Translate This Blog

Friday, December 25, 2009

Happy Birthday

It's Christmas day, and the kids got up early to see what Santa brought them.  My wife and I exchanged some additional presents, and we have cinnamon rolls baking in the oven (a tradition in our house).  We're enjoying some relaxing family time, as well as the gifts we were given.  It's a pretty typical traditional Christmas.

I don't regret the secular aspects of the season, but sometimes we have to be reminded of the rest of it.  Did you know that today is a birthday?  How many of you have forgotten this?  Okay, yes, I know that Jesus was likely born in the Spring and that many "traditional" Christmas beliefs and decorations are related to pagan celebrations.  Christmas is a celebration of the birth of Jesus, and that is the focus of the holiday.  People many centuries ago chose this time to recognize His birth, and we continue that tradition today. 

The birth of Jesus Christ was one of the most defining moments in human history (and arguably THE most defining moment).  For Christians this is one of our most special celebrations, where we recognize the humble earthly beginnings of God's son.  And even if you're not a Christian, the coming of Jesus defined human civilization from that point forward.  A baby's birth is a joyous time...this is even more true when it is the birth of the Savior.

Part of my family's Christmas tradition is to recognize that this is a birthday.  We will read the Christmas story from the Bible, and make a birthday cake for Jesus.  It is important to us as parents to make sure that our children don't get so lost in the presents and decorations, and that they keep in mind the REAL reason for the holiday. 

So happy birthday to Jesus!  He is the greatest gift we could ever receive.

Thursday, December 24, 2009

The Night Before Christmas

It's Christmas eve, a day of excitement in our house.  It's our tradition, based off the Swedish customs, to open family presents on Christmas eve (Santa's presents are for Christmas morning).  Today is also special for our kids because we're going to see the new Alvin & the Chipmunks movie, which they have been anticipating for months.  Like most people, this day is about being together as a family.

I've taken this week off work to relax and have time with my family, and am so glad for that.  I can't remember the last time I've had this much time off to be at home.  Honestly, I probably needed it.  It's been so nice to relax and sleep late with my wife and spend more time with my kids.  We get so busy going hither-and-yon to get ready for Christmas that we often loose sight of what the holiday is really about.

I hope all of you around the world have a wonderful Christmas to celebrate with your own families!  Be joyous and show the spirit of love to each other!

Sunday, December 20, 2009

Facebook Follies

I've avoided joining Facebook for a long time. I'm not a highly social person, preferring a small circle of friends. For the most part I've kept in contact with those I wanted to (some better than others), and have no great desire to meet random people. I also saw how many people were clamoring to join Facebook, and didn't want to go with the crowd. I often said that I wouldn't join just out of principle.


A few days ago I joined. Most of it was due to my wife's gentle pressure, talking about how I could get in touch with some of my old friends better. Partly I also saw there were some interesting games, and I could put my pages in pirate lingo! So in the end, I did finally join. Little did I know what I was getting myself into.

Now I'm playing eight different games, have 41 mateys (errr...friends...pirate language y'know), and am madly loading pictures onto it. My wife tells me that this is typical when someone first joins, and it will calm down in a week or two. I hope so, because I don't think she realized what a monster she may have created.

Now I'll go ahead and forewarn any of my readers here that I likely won't accept any friend requests from people that I don't know personally. I'm pretty private with parts of my life, so please don't be offended if you read this blog and I don't take you as a friend on Facebook. It's nothing personal, just my way of compartmentalizing my life a bit.

I still can't believe that I finally went and did this....

Thursday, December 17, 2009

Time for Muppets

I grew up watching the original Muppet Show, and have never stopped loving Jim Henson's creations.  I have watched every movie and incarnation of the muppets since they first came on TV.  No matter how many times I see them, I still laugh at the same things.  Though all of them are great, I think that Animal is my favorite.  Just about everything he does makes me bust a gut.

Did you know that the muppets have their own YouTube channel? I just recently discovered this!  So here's a couple of my favorite clips from their MuppetsStudio (notice that both prominently feature Animal!).

Wednesday, December 16, 2009

The Humor In A Vet's Life

For all of the hardship, heartache, and difficult decisions in a veterinarian's day, there can be a surprising amount of humor.  Some of it happens naturally.  For example, a year ago I blogged about a particularly funny incident involving a canine University of Tennessee fan.  Some times the humor is completely incomprehensible to others, such as when one of my techs had his pants slip a little while handling a dog, exposing his "crack" a little.  One of the other techs stuck a catheter cap into the space.  Yeah, a bit childish and weird, but we all had a good laught about it.  Other times the humor is forced as you try to find ways to cope with a particularly difficult situation.

I certainly don't consider myself a humorist, though I would love to be.  I'm simply not witty enough to come up with anything funny on a regular basis.  But there are certainly vets who can and do.

Probably one of the kings of veterinary humor is Dr. Robert Miller.  He is currently retired but had a great and varied experience on just about every species imaginable.  He is most well known for his cartoons based around veterinary medicine.  Here's a link to his cartooning site.

Dr. Michael Obenski has been writing humorous columns for DVM Newsmagazine for over 30 years.  When I get that journal every month, his is the first article I look for.  His insights are spot-on (though may be not quite as humorous to the clients he is describing) and based on experiences that every small-animal vet can relate to. You can read some of his articles here.

Then there's Dr. Bo Brock, a mixed-animal practitioner from Texas.  Working on livestock and farm animals as well as pets, he gives a completely different perspective.  Also published in DVM Newsmagazine, you can read his articles here.

So does anyone else have any good resources for veterinary-specific humor?

Tuesday, December 15, 2009

An Allergic Vet?

Here's an interesting and excellent question...

My name is Jennifer. I am a student at West Valley College in Saratoga California. My assignment is to write a paper on a dream career or mine. I picked becoming a veterinarian, and found your site. My question is, Will having my allergies to certain animals (dogs, cats) affect me being a veterinarian? It would be greatly appriciated if you could get back to me Asap. Thank you so much. 

Jennifer, this is more common than you might think. As you mention, allergies tend to be to specific animals and not to all animals.  And there are ways around this problem.  If you have been working with an allergist, talk to him or her about desensitization medications or other ways you can medically handle the allergy.  In some cases regular antihistamines will control your disorder.  Allergy specialists routinely deal with similar situations and would be best suited to help you.

If your allergy is too strong for antihistamines but not problematic enough to see an allergist, you can choose not to work on certain species.  One of the great things about veterinary medicine is the great variety of things you can do with your training.  If you're allergic to dogs and cats, you can choose to limit your practice to horses or other livestock.  You can also choose to go into pathology or public health medicine where you're not actually working with patients. 

Sometimes your allergy will desensitize on its own.  I used to have a fairly strong allergy to cats until I got one of my own when I was in my early 20s.  Now I only have to worry about it if my hayfever is acting up and I touch my eyes after handling a cat.  My allergy is much less severe than it used to be.  However, sometimes the opposite happens.  My associate developed a severe allergy to rabbits as she got older.  It's bad enough that we can't have one stay in the hospital when she is working.  We see few enough rabbits that she simply doesn't see them, we put them in the farthest exam room when I see them, and if one needs to have surgery we schedule it on a day she is not there.

So don't give up on your dream if that's what you really want to do.  There are certainly ways to be a vet and deal with any allergies.

Monday, December 14, 2009

Practice Makes Perfect

Being a doctor isn't easy, and I don't think anyone would disagree with this comment. One of the hardest things to learn is how to take the information from the classroom and textbooks and apply it in a clinical setting.  This is why experienced doctors tend to make better clinical judgements than new graduates (everything else being equal).  It may not seem like it, but there can be a bit of disconnect between what is reported in the texts and what you may actually see.

