The Limiting Factor--A Vet

I've often said, and honestly felt, that I'm not really more important than anyone else on my staff.  Being a veterinarian doesn't give me any greater inherent "worth" than my techs or receptionists, and I don't feel that I'm in any way superior to them.  I couldn't do my job without them, so they are just as important to the function of my clinic as I am.

Or so I've thought, and recently discovered to the contrary.  I actually AM more important!

For the last few days I've been sick with some sort of cold that's developed into laryngitis. I've been coughing, had a sore throat, had difficulty talking, and have even off and on run a low-grade fever.  And through it all I've continued working.  Why?  I haven't had a choice.

I've had staff who come in and work while sick, and I sincerely appreciate their work ethic.  I've also had them call in sick for various reasons, and I certainly understand that.  When someone is sick and can't make it into the clinic, we always try to call someone else in to cover their shift.  However, that's not always possible to do at the last minute, and sometimes I've had to work short-handed.  We always make it through and the doctors sometimes do tasks they wouldn't otherwise have to.  It's not always easy, but it can be done.  I've answered phones, run lab tests, and even checked people in and out because we had fewer than normal people and everyone had to chip in.

When a paraprofessional calls in sick, life goes on and the clinic can still function, even if it limps a bit.  However, if the vet calls in sick, everything shuts down.  Sick patients can't be seen, pets don't get their vaccines, and surgeries get cancelled.  No matter how important the other staff are, none of them will have a job to do without the vet.

That's why I've been going to work the last few days and will go to work tomorrow.  One of my associates is out of town for the holiday and the other one is off for a few days (as well as got called to one of our other locations yesterday).  We've had a full appointment schedule and a full surgery docket, so if I didn't go in we'd have to call all of those clients, reschedule everyone, and not allow any sick pets to be seen.  Obviously that's not ideal for the clients or patients and hurts our revenues as well.  So, I go in.

Okay, before you start getting on my case, I do worry about being contagious, and have been using disinfectant wipes after I make a phone call as well as have been avoiding shaking hands with clients.  I also know that the best thing I can do to get better quickly is to stay home and rest.  But I can't close down the clinic for 2-3 days because I have a cold.

So not to belittle anyone else's job (which are VERY important to me!), but the single greatest limiting factor in the function of a veterinary clinic is the veterinarian.

And yes, if I'm not greatly improved by Friday (my next day off) I will go to see my own doctor.

What Christmas Is All About

It's just a few days until Christmas, and of course this means many things to many people.  Presents, parties, family gatherings, shopping, Santa Claus, the birth of Jesus....  But what does it really mean?  What is Christmas really about?

The answer is rather simple, actually.  Simple enough for children to understand it and simple enough to be put in a short segment of a cartoon.  So in celebration of the season, and if you're wondering what it's all about, I give you the answer....

Long-Term Steroid Use

Olivia sent me this question...

I would be very grateful if you could offer me an opinion on this if you can find the time. I've found it quite difficult to find proper information on.

My dog was diagnosed with lymphangiectasia back in October. It seemed to come out of nowhere, one minute he was well, the next he was barely able to breath and extremely unwell.  His diagnosis was followed by a 'but we're not 100% sure'.  This was all after a biopsy as the vet originally thought he had a growth in his abdomen.  To keep all unnecessary content out of this email, he was put on steroids and has been on a low fat diet since that. This has worked extremely well, in fact, he hasn't been this happy or healthy looking in a long time. However, we were told that the long term affects of steroids are damaging and we'll have to talk to our vet after Christmas about discontinuing them and figuring something else out.

Do you know of any other ways of controlling this or how long a dog can be left on steroids? I'm quite concerned as the only other option we were offered was a very expensive medicine that we'd have to pay almost 200 for a month (I wish I remembered what it was..), and even then the vet said he wasn't sure it could control the problem that it was trial and error at the moment.

 

For the readers who don't know what lymphagiectasia is, let me briefly explain, though the disease isn't really the main focus of the question. In essence this is a disorder that results from a dilation of the lymph vessels and most commonly affects the intestinal tract.  Chronic diarrhea results, and though that's bad enough it's not the main concern of the disease.  The diarrhea and loss of lymph fluid causes often severe loss of proteins from the blood stream, a process called "protein-losing enteropathy".  The low serum blood protein level causes fluid accumulation under the skin in the limbs, within the abdomen, or in the lungs.  Over time this can become a serious and life-threatening disease.  Though the only definitive diagnosis is through biopsy of the intestine, we can often get a very strong idea that we're dealing with lymphangiectasia based on symptoms and routine blood tests.

Treatment always involves switching to a diet low in fat and with high-quality protein.  It may also be necessary to provide supplemental fat-soluble vitamins (A, D, E, and K).  But one of the hallmarks of treatment is steroids to reduce the inflammation of the lymph vessels.  And that's where we get to the heart of Olivia's question.

There is often a lot of talk about the evil of steroid (glucocorticoid use).  And yes, it's not ideal.  Long-term steroid use has the potential of causing liver damage, affecting the immune system (though normally only when given at high levels), and inducing Cushing's disease.  These are all potentially serious issues, but the will NOT happen automatically or in every case.  Every patient is different and should be evaluated individually.  I also believe that long-term steroid use should never be a first option in most cases and other treatment options should be investigated and pursued.

But given all of that steroids are very effective in many diseases and disorders and should not be immediately eliminated from consideration, even long-term.  I have had many patients over the years that have had to stay on steroids for life and most of them have done quite well.  I have treated pets for lymphangiectasia, and I have always kept them on long-term steroids.  In my opinion you have to weigh the pros and cons of such medication use.  Ask whether or not the pet will be better off with the steroids or without.  It's really that simple.  No, long-term steroids are not ideal and can have side-effects.  However, in many cases they are better than the option of not treating.

If this were my case I would start the pet on steroids and recheck the blood proteins every few weeks until they stabilized.  Then I would check the liver enzymes and see if the steroids were causing significant effects.  If so, then I would investigate other treatment options.  If the chemistries were normal I would continue steroid therapy and recheck the blood every six months.  As long as the pet wasn't having significant clinical side-effects and the blood tests remain normal, stay on the medication.  So long-term steroids ARE an option and should be considered, weighing the decision against any potential harm.

Olivia, I hope this helps.  Remember that your vet knows the specifics of your pet's case better than I ever will and you should discuss all of these options with him.

The 12 Dogs Of Christmas

Over the last year or so I've been getting emails from Pet365 when they have new articles and fun stuff.  I don't always promote sites without compensation, but I have to say that the folks at this site have some great stuff, and I've posted with links several times in the past.

Very quickly, let me point you to a recent one on pet obesity.  There are some very interesting and informative statistics, and since the incidence of overweight pets is reaching 50% of the population, I think it might be an eye-opener for many people.




However, what trigged this entry was actually another post they made, this one just for fun.  "The 12 Dogs of Christmas".  It's a lot of fun and I chuckled when I was reading it.  However, why isn't the boxer doing anything?  In any case, enjoy!


Y'know, after almost three years of doing this blog, you'd think I'd find a template or otherwise figure out how to get these banners onto the site.

R U Writin Good?

I believe I have officially ventured into "old fogey" territory.  I am about to criticize the younger generation and lament the degredation of the older ways of doing things.

