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Monday, August 31, 2009

When It Rains...

Sometimes I feel that people may have a misconception of how a veterinarian's life goes. Because we're doctors, we should be living in bigger houses, driving expensive cars, and having relatively easy lives. Part of my reason for beginning this blog was to give the public an insight into the daily life of a vet. Strip away the doctorate and the title, and we're just regular people with problems just like anyone else.

Let's take the last few weeks in my life. First, the water pump on my car sprung a leak (it's a 14 year old-car, so there goes the illusion that we drive fancy vehicles). Then the air compressor on my wife's mini-van locked up and the belt broke while she was about an hour away from home. We managed to get these things fixed to the tune of many hundreds of dollars, pretty much depleting any reserve funds we had. Yesterday I was coming home from picking up a pizza and my car died. Today I had it towed to my mechanic and learned that the starter motor was bad and the battery wasn't putting out enough voltage, requiring both to be replaced. There's another fine chunk of change. All of this specifically while we're trying to get ready for a big annual trip this coming weekend. I'm sure just about anybody can relate to these kinds of problems. But then add to that a problem with the dog I did anal sac surgery on, and we have mental stress adding to the financial stress. It's enough to make you want to crawl into a hole and pull it in after you.

But that's not really an option. And it seems a bit too big of a coincidence for all of this to happen at the same time, right before a group I'm staff with, Fans For Christ, is getting ready for a really big ministry opportunity. Yes, I believe that this situation is largely due to a spiritual battle, though I realize not all of you may believe in this sort of thing.

So you can see that vets are susceptible to problems just like everyone else. I'm as guilty as anyone of seeing my own doctor for his title and skills, and don't often think of him beyond this. The next time your own vet or physician seems a bit stressed, stop to think that some of the difficulties you have may be happening in their own lives as well. Compassion to our fellow humans is an important part of being what we are, and what separates us from the animals.

Thankfully I do have a support network. My staff is great and really help me manage my work day (though they can get pretty stressed themselves). My wife is amazing, and has given me so much support over the years...she is a big reason why I can stay sane in a crazy world. Tristan is great therapy, sitting on my chest and purring loud enough to be heard across the room (I posted on "therapeutic purrs" a few months ago). And I also have my faith and belief in God and His promises to me. He has never let me down, and I know that this will be the case this time as well.

There are a few sayings I try to keep in mind at times like this:
"When it rains, it pours."
"To every cloud there is a silver lining."
"And this too shall pass."
"It can always get worse."
"What doesn't kill you will make you stronger."
"Faith isn't believing that God can, it is knowing that He will."
And then one of my favorites...
"I'm not suffering from insanity...I'm enjoying every minute of it."

Here's to the stresses and craziness of life, and whatever it takes to get us through it!

Saturday, August 29, 2009


It should come as no surprise to readers of this blog, or to those in the profession, that being a veterinarian can be very stressful. Most jobs carry some stress, but I think that it's especially noticeable in those where you are responsible for someone else's well-being. This can be physically mentally, or financially. Your decisions can lead someone into ruin or bring them back from it. That's a lot of pressure for people in these kinds of professions. And at some point you have to learn how to leave it behind and de-stress.

That's a very, very hard thing for me to do, as I tend to dwell on things for much longer than I should. But I still try to work on reducing my stress once I get home. Of course, I'm a husband and father, so there is often a different set of stresses waiting for me at home, but that's a different story. Everyone has different ways of reducing their stress or getting their minds off work. Some exercise, some call friends, some go out drinking...there are about as many ways as there are people.

Most of my ways involve temporarily getting away from the real world and immersing myself in an alternate reality. No, that doesn't mean that I have a VR set-up in my home. Sometimes I will read a novel, letting myself get lost in the characters and settings. Often I will play a video game, especially an action one or one that involves role-playing. Games where I can take out my frustrations by killing monsters and evil-doers are pretty common. When I'm really tired I'll deliberately try to find a rather mindless TV show or movie and simply vegetate in front of it. I've found that chamomile and passionflower tea seems to help take the edge of (and I'm drinking some right now!). My ways are not for everyone (especially the video games), but they can help me. My wife is also great about trying to help reduce my stress and simply love me when I've had a bad day.

So, as I'm thinking of new ways to de-stress, I'm curious what methods you readers use. Since we all have stresses in our lives, perhaps some of the comments might help someone find a new way to get calmer and reduce tension. Let's see what you have to say! Even if you're not a person who regularly adds comments, try it this time and mention something that helps you reduce your stress.

Thursday, August 27, 2009

What, Me Worry?

It's a classic phrase, originating with Mad Magazine's Alfred E. Neuman. It implies that someone has not a care in the world. Unfortunately, it's hard to put into practice, and it's something that I can never seem to master.

Earlier this year I had an epiphany, realizing that problems I have with anxiety stem almost entirely from worrying about things that have yet to come to pass and may never actually happen. Even though I come across as confident in my profession, I struggle with feeling that confidence inwardly. I think this is something many vets and other doctors also have an issue with.