It's common for doctors to talk about whether or not a patient "reads the textbook". This means that some cases present exactly like is described in the textbook.  For example, a hypothyroid patient would have a thinning coat, weight gain, and persistent skin infections.  However, some cases don't have classic characteristics, such as a diabetic patient without an increase in drinking or urinating.  It's easy for a doctor to read symptoms and lab results in a book or class notes and figure out what the disease is and how to treat it.  However, if the patient doesn't have all of the symptoms, or has some conflicting lab results, it can be difficult to make conclusions.  That's where experience and learned clinical judgement comes into play.

There is an art to medicine.  It takes experience to learn how to interpret lab results, determine what treatment is best, and how to implement that.  Lab results do not stand apart from the patient.  Two patients can have the same lab values but look and act differently. Conversely, you can have two patients with the same basic symptoms but radically different lab results.  You can have the same disease that presents in several different ways.  A newly graduated doctor has an incredible amount of "book knowledge", and knows a lot.  But they haven't learned how to apply that knowledge.  There is absolutely no way to teach this.  It only comes from seeing enough cases to learn the wide variety of presenting symptoms and clinical outcomes.

Believe me, this isn't disparaging newly graduated doctors.  Every single doctor was a "new grad" at one point, myself included.  I have had to learn many lessons of the years, and am a better doctor for it.  At the same time, I enjoy mentoring newer doctors as I always learn something from them. 

One reason for this entry is to caution laypeople about reading journal articles and text books and then interpreting their cases.  Yes, many times you can learn a lot and I don't discourage.  I also encourage people to be well-informed, ask their doctor lots of questions, and keep copies of lab results and medical notes.  But you have to be cautious in interpreting this information in light of your particular case. There is a reason why becoming a doctor takes years of intense education and why an experienced doctor's judgement is so critical.  Now, this doesn't mean that a given doctor will always be right...we're only human after all, and it's impossible to make perfect decisions every time.  But in general, an experienced doctor will know more than a new graduate and both will be able to handle cases better than a layperson.

For the educated layperson, this means that you should ask even more questions.  Like I mentioned last time, there is nothing wrong with respectfully questioning the "whys" of your doctor's decisions.  But a little knowledge can be a dangerous thing, and you should realize that no matter how much you read, this information can never compare to a doctor with the same information and years of experience.

Saturday, December 12, 2009

Never Be Afraid To Ask

In her comments to my last post, Stefani made these statements....

I get records every time I leave, and I go over them. I review bloodwork. I ask lots of questions about anesthetic protocols and monitoring. I go a place that uses licensed techs. I make specific requests. 

I wanted to bring these up for those who don't read the comments because they are great words of advice.  While I think that the average professional deserves some degree of initial trust (or you would never follow any recommendations the first time to went anywhere), I also think that full trust needs to be built.  Part of that depends on the professional you see acting in an appropriate, open, and ethical manner.  But a large part of that  depends on you as the client to do your part. 

A common bit of advice you will hear about medical treatments is to ask your doctor questions.  While I have mostly heard this in relation to human physicians, I also believe this holds true for veterinary doctors.  We as doctors understand what we're talking about, and try to explain it to people.  Unfortunately, some clients are afraid to admit that they don't know what in the heck the doctor is talking about.  And unfortunately some doctors (or other professionals) aren't good at communicating (though this doesn't make them incompetent).

Whenever I see a pet and I'm getting ready to leave a room, the last thing I always ask is "do you have any questions" or "is there anything else I can help you with."  I deliberately and actively make a point to ask something like this whether it's a well pet or a sick one.  I want to make sure that my clients always understand what I'm talking about.

I also strongly believe that any professional should be able to explain rationally, logically, and with evidence why they are doing or recommending something.  I certainly do so in my own practice.  That's why I don't mind when a client questions me or asks for more clarification.  I also have no problem with clients wanting copies of their medical notes or lab results.  If your doctor/vet/professional can't explain their rationalle or isn't willing to give you copies of the records, you most certainly should wonder why and possibly consider switching. You may or may not agree with your doctors reasons or conclusions, but medicine isn't always 100% certain.  Disagreement is okay, as long as the disagreement is for legitimate reasons.

Many doctors don't explain something further not out of a lack of caring, but because silence from a client is often interpreted as comprehension.  Always be willing to respectfully question your doctors, and never be afraid to ask questions.  Taking this attitude will only help you.

Friday, December 11, 2009

A Few Bad Apples

Over my lifetime (all 40 years of it so far) I have seen many people do reprehensable things.  Professional businessmen and CEOs who embezel and drive companies into the ground.  Ministers who steal or hire prostitutes.  Teachers who seduce and sexually abuse their students or other children.  Police officers who abuse their charges, physically beating them.  Respected officials who abuse their power.  Celebrities who are supposed to be role-models falling to drug and alcohol addiction.  And don't even get me started on the problems with politicians.

There's the old adage that a bad apple will spoil the whole bunch.  And I guess that it's human nature to see a prominent figure as a representative of their "type".  But is that really fair?  In recent news we're seeing a barrage of apparent infidelities performed by Tiger Woods.  Does this mean that all professional golfers are likely to be adulterers?  Remember Debra LaFave, the Tampa teacher who slept with her 14 year-old student?  Does this mean that all of my son's teachers secretly want to have sex with him?  Back in the '80s the televangelist Jimmy Swaggart infamously was outed over a relationship with a prostitute.  Should we assume that all preachers are secretly hiding scandalous behavior?

My recent discussion on the potential ramifications of increased legal awards in veterinary malpractice suits has brought this home to me because of similar views of my profession.  Most of the commenters on that entry appear to have a very strong view against veterinarians.  Reviewing some of these people's web sites makes it appear that veteriarians as a whole should not be trusted (and please forgive me if I'm mischaracterizing anyone's comments).  One web site seems to proudly boast that they have received "hundreds" of similar reports of horrible veterinary malpractice from around the world.  Reading these sites you would almost never want to take your pet to a vet again.  And I'm sure these people probably feel that way themselves, as the circumstances they describe seem particularly and legitimately heinous.

But let's put a bit of perspective on this.  Okay, so there are "hundreds" of reports.  Can we assume 500?  Just for the sake of numbers.  And that's from just one web site, so we can assume that only a small number of people contacted that webmaster.  It's also a safe bet that only a small percentage of malpractice concerns are ever reported.  So we need to increase that number many times.  Do you think that a 10-fold increase (5,000) is to small?  Let's go with a 100-fold increase, and say that there are 50,000 malpractice cases that happen. In the US alone there are approximately 200,000,000 veterinary visits annually by all pet owners.  So our 50k malpractice cases represents 0.025% of veterinary visits.  Well, maybe only 1 in 1000 malpractice cases are reported, so there are actually a half-million horrible and malicious veterinary visits annually.  Pretty big number, right?  But that's still only a fraction of one percent of all visits in the US alone, let alone the world.  Suddenly "hundreds" of reports from around the world is a prety miniscule number.

Please understand that I'm not trying to belittle the people who have had truly horrifying experiences with their pets, or who have to deal with someone who should have their medical license stripped from them.  I honestly feel regretful that someone with the same title as I have caused them and their loved ones so much unnecessary pain.  But let's not throw the baby out with the bathwater.  I fully agree that anyone (regardless of profession) who behaves abusively and unethically needs to be fully prosecuted and probably deserves anything they get in the process.  However, it's wrong and unjust to assume that all members of a given profession are automatically guilty of the same behaviors. 

I can honestly say that the huge majority of veterinarians that I've known and worked with are honest, ethical, compassionate, and thorough people.  Yes, there are bad apples in my profession, as there are in EVERY profession out there.  Unfortunately, some people fall victim to laziness, greed, anger, and any other sin.  That most certainly does NOT excuse their behavior, and they need to be faced with the consequences of such actions.  However, I would ask people to exercise some common sense and discretion and not let these people spoil their view of the whole bunch.

Thursday, December 10, 2009

Caffeinated Happiness

I have discovered a very important thing about myself.  I am a much happier person when I am full of caffeine.  I'm not much of a coffee drinker, but I drink sodas almost daily (diet only...trying to keep at my goal weight).  Yes, too much caffeine is bad for you, especially with some diseases.  But I'm otherwise healthy so I don't worry about it.  Caffeine doesn't really hype me up too much.  It does get me energized when I'm dragging, but I normally don't get hyperactive on it. 

