Disney!

Today is a big day for my family.  After the kids get out of school we're leaving for Disney World.  And our children don't know it!

Ten years ago my wife and I went to Disney World.  I had been once when I was younger and it was only Magic Kingdom; my wife had never been and is a HUGE Disney fan.  We spent the better part of a week going through the various parks and enjoying things with just the two of us. We had a great time, and it was nice to have that experience prior to kids.  Well....sort of...  She was actually three months pregnant with our son, something we didn't expect when we had made the plans.  For the whole trip she fought morning sickness, always craved pizza, and couldn't go on most of the rides.  It was still great, but it could have been better.

For years we've talked about going back, especially with our children.  Two years ago we made reservations, but ended up having to cancel them.  We've told our kids about Disney and showed them our albums from the previous visit, so it's been a dream destination for them.  For years they've asked "when can we go to Disney World?"  And unfortunately we've had to keep putting it of.  Until now.

This year we decided to just do it.  If we waited until the "right time" we'd probably never go.  My wife found a really great package deal that includes hotel, meals, and park admission. Then we scrimped and saved, cutting back on a lot of things in order to go.  Early on we decided to try and surprise the kids like we've seen happen.  So we have told them that I have to go to a "meeting", which they would think would mean a veterinary continuing education conference.  They don't know that I'll be "meeting" with Mickey, Donald, Goofy, and the rest.

I think our kids have gotten to the point where they don't really believe we'll ever go.  A couple of weeks ago we were talking to them about someday going to Disney, and my son was skeptical that we'd make it.  So I told him "We're going to Disney World in a week and a half."  He looked at me for a moment and then said, "Oh, Dad, cut it out."  He totally didn't believe me, even though I told him the truth! My wife laughed so hard she choked on her sandwich.  A few days ago my wife was taking the kids to school and reminded them about the trip on Wednesday.  My son said, "Yeah, we're going to Disney World!"  He wasn't really serious, but more hopefully.  Our daughter looked over at him and said, "You wish!"  Little do they know!

Our plan is to pick them up from school and start driving to Florida.  It will be about an eight hour drive for us, so we'll get there somewhere around 11:00-12:00 tonight.  Hopefully they'll be asleep, and since we've already checked in online my wife can run into the lobby, get our room information, and we can carry them to the room without them really noticing where they are.  Then tomorrow morning we're getting up really early to be in the Magic Kingdom when it opens at 8:00.  We'll tell them where they are in the morning, and can't wait to see their expressions.  We've kept this secret for months, and they've been begging to go for years.  The instant the truth hits them will be priceless and a once-in-a-lifetime moment.  And we have a video camera to capture that moment.

We'll have four VERY full days at the Disney complex and plan to make the most of it.  It will be great for me and my wife because we had so much fun before and are just big kids ourselves.  My wife is looking forward to getting to do all of the things she couldn't do before because of the pregnancy.  But even more important, we want this to be a memorable time for our children, something they will remember their whole lives.  This won't be the last time we go to Disney World, but there is something very special about the first time.

See everyone when we get back next week!

Tapeworm Blues

One of the common problems we see in dogs and cats is tapeworms.  This is also one of the more commonly misdiagnosed problems by clients.  I've heard clients think of them as roundworms, pinworms, and many other parasites, as well as simply not knowing what they are.  So I thought it was worthwhile to give a quick lesson.

The species of tapeworms we see in pets generally come from one of two sources:  fleas and rodents.  Fleas the most common source, and it's common to see a pet with a flea infestation also be infected with hookworms.  Cats who are "mousers" are commonly infected with a different species of worm.  In either case the tapeworm spends part of its life cycle developing in the intermediate host.  That host (flea or rodent) has to be swallowed by a second host and then develops into a full-grown tapeworm.

It's actually uncommon to see tapeworm eggs on a microscopic fecal exam routinely performed by veterinarians.  Rather than shedding eggs, tapeworms shed segments called proglottids.  These segments are easily seen on the feces, in the fur around the rectum or tail, on a pet's bedding, or even crawling directly from the anus.  When they are fresh they can be an inch or so long, white, flat, and usually move with a stretching motion.  As they age and dry up they shrink and turn an off-white to tan color.  We often describe them as looking similar in size and appearance to a grain of rice.  Here are some pictures.

