Two-Faced Cat

File this one under "tales of the bizarre". 

A doctor we recently hired told me a few days ago about one of his old colleagues who had just seen a puppy with three hind legs and two vaginas.  He showed me a picture of the newborn, and it was truly odd-looking.  We began talking about other genetic abnormalities that were likely to go along with such deformities, and that the puppy had a low chance of survival.  Our discussion turned to similar deformities in other species, such as two-headed snakes.  No kidding!

When I was attending the University of Tennessee for my Master's degree I saw a two-headed python in their reptile research department, alive and well.  One head was the dominant one and tended to control the body, but sometimes the heads would fight over a prey item.  It was really strange, but interesting at the same time.

Then today I just came across a story on the front page of FoxNews.com, about a two-faced cat who was 12 years old and still doing very well, thereby setting a Guinness World Record.  Click on the link above to see the story as well as a short video of the cat and his owner

I have to admit that even having seen many things in 14 years of veterinary practice, this one took me a bit by surprise.  I've seen photos and even preserved specimens of two-faced cattle, sheep, and other animals, but none of them survived long.  These types of deformities are usually so severe that life-expectancy for the unfortunate animals is measured in days from birth.  So it was quite strange to see a cat living a normal life-span with this condition and seemingly very happy and otherwise normal.

I'm not sure that I have a real point or comment about this cat.  But I certainly wanted to share!

You Control The Weight

Yesterday I was talking to a client about their overweight pet and mentioned to her that she has complete control over how much her dog weighs.  She seemed surprised by this revelation, so I thought I'd share it with everyone.

Yes, YOU are the one who determines how much your pet will weigh.  Think about that for a moment.  Who places the food in the bowl?  Who decides to take the dog for a walk or at least let them out in the yard?  Who gives the treats?  Who feeds from the table?  In each of these circumstances the answer is "the pet owner".  And that means you.  So if your dog gets too many treats, gets to large of a portion each day, or doesn't get enough exercise, who is to blame?  Do you see where I'm going with this?

Yes, there are a few circumstances where there is a metabolic problem causing the weight gain.  Most of the time this is related to low thyroid hormone (hypothyroidism), which is a diagnosable and treatable disorder.  But medical conditions are the exception rather than the rule when it comes to overweight pets.  So if you take away problems with a dog's metabolism, that leaves feeding and exercise, both of which are under a client's control.

Many people don't realize just how little a pet needs to eat.  In fact, once a pet is spayed or neutered their metabolic requirements lower dramatically. You know the feeding guides on the package of dog or cat food?  Most of those are based on an "intact" pet.  If your pet has been "fixed" (spayed or neutered), he or she actually needs at least 30% LESS than that recommended amount!  If your pet is particularly inactive, that requirement may go down even more. And that doesn't include treats, which can add up much faster than people realize.

So let me be very blunt for a moment.  If your pet is overweight it's almost always because YOU have over-fed or under-exercised your pet (or have allowed it to happen in your family).  This can be a serious health concern and lead to shorter life spans and more health problems.  The fix?  Talk to your vet about a good weight loss program and food.  It's all up to you.

Lawnmower 1, Dog 0

There are certain things in life that tend to be "givens".  The sun rises in the east, taxes are always painful to pay, people will normally call while you're taking a shower, etc.  Another given is that rapidly spinning hunks of metal will always win when put in opposition to an animal's appendage.

This past Saturday a client called with an emergency.  Apparently his dog was playing around while he was mowing his lawn, and was jumping over the mower.  One of the times she did so, her foot slipped underneath the mower.  I don't think I need to spell out what happened next and why he was rushing his dog in.  Remember, it's a given that lawnmower blades will win out over a boxer's paw.

When she came in she was a bit shocky, likely due to the pain, but stable.  The only injury was the right rear paw, and this was pretty bad.  A couple of toes were missing, a couple were hanging on by strands of skin, and the bones in the paw (metatarsals) were easily visible.  There was comparatively mild bleeding, and certainly nothing requiring a transfusion.  However, the end of the dog's paw was pretty much gone with bones and tissue being traumatically mangled (not that there's a way to atraumatically mangle something).

There was no way to save the paw, but he came in just a couple of hours before closing so it was too late to be able to do surgery on her at our practice, even though I could certainly handle something like this.  I gave her some potent pain medication right away, gently bandaged the paw, and sent her to the local emergency clinic.  He couldn't afford surgery there, so ended up looking around for a couple of days before finally having surgery done yesterday.  There were no other injuries, so the dog is likely going to heal well and do okay, even if she's missing part of her paw.  But I can't imagine her having a mangled foot and having to wait two days before the owner could find someone to do the surgery at a price he could afford.