Today I removed the anal sacs on a poodle. I've done this surgery before but not in over 5 years. I'm a good surgeon, and have done more complicated and life-threatening surgeries. Much of the time I worry about them, but today more so for some reason. This kind of surgery has risks of complications, some of them serious. If you don't remove all of the glandular material, it can lead to draining tracts that require further surgery. Perhaps the most serious potential risk is of damage to the rectal nerves and muscles, resulting in fecal incontinence; basically the dog has a hard time keeping feces in, and they may just fall out. These risks are possible, though don't happen in most cases.

So what do I do? I spend all afternoon worrying about this little dog. I keep rechecking the anal tone to see if there is muscle or nerve damage. I imagine what will happen if there is incontinence, even though I warned the client of this risk before ever doing the surgery. I fret over whether or not I removed all of the sac tissue. And basically I work myself up over things that may or may not ever happen.

This is part of the difficulty in being a doctor. Your decisions and abilities affect the lives and health of pets and their people. This is actually a very stressful part of the job, more so for some that for others. Unfortunately, I happen to be one of those people who worries a lot. No doctor is perfect, and every doctor WILL make mistakes, which sometimes makes it even harder when you have tough situations.

In all likelihood this dog will be fine, as are the huge majority of pets I fret over. I have infinite respect for human medical professionals, as I could not imagine this kind of worry over a person's child or close family member.

Sunday, August 23, 2009

Dr. Chris Bern, Evil Overlord

Dreams are pretty interesting thing. My sister in-law, Mary, sent me this description of a dream she had of me.

I had a dream about you. In my dream you were pretending to be a good kind-hearted vet, when in reality you were performing evil genetic experiments on animals as part of your nefarious plan for world domination. Somehow your actions were the catalyst for some kind of Armageddon-type thing that happened in the USA. There was anarchy and a whole lotta killing, and eventually people moved out in groups for other parts of the world because North America was no longer habitable. It was kind of cool, but it was pretty violent and graphic. The best part that I remember was that you had a bunch of loyal followers that would do anything for you and you lived in this huge compound. The thing is, I think I was on the other side of the fight, and your people tried to kill me. I had to eviscerate someone with a crow bar. Anyway, since it was probably the most interesting dream I've had in a long time, I thought you might like to hear about it. Plus, you were the central character. Sorry you were the bad guy. :)

Hmmmm. Me as an evil dictator. Sure, I simply wouldn't do this kind of thing in real life. I mean, can you imagine the difficulties in managing the personnel involved? I'm sure that evil minions require a lot of care. And the logistics of running a world-wide post-apocalyptic kingdom must be a nightmare. Still, there is something amusing about the idea. I certainly wouldn't have to worry about bills and taxes anymore. If anyone bothered me or my family I could pit my legions of genetically altered hamsters against them. And I'm sure that as world ruler I could avoid traffic jams.

And that begs another question. Exactly what kind of genetic experiments would I do with animals that would lead to World Domination? Probably some dogs and cats, as they are so all-pervasive in world cultures. But I would probably design rats capable of hacking into personal computers, pigeons with mind-control powers, and the previously mentioned hamsters who would be modeled on Boo, the miniature giant space hamster (showing my geek cred here...if you laughed at this reference because you know what I'm talking about, then you can be one of my minions).

Remember how I have said before how veterinarians have lives outside of their professional lives? Now you see another side of us. And Mary, since you have discovered my nefarious plan I'm afraid that you now must die. Hamsters will show up when you least expect it.

Saturday, August 22, 2009

Follow-Up On Fleas & Frontline

My post yesterday generated several comments already, and I thought they were worthy of more discussion, especially if people don't always read the comments section. I'll copy the comments here.

In New Zealand, these products are vet only lines and the manufacturers will not sell to pet shops etc.It is a concern if these are to be so freely available as we need them to be sued properly, and to ensure the battle against the other 95% of the life cycle is also being fought in the environment!

Historically most of these products have been only available through veterinarians here in the US also. However, there are unscrupulous vets who buy these products in bulk and then sell them to other retailers who provide them to the public. Several manufacturers have gone after vets like this, but it's hard to control. I know that you can buy Fontline, Advantage, and K9 Advantix in places like PetCo, and I've heard that this is going to be more common. I think that some of these manufacturers are trying to get them sold through venues other than vets to increase their sales.

I believe Frontline resistance is already a happening thing in America?

A lot of vets and clients talk about this, but I believe it is all speculation so far. I haven't seen any studies that document this. And I've found that about 99% of the time when a client tells me that one of these preventions isn't working, it's actually because the client is doing something inappropriately (see my older posts on flea control). Currently I believe that "Frontline resistance" is mostly client mistakes or noncompliance. All of the talk of resistance is one vet or layperson talking to another suspecting it as the reason for failure of control, with no scientific data to support the opinion. The ingredients in the Advantage products have been studied world-wide and no resistance found. The Vectra line is new enough that there hasn't been time for resistance to develop.

