of dog or cat meat, I would consider eating it.  I'd think about it a lot more than if it was a meat I had eaten in the past, but I wouldn't inherently turn my nose up at it.

Don't Let Them Urinate!

Here's a big pet peeve that vets have.  A dog is scheduled for an appointment for abnormal urinating.  When the client brings the dog in they let them urinate in the parking area before bringing the pet inside for its appoitnment.  Then when we try to collect a sample for analysis the dog is empty and can't provide one.

 

To me it seems like common sense that if your pet is having difficulties urinating or the urine looks abnormal that the vet will want to perform a urinalysis to see if there is an infection, bladder stones, or other problems.  If your dog is allowed to urinate just before being seen, then there isn't any urine to analyze.  Maybe that's just me and it's not so obvious to most people. 

 

Many things can cause a change in frequency of urinating, urine apperance, and other abnormal bathroom habits.  While we may have some suspicions based on an exam, there is no way to tell for certain without performing tests on the urine.  We can identify infections, suspect diabetes, analyze part of kidney functions, and get a hint about bladder stones with a simple urinalysis.  In fact, we're usually hesitant to prescribe antibiotics for frequent urinating because we've all see cases where it's due to something other than an infection.

 

And if we can't get urine, we can't run these tests.  This may mean keeping the dog in the clinic for several hours to allow them to build up more urine, or even getting it in the next day.  Sometimes the only option is to have the owner collect a fresh urine sample and drop it off.  In any of these cases it can be frustrating to the owner because we can't make an immediate diagnosis and start treatment.

 

If you're a pet owner and your dog or cat is scheduled to see the vet for urinary problems, please do yourself and the doctor a favor.  Do everything you can to keep your pet from urinating for at least several hours before the appointment.

No Rest For The Sick Or Weary

Being a vet is a pretty demanding job.  It's worse when you're not feeling good.  And it's really difficult to get a day off.

 

I've been sick off and on for the last six weeks.  It started as a cold around Christmas that turned into bronchitis.  As I got over that I developed a different virus, this time affecting my sinuses.  I've been taking high doses of vitamin C and have been trying to get rest and drink lots of fluids.  What I've really needed was to have several days off where I'm not doing anything and simply taking it easy.  Unfortunately, that's easier said than done.

 

The veterinarian isn't the only important person in a practice.  I couldn't work effectively if not for my techs and receptionists.  However, if one of them calls in sick we can usually call another person in or find some way to pick up the duties among the people there that day.  The day goes on and we continue to see patients normally.  But if I or one of my associates calls in sick we can't easily find a last-minute replacement.  If we're down a tech or receptionist it's stressful and reduces our efficiency.  If a vet calls out we can't see patients.  If we're not seeing patients then sick pets are going untreated as well as our business takes a small hit to the bottom line.

 

This means that most vets come in to work unless they have one foot in the grave.  I'll only call out if I'm having profuse vomiting or running a fever.  In just about every other circumstance I'm pushing through the illness and loading myself up on cold medicine in order to make it through the day.  I also try to avoid direct contact with clients (such as shaking hands) in order to minimize the spread of my illness.

 

There are many days when I and the other doctors in my practice continue to work when we'd tell one of our staff to go home.  I hate this reality, but it doesn't change the fact that it's not easy for us to simply decide that we're sick and want to stay in bed.  In fact, I think I've done that one time in 18 years in practice. 

 

So if you go to your vet and they are less energetic than normal or are moving and thinking slower than you're used to seeing, be patient with them.  They are probably working while sick and doing the best that they can to keep your pets healthy.

Spammers Are Horrible! Especially Liama Jhons!

Pardon me while I rant for a bit. 

 

Over the years my blog has developed a small following, and currently I average about 40,000 hits per month.  To me that's pretty cool, as I never expected to have a world-wide reach and dedicated readers.  But with the success comes a down side.....spammers.

Multiple times per week I get "spam" comments, and often multiple times per day.  Virtually every one of these posts contain a link to an outside website, and it's obvious that the person isn't really commenting on my writing.  Occasionally I'll get a post linking to a website having nothing to do with animals, such as a human hairloss site after I post about skin problems in dogs.  But most of the comments are related to the veterinary field, especially private veterinary practices.  From what I've been able to learn, it seems that the people making these comments are involved in Search Engine Optimization (SEO).  For those who don't understand that principle, it's basically a way to drive traffic to a website and increase its presence on search engines like Google and Bing.  If the SEO person puts a link in the comment, it gets that site's "presence" more on the Internet, and may cause some people to click on the link and go to their client's website.