First let me say that I am a bit of a technophile, and obviously am very comfortable with computers and the internet.  I was using computers, email, and Usenet newsgroups back in the '90s, and remember when the World Wide Web first started becoming well known.  Though not prolific, I do text and even occasionally tweet, so I'm familiar with current modes of communication and social media.  I just wanted to say all of this to set the record straight that I'm not a "prude" when it comes to our digital world, and have embraced our electronic communications.  I'm not so old-fashioned that I think that a "word processor" is a piece of paper and a pencil.

That being said, I think that the currently emerging generation has lost a lot of communication ability because of the prevalence of texting and Twitter.  I know articles have been written about changes in communication style and many people have given opinion pieces on this topic.  But it really hit me this week in an email I received.

As regular readers know, I'm normally happy to answer questions.  Frequently I receive requests from pre-college students doing reports for a class on a given profession where they have to ask details about the job to someone in that particular field.  Yesterday I received the following email, reproduced here exactly as it was written to me (copied and pasted)....

hello i am currently doing a project for my online honors class of animal behavior and zoology, i was wondering if u could answer my interview questions for my project i hope im not taking any of ur time but if u have the time i would really appreciate it thanks and if u do i also need ur name my online teacher requires the information not sure why

I very sincerely hope that this is not how this particular person normally communicates with professionals.  They trample over so many grammatical rules that it would make any English teacher have a seizure, and there is only a single punctuation mark.  Vocabulary is also lacking, using "u" for "you" and "ur" for "your".   They ask for my name, even though it's right on my blog and even in the email address they had to type!  And this is supposed to be an honors student?  When talking to friends, I don't care that people use texting abbreviations, as I've done so myself.  But it's one thing to do this in a casual setting and quite another do so in an official request to a professional.

Let me give a few words of advice to any young people reading this blog entry.  Ability to communicate is crucial to success in just about every field and career.  It's especially critical in a professional setting where you are dealing with highly educated and intelligent people.  The words that you use, both written and spoken, give people an impression of who you are and how you think.  If you use a lot of colloquialisms and slang in a professional communication, you will leave a bad impression and people may think that you're not as knowledgeable as you may be.  When writing and speaking it is very, very important to use proper terminology, grammar, and punctuation, and avoid shortcuts that you may use with friends and family.  Whether or not it's "fair", people are judged by their communication ability, and everyone from supervisors to laypeople will form opinions based on your language skills (or lack thereof).  Reading something like the email above makes me question the writer's intelligence and professionalism, and if this sort of language was used in any form of application I would immediately discard the person from any consideration of working with me.

I am not trying to single out this particular person, which is why I didn't use their name and have even avoided identifying their gender.  Rather this is a chastisement of their ability to communicate well, and a warning to quickly improve on this if they want to be taken seriously by any professional in any field.  Even if you're not going to be a professional writer, you will be much more successful if you have a command of the rules of language and how to apply them.

Medicine Vs. Money

Abby emailed me recently....

I am a pre-vet student and have worked in the veterinary field for close to 5 years now, and am heavily invested in the world of veterinary medicine. That's why I was alarmed and upset to read this article, a "shocking exposé of the profession that puts pets through 'painful and unnecessary treatments to fleece their trusting owners.'"

http://www.dailymail.co.uk/news/article-1232217/Why-Im-ashamed-vet-shocking-expose-profession-puts-pets-painful-unnecessary-treatments-fleece-trusting-owners.html

I think the the author is swinging things unfairly against veterinarians. Preventative medicine is advised, not forced, and for good reason. Complications down the road can cost way more money that preventing problems in the first place. It's articles like these that make owners suspicious of our motives. I'm completely for owners educating themselves, but this guy makes sweeping and horrifying generalizations on the whole of the profession from just a few bad eggs. There are a number of other issues I see with the article, but I'd like to hear your opinion, if you don't mind.

 

This article is from 2009, and I've read it before.  In fact, I could swear that I've commented on it on this blog.  However, I'm too lazy to search my own blog, so I'll just comment again!

 

I have very serious criticisms of this author's article, and feel that he is unduly biased as well as has opinions that are contrary not only to most vets but also to many pet owners.  His statements and opinions also do not represent the veterinary profession from what I've seen in 28 years in the field.  Now, he is specifically talking about UK vets, but I don't believe that the standards and beliefs are significantly different in the US than there (and my experiences with this blog over the last several years has only reinforced my opinion that vets across the world share common goals, outlooks, and experiences).  Let me discuss and refute several of his comments, all quoted from the article.

 

No, instead, its leg was going to be amputated and then a course of chemotherapy would be tried to ensure that 'all was done to save the dog's life' - at a cost of £1,000 to £2,000, or even more.  I have no idea what the owner thought of this. But, as the majority of pet owners want to do the best by their beloved dog, I can only imagine he or she took this 'chief' vet's expensive advice to try to 'save' the pet.

 

Right here the author shows his igorance of the situation by admitting that he didn't know the owner's opinion, and imagining what had actually happened.  He is assuming the owner's thoughts without knowing them.  Is this a good way to form an opinion or make a decision?  Yes, most pet owners will listen to their vet's advice.  But most vets also discuss options and have the client make the decision.  I run into this every day, where I give clients the information and let them make the decision.  Sometimes they don't go as far as I'd like (actually that's pretty common), but sometimes they surprise me or even push me towards more serious treatment. 

 

As a writer I also have to comment here on the author's deliberate use of inflammatory language.  He uses words intended to sway the reader to his rather extreme way of thinking, and uses quotes around "chief" and "save" in a way that can only indicate skepticism as to whether the vet was really the lead one and if the treatment was actually going to save this pet.  This is a very, very opinionated piece, and because of the writing style should not be intended as an objective assessment of a situation.  The entire article is designed to convice the reader in the most graphic way possible of how bad veterinary advice is. 

 

And even if it did give that greyhound an extra year or so of life, how could anyone explain to it that the suffering was for a reason? That lying in a small cage, surgically maimed, and hooked up to a drip for weeks, perhaps months, would be 'worth it'.

 

"Surgically maimed"?  Really?  Again, very deliberately inflammatory comments.  And I've never seen conditions such as described, where the pet is hospitalized in very confined and stressful conditions for months on end.  This is absoultely a false representation of what actually goes on.  Amputations normally go home within 24 to 48 hours of the surgery.  Chemotherapy patients normally spend a few days at a time in a hospital (if that long) as long as they're otherwise stable.  The author is misrepresenting what happens, and I believe deliberately and knowingly so in order to promote his particular viewpoint.

 

Also, I take issue with the author's apparent opinion that because we can't explain the pain and hardship to the pet, we shouldn't be doing the service.  If we could ask the pet, they wouldn't come in for ANY service!  Ask that kitten if it wants a shot.  Ask that dog if it wants to undergo surgery to get spayed.  Animals cannot be reasoned with or comprehend the long-term meaning behind anything that vets do, and because of this we cannot rely on their desires of whether or not to go through the treatment.  Pets are under our care, and as guardians it is up to the owner to make the right decision, just as for an infant human.

 

One might imagine that because there are so many more vets that animals need more medical help than ever. But the truth is far simpler. A whole industry has arisen out of squeezing the most money out of treating family pets.