Thankfully, tapeworms aren't generally a serious health concern.  They sit in the intestinal tract and absorb food that passes through.  In severe cases this can lead to weight loss and even malnutrition, but normally just causes loose stools and looks gross.  Standard over-the-counter medications for roundworms and hookworms will NOT kill tapeworms, so check with your vet about proper medications.

Gross trivia of the day...Did you know that at one time medications containing tapeworms were sold as weight loss aids?  Seriously....

Puppy Hunting

Losing our dog, Guinevere, was very hard for my wife.  My wife really wants another dog to bond with and relate to in a special way.  Our other dog, Inara, is sweet and loving, but is more bonded with me and our kids than to her.  So over the last month we've been talking about getting a new puppy, and today we went to visit a breeder.

I tell my clients to look at shelters for dogs who need homes.  But if they want a pure breed (which I don't have a problem with) skip the pet stores and look for a reputable and good quality breeder.  Visit the breeder before confirming a purchase and get to meet the puppies and at least the mother.  So practicing what I preach we met the puppies and mother today.

The puppies were born September 15th, so their eyes and ears weren't quite open yet.  Mom was a small lab and not show quality, but she was gentle and sweet.  We're only interested in a pet and don't plan to breed or show, so the full lab quality wasn't as important to us.  We were looking for a white-yellow lab (my wife likes the lighter colored ones) female who was going to be sweet and hopefully a little lazy.  In this litter there were two to choose from and we handled both.  One of them on the second handling laid her head on my wife's shoulder and seemed to really relax and almost fall asleep.  Needless to say, that's the one my wife bonded with and the one we chose.  With our deposit having been given, we gave her back to the breeder since she's too young to leave the mother. 

Now we wait for another 4 1/2 weeks.  We'll pick her up on October 28th, which happens to be just two days before my wife's birthday (another reason why we felt this was the right time and right puppy).  We've already decided on the name Yvaine (pronounced "ee-VANE"), the name of the main female character in the movie Stardust.  Pretty soon we'll be beginning a new adventure in raising another puppy.  I'll keep everyone informed.

Inhaled A Battery

A reader sent in this question.

I have a dog that has a hearing aid battery stuck in his trachea and I have an xray to prove it. The vet we took him to didn't know what to do to help him. We have to call around to find a vet that has a endoscopy. Do you have any suggestions of things we might do to help him before we find a vet that can help us. 

Deborah, this is a potentially serious situation.  It would be nice to know where exactly in the trachea the battery is located, and whether it is fully lodged there.  If it moves further down into the lungs it could lodge in a very small airway and need risky, complicated, and specialized surgery on his lungs to remove it.  Most areas now have specialists with endoscopes, and your vet should know of one.  Many emergency clinics also have endoscopes.  There really isn't anything you can do in the meantime to make him more comfortable or help dislodge the battery.  I would urge you to seek aid and don't delay, or you could have a much more serious problem on your hands.

Wanted: Large Animal Vets

I've mentioned before how here in the US there are fewer and fewer large animal veterinarians in practice.  It's becoming a real crisis in some areas, with farmers and other rural people not having easy access to a veterinarian. Personally I believe that this is due to a shift in the demographics of veterinary students reflecting a shift in our general population demographics.  There are fewer people growing up in rural settings and a greatly increasing number growing up in suburban or urban areas.  It has reached the point where the US Congress is stepping in to address the issue.

Last week the Veterinary Services Investment Act cleared the House of Representatives.  The act establishes a grant program through the US Department of Agriculture (USDA) to encourage people to serve in underserved areas.  The chairman of the Agriculture Committee, Collin Peterson said, "Rural areas are facing a critical and growing shortage of large animal veterinarians. These veterinarians are the first lines of defense against animal disease and a crucial player in ensuring the safety of our food. This bill will encourage veterinarians to serve these areas where their skills are needed."