I don't think most private veterinarians realize this is happening.  Several years ago I ended up actually calling and talking to a practice owner after someone repeatedly and annoyingly posted spam comments.  He was surprised and upset, and very apologetic.  He and others pay a company to increase their practices website recognition, and one method is to make these spam posts.

The rampant spamming is the main reason why I now moderate each and every comment that was made.  I hate having to do so, but if I allowed all comments to be published the problem would be even worse.  What frustrates me is that the people making these posts don't even bother to read the statement just above the comment box where I explicitly state that their post won't be published and they're wasting their time.  They do it anyway!  I can't believe how ignorant and hopeless these people are.

Here are some examples of the kinds of comments I get from these people.  You'll notice that they're very generic and I can promise you that they don't relate to the blog entry.  Each one of these had a link to another web site related to pet care or a veterinary practice, or even a non-veterinary site.

you are just too cool.  i really feel great to see such kind of outstanding stuff.

outstanding stuff.  i just really don't have words to explain my feelings.  please do have a looks into i.

Nice post.  Thanks for sharing this blog.  For any pet health issue I have recommend a well pet care specialist in Vista city, located in California.  This is the best Veterinary Practitioners in California.

it is too good too much impressive.  just simply loving it

Nice Post thanks for sharing information about hair loss and prevention tips more helpful for other persons.  Hair Transplant in Bangalore

After a few blog posts on your website now, and I truly like your way of blogging about Scrubs Inc.

This is an interesting blog that you have posted, you shares a lot of things about Puppy Dental Care, Basic Puppy Training and Dog Vaccinations UK.  Which are very informative to us  (This one I've had in the comments more than once, with no change in the wording).

Some of the posts start out seeming to be related to the blog entry, but quickly become generic and then have a link to a business at the end.  No matter how they state it, it's obvious to me that the ONLY reason for their post is to promote the website.  And I'm not going to allow my comment boxes to be filled up with stupid spam. 

Probably the single worst spammer is a person named Liama Jhons, who has a pet care website.  Yes, I'm calling out this person by their real name because they have been such a headache to me.  No, I won't post their website and I strongly discourage anyone from going there simply because of what an annoyance this person is.  I get comments from Liama just about every week, often more than once in a week, all rather nonsensical with a link to their website.  Liama has made more spam comments than any other person in the 6 1/2 year history of my blog.  It got to the point where I found their Google Plus profile and wrote them, asking it to stop.  I've now written a total of four times and have never received a response.  I've reported them for spam through the G+ system twice, and will probably do so again.  Despite all of these attempts to politely and not-so-politely ask them to stop making these comments, nothing has changed.  To me this means that not only are they ignorant beyond hope of redemption (ignoring my messages and the statement above the comments that I won't allow their comments to publish), but they are very deliberately ignoring me and are heartless enough that they simply don't care what anyone thinks about them.  Liama's only focus is to drive people to their website, and they don't care how they do it.  Maybe a little public shaming will help.  But I doubt it.

I know that my little rant won't make much of a difference, and these spammers will continue to try and make posts.  In fact, I will find it extremely ironic and not surprising if one comments on this blog post.


 

This Is Why She Can't Swallow

**WARNING** Mildly graphic images of surgery.......proceed at your own discretion. 

Recently one of my associate doctors saw an elderly lab mix because she was drooling and was having difficulty swallowing.  She couldn't eat well and the owner couldn't figure out why.  On the initial exam a mass was noted far back on the base of the tongue, but my associate couldn't determine whether or not it was an abscess, inflammatory lesion, or tumor.  The dog was placed on antibiotics and initially seemed to improve, but then worsened again.  The growth was so far back in the throat that it was difficult to see the full extent.  She was scheduled for a day when I was in so that she could be anesthetized, the mouth more fully examined, and a biopsy sample taken.

When I first examined the dog I had a hard time seeing much in the mouth.  She was actively resisting me, making it difficult to get a good look at that part of the tongue.  There was no way I was going to be able to really know what we were dealing with until she was unconscious.

We induced anesthesia and I opened the mouth to intubate her and look down the throat.  This is what I saw.

When I pulled on the tongue a little more it made the mass more visible.

No wonder she couldn't swallow food!  This was growing from the very back of her tongue, essentially down in the throat.  It was big enough that it was blocking the back of her throat, allowing very little to pass by it. 

I was very concerned, because as large as it was and in that location it was essentially inoperable.  It covered enough of the surface of the tongue that I wouldn't really be able to remove enough without taking a considerable amount of the tongue with it.  But as I felt around and examined it I realized that it looked worse than it really was.  There was a surprisingly narrow stalk growing from the surface of the tongue and then the mass bloomed outwards kind of like the structure of a mushroom.  In fact, it was narrow enough that I thought I'd be able to remove the whole thing with minimal damage to the tongue itself!