 

Once again, deliberately inflammatory language..."squeezing the most money".  There are increasing vets because the population is increasing and more people want to go into the profession.  And most veterinary students know that they will make a pittance compared to their human counterparts, so it's certainly not about the money.  Clients are also expecting and demanding a higher level of care than they did 50 years ago, as well as more personalized attention, so vets are really just providing what the client wants.

 

It is not unheard of for vets to Google a pet owner's home to see which area the family live in. Big house in a posh road  -  well, you can offer more treatment to that pet owner, of course. I never witnessed this in my practice, but I heard of it happening. Charge more for your services so a vaccination that costs a few pence becomes a £35 'consultation'. And that isn't all.

 

Here the author once gain subverts his own creditability.  "I never witnessed this...but I heard of it..."  And a rumor passed from person to person is enough to form an opinion about an entire profession?  Until reading this article I had never heard of this and have never considered it as happening.  I've known dozens to hundreds of vets in my career so far, and I've never heard any of them talking about anything even remotely like this.

 

While the owner might believe he or she is only taking their cat for a vaccination (and I have no problem with sensible preventative healthcare) for the vet, this visit can be a way to make even more money out of a perfectly healthy animal.  During the 'health check' which accompanies the vaccination visit, it is amazing the potential 'problems' the vet might find.

 

Notice the quotation marks indicating skepticism and derision?  Yep, the author is predictable.  I'm sorry to say but the client is not always observant or aware of health problems.  The point of the exam is to check for any problems, and if the vet isn't doing their job properly an issue might be missed resulting in a lack of treatment.  The two most common health issues I see are dental tartar and weight issues.  I would say that 70-80% of my patients are either overweight or have some form of dental tartar.  Am I trying to gouge a client by talking to them about treating these issues and recommending products or services that might help?  I've noticed loose teeth due to periodontal disease that the client never did.  I've found cancerous masses, bladder stones, ear infections, fleas, arthritis, and numerous other problems on an apparently "healthy" pet (yes, I use the quotation marks myself on purpose).  Finding these things has nothing to do with wringing money from clients.  Instead it is about trying to catch health problems early, before they turn into life-threatening issues, or finding problems that the owners never noticed.  I have prevented many serious problems by informing the owner what I found on a routine exam.

 

Sadly, the best way to deal with many problems is not to treat at all. Small animals such as guinea pigs and rabbits should be put to sleep if they present with an illness that can't be easily rectified with a dose of antibiotics. Their lives should not be prolonged at all cost.

 

Wow, what an absolutely shameful comment!  I do agree that we shouldn't prolong life at any cost.  But to say that a pet isn't worth saving if it doesn't respond to antibiotics alone is being extremely jaded and uncaring.  I've known people to spend hundreds of dollars on their hamster or guinea pig and were very happy afterwards because their beloved pet was still alive a year later.  These pets have just as much emotional worth to some people as a dog or cat would.  Recently I've been treating a small parakeet for chronic egg-laying, including hormone injections.  This client has spent almost $400 in the last four months on a $30 bird, and is now getting ready to go to an avian specialist.  According to this articles author I should have already recommended euthanasia, even though this bird is this owner's best friend and she is very willing to spend the money. 

 

 Nor should cats that are run over and experience a complex injury or bladder problems - sadly an all-too-common feature of road accidents as the car catches the back of the cat as it tries to escape - endure lots of operations in the hope that the problems can be cured.   Even if they can be - eventually - I believe putting any animal through this is barbaric.

 

Wait.  We shouldn't do life-saving surgery even if there is a chance of the surgery fixing the pet and that pet going on to live a relatively normal life?  How is that kind of treatment "barbaric"?  We're putting the pet through temporary pain and inconveience to safe its life and give it longer term relief.  Of course, by this point in the article I've completely lost any faith in the author's credibility and have chalked him up to a biased lunatic with an agenda he is trying to foist on an unsuspecting public.

 

Expose my left butt-cheek!  This is nothing more than an opinion piece by someone who doesn't have any proof of his viewpoints (how many times did he admit that he had never seen something that he was stating was reality?) and is trying to convince people of his radical view.  You can summarize this author's belief system very simply....if an animal get sick or injured past the ability for cheap oral medications to cure, that pet should be euthanized regardless of a client's wishes or our medical ability to treat the problem. 

 

Now stop and think about the consequences of this viewpoint, and follow the thought to its logical conclusion.  The author claims to be only looking out for the best interest of the pet, and not putting it through any unnecessary procedures.  However, by saying that we should never do anything complex or protracted, he is demeaning the value of pets to their people, and saying that they really aren't worth treating.  How is this a compassionate view?  In essence, he views pets as disposable and not worth the money it might take to make them better.

I could go on and on and pick the article apart line-by-line, but this is already one of the longest blog entries I've written and the more I read that article the more I am infuriated by the author.  So I'm going to stop for now.

Abby, you asked for my opinion, and there it is!

Vets, Motherhood, And Debt

Over the last few years I've blogged a few times about the overwhelming debt that vets acquire during their education and how the debt is rising much faster than salaries.  Stephanie emailed me a question a few days ago, and a recent journal article brought up the same issue, so I thought I'd spend some time discussing it. 

I found your blog online when I was researching day-to-day life as a Veterinarian. I'm currently a Biology undergraduate student deciding which I want career path I want to take. For as long as I can remember I've wanted to, and planned to be, a veterinarian; but recently I've been trying to consider more realistically if I this is the most practical option for me. Although veterinary medicine is what has captivated my interest since I was a child, I don't want to lose site of the bigger picture. I'm worried about being able to pay back student loans I may obtain during graduate school, and I also want to be a stay at home mother some day. I don't want to feel I've wasted all the time, effort, and money on becoming a veterinarian if I'm planning to give it up some day.

I was wondering if, as somebody who has gone through vet school and can speak from experience, you could give me some advice. Is it impractical to go through the process of becoming a veterinarian if I plan to give it up someday to become a mother? And hypothetically speaking, do you think based off of a general small animal veterinarians salary, would I be able to pay off any debt acquired during my four years in vet school, in say 10 years of practicing? My main concerns are that I will go through vet school and have no choice but to continue practicing after I've had children, just to pay off the school debt. I know I would want to practice for as long as I could, if I weren't considering having a family in addition to my career, but I want to leave my options open because I know I may also want to stay at home and take care of my family.

 

In the November issue of DVM Newsmagazine there is an article related to this topic.  According to the article in the last year starting salaries for veterinarians declined, but debt hit record-breaking levels.  The average financial debt for a newly graduated vet in the US is $142,613, while the average starting salary is $46,971.  That translates to mean debt being 213% of starting pay!  From 2010 to 2011 this debt rose by 15.6% while salaries decreased by 1.3%.  Yikes!  Additionally, the number of offers new vets are receiving is decreasing steadily.  In 2001 35.6% of new graduates received only one offer of employment and 23.5% received four or more.  By 2011 this has changed to 63.1% with one offer and 4.8% with four or more!  It's becoming harder to find work, as well as becoming more financially burdensome.