Does that mean that I'm addicted?  Probably.  But I'm not as bad as some people I've known.  I don't keep an energy drink around, and rarely even buy them (y'know, Red Bull and similar drinks).  I have at most 2-3 sodas per day, and if I have coffee it's no more than a cup.  I know people that need 2-3 cups of coffee just to get going in the morning!  But I definitely do better and am more pleasant with caffeine in my system.

My wife has learned this also.  When I'm feeling frustrated or depressed, she tries to talk me into pumping up on caffeine.  And I can't say that this is a bad thing.  I never realized it until recently, but I feel happier and joke around more when I have had caffeine.

I guess there are worse things to be addicted to.  At least this particular addiction is legal!

Tuesday, December 8, 2009

Phosphorous Problems

This question comes from Barbara...

My question is what is the highest abnormal phosphorus level that a canine has ever been successfully treated for without total loss of kidney function and maintained on diet & medications. And is there a citable article in any journals?

First, a little bit of explanation on what abnormally high phosphorous levels mean.  There are several things that can cause the phosphorous levels in the blood to increase. The most common reason is for renal (kidney) disease.  As the kidneys fail in their function, phosphorous is retained in the body rather than being expelled.  Other causes can include low parathyroid hormone levels, increased intestinal absorption, acromegaly (a growth disorder), destructive bone lesions, and normal bone growth (mainly in puppies and kittens).  The main thing to keep in mind is that high phosphorous is NOT a disease.  Phosphorous levels don't increase without another reason, and therefore this value is used as an indication of other disease rather than a marker of a specific disorder.

Now let's talk renal disease specifically.  There are numerous reasons why the kidneys may quit functioning, including toxins, genetic tendencies, cancer, and age.  We use several values to assess renal disease, most commonly creatinine, blood urea nitrogen (BUN), and phosphorous.  It is common to have increases in creatininine and BUN with phosphorous remaining normal.  In my experience, if the phosphorous is also eleveated, it indicates a more severe renal insufficiency.  Once the kidneys are damaged, they do not heal.  This fact makes renal failure difficult to treat in pets, and often leads to euthanasia.

Treatment for renal failure is multi-modal.  Special diets are required to help reduce protein stress to the kidney and minimize certain minerals (such as phosphorous).  Fluid therapy may be used to help increase the flushing through the kidneys, helping to prevent build-up of toxic chemicals in the body.  With increased phosphorous levels, medications may be used to bind the phosphoruous and reduce its absorption in the intestines (usually with common antacids!).  Depeding on the cause, other medications may be used to try and more directly treat the underlying problem.

Now back to the question...Barbara, focusing on the phosporous level is not looking at the whole picture.  In your case it sounds like the elevated phosphorous was due to kidney failure.  You need to look at all of the renal values and the urine values and not focus on a single lab value.  If the kidneys are being treated well and phosphate binders are used, the blood phosphorous levels should be controllable.  If the BUN and creatinine are normalized but phosphorous is still high, then more testing is needed to determine why this value is not falling.

The "highest level ever treated" is simply not something that is recorded or even important to doctors.  Journals don't track this data and truthfully it isn't clinically relevant.  Normal phosphorous value can range from 3.0-8.0 depending on the lab or equipment used.  I have seen phosphorous values in the upper teens to low 20s in my own cases.  But truthfully whether a value is 15, 20, 25, or higher doesn't really matter to me.  All of these are significant elevations, and I'm going to treat them all in the same way:  phosphate binders and try to address the underlying cause.  Diagnostic laboratories do keep track of these values to determine what a "normal" range is, but a "highest ever" would be what is statistically called an "outlier" and is insignificant in the analysis of normal ranges.  Therefore these values aren't reported to the profession at large.  Journal articles also don't focus on these extreme values, but instead discuss clinical relevance, especially in the larger picture of the disorder as a whole.  So I hate to say it, Barbara, but your question isn't something that can be answered. 

I hope this at least explains things a little better.  Feel free to ask any follow-up questions.

Saturday, December 5, 2009

Sue For Emotion?

It happens from time to time that people will threaten to sue for one problem or another.  Here in the US, as well as in many parts of the Western world, there are people that are ready to jump into the legal system to solve their problems.  Often, this is because of money rather than a true need for justice.  When human medical malpractice settlements and judgements can easily be in the millions of dollars, it's easy to see why some people would be tempted.  But it is quite different in veterinary malpractice claims. 

Pets are considered a special kind of property by the legal system.  Due to this status, a pet owner can only sue for the actual value of the "property" and any medical costs incurred.  For a breeding animal this dollar figure can be in the thousands of dollars due to lost potential revenue.  For a stray it may be less than $100.  Currently people cannot sue for emotional damages due to the loss of the pet, similar to how they cannot sue for emotional damages due to the loss of a car or television.  But this attitude may be changing.

Over the last century the status of pets has changed.  We have allowed them into our homes, families, and beds, and now consider them a part of our extended family.  We have closer bonds to them in ways that were very uncommon 100 years ago.  Our emotional ties have grown as our societies have moved from rural to urban and we have brought our pets in closer contact to our daily lives.  These stronger bonds mean that we often feel the loss even more acutely.  The loss of a pet can generate genuine emotional distress.

And vets are encouraging this.  We celebrate that human-pet bond, calling pets "furry children" and the owners "parents".  In my own practice we delierately call our patients "pets" rather than "animals" to help enhance and recognize this bond.  As medical professionals, we want our clients to care about their pets as much as they do about their children, and get upset when the people don't seem to care as much as we think they should.  Many vets and pet stores sell clothing and other things for pets that make them seem like little people.

As vets we have very low malpractice insurance costs.  I have to pay less than $300 per year to get a $1 million coverage policy.  The same level of insurance for a human physician can be anywhere from $20-40,000 per year.  Someone in a higher risk field such as obstetrics may have to pay $100,000 to get adequate coverage.  Truthfully this has become a crisis in human medicine.  There are more and more doctors getting out of higher-risk fields and specialties due to the outrageous insurance costs.  Doctors are also leaving certain parts of the countries where the courts have historically allowed extremely high settlements.  And a large part of the reason why human health care is so expensive is due to the multi-million dollar settlements and the insurance necessary to cover the doctors.

Now here is the dilemma.  As veterinarians we see what has happened in the human field, and don't want that to happen to us. We pay literally 1/100th of the insurance costs of human doctors, and we don't have to deal with outrageous lawsuits.  Yet we want people to have strong emotional ties with their pets and strongly promote these bonds.  In essence we want to have our cake and eat it to.  We want people to be emotionally attached to their pets but don't want them to be able to sue for damage to this bond. It is also hard for the pet owners, because if we have to start paying higher malpractice insurance costs, these costs will be passed on to the consumer, meaning higher charges on veterinary services.  It also means that we are going to need to be running more diagnostic tests to cover ourselves much like human physicians have to do.

And that brings me to last month's survey.  I asked if pet owners should be able to sue for pain and suffering even if it increased the costs of medical care.  And it seems like people aren't really sure. There was an even split for and against the idea, with 27% each.  And 44% simply didn't know.  As you can see this is a complicated issue.  If people can sue for emotional suffering for themselves or their pets, medical costs will rise. Yet the courts recognize awards for similar suffering in humans, and we are encouraging such bonds and ties with pets.

There are already movements in certain districts in the US to allow pain and suffering awards, though so far only up to a few thousand dollars.  As pets become more integral in our lives, we will likely see this legal trend continue.  And if it does, expect to pay more at your vet.

Thursday, December 3, 2009

Fun With Words

Here's a weird thing about me (one of many)....there are certain words I just love to hear and say.  I don't know why, but some words simply sound interesting to me, or I love the specific meaning that they give.  Here are some examples....