Here's a rather simple lesson.  If you're running a lawnmower, realize that the blade can chop through bone and skin just as easily as through twigs and grass.  And don't let your dog play anywhere near the mower!

Getting Old

Yesterday I went to the ophthalmologist for my routine annual exam and had a rather rude reality check.  She said that I was at the early point of needing bifocals.  BIFOCALS!  Yikes!  Those are for old people.  Okay, so the average age to start using bifocals is 40-45 years old, and I'm 42.  But I dress up in costumes at sci-fi cons, collect action figures, and still watch cartoons.  I really don't feel like I'm at my age, and have always looked at bifocals as being for older people.

Now I am one.  That's a bit depressing, really, though it shouldn't change anything about who I am or how I feel.  After all, it's just changing vision, right?  Not a big deal and it doesn't mean that I'm falling apart.  Right?

No, I'm not going to start going through a mid-life crisis, and I won't be buying a motorcycle or convertible any time soon.  But it is a realization that I ain't gettin' any younger and can only expect more changes like this.  Next thing you know my doctor will start talking about colonoscopies.  

So say a few prayers for this aging doctor.  I think I'm going to go eat some ice cream and play with my action figures.

US Parasite Prevalence

I attended a lecture on parasite prevention this week and was directed to the Companion Animal Parasite Council web site.  This is an organization here in the US that was developed to bridge the gap between veterinarians and physicians with regards to parasitic diseases in pets.  The group also seeks to educate pet owners on the parasites and disorders that can happen in pets, several of which are transmittable to humans.

Now all of that is good, but not revolutionary.  What grabbed my attention was an interactive map they have which shows county-by-county incidence of various diseases in the us. I would highly recommend all US vets and pet owners check it out if you aren't familiar with it.  The map shows the rates of various tick-borne diseases (lyme, ehrlichia, anaplasma), heartworm disease, and intestinal parasites (hookworms, roundworms, whipworms) in dogs and cats (you can view by each species).  And the results can be a bit surprising.

For example, let's look at heartworm disease in my state of Georgia.  In 2010 there were 4647 positive diagnoses in dogs and 367 in cats.  These are pretty high numbers, but we're not the highest in the Southeast (Florida had 1396 in just cats).

And here's the scary part.  All of the numbers on this map are in all likelihood lower than the actual infection rate! The data is compiled from Banfield Pet Hospital (a nation-wide veterinary chain that has extensive computer records), Idexx Laboratories and Antech Laboratories (two large, national veterinary diagnostic labs).  Records come from these sources' databases, as well as data sent in by veterinarians.  However, not all vets will participate in these studies, so there are certainly positive cases that never make it into this data set.  Also, many pets are never tested for these various diseases, so there are certainly positive cases that go undiagnosed.  So when you review the numbers, realize that these are the bare minimum cases, and the actual infection rate is likely a good bit higher!  Realizing how the data is collected puts in perspective the true incident rate.

I've made sheets to post in all of my exam rooms showing the rates in our state and county, to use as a conversation-starter with clients.  If we can make more people aware of these diseases (all of which are considered preventable!), then perhaps we can lower the number of positive cases and improve the health of pets.

Finish The Meds!

I have to be honest and admit that I don't always follow my own doctor's directions.  I'll forget to take a dose, or get near the end of a prescription and decide that I probably don't need to continue taking them.  And I know better!!!!  "Bad, Dr. Bern!  Take your meds!"  As someone in the medical profession, I know all of the reasons why I need to follow my doctor's recommendations.

So why is it so important?  And why bring that up in a mostly-veterinary blog?  The exact same problem happens with pets and their owners.  A pet will start to feel better or symptoms will improve and the owner will stop giving medications.  Or they miss several doses and get off schedule.  Several studies have shown that pet owners' compliance with the vet's directions is far lower than we veterinarians believe.  Such noncompliance can actually have negative consequences.  Let me go over a couple of examples.

Antibiotics normally need to be given for at least 10-14 days, and often longer (especially with severe skin or urinary infections).  You should never stop antibiotics as soon as the symptoms go away because the bacteria may not be gone.  There needs to be a certain level of infection before you notice an issue clinically.  An infection may still be present, but the bacterial numbers have been reduced to the point of no longer seeing an obvious problem.  We call these sub-clinical infections.  However, in these cases the bacteria are still there!  When you stop antibiotics, any remaining bacteria can then start to grow again and the problem can come back as bad as ever.  Dermatologists recommend continuing antibiotics for two weeks past complete resolution of symptoms!  Another danger is that any remaining bacteria were not killed immediately and so may have some degree of natural resistance to medications.  Allowing them to live and reproduce could be selecting for a resistant strain that then won't respond well to antibiotics.