 

Now if someone really, really has a passion for veterinary medicine and is willing to live on less than they want, and less than practitioners made (relatively) 10 years ago, I'm not going to say don't do it.  But everyone going into the field needs to be very aware of the financial challenges they face.  So, Stephanie, I'm glad that you're really giving this some thought.

 

I'm not going to tell you that you should give up your interest in becoming a vet.  However, if you plan on leaving veterinary practice within 10-15 years of graduating, I would recommend against it.  I graduated in 1997 and I'm still paying off my loans.  I also had a far lower debt load than most of my classmates, so it wasn't as hard for me to make payments.  Most vets that I know do not pay off their student loans within 10 years, though I don't know the official national numbers.  If current salary and debt trends continue (and there's no good reason to expect that they're not) you're probably going to be paying for your education for at least 20 years after your graduate.  That's a very steep price to pay! 

 

With the profession now mostly female and the percentage sharply increasing with each new graduating class (most are 75-80% female now), the reality of being a mother and a vet is starting to affect the profession.  This doesn't have to be bad, though.  More practices are willing to have a vet in a part-time capacity, helping the women to balance family and work.  It's also certainly possible to be a full-time vet and a mom, and women have been doing this for a very long time.  However, you can't be a full-time vet and a full-time mom, as vets often work long and diffuclt hours, and depending on where you work you may be on call for emergencies at night.  Now I don't want any of my readers to mistake my intent.  I have no problem with female vets or vets who are parents, and know many who are successful doing both at the same time.  But you simply can't be home as much with your children when you're working any job full-time, which makes balancing family and work difficult.  If your priority is going to be to your children and family, then you will have to give up time at work.  That is a personal decision to make, and one only you can make.

 

Stephanie (and anyone else in the same situation), look at the starting salaries and debt loads of vets and plan ahead.  If you can make it through vet school with little debt, the idea of giving up practice at some point is feasable.  But if you're one of the average new graduates, then you will likely have to continue being a vet longer than you might want.  In cases like this you may want to look at other career options.

 

I also expect many of my readers who are women, moms, and vets will be happy to share their own experiences and advice.  I am a guy, after all, and my wife has been a stay-at-home mother for the past 3-4 years, so I can't completely relate to what many vets go through.

Believing In Santa

Today I read a news story about a second grade teacher who told her students that Santa Claus didn't exist.  The class was doing a geography lesson and talked about the north pole.  The students said they knew where that was because it was where Santa lived.  The teacher took it upon herself to tell the class that Santa didn't exist and it was their parents putting presents under the tree.  Remember, these were seven and eight year-old kids!  I was shocked that a teacher would squash a child's imagination and wonder so callously.

I know the reality of Santa, and also know that the most important part of Christmas is not him but Jesus.  However, we want to encourage our kids' belief in something beyond this world and foster their imagination.  So we have always told them about Santa.  In fact, their belief is so strong, that it's just about impossible to change it!  This Christmas our daughter is nine and our son ten and they believe in Santa Claus.  Some of their cousins and school friends have told them that it's just parents, but they don't believe it at all.  Last year they tried to set up a video camera to catch Santa and prove to their friends that he exists; thankfully it was a cheap kids' camera with an automatic shutoff and didn't record long enough (though I had a plan for the cats to "knock over" the camera and film only boots....which I happen to have).  

We also follow Swedish beliefs in Jul Tomte who comes on Christmas Eve while people are home (Santa comes after everyone is asleep).  Each year we have come up with some excuse to leave the house for a while and when we get home Jul Tomte has visited and left presents and a note (I always find a way to sneak around and leave the presents on the back porch).  This year the kids are adamant about not going anywhere and missing Jul Tomte yet again.  We're still trying to figure out how to get around that, but are hoping to convince someone to stop by as Jul Tomte.  

Some may think that we need to prepare the kids for the reality of the world and not foster false beliefs.  But the world is cold and banal, and growing more so every day.  So many people lack a sense of wonder and joy, and we don't want our children to be that way.  I remember when I found out that Santa wasn't real, but I was around the age of my son and my parents did a great job of talking to me about Santa, gnomes, and other wondrous beings.  I feel that I am better because of it and not worse, and that it's helped my outlook on life.

We need more magic in our lives.  As much of a challenge it is to keep up with our kids determination to get proof of Santa and Jul Tomte, my wife and I are proud of the job we've done getting them to that point.  The world is dark enough, and I want our children to see some brightness in it.

Dealing With FIV

This email came from Nancy.

My 12 year old cat Billy was recently tested positive for FIV. He used to be free roaming. He now lives completely indoors and gets along well with my three other cats. I am going to get my other cats tested for FIV, to be on the safe side. As of right now Billy seems to be doing well, though I am keeping a vigilant eye on him. My main questions are: What is the best way to care for Billy, in terms of should I feed him anything special, do I need to make sure that he stays warm, etc? What are the warning signs that I need to look out for as the disease progresses? 

Feline immunodeficiency virus is very similar to HIV in humans.  Both viruses can lay dormant for years, during which time there are no outward signs of illness.  FIV affects the immune cells and bone marrow, making cats more susceptible to infection.  Because of a deficiency of proper immune cells the entire immune system is reduced in efficacy (hence the name).  The virus itself does not cause death.  Instead infections that would otherwise be fought off take hold and lead to serious illness.

As long as Billy is acting normal, there really isn't anything you can or need to do for him.  Until the virus activates, there really isn't anything wrong with him and he doesn't need care any differently than a non-infected cat.  The best thing you can do is to keep him inside (as you are doing) and keep stress to a minimum.  Physiologic stress can lower the immune system and cause dormant viruses to become active.  Being inside keeps him from spreading the virus and puts him at a lower risk for injury and disease.

You also need to have him seen regularly by your vet.  I would recommend a minimum of every six months even if he is acting normal.  A full chemistry panel and blood cell count may show early signs of oncoming illness and would give you some warning that something is wrong, so this should be done at least annually.  Also take him in at the first sign of any illness in order to try and head it off.

If and when the virus activates, the initial symptoms will likely be subtle.  You may notice a decrease in activity and appetite, find him acting more reclusive, or see some weight loss.  Most of the time there aren't dramatic changes early on.  If you see these things talk to your vet, as there will likely be changes in the blood cell count that will confirm that the disease is progressing.  At that point there are only limited things that can be done.

Best of luck to you.

Where's The Uterus????

Sometimes very, very odd things happen.

Today I did a spay on a normal, healthy, happy puppy that I have been seeing for the last couple of months for routine preventative care.  All of the pre-anesthetic blood tests were normal and we proceeded with the surgery.  When we first go into an abdomen on a spay, most vets "fish" inside using an instrument called a spay hook (also sometimes called a snook hook).  The purpose of the instrument is to gently hook around the uterus and pull it out of the belly so we can work with it.  Using this hook allows us to make a smaller incision than we would need if we explored the abdomen with our fingers.  It's not uncommon to have difficulty finding the uterus, especially in a small pet.  The uterus itself can be pretty small, and we're searching among all of the other abdominal organs.  However, most of the time I can find the uterus within five minutes or so.