Language can be fun, and I enjoy learning about the origins and underlying meaning of words and phrases.  The English language is such a hodge-podge (there's another good one!) of words from other cultures and languages and is constantly evolving that some people spend their lives studying it.  Unfortunately, people often butcher words, usually unintentionally.  I have learned to live with these mistakes, but it still bothers me sometimes.  For example, there is no such word as "irregardless".  It's simply "regardless".

Anyone else have this quirk?  I'd love to hear other words that people find interesting/alluring/gripping/intriguing/etc.

Wednesday, December 2, 2009

Cat Vs. Fan Belt

As the weather in the Northern Hemisphere gets cooler, everyone needs to be aware of a very tragic possibility.  When temperatures drop, cats will often dry to find warm, dry places.  This all too commonly includes a car's engine.  The cat will climb up into it from underneath and make themselves cozy.  The person doesn't notice the cat there until the engine is turned on and the cat gets caught in the fan belt or other moving parts.  And this can be a very, very bad thing.

Today I saw a cat unfortunate enough to have this happen to her.  She was an indoor cat that had somehow managed to sneak out without the owner knowing.  He got into his truck and drove to his mother's house.  He never knew that she was in the engine until he turned the motor off and heard her screaming.  They had to literally take apart the engine to get her out, and they're not sure if it will ever run properly again.  She was rushed into my clinic and brought straight back to me.

As soon as I saw her I knew it wouldn't be good or easy.  I have heard of cats that have literally been cut in half in situations like this, and thankfully that wasn't the case here.  But part of her tail had been chopped off and her left hind leg was a mess.  The tibia (long bone in the lower leg) was shattered and completely exposed, with marrow missing from the center.  The skin and muscle was stripped from the bone from the upper leg down to the ankle, and I could see the bones in the ankle joint.  Several of her teeth were chipped, likely from her chewing at the engine.  The claws on all her paws were torn and bloodied by her attempts to escape.  There may have been internal injuries, but I couldn't see anything else at first glance.

Even given all of that there was a chance of saving her.  She would have had to be stabilized first, as she was in shock, and then had her leg and tail amputated.  If there were no other injuries, she could have ben okay.  However, she was looking at close to $2000 worth of medical care in the next 24 hours, and this wasn't a financial possibility.  In the end, we elected to euthanize her, as there was no way she could survive without extensive care and surgery.

This is a tragic accident, and one that is difficult to prevent.  It's hard to check your engine every time, but try to be aware of the possibility.

Tuesday, December 1, 2009

Never Work With Children

An adage in Hollywood is that you should never work with kids and animals.  I'm finding this out all too clearly.  My family is currently involved in a production of The Best Christmas Pageant Ever.  Most of this cast is children, about 20 in total.  And oh, my gosh this is crazy! 

I wasn't planning on being in another play so soon, but got talked into it by my darling wife and the director.  Thankfully I only have five lines in one scene, so it's a pretty quick and easy appearance.  Unfortunately, that means that I spend most of my time backstage, trying to wrangle a couple of dozen teens and pre-teens that don't seem to understand the meaning of the words "keep quiet". There is constant chatter and noise, which can be heard in the theater if we're not careful. So I am constantly "shhhhh"ing the kids, snapping my fingers, and otherwise trying to get them to understand that a true whisper can't be heard across a room.  All of a sudden I feel like I have 20 kids of my own!

The first show is this Friday, and we'll have a total of seven performances over the following week.  Hopefully we can get through this without me duct-taping some of the kids to their seats.

Thursday, November 26, 2009


Today in the US was the holiday of Thanksgiving.  The origins are meant to celebrate how some of the original English colonists made it through a hard winter with the help of Indians and gave thanks afterwards. But nowadays it is mostly a time to get off work, eat a ton of food, hang out with family, and prepare for huge after-Thanksgiving sales in the stores.

We're also supposed to reflect on the things we are thankful for.  Many people find this difficult in the current economy, with job losses, lower pay, and less joy overall.  But I think if anyone tries hard enough, they can find something to give thanks about.

I'm thankful for God and His blessings.  For my beautiful and wonderful wife, who is endlessly patient with me.  For two great children who fill my life with joy and help teach me patience.  For a good job with great prospects.  For a healthy family and money in the bank (though barely so!).  For a father who has given me great guidance over the years and continues to be proud of me.

Everyone has different traditions on this holiday.  We do the standard ones of eating, spending time with family, and goofing off.  But a bit of a different sort of thing that we do in the Bern household is decorate for Christmas.  I take care of the lights and outside decorations while my wife makes things festive inside.  Yeah, I know we have a full month until Christmas, but we love the season so much that we can't wait to get it all up.

I hope that all of you can find something to be thankful for, and that you enjoy your own traditions.  Happy Thanksgiving!

Wednesday, November 25, 2009

A Cat's Dietary Needs

Clearing out my inbox, Jodi poses this set of questions about feline nutrition.

why does it seem that so few veterinarians are interested in nutrition?? I believe a cat is a carnivore .Isnt an ideal diet one that consists of high qulity meat, very little carbohydrate, and no grain? My mothers cat has struvite crystals and bladder stones......all he has eaten is good quality canned food and very little dry. the special diet the vet wants him to eat is garbage!
Since when do cats eat corn? and wheat? and by prodcuts and artificial (and toxic) preservatives?

Isn't there a way to feed him and acidifying diet that has good quality nutrition? Even if this diet gets rid of his problem how can it be good for him?? He'll be free of crystals but malnourished!

Thank you for any help or resources you may have,

Well, Jodi, nutrition is actually much more complicated that it may first seem, and many veterinary schools don't emphasize this particular topic enough (in my opinion).  I have done a lot of personal research on this in the last year because I realized the failings in my own knowledge.

You have to realize that pet food is a bit of a compromise.  Until someone is able to create and successfully market a cat food that is made up of ground whole rodents and birds, we won't be 100% accurate in replicating a cat's natural food.  And truthfully, do we want to duplicate the natural conditions of cats?  Pet cats live far longer, healthier lives than wild ones, and that is in part due to good nutrition.

However, I concede that the current diets are not always ideal.  Recent research has suggested and supported the viewpoint that our feline friends should have a "catkins" diet.  This means high protein and low carbohydrates.  A few studies have shown that this helps regulate weight, lean muscle mass, and blood sugar levels better than the typical foods.  However, the only way you're going to get the right balance of protein and carbs is in canned food.  Canned foods are more expensive and more hassle to feed daily than dry foods.  In order to make a food maintain it's shape and consistency as a dry kibble, you have to have more carbohydrates than might otherwise be ideal.  This is most commonly and inexpensively achieved through the ingredients of corn, wheat, and rice.

Now the first thing to realize is that corn and wheat are NOT poor nutrition.  Ground corn is actually very nutritionally dense, and is not filler.  I have consulted with several independent veterinary nutritional specialists to come to this realization.  No, it's not a natural part of the diet of a wild cat, but I doubt you're going to feed such a diet. When you're ready to go to the pet store and buy mice, hamsters, and small lizards to give to your cat as it's food, then we can talk about the realities of a "natural" diet.

Along a similar line, by-products are NOT bad.  Here's the official definition used by the Association of American Feed Control Officials (AAFCO), the organization that determines the nutritional requirements of all pet foods sold in America.
The non-rendered, clean parts, other than meat, derived from slaughtered mammals. It includes, but is not limited to, lungs, spleen, kidneys, brain, livers, blood, bone, partially defatted low temperature fatty tissue, and stomachs and intestines freed of their contents. It does not include hair, horns, teeth and hoofs.
Think about this for a minute.  In the wild, what do dogs and cats eat?  Do they eat only the muscle meat?  Nope.  They eat the entire animal, including organs and bones.  And that's exactly what by-products are! So you can in no way say that by-products are poor nutrition.  In fact, there are many important nutrients found in organs such as the liver that you can't find in muscle (what we normally term "meat").

Here are a few other probably little-known facts. 