Another example...demodex mites are not uncommon in puppies and there are various treatments available (oral ivermectin, amitraz dips).  These mites are pretty sturdy and it normally takes several months of continual treatment to cure the pet.  As the pet is improving any hair loss starts to resolve and grow back.  I have had clients stop treament once this happens, and in many cases they end up back in my clinic because the problem came back.  They didn't follow my recommendations and stopped treatment too soon, before all of the mites were dead.

Doctors don't prescribe medications for a given length of time based on how much money they want to make.  There are well established protocols based on strong data for how long it takes to eradicate a given infection or cure a problem.  The length of time will vary based on the severity of disease, the tissues involved, the type of bacteria, and other similar factors.  So some infections may be gone in 10 days, but others may take 2-3 months.  This extends beyond infections to other diseases as well.  The frequency of administration (once daily, twice daily, etc.) is also important and varies between medications based on their method of action.  Not giving it at proper intervals (such as giving a twice daily medication only once daily) can prolong a disease or result in a lack of a cure.

The bottom line is that you need to competely follow your vet's directions for your pet.  Finish the medications as they are directed!

And yes, I'm going to finish my own.

Nonchalant About Bites

If you're in the veterinary field for long, it's pretty much a given that you're going to be bitten or scratched.  After a while most of us take it as almost a routine occurrence.  Obviously we don't want to get so relaxed that it happens every day, but I receive minor scratches and abrasions several times per year.  I've been bitten numerous times, thankfully never very severe and I only have minor scars from those cases.  What becomes almost amusing is the nonchalant nature some of us take.

A few days ago I was dealing with a cat that started becoming fractious.  It had already been to another vet that day and the owner said it was lunging at that vet.  We got her out of her carrier and at first she acted fine, so we started working with her.  The longer we handled her the more irritated she became, until she started getting aggressive.  At one point she suddenly "flipped out" and managed to squirm out of my grasp.  I made a sudden grab for her, and she managed to land a quick bite on my finger before I was able to get her back under control.  We finished the vaccines, put her back in the carrier, and took her back to the client.

Now first let me say that cat bites can get severely infected very quickly, so nobody should take them lightly.  If you are bit by a cat, seek medical attention, even if the wound is not severe. 

But in my case it wasn't my first rodeo (as we say here in the States).  I've been bitten enough times and been to the doctor enough times that I know how to treat my own wounds.  I washed the wounds out, flushed them with chlorhexidine (a disinfectant), applied antibiotic ointment, and placed simple band-aids.  Then I finished the rest of my day.  It didn't seem bad, but the finger was painful that night and by the next day there was mild swelling, redness, and warmth so I suspected that the bite went deeper than my original impression.  It was just the tip of my left index finger, but I didn't want to have a problem so I went to the doctor.

The ONLY reason I saw a doctor is because I can't legally write a prescription for any humans, including myself.  I think the doctor's office was a little surprised because I had a laid-back attitude about the whole event.  I described what had happened and how I treated it and told the doctor that I knew I was going to be put on Augmentin (amoxicillin & clavulenate....we call it Clavamox in the veterinary field) and was only there because I need a prescription from him.  And like I expected, he really didn't need to do anything to me.  I got my prescription and was out of there pretty quickly.  This exact pattern has happened before (thankfully it's been around 8 years since my last real bite wound), and I get a little amused at the expressions on the human medical team when they realize that I did everything for them.

So how bad is it that I've had enough wounds that I know how to self-treat and know exactly what my physician will do?  When I get this jaded and nonchalant, it's an indication that I've been doing this waaaay too long!

Cats Need Care Too

There is a disturbing trend in veterinary medicine.  The number of visits by feline patients has been steadily decreasing for several years.  Much of this has to do with a trend in increasing duration of vaccines, especially in cats, as well as a mistaken perception that cats don't need vaccines and therefore don't need to see the vet.  These attitudes do cats a great disservice.

Today I saw a cat who is seven years old and hasn't been to the vet since she was a kitten.  Cats age much faster than we do, so this patient was in a situation equivalent to a 50 year-old human who hadn't been to a physician, ophthalmologist, or dentist since they were around 10.  Putting it in this perspective really emphasizes the complete lack of medical care that this cat was receiving, as few humans would go 40 years between doctor's visits.