But not today.  We're taught to start on the right side to avoid accidentally snagging the spleen and potentially tearing it.  I fished, and fished and simply could not find it.  In case like this I normally extend the incision slightly to allow me to reach in with my finger and try to feel for it, a trick that normally works well.  Again, not so in this case.  I was getting pretty confused and worried, so I extended the incision more to explore the abdomen better.  At one point I thought I found part of the uterus with a cyst on it, but there was something very strange about the anatomy since I kept searching.  After doubling the length of the incision I was finally able to locate the left horn of the uterus.

Let me pause here to give a brief anatomy lesson.  A dog's uterus is a bit different than a human's.  The uterus is Y-shaped, with the "body" being the main part of the uterus and each arm of the Y called "horns".  The ovaries are at the end of each horn, and puppies develop in the horns.  When we spay a dog we ligate at the ovaries and then at the uterine body, removing the uterus entirely.  Here's an image showing what I'm talking about....

 So I found the left horn and ovary and everything looked okay.  I traced it back to the cervix, and normally when doing so I'll find the bifurcation leading to the opposite horn.  Nope.  Nothing there but some blood vessels and connective tissue.  I extended the incision further and started digging around where I thought I found the other uterus.  As I looked around more, I found what appeared to be an abnormally shaped ovary and a little section of uterus, though not in the normal place.  I followed the connective tissue and ended up at the other horn.

This is a rare condition, but it can happen.  Part of the uterus doesn't fully develop or doesn't develop at all.  In 14 years of practice and a couple of thousand spays (literally), this is only the second time I've seen this happen.  In cases like this we remove the identifiable tissues and proceed relatively normally.  Because there is already abnormal anatomy, we cannot rule out the possibility of pockets of ovarian tissue that develop unconnected to the rest of the reproductive tract, which I warned the owners of.  However, usually in cases like this it's an incidental finding and the dog does fine afterwards.

It's pretty true that you never know what you're going to face on any given day as a vet.

Causes Of Vomiting

Back from the Thanksgiving holidays and back to answering questions.  Here's one from Megan.

My name is Megan. I started following your blog about two weeks ago and have found it entertaining as well as informative, so first of all thank you for writing. I was wondering if you might answer a question for me. I have a 2 year old long haired female kitty who used to have seizures at least twice a month (I did take her to see a vet about this) but since I moved to an apartment 6 months ago and made her a 100% indoor cat, she hasn't had a single seizure since. She's been a picture of health til a few days ago when she started vomiting frequently. The vomit looks like mushy cat food. There doesn't seem to be much else in it. She does not appear to be over eating, and has otherwise been herself. I would take her to a vet, but at the moment my husband and I can't afford it, and I'm not even sure it's something to be worried about... Is it?

Megan, the short answer is to have your kitty checked out by a vet.  Unfortunately, vomiting is one of the most common symptoms we see and can indicate numerous problems, from serious to simple.  But let's see if we can narrow down things a little bit.  Three things come to mind based on this limited information:  gastric foreign body, inflammatory bowel disease, and dietary indiscretion.  

Some things can become lodged in the stomach or small intestine without causing a complete blockage.  This can be irritating to the gastrointestinal tract, leading to vomiting.  However, most foreign objects in the GI tract cause more serious illness than simple vomiting, and it doesn't sound like your kitty is that sick.  So I would put this lower on the list but not rule it out.

Inflammatory bowel disease (IBD) often rears its ugly head as frequent vomiting.  Most commonly this is an inflammatory process secondary to a food allergy.  There is no specific test for this other than surgical biopsy (sometimes endoscopic biopsy will be sufficient), so we end up running tests to rule out other problems and then look for a response to therapy.  This therapy is normally a combination of steroids and hypoallergenic foods, and often requires life-long treatment.

Dietary indiscretion is a fancy medical phrase that means "eating things they shouldn't".  Cats are notorious for getting into plants, garbage, and other things around the house.  Look around your home and see if this might be a possibility.

Sorry this wasn't much help, but if this doesn't stop soon or if your cat acts sick, I would recommend a vet visit, planning on the possibility of blood tests and x-rays.  Good luck!

Flexibility Is Important

Some stories you just can't make up.

Yesterday I saw a couple and their yorkie puppy.  The owners were, shall we say, rather "stout".  Normally I wouldn't mention this, but it's an important mental image to keep in your head.  It was a pretty routine exam and vaccines on a healthy puppy.  On the previous exam my associate hadn't felt the puppy's testicles, so I paid particular attention to this particular area and gladly told the owners that both were present.  Since we were in that area, the wife asked me about the "dumbells" on his genitals.

Now I need to interrupt the story for a little anatomy lesson.  Male dogs have erectile tissue at the base of their penis called the bulbus glandis.  This is a normal structure and can enlarge with any excitement, whether it be sexual, play, or just about anything.  The true function is to act as a "knot", allowing the male to "lock" with a female during intercourse.  The male inserts into the female and the bulbus glandis enlarges, locking him into a position inside her.  This allows him to stay inside longer, prolonging the amount of sperm and keeping another male from mating right afterwards.

One of the most interesting things about all of this is that once the male is locked, he swings his body around so that he is butt-to-butt with the female, while staying inserted!  It looks something like this....

While it seems a bit strange to us, this is normal in all canines, increasing the chances that the male will fertilize the female.

Back to the story....

I was explaining that the "dumbells" were the bulbus glandis and then described what it was and it's purpose.  I ended up describing the locking of the male and female, with the male ending up facing away from the female without coming out.  The wife gets a wide-eyed expression, turns to her husband, and says, "Dadgum!  Why aren't you that flexible?"

My jaw dropped as I struggled to save myself from the suddenly awkward situation.  We moved on to other topics, but I must say that was a mental image I certainly didn't want to have.

Making The Boys Cry

It's never easy when you have to euthanize pets, especially when the owners cry in front of you.  And for whatever reason, it seems to be harder to see men cry than women.  Today I had opposite ends of the age spectrum of owners do this.

The first one was an elderly man on Social Security and a limited income.  His cat had had a decrease in appetite and was acting a little lethargic.  When I examined the kitty he was very sweet and purring, but had a noticable jaundiced appearance to his skin and gums.  This usually indicates a liver problem, but can also indicate red blood cell destruction.  Since this was a very obese cat who had lost 6 pounds (24 to 18 pounds) in a month, I was very worried about a serious and potentially deadly condition called fatty liver syndrome.  Because the owner didn't have much money we ended up euthanizing to keep the cat from suffering.  As we were talking about it and doing it, there were tears running down the man's face. 

The second one was later in the afternoon when a mother and her sons brought a hamster in.  I quickly saw that he had a large tumor around his testicles and rectum and a smaller but still worrisome tumor on his left hind leg.  There wasn't anything we could do, so I started gently talking about euthanizing him.  Before I actually came out with the words one of her sons started crying.  He was 10, the same age as my own son, and obviously taking it hard.  While crying he said he didn't want to do it, so I gave the mother some time alone in the room and she explained to him how this was better.  Thankfully the end was quick and painless for the hamster.

After both of those I felt pretty rotten.  I realize that in both situations we did what was best and most humane for the pet and the owners had every right to grieve.  That knowledge and assurance still didn't make me feel any better and I hated seeing the naked emotions.  But it's not the first time I've dealt with either circumstance, so I can make it through.