AAFCO mandates minimal nutritional requirements in any pet food sold in the US, regardless of who manufactures it.  Now admittedly, the food company can meet these requirements by nutritional analysis rather than actually feeding it to pets.  Look on the label somewhere around the ingredients list.  If it says "tested" or words to that effect, then a nutritional analysis was made on pets actually fed the food;  "formulated" means a chemical analysis of the food was done without testing.  Testing the food is a better analysis of the quality than merely formulating it, though formulating can be acceptable if the company is good.

ALL cat foods currently on the US market will acidify the urine!  That is a legal requirement mandated by AAFCO.  Decades ago the incident rate of struvate crystals in cats was very high.  It was discovered that by acidifying the urine, we could help prevent formation of these crystals (which can lead to bladder infections and stones), and so it became a requirement of cat foods. However, there is another type of crystal, calcium oxalate, which will form in acidic urine!  And this type of stone is much harder to deal with than struvite.  So really, we traded a tendency for one kind of crystal for another one.

Crystal formation is also more complicated than merely the pH of the urine.  Many other things play a factor, including genetics, urine concentration, mineral intake, and so on.  There are some dogs and cats that will develop bladder stones despite the best diets and medications. 

So what can you do?  First, follow the vet's recommendations.  A pet with a tendency for these stones needs to be on a specific diet.  This may acidify the urine, but ideally should result in a moderate to slightly acidic pH.  If you get too acidic you can increase the risk of calcium oxalate stones.  You also want dilute urine.  This means that the food should be designed to promote drinking water (by slightly increasing salt content and therefore stimulating thirst) or by containing more water, such as in canned foods. 

I can assure you that by feeding these recommended diets the cat will NOT be malnourished.  We have many decades and millions upon millions of dollars worth of research to show that these diets give complete and balanced nutrition.  And it's not all done by food companies to promote their products.  Much of this data is from independent, government-sponsored, or university-sponsored research.  And even the data from the food manufacturers can't be discounted, as it is reviewed and studied by people outside of the food industry.  It's also in the manufacturers' best interest to have high-quality foods that promote healthy pets.

Hopefully this helps answer your questions, Jodi, and shows you some of the realities behind pet nutrition.

Tuesday, November 24, 2009

A Medical Mystery

Here's a truly bizarre case sent in by Erin. 

Okay, this is going to be kind of long so I apologize in advance. Let me just say first that we have had our 4yr old beagle, Daisy, to at least 11 different vets, including one internist in Jacksonville, FL as well as the vets at Auburn University's small animal clinic. Whew! :) Okay. After seeing all of those vets and endless tests we still do not know what's wrong with her. Here are her symptoms:

About every 3-7 days she'll have what I call an "episode" where out of the blue she'll start frantically licking the floor (or anything else), and swallowing in a very exaggerated manner. She'll make this sucking noise through her nose (not  reverse sneezing) and swallow more as if she can't get something down. She will also occasionally hack and cough up white foamy mucus and sometimes stomach contents. This can literally go on for HOURS. If we crate her she will lick anything she can get her mouth on, if we don't she'll eat fuzz off the floor that she wouldn't normally touch. If I hold her she'll just continue to lick the air or occasionally try and eat my hair. When she finally does settle down, usually from exhaustion, she'll wake up and cough a mucusy sounding cough occasionally. She's been examined by internists and we've talked to a neurologist and a behaviorist. Nothing....

Here are links to some videos that we took:

Anyway, on a normal day her breathing will sometimes sound congested and we're pretty sure she has allergies, although she hasn't been tested.

Tests we've done (all were normal):

Endoscopy (only throat and back of nasal cavity
Full blood panel (several times)
Throat Wash
Chest X-rays (several times)
Abdomen X-rays
Sinus X-rays (also looked at her throat)
Urinalysis and Fecal tests
Heartworm tests regularly

(I think that's it...)

Meds/things we've tried that don't work:
Many antihistamines (both prescription and over-the-counter)
Pepcid and Tagemet
Food Trials
Several Antibiotics
Anti-nausea meds (both liquid and a shot during one of her episodes)
Valium during an episode

(That's all I can think of right now)

What works (don't know why):
Giving at least 1 Temaril-P per day, every day
During an episode, letting her completely gorge, and I do mean gorge, herself on grass. Sometimes she throws it back up, sometimes she doesn't. But she'll eat it for as long as I'll let her for the most part, or until her belly is bulging.

So basically, no one knows what's wrong with her and we've been dealing with this since we adopted her two years ago. It's stressful and it makes me sad that she has to go through this. Anyway, all the vets we've seen are stumped and any advice you may have would be wonderful. I'm just trying to get as many opinions as I can, hoping that someone may have seen something like this before. The vets at Auburn want to do surgery and explore her stomach to see if she has a sliding hernia, but a)it's extremely expensive b)they're not even sure that's what she has, so it could be pointless and c)I just don't know if I want to put her through it if we aren't sure it will give us an answer.

Anyway, sorry this was so long. Hopefully you can make sense out of it! I greatly appreciate any direction you may be able to give.

Wow, Erin, that’s some problem!  And I hate to tell you, but I’m not going to be much help either.  But there are a few things that I can try to share.  First, if this many specialists at this many high-quality locations can’t figure it out, then I hate to say it but I’m concerned that you won’t find answers too easily.  Honestly, I can’t think of any problems I’ve heard of that has gone through this many doctors without being solved.

One of my first impressions on watching the video was of an unusual kind of seizure activity.  But from what you’ve stated here, this has been ruled out by specialists and anti-seizure medication.  And all of the other tests would rule out many of the other things I would consider.

Temaril-P is medication mostly used for allergies.  It is a combination of a steroid and an antihistamine with the two of them working synergistically.  I do have one question, though.  You said that antihistamines alone don’t help.  Have you tried prednisone by itself?  I would suspect that it would help, which may indicate that this is an inflammatory process.  The inflammation could be caused by allergies or by some other situation.  If steroids help, they may the only solution that helps even a little.  As much as we don’t like to use them long-term, sometimes we have to.

Sorry I couldn’t give you a better answer, but you’ve already been to some of the top people in the field.  Good luck.

Monday, November 23, 2009

Sore Throat

Matt sends this in,

The last couple of days my dog has been yelping out of nowhere, and when she barks it is a bark that quickly turns to a yelp.  We removed her collars thinking it was maybe constricting her throat but in the last day she has been less active and just lays around yelping occassionally.  She still has an appetite but you can tell that it is difficult for her to swallow.  Is there anything we can do to cause her to expel the object and help it's way down the rest of the way if you feel it is indeed an object in her airway?

If there was something truly stuck in her throat, she likely wouldn't be eating, or would have more difficulty breathing.  Honestly, "stuck in the throat" is a common concern of clients but is a rare occurence.  She could have laryngitis or a similar inflammatory process in the esophagus or trachea.  It may also be a problem in her neck, with the muscles being sore or a partially slipped disc in the neck.  In these cases, any sudden movement of the head or neck can cause pain.

I definitely recommend taking her to your vet as soon as you can.  This is something that needs to be seen in-person, and your vet can help figure out exactly what is wrong.

Saturday, November 21, 2009

Reverse Sneezing

It's common for vets to get clients concerned about a strange coughing/sneezing/hacking/wheezing in their dogs.  It's a scary thing to watch, as it seems like the dog can't breath, and people worry that they might die or have severe problems.  Most vets, myself included, have actually gotten pretty good at duplicating the noise as we try to figure out what the problem is.  But now I can go one better.  Here's a video...

This condition is called reverse sneezing, and it's just like the name implies.  It's basically a sneeze that goes backwards in the throat rather than forward out the nose.  Anything that irritates the nasal passages can potentially trigger it, such as allergies, dust, strong odors, or even rapid movement of air through the nose.  As disconcerting as this may seem, it's really a harmless condition.  If it happens frequently, talk to your vet about using antihistamines to help.  If it's infrequent, you really don't have to worry about it.  Some people have advocated holding the nose closed to force the dog to breathe through the mouth, which will stop the sneezing.  This method has debatable effectiveness, and I don't normally recommend it.