Frontline is the ONLY product I've ever had a problem with. I was using Adams before and that wasn't doing it, went to frontline from the vet and Dispatch had a BAD reaction (was almost in a coma), a bath and a couple days and he was back to normal but I will never put it on him again. Might have been the leftover Adams spray from previously and the frontline but we will never know.

Adams is actually a must stronger product than Frontline, and is more likely to cause toxicities than Frontline. I've never heard of a reaction this severe with Frontline, and would more suspect that there was something else that happened. However, it is possible that he was a one-in-a-million case and had a personal sensitivity to the Frontline ingredients.

Could you give a little more detail on your rationale for preferring Advantix/Vectra over Frontline for flea/tick prevention? (In my area fleas exist but are mostly an afterthought to tick prevention - Lyme is the #1 thing we are trying to prevent with our FTP). My veterinarian recommends Frontline because of concerns about permethrin toxicity, which I see is an ingredient in both your recommended products. He also recommends Interceptor as a heartworm preventative, eliminating the need for a topical product that affects mosquitoes.

Good question! I have always felt that if any person or doctor has an opinion about something, they should darn well be able to support this opinion. You may or may not agree with them, but they should have the information to back it up.

First, I don't believe that permethrin toxicity is a real concern for your average dog. Yes, cats are very sensitive to it and can have life-treatening reactions. But these products are only dangerous to the cat if it licks it off the dog in the first 12 hours while it is wet, or if you apply a dog product to the cat. I have used Advantix since it came out and now Vectra, and have never had a problem with my cats around my dogs. Permethrin toxicity can happen in dogs, but generally only in very sensitive individuals and usually only at higher dosages. I have seen cats with this toxicity, but personally never dogs (though I know it does happen). For a dog, I don't think that the safety is any worse with permethrin than with fipronil. I don't think any of these products have strong enough mosquito protection to allow you to not use proper heartworm prevention, and that's less of a concern to me. Interceptor is a good prevention, and I have no problems with it.

Most of my preferences are based off the research and personal comments of two veterinary parasitologists, Dr. Mike Dryden of Kansas State University and Dr. Byron Blagburn of Auburn University. Both are world-respected specialists in flea and tick biology and control. A few years ago I heard Dr. Dryden lecture, and he gave the opinion that he slightly preferred the control of Advantix over Frontline, and that his studies showed that the Advantix had a slightly quicker flea and tick kill after application, though both performed about equally by the time of the next dosage 30 days later. Last Fall I attended a conference and spoke to Dr. Blagburn who was being sponsored to lecture by Bayer. He said that he really liked both Advantix and Vectra, but preferred the insect growth regulator in Vectra. If someone was starting for the first time, he leaned towards Vectra, but if there were no problems on Advantix there was no reason to switch and it was still a great product. In a short version, the ingredients in Vectra will help control more of the flea's life cycle than other products currently on the market, thereby granting better environmental and population control. In addition to all of this, I have seen other studies that indicate a slight advantage to Advantage/Advantix over Frontline (though I know that Merial has data to show the opposite). It's also comforting to me to know that the Advantage line has been tested for resitance and data proves that none exists; even though I'm skeptical about true Frontline resistance, I like having the data on my side.

In the end, I don't believe that Frontline is a bad product, and definitely better than any non-veterinary topical flea and tick preventions. However, based on my personal experiences, data I've seen, and the conversations I've had with specialists, I prefer to use Advantage, K9 Advantix, or Vectra on my own pets, and recommend these to my clients.

Good questions, everyone!

Friday, August 21, 2009

eBay Flea Prevention

Kathy asked a follow-up that was a little more generic, and I think it makes a good discussion.

I was looking online and found bulk supply of Frontline Plus on Ebay. It says that the formulation is the same for cats and dogs except that for cats it's a bit stronger... Is this true? This would be the only affordable way for me to treat the boys right now. It would truely help out with finances. The flea problem is awful currently. We live on a barranca and have all sorts of fun critters visit the yard to share hitch-hikers with our 'indoor only' boys.

Frontline Plus is manufactured by Merial, and is a common topical flea and tick prevention, though not my personal preference. Based on my experience, published data, and discussions with well-recognized parasitology specialists, I much prefer the Advantage line of products by Bayer or Vectra by Summit (sold under the brand FirstShield in Banfield Pet Hospitals...same product, different name). Frontline contains two chemicals: fipronil, which kills the adult fleas and s-methoprene, which acts as a growth regulator, helping to control other life stages of the flea. The concentration of fipronil is the same in both the canine and feline products, with the volume applied being different. The s-methoprene has a higher concentration in the cat version compared to the dog, but this isn't your primary method of killing the fleas.

Please don't split dosages between pets, or try to use the dog version on cats. Though the products are considered very safe, cats are extremely susceptible to toxicity from a number of flea products, and you may overdose your kitties. Splitting dosages is also not very accurate. If you use the products against label directions and then have a problem or find it not working, the manufacturer will not support you, help you out, or give you a refund. It is tempting to try and save money, but I strongly recommend against it.