I'm not sure how successful this program will be, as some people are simply not going to be interested no matter what the incentive.  But if it helps in some way, then I can be in favor of the program.  Large animal vets do serve an essential role in our food production, so we need a way to move more people into this part of the profession.  And for anyone who has even a passing interest in this field, it's encouraging news in our current economy because these vets can easily find work.

Do-It-Yourself...

Before I was born my father was a mechanic and continued to like to work on cars through my childhood.  He would do basic repairs to our cars himself, only taking it to the shop when it was too big for him or he needed a lift.  When I was young he tried to teach me a fix-it principle.  "Learn how to do it yourself of make enough money to pay someone else to do it."  Probably to his disappointment I didn't like to work on cars, so I tried to opt for the latter.

This year our minivan has had a number of big problems:  air conditioning broken, alternator gone bad, starter coil malfunctioning, etc.  All of these have lead to a couple of thousand dollars in repairs, which has hit our budget pretty hard.  My own Lumina has been having a number of problems and is on its last legs. However, we can't afford to get another vehicle right now so I'm trying to make it last as long as I can. 

One of the big problems that happened recently is my brake lights stopped working. I thought it was the light bulbs but a quick exam showed that it wasn't.  I did some searching on the Internet and discovered that the brake light signal was routed through the multifunction turn signal switch, and it was a known problem that the switch could go bad and lead to the brake lights malfunctioning. Some more searching lead me to a step-by-step tutorial of how to replace the part.  Trying to save more mechanic bills and keeping my father's advice in mind, I decided to give it a try.  So I ordered the part through a local auto part supply store, rented a few tools, and got to work.

Ugh.  I quickly remembered why I didn't become a mechanic, and also again learned why mechanics are usually worth the price.  This switch is down at the bottom of the steering column, which means that I had to take the entire steering wheel apart.  There were also numerous wires to try and disconnect, some of them far under the dashboard.  I discovered that the tutorial didn't have pictures of some of the details, so I was left to figure it out on my own.  I can work my way quickly through the abdominal anatomy of a dog or cat, but making heads or tails of some of those parts and connections is totally confusing.

I've started to come to the conclusion that the automobile industry is in collusion with mechanics to make automobiles as confusing and difficult to work on as possible.  That way an average, untrained person (like myself) gets frustrated and doesn't want to try and do it themselves.  I used four or five different sized sockets, three kinds of screwdriver heads, and several very specialized tools.  I had to remove two fuses, disconnect the battery, take apart the steering wheel, and remove covers and braces under the dash.  Wires were difficult to follow, connections were difficult to see and reach, and I sometimes felt like a contortionist trying to get to everything. It's like car manufacturers deliberately try to make it as complicated as possible.  Yes, I realize that an automobile is a complex machine, but I could see so many ways to make connections simpler and easier to replace.  A personal computer is far easier to work on than a car.

But the good news is that I finally got the job done.  It took me five or six hours, but everything is back in place and the brake lights work fine.  I did learn a lot, and It would probably only take me an hour or so to do it again.  Not that I ever hope too.

Yeah, next time I'm paying my mechanic.  Give me a spelectomy or bladder stone removal over auto repairs any day!

Is He Really Sick?

My practice performs blood tests before every surgery, even routine ones like spays, neuters, and dental cleanings.  Our surgery packages include these tests in the pricing, and it's not an option that our clients can decline. Why?  Because we feel it's important to the safety of the pet and many clients would decline because of perceived lack of funds.  Just because a pet looks healthy externally doesn't mean that they really are healthy.  Here's a case in point.

Today we had a puppy come in for a routine neuter.  We had seen him for his vaccines and hadn't found any problems on routine exams and the owners hadn't reported any serious concerns that couldn't be attributed to normal puppy behaviors.  As normal, we performed blood tests and were quite surprised at the results.  According to the lab results this 19 week old puppy was in complete renal failure.  All of his kidney values (creatinine, phosphorous, and blood urea nitrogen) were significantly elevated by several times and his red blood cell count was noticeably lower than normal.  Why is the blood cell count significant?  The kidneys produce erythropoetin, which is the hormone that stimulates the bone marrow to create red blood cells.  If the kidneys are sufficiently damaged for long enough the hormone levels decrease and fewer red cells are generated.  This normally happens in chronic kidney disease rather than acute, which means that this puppy had underlying problems for much longer than we had thought.