The main thing to keep in mind is that this is a harmless condition that doesn't cause any long-term effects.


Thursday, November 19, 2009

The Joy Of Play

There's a video making it's rounds of the Internet that you may have seen.  A lecturer at the conference I attended last week had it in his presentation, and my father sent it to me today.

This is incredibly adorable and cute!  But I think it reminds us how important play is.  As adults we get so bogged down in our work, bills, and life troubles.  We wish we could be as free as our kids, and marvel at how much they enjoy playing.  Don't we forget to play enough? How many of us can just revel in the sheer joy of the moment?  We forget what even animals know.  As part of my degree in animal behavior I studied play behaviors.  One thing that surprised me is how universal certain stances and actions are across mammals.  Wide eyes, open mouth, a lowered front end, and a raised hind end indicate a desire to play in many different species.  Play is actually universal, and can be witnessed in many different kinds of animals.  Why do adult humans have to be the exception?

So take some time today to play.  You may not have a mud puddle to jump in, but you can find something.  Enjoy the day!

Wednesday, November 18, 2009

Skeeter Update

Back in July, I received a question about a very strange case (you can review it here).  Last week I received this update from Denise.

I am sure you remember me, I have the cat 'Skeeter' and you ran a post on her and helped me when her wrists had broken down.  I wanted to update you.  Skeeter deserves to be on the show Medical Mysteries.  

When the 8 kittens went to kitten food, I had them on Purina One Chicken and Rice Kitten.  At about 6 or 7 mos old I believe, could have been sooner, I switched them to Diamond Naturals Kitten food.  If you recall she was about 10 mos when I noticed the wrists breaking down. 

A few months later I switched her and all my others back to Purina One Chicken and Rice.  The second week of October (she was at this time 13 mos old) I noticed she was not toeing in so much and that her wrists were straightening out.  I attached two photos taken the 13th, showing how they were straightening out on their very own.  Today they are almost perfect, I need to get updated photos. 

We did not go for surgery or any treatment and she has not been spayed even.  With my daughter having a baby we opted to hold off, more monetary wise than anything and hoping to get her to CSU when we move back to Denver.  Skeeter's wrists broke down even more in August and September and I was really getting worried about her legs and healthy lifespan.  But wham, all of a sudden they fixed themselves.  Nothing else has changed, I am not sure if the food is what caused it and corrected it with switching back or what happened.  Maybe a calcium deficiency in the Diamond?  I would think that Diamond beats Purina in nutrition but my cats have always done very well on it, healthy, happy, super shiny coats, and now the mystery cure for her. 

One thing I am so glad about is, that I did not have the money for surgery and we were forced to wait, or we probably would have had he go through the surgery. She would have had both front legs fused for life and the problems that probably would have come later from the surgery, and for nothing.  Her legs just keep getting stronger.  Right
now I suppose it is a mystery if they will stay corrected, but it so far it appears they will.  She is back to retrieving and playing like she did prior, she is back to herself.  She is a beautiful cat and this is just amazing.

Do you have a clue?   I am just so elated and was so stoked when I noticed they were correcting them self.  So bizarre but a true blessing!

That is certainly a strange situation.  Purina ONE is a good food, and the Purina company overall does good nutritional research.  But I don't think it would be significantly different than Diamond, which is also a good food.  I doubt it was a single deficiency in the food, as you would notice it with your other kittens.  Also, a severe calcium deficiency would have resulted in more problems than dropped wrists.  Honestly, I think that they probably healed on their own as she continued to grow and develop.  A very, very odd case! I sometimes tell clients that pets will get better in spite of us rather than because of us.  In the end, I'm not bothered by this as long as the pet is better.  Keep me updated on Skeeter!

Monday, November 9, 2009

Oh, My Achin' Butt

It's time for continuing education again, something that most professionals have to do. Once or twice each year I go to a conference to learn about new developments or procedures in veterinary medicine, refresh my memory on things I thought I knew, and get free stuff from the various vendors. It can be very interesting and educational, but most of us run into a common problem...butt fatigue.

You see, most vets are pretty active people at work. We're going from room to room and case to case. On our busiest days we may never sit down and may not even have time for a lunch break. Our minds are having to shift gears every 10-20 minutes as new patiets come in, hospitalized patients get discharged, or lab results become available. Mentally and physically we're pretty much on the go for the whole workday.

Now take a normally active person and make them sit in a chair for 1-2 hours at a time for an entire 8 hour day. Ouch! Even in the most engaging lecture I'll find myself getting bored and restless. My hind end starts to literally hurt and I'm shifting positions to keep comfortable. In one of my lectures this morning we didn't have a break for an entire 2 hour period. For someone who is normally moving around a lot, this is a minor form of torture.

But we get through it. My colleagues and I know that we have to go through this to keep ourselves informed about current medical trends and information so that we can be the best doctors possible. I guess it makes us appreciate those days when our feet hurt instead of our behinds.

Friday, November 6, 2009

No Longer "Swine" Flu

The spread of the H1N1 influenza virus, commonly called swine flu, has been a bit of a panic for many people world-wide. Back in September I blogged about the flu, and said that pets couldn't get it.  I made that statement because at the time there was no evidence of that.  I now have to change that opinion. 

Here in the US it has been confirmed that at least one cat became sick with H1N1, though it survived.  Several ferrets have been confirmed to contract it and died.  This last fact is not surprising, as ferrets are very susceptible to human influenza viruses.  But the fact that a cat contracted it is more concerning.

Viruses can mutate to change and affect different species.  The virus we now call parvo mutated from the feline panleukopenia virus to be able to affect dogs.  Now only canines can get parvo even though is started as a strain of feline disease.  HIV mutated from a monkey disease to affect humans.  Avian flu has changed to be able to affect species other than birds.  And now H1N1 is affecting species it has never been seen in.

As scary as this may seem on the surface, I would caution people not to panic.  In the recent cases of this cat and the ferrets, the pets acquired the disease from their owners, not the other way around.  And these are extremely isolated cases, the only ones documented so far.  However, if the disease goes one way it can also go another, so a risk of transmission from pets to people is not impossible.  Sick pets should be taken to see the vet, but any human risk is extremely low.  Be cautious, but don't be overly concerned. 

Thursday, November 5, 2009

Too Easy Tech?

My associate vet told me about a rather strange situation that happened to her.  When her husband looked at their cell phone bill, apparently there was $80 in songs downloaded to her phone.  She had no idea how this had happened, as she didn't do it herself.  After some investigating they realized that their 16 month-old daughter had done it!  Apparently if you hit the "Select" button on her phone three times in a row, you've gone through the proper menus to order a song.  So their little girl was playing with the phone and by simply pressing buttons had ordered dozens of songs!  Her mother didn't even know how to do it!

My kids are older, 6 (almost 7) and 8, and they have been able to use the camera on our cell phones for a few years now.  It took them no time at all to figure it out, and we had to disallow them from playing with the phones because my wife and I would sometimes find odd pictures or videos on our phone.  These kinds of things come naturally to this generation, and it almost seems like they were born with a BlackBerry in their hands. 

This is a generational thing, and completely natural.  I know that I have always been far more tech-savvy than my parents.  I remember when my parents got a new RV and my father was trying to figure out how to set the clock on the microwave.  By the time he looked and found the instructions in the manual, I had simply looked at it, figured it out, and set the proper time.  With the speed of technological development nowadays it can be hard for adults to keep up.  But the kids grow up around this and find it easy and expected.  My kids have never known a time when cell phones, laptops, satellite TV, and video games didn't exist. 

Thankfully I'm a bit of a geek and technophile, and I can still surpass my kids.  However, I'm waiting for the day when I get a new holographic projector and while I'm perusing the instructions my son just walks up and gets it running. 