These are the human interactions that many vet students and new vets aren't prepared for, but will regularly be faced with.  We perform merciful actions and help ease animal suffering, but at the same time we are "causing" tears in the owners.  It's a sad necessity. 

Tomorrow I'll share a rather amusing comment that happened between these cases and kept the day from being a complete downer.

Does Major Matter?

Ashley sent this in...

I am interested in becoming a vet and am wondering if i should major in Biology or Zoology?  Many people have given me different answers to this question, but i don;t know what to believe.  Which one is a better Undergraduate course for someone who wants to become a Veterinarin?

First just a few caveats and disclaimers.  I am only familiar with US veterinary colleges and even with the 28 we have there can be differences in the entrance requirements for one over another.  The best thing to do is to check with the school or schools that you are considering and see what their specific needs are.  Also, search back through my blog (search box on the top left) and you can see other responses to questions about getting into veterinary school that might help with any other questions you have.

I honestly don't think your major matters in the least.  In my experience the vet schools don't actually look at your major itself.  They have specific courses that they require, many of which may not be obviously applicable, such as calculus.  The admissions office looks at whether or not you have those courses, as well as your GPA in them, rather than looking at your major.  Most vets I know had a Biology, Zoology, or Animal Science undergraduate degree.  But I've known people with majors in teaching, computers, chemistry, English, media/publishing, and so on.  From everything I've seen it really doesn't matter what your major is as long as you have the appropriate classes.  For the record, I have a Bachelor's in Biology.

When you're getting to something as small as a difference between Biology or Zoology, look at what each major requires and how many classes for vet school you can get in each.  I would recommend picking whichever major already includes the most pre-vet classes.  If it's pretty much the same, pick whichever you find more interesting, which in the case of someone going into veterinary medicine would probably be Zoology.  Personally I've always been bored by botany and much of ecology, so you may be able to avoid some of those classes with a Zoology  major.  But in the end the decision is up to you, and I really don't feel that one of these majors is going to be "better" for getting into vet school than another.

I hope this helps, Ashley.  Best of luck!

Aqua-geek

Any regular reader of this blog will know that I am a big geek.  Being a vet is pretty much what I do to support my other interests as well as my family, and those interests are usually geek-related, involving sci-fi, fantasy, comic books, and so on.  Just look back through this blog for my annual attendance at Dragon*Con in Atlanta, Georgia.

One of my favorite comic book characters is Aquaman.  I've always loved the idea of being able to swim underwater and communicate with animals.  I also enjoy the stories told about him and have followed him through his various incarnations in comic books and animations.  When I was younger I did competitive swimming and often used Aquaman as my inspiration, pretending I was him when I was practicing or simply playing in the pool.  I was excited when his new comic book started (with the entire reboot of DC comics) and have really enjoyed the story and art so far.  I have several Aquaman action figures and plushes, and have even gotten into minor arguments with friends about how awesome Aquaman is.

Earlier this year I found a site called the Aquaman Shrine, written and updated by a true Aqua-fan.  One of the things he does is maintain a fan designation called "F.O.A.M.", which stands for "Friends Of AquaMan".  To achieve F.O.A.M. status you must send in something unique and Aquaman-related.  It can't be simply a picture of an Aquaman action figure, or a website with an Aquaman hoodie, as those are common.  It has to be something new, obscure, unique, or otherwise different.  And today I earned my F.O.A.M. membership!

I love comic strips (the "educational" section of the newspaper, as my father calls it) and read most of mine on GoComics.com.  One of my favorites is Thatababy, which frequently has geek-related themes, but is funny even without that.  Today's comic is what caught my attention.

I sent that in to Rob, the webmaster of Aquaman Shrine, and he sent me my F.O.A.M. membership certificate!

So now I proudly claim the title of "Friend Of Aquaman", Aqua-fan, and geek!

Modern Pet Ownership

For the last few days I've been treating a very sweet mastiff for sudden kidney failure.  She didn't respond to any treatment and her kidney had completely shut down, so today we euthanized her.  But her medical condition isn't the focus of my blog today.

Yesterday I learned that the ownership was a little bit complicated.  The owner and his ex-wife had apparently included their dogs in the divorce settlement.  They didn't have children and really loved their dogs, so they officially and legally had joint custody of the dogs.  All of this came to light when each owner came to check on their dog individually and told me about the situation.  They were both involved in her decisions and were talking to each other, but lived separately.

Today when we euthanized her the man was there with his current girlfriend.  When it was time to give the injection the girlfriend left while the ex-wife came in to be present when we did it.  Once it was over she left and the girlfriend came back in.  All-in-all it was one of the stranger situations I've been a part of, and seemed very much like situations I've heard of when ex-spouses have to come together over the illness of their child.

I guess this is a reality of modern pet ownership and something we may see more of.  Pets are increasingly a part of our extended families and people feel very strongly about them.  When people separate there can be as much disagreement over the pets as there is over the car or house.  This can also make it challenging to vets as we may have to deal with situations like this that we are not trained for and have to deal with more complicated decisions over their pets' well-beings.  

I'm certainly not looking forward to dealing with a joint-custody situation where the co-owners disagree on what to do.

Financial Impacts On Medicine

World-wide there are financial crises, from the persistent recession in the US to the near-default in Greece and with several other European countries not far behind.  We hear about these issues on the news but I'm not sure if we always realize the trickle-down impact such economic problems can have.

Veterinary medicine is certainly not exempt.  There have been many articles in veterinary journals over the last few years about the significance of economic downturns on the way we practice medicine and the clients that we see.  Many people are out of work or "under-employed" and have less money to spend.  This usually means that their pets come in less often and they do less care, sometimes with serious consequences.  For several years now overall veterinary visits have been on the decline, especially with cat owners.  And that was the reason for my latest poll.

This time I asked questions of each group of readers differently.  For pet owners I asked whether or not they had spent less at the vet in the last 12 months.  The results showed that 29% (16) said "Yes", 63% (35) said "No", and 7% (4) weren't sure.  My veterinary readers were asked if they had seen less spent at their clinics in the last year.  Seventy-six percent (16) said "Yes", 14% (3) said "No", and 9% (2) weren't sure.  As usual, this is a very unscientific poll since my readers are likely skewed towards the better pet owners, and there wasn't anything physically keeping owners from answering as vets and vice-versa.  Still, I think the results can tell us some things.

Most vets said that clients were spending less, yet most clients (at least here) said that they didn't spend less.  So there appears to be a discrepancy between what clients think and what vets think.  Though as I said the data here are likely skewed, this does seem to reflect other studies that show differences in how vets and clients perceive the care that pets are receiving.  And despite what some clients may think, other studies and polls show that pet care and veterinary visits are declining.  What's interesting is that overall spending on pets is increasing some, which means that people are spending more money on pet supplies but not on veterinary care.  To me this is the wrong emphasis for clients to make.

I think that this poll also gives a little insight into this blog's readership, though that wasn't originally the intent.  There were 21 respondents who classified themselves as vets and 55 who said they were clients.  Some of the "vets" may include students or techs, but there are still quite a lot of readers in the profession. 

So in any case, make of the numbers what you will.  And while I do agree that when money is tight spending should be focused on the human members of the family first, we also don't want to forget proper care on our fuzzy, feathered, and scaled friends.