All of this sounds pretty bad and it normally is.  Usually patients with values like this are very obviously sick, even critically so.  Yet this puppy was doing pretty well.  Or so we thought.  No, he wasn't at death's doorstep, but there were some subtle signs that further questioning of the owner revealed.  He had seemed to be drinking a lot of water, but that's not uncommon with puppies.  He seemed "quiet" to the owners, but some puppies can be that way.  He had vomited a few times, but not predictably or routinely, also something that puppies may do.  Individually and even collectively these weren't outrageous symptoms.  However, when combined with the laboratory tests they were early signs of an underlying problem.

Despite the fact that he didn't seem particularly ill, the pattern in the tests and the subtle symptoms could not be ignored.  At his age, the most likely possibility was a congenital defect in the kidneys, though a previous toxin could not be ruled out.  Whatever the underlying cause, once the kidneys are damaged they won't regenerate, so there wasn't much we could do for the puppy.  The owners took him home and are looking into their options but will likely end up euthanizing him.

Preanesthetic blood testing really and truly is important!

Baby Squirrel Blues

Because I see a lot of exotic pets I often get some strange cases referred to me.  Today I had someone who does wildlife rehabilitation bring in a baby squirrel that wasn't weaned.  It had fallen out of a tree a week ago and her dogs had brought some of the babies to her.  One of them had suffered a wound to its head and she was worried, so I got to see him.

Unfortunately, the wound was pretty bad, with skin missing on the top of his head and showing no signs of growing back together.  His left eye was also injured and didn't appear to have normal function.  Situations like this can be difficult for many reasons.  First, because it's a wild animal, you can't easily keep them in captivity even when raised from a baby like this.  Thankfully the person was experienced with keeping wildlife, so this didn't concern me.  The squirrel needed surgery to do a skin graft and remove the injured eye, which wasn't inexpensive.  And lastly this is a risky surgery in such a small, young animal (110 grams), so there isn't a guarantee that he would survive surgery.

From a medical perspective it's interesting to see uncommon animals like this, and would be a great surgery to perform.  However, with the risks and costs, it may not be realistic.  And at this point the squirrel will never be able to be released into the wild because he is blind in one eye.  It's a tough decision, and one that hasn't been made yet.  The owner was going to talk to her husband and let us know.  If I hear back from them I'll post an update.

Hidden Testicles

There is a medical condition called cryptorchidism where one or both testicles do not descend into the scrotum.  In a fetus the testicles develop near the kidneys and during and shortly after pregnancy they move through the abdomen, through the groin, under the skin, and down into the scrotum.  At any point along that journey a testicle can stop moving and remain where it is.  This can be a problem since a testicle is not designed to stay in the abdomen, and the increased body temperature can predispose it to become cancerous over time.  Why?  Testicles in mammals are actually designed to function best at a little less than body temperature, which is why they are normally housed outside of the core of the body.

By a few weeks old both testicles should be noticeable on a routine exam, and definitely by 3-4 months old.  If they haven't descended into the scrotum by then, they really aren't going to.  This means surgery, and not just a routine one.  If the retained testicle is under the skin next to the penis, it's usually just a matter of making a second incision and taking it out.  But if the testicle is retained in the abdomen, it can be quite a challenge to find it.  We have to make an abdominal incision and go hunting for it.  It's a little like doing a spay on a female, but the testicle is smaller than a uterus and often harder to find.

Why bring this up?  Well, many people aren't aware of this condition.  If your vet diagnoses your dog with this disorder, follow their recommendations and have your dog neutered and the retained testicle removed.  And when they present you with the extra charges, especially if it's in the abdomen, understand that this is often more difficult than doing a spay and the fees are necessary.  One of my associates was doing this surgery yesterday and had a heck of a time finding that retained testicle.  It took about 45 minutes, when a routine neuter for her is less than 10 minutes and a routine spay 30 minutes or less.  That poor puppy had a very large abdominal incision, but thankfully he will heal and be just fine.  But it was a reminder that this kind of surgery isn't always routine.