Wednesday, November 4, 2009

Rockwilders and Datsuns

One of the things I have to sometimes snicker and shake my head at is the way that many people butcher the names of certain breeds.  It's even more amusing and pitiful if the client actually owns that breed!  And having practiced in many parts of the country, I can't say that it's localized to one region. I can somewhat understand that people may have a problem with some names, as many breed names are from countries that don't have English as the primary language.  But these people usually are completely confident in what they call the breed and are completely ignorant of the proper name.  Let me give you some examples....

Rottweiler--I commonly hear them called "rockwilders", which butchers the name in so many ways.
Dachshund--I've heard both "datsun" and "dash-hound"
Shih-tzu--Oh, don't get me started on this one!  "Shit-zoo", "shee-zoo", and so many other mistakes.

I'm sure there are others that I haven't heard or just can't recall.  Really, it gets humorous until you realize that the people are completely serious.

Anyone have other examples of breed names you've heard people mess up?

Monday, November 2, 2009

Leave The Horses Alone

So this month's poll is finished, and it probably isn't too surprising.

It is acceptable to slaughter horses for food:  18%
It isn't acceptable:  66%
Not sure:  15%

As I mentioned when the poll began, eating meat has a cultural bias.  What might be perfectly acceptable in one country would be completely abhorent in another.  In this case, eating horse meat is considered common and even a delicacy in many parts of the world, including parts of Europe.  In the US I bet there are many people who aren't even aware that this goes on, let alone that there is a controversy.  Because of the bond that Americans have with horses and the importance that these animals have had in the development of our country, it would be strange for most people to consider killing them for food.

Now, my discussion hinges on humane treatment of these animals, including housing and slaughter.  I know that this doesn't always happen, and I am against that as well.  But I also realize that many animals exist in their current breed or state merely because we humans decided that they were a food source.  We have selectively bred them for better meat, and keep them in existence solely for that purpose.  Humans have always eaten meat, and most always will.  That doesn't mean that we can abuse these animals, but should try to avoid most discomfort for their brief lives.

So those of you who are against horses as food sources, I would be interested to hear your views.  Feel free to express them in the discussion.

Oh, and a new poll is now up!

Saturday, October 31, 2009


Though practiced in many countries, I believe that Halloween and trick-or-treating is biggest in America.  I know that I grew up loving the holiday, and had a lot of fun.  Some of my best memories of childhood are wandering through the neighborhoods begging for candy with a simple "trick or treat!"  One year my parents and a few other neighbors designed a haunted woods that wound through the suburban forest behind three houses.  There were elaborate spooks, decorations, and even a miniature Dr. Frankenstein's laboratory with a brief skit (I was Igor!).  All of it was safe, mildly frightening, and always fun. As I grew up I realized that I still enjoyed Halloween, with all of the spooky decorations and costumes. Now I get to pass it on to my own kids.

Nowadays are different, though.  With child predators and other fears, there seems to be less focus on the trick-or-treating aspect. Fewer kids go through the neighborhoods anymore, and many go around to stores in the malls.  When I was young you could barely drive a car down a street because of all of the wandering children.  Now the streets are pretty bare and it's much less common to have your doorbell rung.  It also seems like there are fewer houses handing out candy.  In the past you could go from one house to another.  Now it seems like less than half the homes in a neighborhood, and maybe as few as a third, actually welcome the kids.  Honestly, it makes me a little sad.  There is a certain innocence of childhood that is lost in the modern world.  To me Halloween is more about candy and fun costumes than it is about any real frights.  And despite what some people want to make it out to be, in modern times it simply isn't about anything evil.

But all is not lost.  Tonight my wife and I watched our kids have a great time.  Because we're usually involved with events at our church the kids haven't been actually trick-or-treating in over three years.  This year our church events were in the afternoon, so the evening was free.  Lucas and Elena were running from house to house, completely enthralled by the idea of being able to get free candy merely by rining a doorbell and saying a simple phrase.  Hyped up on sugar and excitement, they were practicaly non-stop.  That joy was contagious, making my wife and I smile and laugh at them.  It was also so nice to see the people passing out candy.  These were people who wanted the kids to come by, and they were all very nice and welcoming.  There was happiness, not obligation from these adults.  In today's society we see so many jaded, banal people that it was refreshing to see some of that simple, neighborly happiness, harkening back to a simpler time.

Oh, and the biggest surprise came from my daughter.  This is my little, cute, six year-old princess, who is nicknamed "Ladybug" by me and "Angelfish" by my wife.  This little girl is obsessed with Littlest Pet Shop toys and anything that is pink.  Yesterday she suddenly announced that she wanted to do something new for her Halloween costume.  My little, sweet girl stated that she wanted to be......a zombie cheerleader.  We have no idea where this came from!  But my wife bought simple white and black makeup and she got her wish.  As she went through the houses, the kids came to one where a party was going on.  The people thought she was adorable.  My little zombie cheerleader came running back to us laughing with pleasure because one of the people said that he was going to save some brains for her.  That's my little Ladybug....

Happy Halloween, everyone!

Friday, October 30, 2009

Brad's Guide To Veterinary Medicine

A vet I know named Brad sent me a list of 31 rules he has developed over a lifetime around veterinary medicine (his father is also a vet).  Here are a few of the choicer ones.  These are all tongue-in-cheek, but also give some profound truths about life as a vet.

Rule #6--The condition is never an emergency until 3 a.m.

Rule #8--The more money spent on procuring the animal, the less spent on maintaining it.

Rule #11--The more ignorant the client, the more certain they are that they know more than you do.

Rule #12--The nicer the clothing, the more nasty, disgusting, and malodorous a procedure you will be asked to perform.

Rule #17--If the client does not comply with orders and the animal gets worse or dies, it is your fault.

Rule #18--All lesions occur overnight ("Really, Doc, he was fine yesterday").

Rule #24--Any unexplained illness seen in a pet is the direct result of the spay/neuter you performed 3 years ago. ("I don't know, Doc.  He was just fine until you neutered him back in '95.")

Rule #26--No matter how late you stay open, or how many days your office is open, there's always one client that will show up 5 minutes before closing with a patient that's been sick for 3 weeks, and complain that you're not open late enough.

Rule #27--Four years of veterinary school cannot possibly compare with the 15 minutes of training that the high-school drop-out got at the pet store.

Rule #28--Consciousness is a privelege; if you abuse it, it will be taken from you.

Rule #30--It is a geophysical phenomenon that all of your clients live only 5 minutes away from your hospital if it is within 30 minutes of closing.

Hope you enjoyed them as much as I did. I know that my veterinary readers will appreciate this in a special way!

Wednesday, October 28, 2009

Helpful Paranoia

Remember my "almost-deadly mistake" of last week?  Today I did my first neuter since then, on a dog about the same size.  Last week's case was running through my mind the whole time, and I was extra careful.  I watched my suture placement more closely than I have since I first started doing this surgery, despite the fact that I've done thousands of these procedures.  This is something that I'll probably do quite a bit in the future, not being as comfortable and complacent as I have in the past.

Honestly, this isn't necessarilly a bad thing.  I realize that I'm only human and mistakes will happen (not just as a vet but in my life in general).  However, I hope that I learn from my mistakes and never make the same one twice.  I can clearly remember each slipped stitch, wrong drug dosage, and missed diagnosis I've made, as well as I remember certain of the highly successful cases.  Everyone will make a mistake once.  I try hard never to make the same mistake twice.  Part of experience is learning from your past screw-ups and preventing them from happening again in the future.  There are many things I am confident that I will never do a second time because I felt so bad or stupid the first time. 

A little paranoid to triple-check this surgery? Probably.  But I consider this a helpful kind of paranoia, as it makes me a better doctor.  Sometimes the hardest lessons are the ones we learn the most from.

Monday, October 26, 2009

Private Vs. Corporate Medicine

Here in the US we have two basic business models for veterinary practices.  The most common is the standard private practice.  Most are owned by a single veterinarian who has a single practice location.  However, it's not uncommon to have 2-3 partners owning a practice together and perhaps having a couple of locations in an area.  A corporate practice is run a bit differently.  There are multiple locations within a region or nationally who are run as any corporation:  there is a president, board of directors, location managers, and so on.  In the US the two biggest corporate practices are Banfield, The Pet Hospital and VCA, each having hundreds of locations.  However, there are also smaller, regional corporate practices that may have a few dozen clinics.