Please Come In!

Here's something I can't emphasize enough:  If you have any concerns about your pet, take them to a vet!

Today I saw a cat that I spayed last Saturday.  By Monday the incision had started to slightly open at one end.  The owner looked on the internet and determined that it wasn't anything she needed to be worried about and that it was normal to do this.  Today she brought the cat in because the incision had become infected and was looking rather nasty.  Luckily, the abdominal wall was still in good shape and a cat spay incision is pretty small, so with some antibiotics and time she should be fine. However, she should have brought the cat in much earlier.

Later in the day I vaccinated a kitten.  A couple of hours later the owner called, worried that her kitten was having a reaction to the vaccine because it's eye was closed.  We recommended bringing her back in, though it didn't sound like a typical reaction based on her description.  When we rechecked her it was obvious that she wasn't having a reaction and had some hair in her eye.  A little saline flush and she was fine.  But this way we could be sure to document the incident and make sure there wasn't anything serious going on.

I am always quick to tell my clients that if they ever have any concerns, come in and let us take a look at their pet.  I would rather they take the time to come in and us tell them that there isn't anything serious than to have them wait it out and something worse develop.  It's always better to see a problem early when it's easier to treat.

People also need to be very, very careful about advice they seek on the internet.  And yes, I say this having had a blog for three years that involves giving advice and recommendations.  If the first client above had not listened to something on the internet maybe she would have brought her cat in sooner.  No matter what you say, read, or do, there is no way that something found via a computer can take the place of a skilled vet actually looking at the pet.

I know that many people don't want to take their pet in for something trivial, pay the office visit, and then be told that there's really nothing wrong.  But take it from me, there are times when someone comes in for something "simple" and it turns out to be anything but.

If you get nothing else from my blog, remember this.  Any time you have any concern about your pet, go in and have a vet take a look.  NOTHING takes the place of doing this.

Getting Ready For Winter

Here in the northern hemisphere we're gearing up for winter.  Some parts of the US have already seen an unusually early snow storm, though it won't be the last.  As the weather cools down and snow and ice loom we have to take a look at how we care for our pets.  Which brings us to this question from Sam.....

My dog refuses to wear booties but NEEDS a daily walk even in winter. My friend swears that using Vaseline on his paws before a walk will protect them from ice balls and salt. I would wipe them off after the walk but am not sure how safe this is. What would you advise a client regarding Vaseline? Also, when is it too cold. Anything below 0•F?

First, just to point out to everyone, the pads of a dog's feet can be very sensitive.  Yes, as they age the pads thicken but we still have to be concerned about their feet, especially in cold weather.  The traditional salts used to de-ice driveways and sidewalks can be very irritating to the skin and can cause gastrointestinal upset if swallowed.  In sub-freezing temperatures you can also get damage from ice due to the severe cold, or irritation from balls of snow and ice getting trapped in the fur between the pads and toes.  So these are legitimate concerns.

I really like using booties for dogs, as they are specifically designed to protect the paws against many different kinds of irritants or damage.  Rescue dogs often wear them when going into areas of rubble and debris.  But I do realize that some dogs simply won't tolerate them.  The first thing I'd do, Sam, is work with your dog with the booties.  Put them on and let him stay in the house.  Give him praise and a treat if he lays there without trying to take them off.  If he starts walking around without problems, give him more rewards and treats.  Most dogs can become accustomed to booties, but it's not natural to them so it's common for them to try and get them off.

If this doesn't work, you can try the Vaseline.  Personally I've never heard it used this way, but this and other petrolium jellies are pretty harmless, even if swallowed.  Some of my readers may have more experience using it this way and could give opinions.  But I certainly don't think that it would hurt, even if he swallows small amounts.

As far as being too cold I think it depends on the dog and the temperature.  Certainly anything below freezing can potentially be dangerous, and the farther you get below freezing the greater the risk increases.  I don't think that most dogs should be left outside for long periods of times in sub-freezing temperatures.  The breed is also important, and the coat of a dog like a Siberian husky is going to be more protective that that of a chihuahuah.  The size of the pet is also important, as larger pets have a smaller surface area to body weight ratio, enabling them to maintain their body temperature more easily (this is why you tend to see larger animals in the Arctic and smaller ones in the desert).  So a small short-haired dog would suffer adverse effects more quickly than a large thick-coated dog.  Use your best judgement, but I do realize that most dogs need to go outside at least a little bit each day, even in cold weather.

Getting A Start

Caitlin emailed me the following....

I am 17 and a junior in high school. I have always had a love for animals and I've dreamed of becoming a veterinarian since I was in elementary school. I have shadowed at my local veterinary hospital and volunteered with animal rescue groups. What advice do you have for a high school student wanting to pursue a career in this field? I know that I still have another year before starting my undergrad in pre vet, but what can I be doing now to ensure I have the best chance possible to get accepted into veterinary school? Also, any idea what jobs are typically offered at animal hospitals for my age group?

Good questions, Caitlin.  Do a search on my blog, as over the years I've talked about various aspects of getting into vet school.  You can find the information here, as well as what life is like as a vet which may influence your decision.

The number one bit of advice that I would give is exactly what you're looking to do.  Get a job in a veterinary clinic.  There is simply no better way to get an idea of what it's like to be in the field than to work alongside a vet.  You get to see the often long hours, hard decisions, cases that go bad, and the rewards that can go along with the hardships.  You can also talk to the vets one-on-one about their specific paths and what they like and dislike about the job.  And you get to see if you can really handle the blood, pus, diarrhea, and other gross things.

Depending on where you live state laws limit what you can do as a minor.  You are limited to how many hours you can work and what kinds of things you can do.  For example, in my state you are not allowed to assist in taking x-rays if you are under 18 years old.  A veterinary clinic is also unlikely to hire an inexperienced teenager into an important or skilled position, which means you may start out as a receptionist or helping clean kennels.   And there's nothing wrong with these jobs!  My first job was working for my local vet as a kennel worker, cleaning cages and walking dogs.

Truthfully, any work you do prior to being in college isn't going to be looked at during the veterinary school admission process.  At this point you need to focus on whether or not this is really the career path you want.  You still have several years before you will even think about applying to vet school, so use this opportunity to explore the field and talk to vets about what career options you have within the various aspects of veterinary practice.

Again, do research, get ANY job in a veterinary clinic, and ask lots of questions to the vets around you.  Best of luck!

Determining Lifestyle Risk

As vaccine recommendations and protocols have changed over the years, the profession has moved from recommending a set of vaccines to every pet, to more of a risk-based assessment that takes into account a pet's lifestyle and environment.  It seems to make sense that a pet who isn't at risk for a given disease shouldn't worry about being vaccinated for it.  However, I don't believe it's as clear-cut as many might think. 