I am also concerned about getting these products from eBay. There have been numerous cases of people purchasing veterinary products from online retailers that turned out to be from dubious sources. Many people selling these will get them from other countries, where labeling, shipping, handling, etc. are questionable. I have nothing against eBay specifically, and have been using the site myself to buy and sell for about seven or eight years. I also know that it has gone from being merely an auction site to hosting storefronts for reputible vendors. But you may not know what you're getting with an eBay transaction, and I personally wouldn't purchase a product like this from eBay. I have no problem with you getting things like this from sources other than a vet, but make sure you're using a well-known and trustworthy site. The benefit of purchasing these things from your local vet is you can ask them questions and get immediate help or support if there are problems. Always use caution when buying products from unknown sources, especially when your pet's health and well-being is at stake.

Thursday, August 20, 2009

Cat With Food Allergies?

Kathy sends in the following situation about her cat...

Thom is about 7 yrs old. I found him by the roadside hunting bugs when he was small enough to fit in the palm of my hand. He had a pretty rough beginning including a 'D' ride via the fan belt of my car about a week after I rescued him from traffic. Shortly after recovering from that he bailed off the 'cat walk' in my house and re-injured himself. He walks with bowed legs that remind one of a cowhand off a long cattle drive. Anyway, this past New Years Eve he visited the Cat Dr not feeling well. Hair loss, blisters, flakes, sores, weight loss, vomiting... All of these things have come and gone... He weighed 10.44# on 12-31-08 He's been to see the Dr a total of 7 times between then and 7-21-09 at which time he weighed 8.06#. We've had him on Royal Canin Hypo-Allergenic Diet and Royal Canin IVD Green Pea and Lamb. (We are feeding the same diet to our other cat Chuck so he doesn't cross contaminate Thom when he grooms him). We tried a couple bouts of Derm Caps. At this point I think we've about decided he may be allergic to fish oils. He's had antibiotic shots, he just completed a week of Orbax 22.7 mg tabs. This just seems to keep going on and on and on.... Poor fella. We joke that he has Sympathetic Lupus in honor of my mom. She wondered if he might have diabetes. That has been ruled out. Dad has Parkinson's. I will run away if he developes that! I'm sole caregiver to both my parents... I know that's not funny but I have to have a sense humor or else... Oh yeah, I forgot to mention that New Years Day 08 he went to ER because he was passing bloody urine. So as you see he has a fairly extensive medical history and to get to the point do you have any idea as to what his problem might be? And what we could feed him that might be more affordable. Royal Canin just went up again and is almost $40 per 6# bag. I have no income and Mom and Dad are on a fixed income that is stretched pretty darn thin... Any suggestions you have would be greatly appreciated.

Unfortunately, Kathy, this isn't a lot to go on. But based on what you're telling me, I can make a few assumptions and guesses. I will also assume that he has had a full chemistry panel and blood cell count since you said that diabetes was ruled out. If not, then this is the very next thing that needs to be done. If they haven't checked his thyroid level, then this should be done right away, as cats can be prone to hyperthyroidism which can lead to symptoms similar to what you describe.

If he was placed on one of these diets, I would assume that your vet is considering a food allergy. Allergies such as this are due to a reaction to one or more ingredients, usually something that he has been exposed to before and has developed a hypersensitivity to. There is no specific test for these allergies (well, tests exist but are notoriously inaccurate) so the affected pets are placed on a hypoallergenic diet to limit their ingredients. You also have to limit ANY other foods, snacks, treats, etc. during this trial period. If it is related to dietary ingredients, it can take 8-10 weeks to see any results. There are NO, I repeat NO foods other than veterinary diets that are truly hypoallergenic. Yes, these foods are expensive, but you can't look at them as strictly providing sustenance. The foods are a form of medical therapy as much as any injection or pills. For food allergic pets the diets are usually the ONLY form of therapy that really works. In situations like this, there really is no good alternate options, and you need to rearrange your budget to account for the cost.

Allergies can lead to skin irritation, which can allow secondary bacterial infections to affect the pet. Antibiotics are prescribed to help resolve the infection, but this does not treat the underlying condition that led to it in the first place. As far as the other conditions you mentioned...Diabetes is easily ruled out with blood and urine testing, but wouldn't cause skin problems like this. Lupus doesn't really affect cats and dogs like it does in humans, and has different symptoms that what it sounds like Thom has. Parkinson's isn't a concern you need to worry about. Fish oils are an uncommon food allergy, but not impossible. In fact, the omega fatty acids in fish oils are usually beneficial to skin problems by reducing inflammation. The bloody urine doesn't sound related to any of the rest, and urinary tract infections are a risk in male cats.