When They Do What They're Supposed To

Today I had an extremely proud moment as a father.  Kids don't always do what they should, but today my son did in a great way, and I think he got a great lesson in doing the right thing.

We had a family day together, and as part of it we went to a very large used book store we like to visit.  This store has books of all kinds, as well as DVDs, CDs, and video games.  We were trading in some of our own things we no longer wanted, and planned to use the store credit we earned to each buy a few things.  As my son was looking around, he noticed some money on the ground.  From what he told us later, he saw the "1" and thought it was a $1 bill until he picked it up and discovered that it was a $100 bill.  Now here's the pretty remarkable part.  He's nine years old, and on his own he went up to the counter and told somebody that he found it on the floor.  He didn't keep it.  He didn't even come to find me or my wife.  By himself he decided to take it to someone in the store, and felt comfortable enough doing that.  He knew that the right thing to do was to turn it in and report it, and he knew who he had to go to. 

My wife came and told me about that and the news made me beam.  Apparently the clerk had asked him for his name and address, and told him that if nobody came to claim it within 30 days, it would be his.  A few minutes after this I heard his name on the overhead speakers, asked to come to the front desk.  I thought that perhaps the person had claimed the money and wanted to thank him, perhaps even giving him a little reward.  But no, his day got even better.  The clerk had told the store manager, and the manager was apparently so impressed by his honesty that she gave him a $50 store credit voucher!  And if the money isn't claimed in a month, he still gets that as well!

I went and found my son, gave him a big hug, and told him how proud I was of him for doing the right thing.  One of the life lessons I try to teach my kids is that "when you do bad, bad things happen...when you do good, good things happen."  This has been a philosophy of mine as I try to instill in my children the understanding that actions have consequences, both good and bad.  By choosing how you will act, you can often choose the outcome of events.  Today was a great life lesson for my kids, as my son did the right thing without being told, and was greatly rewarded for it in praise and materially.  With that voucher he was able to get three books and two video games, which was more than he was planning on being able to buy.

The longer I'm a parent, the more I realize how difficult that job is.  You do everything you can to instill the right values and ways of thinking in your kids, hoping that some of it will stick.  My parents did a good job of it, and even though I didn't always agree with them (and sometimes still don't with my father), they definitely taught me right from wrong, and I'm a better man because of my upbringing.  Even though my son is generally a great kid and usually considerate and sweet, today was such a big moment of me realizing that those lessons had really sunk in. 

In Memoriam

I now have my computer back and running normally.  Now that I'm getting back on the internet and blogging again, I wanted to start with an event that happened two days before losing my hard drive.

Guinevere was always a special dog, and the best dog I've had.  She was sweet to everyone she met and had a joy about her that was immediately evident.  She wasn't a typically hyperactive lab, and was instead content to lay at the foot of the bed or crowd next to you on the couch. She was gentle to and accepting of every pet we brought in after her, welcoming them with her quiet curiosity.  And at only five and a half years old, we lost her.

The symptoms began a couple of months ago when she had the strange gastrointestinal signs I blogged about.  Though she recovered from that bout, there were very subtle issues that would crop up now and again but weren't severe or obvious.  A few weeks ago we noticed an increase in some of the signs, as well as a sudden enlargement of the lymph nodes in her neck.  Neurological signs began to show, and the biopsy revealed lymphosarcoma.  A phone consultation with a neurologist confirmed that it was in brain and that even with chemotherapy the prognosis was very poor.  As her symptoms quickly worsened over only a few days, we made the decision to euthanize her.  That was one of the hardest things I've ever had to do.

The house is emptier without her, and our hearts miss her terribly.  Though it has now been close to four weeks, we still acutely feel the loss.  So this blog is dedicated to our sweet girl, Guinevere.  We will always love you, and look forward to when we can see you again in Heaven.