Let's take my in-laws as a great example.  They have a chihuahua and recently got a yorkie-chihuahua mix puppy.  These are small dogs who are completely babied and spoiled.  Most of their existence is inside a home, though they do go outside for short periods.  If I saw them in my practice as a regular client, I'd ask about their environment and likely come to the conclusion that these are indoor-only pets with little risk for exposure to leptospirosis or bordetella (kennel cough).  Based on a risk-assessment analysis, these vaccines (both consider non-core by many or most vets) do not need to be given.  However, I know a bit more about the environment of these dogs than the average person.  There is another dog next door to them that stays outside and lives in a fenced yard where there can be nose-to-nose contact, as well as spread of urine along the border.  My in-laws have also seen coyotes in the woods behind their house and though there is a fence eliminating direct contact, there is risk of the coyotes as lepto carriers urinating into the yard and therefore contaminating the soil.  Knowing these things it seems like my in-laws' dogs should certainly be vaccinated for lepto and possibly bordetella.  Would these risks be obvious to someone who hadn't been to their house?

How much of this information do we really get in a routine exam visit?  How many questions do we really ask of the lifestyle?  And how open are we to non-standard options?  I've seen plenty of "fluffy" dogs such as yorkies, shih-tzus, and other traditionally indoor dogs who go hiking and camping with their owners.  These dogs are at higher risk for exposure to lyme and leptospirosis, yet just to look at them you might think that they rarely touch grass and only through careful questioning do you learn the truth.  Also, do owners really share or volunteer all of the information we might need?  Where I practice there is only a low risk for lyme disease, so I don't recommend it for most pets.  But what about the pet who travels with their owners to the northeast where it's frighteningly common?  Will owners even think to tell us that they go to New Hampshire three or four times per year?  Will we think to ask about traveling?  

Now don't misunderstand me.  I actually do support asking the right questions and determining preventative care based on a pet's risks.  And I don't think we should vaccinate every pet with every vaccine "just in case".  But anyone in this profession needs to be very, very careful in their assessment of these risks and ask the detailed questions.  As in the case of my in-laws it might not be so clear-cut and we shouldn't let prejudices for or against vaccines cloud our judgement and decisions that would be best for the pet.

And to pet owners I would strongly recommend having open and honest discussions with your vet about every vaccine available.  Ask your vet what vaccines they carry, which ones are available, and whether or not your pet is at risk for each one.  You might be surprised at what your pet could be exposed to that is potentially preventable.

Leptospirosis Is Still A Concern

There has been a misconception over the years that the leptospirosis vaccine is unnecessary and even dangerous.  Some persist with the opinion that the lepto vaccine has a higher risk of causing reactions, and therefore should not be given.  I've seen veterinary staff perpetuate this idea, yet when asked what the reaction rate is or any data to support it, they can't give it.  I've seen clients come in with sheets from breeders with a big "never give leptospirosis" plastered in bold letters.  Such viewpoints over the last 15-20 years has led to a decrease in vaccinating for this disease.  And I believe this is a mistake.

Leptospirosis is a bacteria that can be found in numerous kinds of wild mammals.  Infected animals shed the organism in their urine, which can contaminate soil and water.  Anyone or any animal coming into contacted with these areas can in turn become infected.  This is a serious disease, leading to often deadly kidney or liver failure.  Humans are as susceptible to lepto as animals, and an infected dog could be a risk for its owners.

Why bring this up now? An article was published a few days ago about an outbreak of leptospirosis in Detroit, Michigan.  Twenty cases were recently diagnosed and nine dogs died as a result of the infection.  This is not rare, and may be a growing concern.  Over the last few years cases of lepto have increased around the country. Personally, I believe that the increase in lepto cases coincides with the decrease in people vaccinating.  I also believe that the true rate of infection is much higher, as most vets (myself included) don't think to test for lepto when we have a case of acute liver or kidney disease.  In fact, we have historically done such a good job of vaccinating that many vets have never seen a case of leptospirosis, though this may change.

Lepto vaccines are common, easy to give, and available at just about every vet.  A few studies have compared reaction rates of the distemper-parvo vaccine with and without lepto components and found the reaction rate to be statistically identical, which means that modern lepto vaccines are NOT more reactive and are NOT an increased risk.  And with cases such as the one above, we should be recommending the vaccine MORE and not less.

Inside/Outside Dilemma

Early on in my career I learned an important lesson.  When asking about a pet's environment and lifestyle, don't ask "does he/she go outside?"  Instead ask "how much time does he/she spend outside?"  That's a subtle but important distinction, and one we have to often almost physically extract from owners.

Today is a great example.  I saw a chihuahua mix for the first time, a really sweet little girl.  The owner didn't want to get vaccines done because she never really went outside.  Now at face value, this may make some sense, as many small-breed dogs rarely touch grass.  But it's important to dig a bit deeper, as it can have implications on the best recommendations for the pet.  As we talked more I learned that the dog went outside to potty, and sometimes on walks.  Then the owner started talking about going to parks and interacting with other dogs.  Huh?  Wait, I thought he said the dog never really went outside and therefore didn't need much preventative care!  Yet the dog is really at pretty high risk since it goes to public parks and is around other dogs.

We see similar issues with cats.  I've had so many clients who say things like "Oh, my cat's completely indoors.  He just goes out on the porch and then a little into the yard when we're outside also."  Um, what part of "indoors" extends to grassy areas?  Again, there is a much higher risk of disease exposure with being outside even a little bit compared to truly never going outside.

So you pet owners, try to be a little more honest about whether or not your dog or cat really stays inside.  To veterinarians if your pet moves outside the walls of your home, it's at least partially outdoors, even if only for a short period of time.

And to vet students and new vets, be sure to ask the right questions to get the complete answer.

Peeling The Couch Potato

Sometimes it's hard to keep in shape, especially as you get older. Working 40+ hours per week I often feel like I don't get enough time with my wife and children.  I also work long days, around 9am to 7pm.  This kind of schedule makes it hard for me to find time to work out, even though I know its in the best interests of my health.  The last time I went to the gym regularly was shortly after graduating vet school, and that pretty much stopped once I got married.  In the intervening years I've ended up in the typical middle-age situation where I'm not in great shape and am carrying about 10-15 more pounds than I'd like.  Part of my problem is that I like cookies and pastries too much and have little willpower when it comes to these foods.  We eat pretty healthy overall, but I indulge in high-carb and high-calorie foods a bit too much.  I'm also rather lazy and honestly hate the amount of work it takes to get in good physical condition.

My wife recently found a "Couch to 5k" program. The idea is that over 9 weeks you gradually go from a couch potato (me) to being able to run five kilometers.  Though I really don't like running, the idea of getting into shape is a good motivator, especially if my wife and I do it together.

However, I have to admit that I have a slightly different motivation.  Regular readers of this blog should have learned early on that I'm a big geek.  A friend of mine posted a link on Facebook to a "zombie run" and the idea intrigued me.  This is a pretty unusual 5k run, as it involved an obstacle course and being chased by people dressed as zombies.  The runners have "life" flags, sort of like in flag football, and must run the 5 kilometers through a park. There are some obstacles along the way that you have to overcome.  And then of course the zombies chasing you, trying to get your flags.  The goal is to make it to the end of the course with some of your life still intact.  It's a race not just against other runners, but also a race for survival against zombies.  To a geek like me this is very intriguing.  Check it out yourself...appropriately enough it's called "Run for your lives."

We started the training this week and I was surprised that I did well on the first section.  We'll see how well I do next week when we increase the intensity.  And the nice thing about doing this is that not only will I be improving my health and spending time with my wife, but I'll be better prepared to survive the inevitable zombie apocalypse!