So to summarize the steps....(1) Perform a complete blood chemistry, blood cell count, urinalysis (not just for an infection), thyroid test, and test for feline leukemia and FIV. These tests will reveal a lot of information and can at least rule out possibilities even if it doesn't give you a specific answer. (2) Do a food trial on hypoallergenic diet for a minimum of 8-10 weeks. If this helps, then there really is no other option. (3) The next step is likely seeing a specialist. If the weight loss and vomiting is the main concern, then an internal medicine specialist may be needed. If the skin is the main problem then a dermatology specialist is your choice.

I realize that money may be tight, but in cases like this you aren't likely to get easy answers. The only way to get to the bottom of the problem is to follow the diagnostic pathways.

Kathy had an unrelated "P.S." on her email, which I'll address tomorrow.

Sunday, August 16, 2009

Pet Voyeurs

I'm sure that most people with pets can relate to the following scenario. Nature calls and you go to the bathroom to relieve yourself. Since you're in the privacy of your own home, you don't bother closing the door. While you're sitting there, one of your dogs or cats comes in to get some attention. Shortly thereafter the others follow. Before you know it you have a small audience as you take care of your business.

In our house it's not uncommon to have these voyeurs watching us. I've had both dogs and a cat or two standing in front of me at one time. This event is obviously entertaining to the pets, as just prior to this they were off doing their own thing. For some unknown reason, a human using the bathroom is fascinating to them and a signal to come watch. There you are, doing your thing, and a pet comes up for attention. Not exactly your thought at the moment, but you learn to deal with it.

To me this is a mixture of amusement and annoyance. Do I really want a gathering of animals while I'm sitting on the toilet? No, not really. And I don't understand why they can be uninterested in us until we actually go in there, when suddenly they feel the need to figure out what we're doing. I do have to shake my head and laugh a bit, especially when several of them come up at the same time. In our house my wife and I have learned to live with it and tolerate it.

Ah, the idiosyncrasies of pets!

Saturday, August 15, 2009


Today I saw a dog for an emergency that had suddenly collapsed in the yard. When it came in it had a temperature of 105.2 F. Considering that a dog's normal temperature is 101-102, that's pretty high, and is very dangerous. Thankfully we were able to get his temperature down to normal, and he ended up stabilizing and doing fine. But this brings up an important discussion.

Heat stress and heat stroke can kill a pet, and I have seen it happen several times. When the core body temperature gets above 105, cell membranes and body proteins can begin to degrade and break apart. This can lead to numerous problems such as brain damage, internal and external bleeding, diarrhea, muscle damage, and many other serious consequences.

Truthfully, this is usually a completely preventable problem. Pets who are kept outside on hot days with limited shade or water are the ones most likely to succumb. By providing cool, shady areas and plenty of fresh water, the risk can be lowered. Dark colored or black pets are at a higher risk because the dark fur absorbs the light and therefore the heat more easily. In very hot and open areas, it is usually best to bring dogs inside to prevent dangerous overheating.

If your pet collapses in the heat, or you find them laying in the sun unable to move, you need to consider this a life-or-death situation. The faster you can get them to a vet, the better the chance of recovery. But the longer they have been overheated, the worse the prognosis. Don't wait and see if they will recover, but get to the closest veterinarian or emergency clinic immediately.

Friday, August 14, 2009

Stuffy-Nosed Kitty

Here's a question about a not-uncommon problem.

How do you get a cat to eat when she can't smell her food?

We have a sick kitty with a stuffy nose so I got three cans of the smelliest Fancy Feast I could find and mixed it together with some tuna juice. My husband could smell it from across the room. The cat though, doesn't seem to be interpreting it as food when it's right under her nose.

I've also got her segregated away from our other two cats in the bathroom. I've got a vaporizer running in there for her to help break up her congestion. Is there anything else I can do to help her feel better and get her to eat?

Cats are very particular about being able to sense their food. When a cat can't smell the food, they won't eat it. This can make sinus or upper-respiratory infections pretty serious even if the infection itself isn't bad. First, the reason for the infection should be addressed. Whether it is viral or bacterial your vet should be able to help find the right medication.

Another consideration is whether the congestion is caused by a tumor or foreign object. Masses or something inhaled can cause a blockage in the airways that can be more serious than simply having difficulty smelling. Again, your vet can help determine if this is the problem and what could be done.

Let's assume that we have the problem properly diagnosed and under treatment, but the kitty can't smell or eat. The first thing is to use something with a very strong odor, such as you're doing. If that doesn't work, try to warm it up in the microwave for a few seconds. Be careful not to overheat it or it could burn the mouth. Warming it makes the odors stronger which will hopefully entice kitty to eat.

A few days of not eating isn't a serious problem, but not eating for longer can cause serious problems, including a disease called fatty liver syndrome (hepatic lipidosis) which can be life-threatening. Your vet may be able to give vitamin or other injections to stimulate the appetite. Intravenous valium stimulates the appetite in cats for reasons that we don't understand, but this isn't something you can do at home. If the appetite doesn't pick up soon, be sure to consult your vet.

Good luck!