What does this matter to the average pet owner?  Not necessarilly much.  You will have a personal relationship with your doctor and will get to know the staff at the location, regardless of who owns  it.  A private owner has more flexibility in what decisions they can make for your pet and your charges.  With a corporate practice you have more consistency when you move around.  Like with any large company (McDonald's, Sears, Payless Shoes, etc.) you know what you will get when you go to any location in the country.  With our highly mobile American population, having a basic idea of what to expect from your veterinarian often will help in chosing a new vet when you relocate.  But regardless of who owns or runs the practice, studies have shown that most clients make their decisions about veterinary care based on two factors: location and veterinarian.  If they like the vet and the practice is conveniently located, the client will continue to take their pets there.  Believe it or not, according to the surveys price is not the most important factor to clients.

What about as a veterinarian choosing where to work?  The pros and cons are bigger to the vets themselves.  With a private practice you have a chance of eventually "buying-in", becoming a partial or even complete owner.  You also have fewer steps to go through to get approval for ordering new medications or equipment.  If you're the practice owner yourself, you have complete and utter control over how the practice is run.  The down side to this is that as an owner you spend a large portion of your time being a business owner and manager, not a vet.  Many vets don't want this, as we don't go to business school.  Historically vets are also poor business owners, with a large portion of veterinary businesses failing.  To be successful you have to have an entrepreneurial mindset, something not every vet has.  The big benefit to this is that a practice owner will have the potential to make more money than any other veterinarian.

A corporate practice is nice for those who never want to own their own business.  You have other people handling the management, payroll, business matters and so on so you can concentrate on being just a vet.  It can be nice to put 100% of your time and effort into practicing medicine.  If you work for one of the larger practices you also have the opportunity to simply transfer to a different location if you move around the country, keeping your seniority and benefits, as well as being able to jump into the new location with minimal hassle.  The down side is that you are limited to what the corporation decides to keep in stock for medicine and equipment, though this is not as big of a problem as many would think.  You have to uphold the practice's policies and procedures, though this is true of working for a private owner as well.

Which is better medicine?  Honestly you can have high quality and poor quality care with both business models.  For a client I would recommend simply finding the right fit for you and don't worry about who owns it.  For a vet looking for a job, check out both.  If you want to be an owner, then private practice is the way to go.  If you don't have that business mind-set and don't plan on ever being an owner, then a coporate practice might be a good fit.

I'm curious about whether or not both models exist in other countries.  So to my veterinary readers around the you have corporate practices as well?

Saturday, October 24, 2009

Almost-Deadly Mistake

I've mentioned this before, but it bears repeating.  Veterinarians (and other doctors) are humans; therefore they can and do make mistakes.  The bad thing about these mistakes is that when things go wrong it can affect the life and health of the patient. I just had a mistake that was almost very, very bad.

Yesterday I neutered a Yorkshire terrier.  This isn't normally a big deal, as by my calculations I have performed over 2,000 of these surgeries.  This case was slightly complicated by the fact that one of the testicles had been retained in the abdomen (a condition called "cryptorchidism"), which means we have to make a second incision and go hunting after it.  Again, this isn't normally a real concern as I've done several dozen cryptorchid surgeries over the years.  The pet recovered well and was sent home.

This morning the owner called, concerned about the fact that he was trying to urinate but couldn't.  He also wouldn't eat or drink and seemed more painful than expected.  I told her to bring him in for us to look at him.  Once I examined him I could immediately tell that his bladder was extremely full as well as painful.  It appeared that he had been completely blocked overnight, and was in a very serious condition.  However, I couldn't figure out how that could have possibly happened.  When we neuter dogs, we don't actually do anything to any part of the urinary tract.  Even going into the abdomen we don't handle the bladder or any other part.  So I was perplexed as to how it could have happened.  But mostly I was worried.  Very, very worried.

I have made mistakes in the past, but rarely have I felt this concerned.  Because I genuinely care about the outcome of my cases, I take my mistakes seriously and personally.  Though I know it isn't good to do, I will worry over some of my cases for days, especially if I think I might have messed up.  With this puppy I was so worried about what I might have done that I started getting nauseas and light-headed.  My anxiety was so high that I had to actually sit down for a while because I was afraid of passing out.  I can't remember ever being that worried and anxious, but this time I was severely affected.

In cases like this we can't simply give up and tune out.  The dog needed me to figure out what was wrong and fix it.  I also had other patients that still needed to be seen.  So with a round of prayer, I steeled myself to continue.  I sedated him and passed a urinary catheter to see where the obstruction was.  Surprisingly it was at the site of the standard neuter incision.  I couldn't figure out what I had done, but I knew that something had blocked his lower urinary tract at the base of his penis, and the only thing that could have caused that was the suture.  I knew that I had to go back in surgically and try to fix things.

I anesthetized him, opened up his incision, and removed the suture I had placed just 24 hours previously.  Once I had done that I had my tech try to advance the urinary catheter.  This time it passed easily into his bladder, and we were able to empty it of urine.  Somehow a suture had passed around or through part of his penis, obstructing his urinary tract and keeping him from being able to urinate.  I closed the surgery site again and recovered him.

He did well post-operatively and recovered quickly.  I knew he was doing better when we gave him some dog biscuits and he ate them with gusto, something he hadn't done in over a day.  He was much improved when we did send home.  Thankfully the owners were understanding and we covered all costs of the second procedure.  I was very honest with them about what had happened, as I don't believe it is right to ever lie, especially in situations like this. 

Part of being a doctor is having do deal with situations like this.  And I can't say that it ever gets easier.  We are expected to be perfect by the law and by most people, often including ourselves.  Yet it's impossible to be perfect.  Impossible to never do something wrong.  I'm the worst when it comes to expecting myself to do the impossible like this. This was a once-in-a-lifetime fluke that I still can't figure out.  It shouldn't have happened, and I don't know how it did.  But the reality is that I did make a mistake and the pet could have died because of it. Thankfully, he seems to be doing well now. And yes, I will continue to worry about this dog until I know that he does well over the next two days.

Thursday, October 22, 2009

Lead In Tennis Balls And Other Pet Products

A very interesting study was just released showing a potentially serious danger with some pet products. According to, numerous pet products had noticable amounts of lead.

"Pet Products – tested over 400 pet products, including beds, chew toys, collars and leashes. Since there are no government standards for hazardous chemicals in pet products, it is not surprising that alarming levels of toxic chemicals were found. One quarter of all pet products had detectable levels of lead, including seven percent with levels higher than 300 ppm – the current Consumer Product Safety Commission (CPSC) standard for lead in children's products."

A particularly startling finding was that almost 50% of tennis balls sold for dogs had lead in them, and that tennis balls designed for dogs had far higher lead content that "normal" tennis balls.  Surprisingly, sports tennis balls had no lead at all.  Considering how many people buy tennis balls for their dogs and how many dogs like them, this is a very big concern, and one that had me raising my eyebrows when I read it.

Why the concern?  As most people are aware, lead toxicity is serious.  It can cause anemia, gastrointestinal symptoms, and neurological problems.  Because the toxicity is not always detected early, pets can become severely ill and even die.  Lead also accumulates in the body, meaning that continual low-level exposure can be as bad as a single high-level exposure.  The take-home point is that lead is bad, and any products that contain it should be avoided.

Frankly, as both a veterinarian and a pet owner, this has me concerned.  There are no standards for lead content in pet products like there are in human products, yet the risk is the same.  We rarely see true lead toxicities, but it seems that this dangerous metal is more common than previously suspected.  Hopefully this data will shake some things up and have the pet product manufacturers watching more closely or face legislative action to control this health danger. has a pet section where you can look up the products tested and see the specific brands.  Anyone who has purchased pet products recently or plans to should double-check to make sure the risk is low.