The American Veterinary Medical Association recommends twice annual exams for dogs and cats.  Why?  Because of the speed of their aging compared to humans and the ability for vets to often detect problems in the early stages of disease rather than waiting for it to become advanced.  In a veterinary visit the most important component is the physical exam.  We can discover many problems that the owner may not even be aware of.  On routine exams I've discovered broken and loose teeth, mammary tumors, bladder stones, developing cataracts, and other serious issues; all of which the owners had not noticed!  Without routine exams these abnormalities would have gone undiagnosed even longer and may have created serious health risks.

Let me give you another example, emphasizing the importance of routine exams and blood testing in cats.  Our feline patients are very prone to kidney disease as they age.  In fact, a number of years ago I heard a specialist lecture on this subject and he said "cats are kidney disease waiting to happen."  The kidneys are remarkable organs with amazing redundancy, which is why people can donate a kidney and be perfectly fine with only 50% of the renal function they were born with.  In order to show up as abnormalities on routine blood testing you have to have lost at least 66% of kidney function.  However, you have to have 75% loss before a patient will act sick.  So there is a window between 2/3 and 3/4 kidney loss where we can detect it but the patient acts perfectly normal!  You can't look at a cat with a 70% loss of kidney function and tell that there is anything wrong.  If we detect the problem early, we can potentially intervene and slow the progression of the disease.

So for those of you who have cats, don't neglect their medical care, even if they are receiving vaccines only every three years.  Regular veterinary exams are the key to good preventative medicine and therefore a longer and healthier life.

Risking Pets On The Highway

Please excuse me while I rant for a little bit.  Today I saw something that I witness from time to time and it really bothers me both as a pet owner and a vet:  dogs riding in the bed of a pickup truck on the highway.

One of the first times I really noticed this was many years ago when I saw a truck going down an eight-lane interstate.  There was a lab sitting on top of the tool box behind the cab of a fully-laden pickup traveling at around 80 mph.  Today it was a German shepherd standing up and walking around in a mostly-full truck bed going around 70 mph.  Whenever I see this I cringe and want to make the driver pull over and take their dog inside the cab with them.

This is a huge risk for injury!  Yes, most dogs will probably stay in the back and be okay, which is what lulls people into a false sense of security.  Dogs don't have the cognitive reasoning to be able to think about what harm would happen if they jumped out of a moving vehicle.  They may realize some danger and try to avoid it, but a strong enough stimulus could cause them to make the leap.  The other risk is if the driver of the truck suddenly has to swerve or slam on breaks to avoid a road hazard or other vehicle.  Such a sudden move could send the dog out of the truck and onto the highway or into another vehicle.  Even if the dog is secured by a leash, there could be a risk of it falling over the side while still being attached, causing it to be dragged or strangled.  In any of these circumstances we have a deadly situation.  If the dog jumps or falls onto a busy highway going at high speeds that dog will die.

I simply don't understand why people take these sorts of risks.  They would never consider doing that with one of their children, so why do they do it with their pet?

Dragon*Con 2011

Anyone who reads this blog for long and looks at my links will easily see that I'm a big geek.  And for fans of anything geek-related there isn't much better than Dragon*Con.  This multi-genre convention takes over five hotels in downtown Atlanta every Labor Day weekend, and 40,000+ people attend.  This year was the seventh year that my wife and I attended, and the fifth year for our kids.  We also attend as part of our group, Fans For Christ.  As usual, we had a blast!  We spent the long weekend hanging out with friends, seeing celebrities (William Shatner walked across the street about five feet in front of me!), and taking pictures of amazing costumes.  And like the big geeks we are, my family and I dress in costumes.

 Here we are as Nymphadora Tonks, Remus Lupin, Luna Lovegood, and Harry Potter, with a friend of ours dressed up as Hagrid.  We won "Cutest Family" at the Harry Potter costume contest!

My wife as Tonks and a friend of hers as Bellatrix Lestrange.

 A closeup of me as Lupin, showing the fake scars we added. This was my first attempt and we learned a lot about making them, so next time they'll be pretty screen-accurate.

 Us as Flynn Rider and Rapunzel from Tangled.

The kids were a young Rapunzel and Eugene Fitzherbert (aka Flynn Rider).

My wife's friend again, dressed as Mother Gothel. 

Oh, and my wife made all of our costumes herself!!!!  She's going to start a custom costuming business soon due to so many requests for people to make things for them.

So once again we have to go back to reality and I go back to work tomorrow.  But it is one of our favorite events of the year and we always look forward to it.  Only 359 days left until the next Dragon*Con!