Wednesday, August 12, 2009

Microchipping Pets

Pretty much everyone has been faced with the fact or risk of a petting getting away from them. I have had one of my dogs make it a few houses down before I noticed and called her back, and three of my cats have managed to get out of the house at one point or another; one of them was missing for two weeks before we saw him and coaxed him back in. And that's why all of my pets have microchips.

If you're not familiar with this, it's a pretty fast and easy way to permanently identify your pet. A chip the size of a grain of rice is quickly implanted with a needle under the skin between the shoulder blades. Most pets don't object to this, though it is admittedly a large needle, and it's over in a couple of seconds. This chip is inert and won't affect your pet in any way. If he or she ever gets lost, a shelter or vet can use a scanner to find out of a chip is present. If so, a unique identification number will pop up and the vet can then call a phone number and find out who that chip is registered to. The microchip is difficult to find once implanted, so a stranger can't easily even locate it to remove it. Any vet or shelter will have a scanner and should be checking all strays.

Microchips are in my opinion the best form of identification available. Collars and tags can come off or be lost. Tattoos aren't standardized, and don't provide a way to find the owner. Microchips are safe and effective, and best of all are unique and permanent.

Costs can range quite a bit. In my practice we charge $24.95 to implant, and this includes lifetime registration. I have seen implantation cost as much as around $50. With some microchip manufacturers there is an additional charge (usually $10-15) to register your information when you first have it implanted and then any time your address or phone number changes. I have known many shelters that will include microchip implantation in the cost of the adoption.

Most of the world uses an ISO (International Standards Organization) compatible chip that has a frequency of 134 kHz. Unfortunately in the US, there has been a lot of controversy in the last several years. Historically the microchip manufacturers have used 125 kHz chips in America, and there have been only a couple of companies. About six years ago some new manufacturers began to come out with the ISO chips in the US, which created a lot of problems, as most of the shelters had scanners that could only read 125 kHz chips. The 134 kHz chips can be read quicker and from a greater distance than the 125 kHz ones, but it's hard to change tradition. Various manufacturers fought hard against a switch, even though the AVMA, ASPCA, American Humane Society, and many other groups had endorsed the ISO chip over the 125 kHz, and the government had in principle agreed to using the 134 kHz chips. To make a long story shorter, the last six years have been hard in the use, but there are finally more ISO chips available, and most shelters and vets have universal scanners that can read any chip out there. I definitely recommend the 134 kHz over the 125, though your vet may only use the latter.

Unfortunately, only a small percentage of US pets have microchips, and only a little larger percentage in other industrialized countries. It's inexpensive and may be the only way to get a lost pet back. Talk to your vet about the costs and procedures, as I strongly recommend having it done.

Saturday, August 8, 2009

Dachshund Back Problems

Anyone who has or intends to have a dachshund needs to pay attention to this entry. Many dachshund owners are already aware of this issue, but those who aren't need to learn about it.

As a breed, dachshunds are extremely prone to injuring their backs. Specifically this involves a herniation of one of the discs between the vertebrae in their back. Between each bone is a cushioning disc that helps to soften movement of the spine and prevent pain and injuries. Imagine the disc like a seeded grape. If you squeeze the grape firmly, you'll compress it without breaking it, and the grape will return to its shape. If you squeeze too hard, the grape ruptures and the seed inside shoots out. An intervertebral disc is like that grape, with a hard center. When the center of the disc comes out, the only direction it can go is against the spinal cord. This causes a sudden pressure against the spinal cord and damages it. This can lead to temporary or permanent nerve damage. The nerve damage can affect anything behind the injury, causing paralysis, inability to defecate, and inability to urinate.

Depending on how severe the injury is, it can look like anything from difficulty standing, instability in the back legs, or full paralysis. This should be considered an emergency, as time is of the essence. The longer the pressure continues against the spinal cord and the more severe it is, the greater the likelihood of having long-term or permanent problems. The chances of improvement can drop dramatically within hours, so you shouldn't wait a day or two to see if this improves.

In mild cases, first therapy is usually high doses of steroids or similar potent anti-inflammatories. Studies have shown that this treatment has limited effectiveness, and there isn't much evidence to prove that it is worthwhile. However, most vets (myself included) have seen dogs improve on steroids, and therefore will usually try it. When cases or severe or if there is no improvement on steroids in 24-48 hours, surgery is indicated. This kind of surgery is done by a specialist and involves cutting away part of the vertebrae and removing the damaged disc material from the spinal cord. This is very expensive and delicate surgery, but can make a huge difference. Again, the faster the surgery is done, the better the outcome. If you wait days or weeks, chances are low that it will work.

Healing of nerve damage is very hard to predict, as it is difficult to tell if there is too much damage for the nerves to regenerate. That's why it can be hard for your vet to tell you if any kind of treatment will work, and it's why you can get some cases that start to heal after many weeks even beyond the expectation.

There are some things you can do to lower the risks. Keep your dachshund's weight normal, as any extra weight will put additional stress on the spine. Keep him or her from jumping on or off furniture, especially high things like beds. Sudden twists of trauma to the spine can cause a disc to slip out of place. However, there are some cases that you simply cannot help.