After a quick call to discuss the new findings, the owner agreed to let me try and take it off completely.  Here's what it looked like just prior to surgery.

And just after I removed the mass.

It appeared to be growing superficially and didn't obviously penetrate deep into the muscle of the organ.  I was able to get a small distance around the base, though I couldn't get the 2 cm margins that we ideally want when removing an unknown tumor.  The tissues came together nicely and the bleeding stopped quickly.  Here is what it looked like immediately after surgery was completed.

Here's a better look at the tumor itself post-operatively.  The whole thing was about 5 cm in diameter.

This is the underside of the mass, with the calipers showing the diameter of the tissue I actually removed.  The stalk itself was only about 1 cm wide, about 20% of the total size of the mass.

The dog recovered well and went home that night.  We talked to the owner the following morning to check on her, and they said that she ate like crazy that night.  Even with the soreness of the tongue, she was finally able to pass food down her throat!

The biopsy report came back as malignant melanoma, which I had strongly suspected based on its appearance. Thankfully the surgical margins were clean and there was no evidence of invasion into lymph tissue, so we may get lucky and not have any recurrence.

Apparently S.H.I.E.L.D. IDs Are Valid

Any regular reader will quickly learn that I'm quite the geek.  Just search my blog for the terms "cosplay" or "DragonCon" and you'll learn just how deep down the rabbit hole I go.  Last year when Captain America: The Winter Soldier came out in theaters there was a promotion on Cafe Press for a custom S.H.I.E.L.D. identification card.  For those who don't know, this is the spy organization from Marvel Comics and has played a prominent role in most of the Marvel Studios movies, including spawning a TV show.  Originally it stood for "Strategic Headquarters, International Espionage, Law-Enforcement Division", but was changed to "Strategic Hazard Intervention Espionage Logistics Directorate".  To further confuse things, those are from the comics and the movie universe uses "Strategic Homeland Intervention, Enforcement and Logistics Division".  No matter what it spells out, S.H.I.E.L.D. is an uber-cool group of secret agents going toe-to-toe with some of the most powerful superheroes and supervillains in comics.  And I was excited to be a card-carrying operative!

The card was free and I just had to pay shipping charges.  It cost less than $5 to get four cards, one for each member of the family, and it was cool to be able to load a photo, chose a role within the organization, and wait for it to come.  It wasn't a flimsy laminated piece of paper, but a direct printed hard plastic card, like any ID card.  Honestly it was a great value and of surprisingly high quality.  Of course I put it in my wallet, right in the window where my driver's license is supposed to go.

I thought it was just neat to have it.  But one time we were shopping and the cashier asked to see my ID when I payed with a debit card.  Just as a joke I flipped open my wallet, showing her my S.H.I.E.L.D. card, and fully expecting her to give me a strange look and ask to see my real ID.  To my great surprise she looked at it and then went ahead with the transaction.  She had used it as a valid ID, rather than a novelty one that I had made up!  Okay, that was highly amusing, but it couldn't happen again, right?  She was just careless, right?  So I tried it again in another store.  The same thing happened!  I couldn't believe it! 

Here's what it looks like when I open my wallet to show my ID.

And here's what the card looks like removed from my wallet.  Look closely at the photo.  It's from a picture of me at a Renaissance Faire and I'm wearing a cavalier hat!

By comparison, here is an example of a Georgia driver's license.

Over the last year I've used it more and more, trying to see how many people will accept a S.H.I.E.L.D. card as a valid ID.  And you know what?  Almost every single store and cashier has accepted it!  Wal-Mart, Hot Topic, The Disney Store, Target, and just about everywhere else I've shopped has looked at it, confirmed the name and picture, and then finished the transaction.  There have only been two businesses that have done a double-take and have asked for my real ID:  Dragon*Con and my local comic book store.  It should be no surprise that the businesses who make their living catering to geeks and selling Marvel merchandise would immediately noticed the rather large S.H.I.E.L.D. logo and name, calling it into question. The surprising part is that other businesses have no problem with it.

On one hand this is incredibly amusing to me, and I continue to use it when asked to show ID.  But on the other hand it's a bit frightening and disappointing.  Identity theft is rampant in today's society, and the reason behind asking to see an ID when someone pays by credit or debit card is to confirm that they are the person whose name is on the card and not a scam artist or thief.  If a $2 novelty ID can be accepted by 98% of cashiers, how secure is the process after all?

Or maybe S.H.I.E.L.D. really does exist, and by placing themselves in movies and comic books they make us think that they're fictional.  The cashiers know this and don't dare question me as part of the organization.

That's right.  Chris Bern, Agent of S.H.I.E.L.D.!