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Wednesday, December 28, 2011

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.

Friday, December 23, 2011

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....

Thursday, December 22, 2011

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.

Wednesday, December 21, 2011

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.
Pet Obesity Infographic

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!
12 Dogs of Christmas

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.

Wednesday, December 14, 2011

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.

Thursday, December 8, 2011

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.'"
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!

Tuesday, December 6, 2011

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.

Sunday, December 4, 2011

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.

Saturday, December 3, 2011

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.

Thursday, December 1, 2011

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.