Even though dachshunds are a high risk breed for this kind of injury, it can happen to any dog. If yours ever shows any problems like this, get them to your vet immediately. It could be the difference between walking or using a wheeled cart.

Friday, August 7, 2009

Higher Price Vs. Longer Wait

A little while back I posted my first poll after some entries on quality or quantity of medicine. The results are interesting.

Get a free or discounted office visit, but have to wait for an hour or more--35%
Pay a full office visit ($40) and be seen in 15-20 minutes--65%

Many people talk a lot about wanting discounts, and unfortunately we see a lot of price-shoppers in veterinary medicine. Many people call around to various vets wanting to find the cheapest price but aren't as interested in exactly what services are included. Not all services are created equal, and it can be frustrating when people care more about the cost than their pet's health. Don't get me wrong, as I look for good value also. But there is a difference between "cheap" and "value". Something that is a great value may not be the cheapest. A high value service or product gives you a lot for your money. When I was growing up I worked for a vet who was one of the highest-priced in the area. He wasn't apologetic, but emphasized to all of the staff that if we were going to charge these prices, we had better give the clients service worthy of that price. Apparently the clients felt it was worth it, as the practice grew quickly.

For the readers here, it seems that most people are willing to pay a normal price in order to get seen quicker. To them, there is value in a reasonably rapid visit, and they're willing to pay for it. To me as a vet and a businessman this is nice to know. It means that most people realize that a veterinary visit is a service worth paying for.

I've added a new poll for everyone to take. I've often said that pet owners should have an emergency fund of at least $500 (or equivalent for people outside of the US) to help cover any sudden illnesses or injuries. Let's see if anyone could actually do that!

Thursday, August 6, 2009

The Clients You Want

The last two days I have been dealing with a rather difficult case and a rather great client. In fact, he was the kind of client that every vet wants to have. Let me explain.

Maggie is a dog I've seen before, a 10 year old large breed dog. She's had arthritis problems that we've been managing, but over the last month she has had more difficulties moving around. I saw her yesterday to be evaluated, and noted that she was weak and had pale gums. The owner is actually in another state for his job, and wasn't going to be home for weeks. He wanted to handle anything over the phone so his wife wouldn't have to worry about things. I called him with my initial assessment and my plan to run some tests. He said that he was willing to try and figure out what was going on, but also didn't want her to suffer if there wasn't anything we could do. Then he dropped a bombshell on me that honestly I can't say I've ever really heard from a client.

"Tell you what, doc. Go ahead and go up to five or six hundred. I don't want you to have to worry about calling me. Just do what you need to do."

Wow. If only every client could tell me that. It wasn't really the fact that I could get money out of him. My eyes didn't light up with dollar signs. It was the freedom he gave me that mattered. He gave me the leeway to make my own decisions on what was necessary, and the budget to actually do these things. I didn't have to call him on every choice or negotate what we could or could not afford. It was so nice to not have to call him every time I wanted to do a different test or change my diagnostic plan. I was allowed to be a doctor and the trust to proceed as I felt was best.

Over the next 24 hours I ran some tests, sent some to our diagnostic lab for further information, and kept in regular contact with the client. Each time we talked honestly about Maggie's situation, and each time he told me to go ahead and do what I thought was best for her. He wasn't worried about another $100-200 if we could help her, and was willing to do surgery or other treatment if necessary.

I wish that I could say that the story had a happy ending. Maggie was anemic, and it appeared to be a problem relating to her spleen. I was concerned about a tumor, and took some x-rays. There was fluid around her lungs, and when I tapped her chest to examine it, there was blood. My final diagnosis (unconfirmed) was a type of blood cancer called hemangiosarcoma, which can be very malignant. The owner made the decision to put her to sleep since there probably wasn't much we could do for her, and I agreed with him. Maggie passed away very quickly and peacefully.

In our last conversation I thanked him for his concern, care, and realistic attitude about his dog. I really appreciated how he wanted to go as far as necessary with the case and that he trusted me to make the decisions as to which diagnostic tests to do next without having to check with him. I also respected him for wanting the best for Maggie, whether that was treatment or letting her go.

I know that not everyone can be that relaxed with hundreds of dollars, and it doesn't mean that people without that money love their pet any less. But it was a great relief and honor to be able to actually do what was needed without any real barriers. I felt the freedom to actually be a doctor with no limitations. I really wish we could have saved Maggie, but despite that I have to say that this was one of the most satisfying cases I've had in a long time. I look forward to dealing with this client in the future when they decide to get another pet.

Monday, August 3, 2009

Pop Culture Pets

It's pretty interesting how people pick names for their pets. Much of the time it has to do with whatever is big in pop culture at the time. When the 101 Dalmations movies came out, we saw several new dogs named Pongo and Perdita. After The Lion King we started seeing a lot of cats named Simba and Nala. I even saw several Frodos after The Lord of the Rings series. It's understandable, as these films touch us in one way or another. We show our respect and interest by naming our pets after characters. One of our cats is named after the main character in Pokemon (Ash).

This comes up now because in the last month I have seen at least four pets named Miley. For those without girls, this is Miley Stewart, aka Hannah Montana. She is the biggest thing in tween girls minds, and often pre-teen. My six-year-old daughter used to be obsessed with her and we went to the Hannah Montana movie on opening weekend (her interest has now switched to the Jonas Brothers...she's six going on 18). I bet that most of these clients though that they were being original by naming their pets Miley, and normally it would be a good choice. They just didn't figure on all of the other families with young girls getting new pets.

If we looked back in history, I feel confident that we can trace pop culture trends by studying names of pets. Kind of interesting to me, and something I may have to pay more attention to.

Sunday, August 2, 2009

Dane Disorder

Here's a question sent in by Malinda...

I read your article about people thinking that their dog has something stuck in their throat. I guess I'm one of those people. I have 2 Great Danes. The one in question is 7yrs old. He keeps "coughing" or gagging. I'm not real sure what I would call it. I plan to take him to his own Dr. Monday. He has quit eating, acts like he feels bad. He does this coughing thing mostly when he moves around a lot. Before he quit eating, he would regurgitate his food.

My question, if they don't have something in their throat, then what can it be? I have also noticed him doing the "wobblers" thing with his head. Could this be related to the problem?

He's also been having trouble getting up and down. Something with his back legs or hips. I have been giving him an aspirin hoping to make him feel better, at least until I get him to the vet. I plan to have his Dr. check that too. I pray that he's not just getting old on me. I LOVE my two boys so much. I've just lost one dog that I had for 16yrs. I don't think I could bare another loss right now.

What do you think all of this could be. Maybe help prepare me for what his Dr. is going to tell me. I'm pretty scared.

Thank you.

Malinda, as you're probably aware, seven is pretty old for a Great Dane, and many things can go wrong. You're doing the right thing by taking him in to the vet, as his doctor will have a better ability to determine the problem than I can.

Based on what you've described, I would be concerned about a disorder of the esophagus or stomach. If he was regurgitating or throwing up food, some may have gone down into his lungs and possibly created an aspiration pneumonia. This could be either a problem with his ability to swallow and hold down food, or could be a problem in his lungs causing fluid and mucus. Danes are prone to heart disease, which in advanced cases can cause fluid accumulation in the lungs, which can then cause coughing. The wobbling of the head is strange, and I'm not sure that I could tell what's going on based on what you've described. There is a condition called "wobbler's syndrome" that involves a problem with the spine in the neck. However, this much more common in Doberman pinschers than other breeds. It's difficult to say whether this has anything to do with the coughing issue.

The difficulty getting up and down is likely due to arthritis or hip dysplasia. Both are common in the breed and he's definitely the age when this can happen. I don't recommend aspirin use, as dogs are much more prone to the side-effects than are humans. Gastrointestinal irritation is a strong possibility and can even lead to ulcers in the stomach and intestines. Pain medications designed for dogs may be more expensive, but are safer and cause fewer problems.

This is one of those situations that can be very difficult to describe and diagnose. That's why it's so important to actually see a vet. Every day we get calls from people trying to to get us to tell them what's wrong with their pet over the phone, and may even get upset when we can't tell them exactly what it will cost to see their pet or what tests will be run. And that's why I have the disclaimer on this web site!

Malinda, I wish I could give you a better idea what to expect, but this is something that really needs to be examined directly. Expect your vet to want to do x-rays and likely run some blood tests. I hope this turns out to be nothing serious and that your Dane can be around for several more years.

Saturday, August 1, 2009

Pregnant Or Not?

Martha asks about this situation...

I need help, my toy fox terrier is 8 yrs old she is producing milk is been for a couple of weeks
lately she is has been having diahrrea does the milk produce this, or is it sometimes not to oftern i give her ground meat with veggies or chicken and the results are the same.
please advice

There are several situations to discuss here. First, I would want to know if your dog is spayed. If she is spayed, then we have a completely different problem with her lactating. There could be a serious hormonal disorder here and she needs to be examined for it. If she isn't spayed, then we could be dealing with a false pregnancy. This condition happens when hormones get out of whack and the body thinks it's actually pregnant. The dog will show all signs of pregnancy, including lactation, abdominal enlargement, and maternal behaviors. This isn't normal, and may indicate an abnormal hormonal issue. The cure for this is having her spayed. At 8 years old she's beyond optimal breeding age anyway. No, this isn't too old to spay her, and I would recommend it.

Lactation or false pregnancy will not cause diarrhea. You should have your vet look for parasites, giardia, clostridium, or some other intestinal disorder. It sounds like you give her "people food", which isn't a good thing (see some of my previous posts) and can definitely cause diarrhea. Stop giving these foods immediately and don't give them any more. You could give your dog a much more serious problem than diarrhea by continuing to feed these things.

In any case, I would strongly recommend having your vet examine her and figure out what's going on. Thanks for asking the question!