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Monday, January 30, 2012

Vaccine Duration In Cats

Here's a question from Madeline....

My two cats come in annually to the vet for an exam and booster shots. In 2011, when it was time to have their annual, one of my cats got some sort of stomach bug and the vets advised that they do their annual routine later as she required daily anti-biotic shots and some other injection later on (she hadn't eaten or drank water for two days at that point). Just when we were about to get their annual done, the other cat somehow injured his back and they had decided not to give him his shots. So in 2011, they missed their annual shots. I'm wondering do they need to have their shots done twice in 2012 or is taking them to their 2012 annual sufficient enough?

I already know that this one is going to open a rather large can of worms since vaccines are such a hot-button topic and there isn't a great consensus of opinion in the veterinary profession.

First of all, it's common not to vaccinate sick pets.  Honestly I think it's more anecdote and speculation than hard evidence, but few vets will give vaccines during an illness.  The rationale is usually centered around avoiding stressing an immune system that is already working on a problem, as well as avoiding any side-effects from immunizations that may mask effects of the illness.  Even without hard evidence, I think the reasons are valid enough that I agree with this practice.

Madeline's question isn't as simple as it may seem.  There is great debate in veterinary medicine about the duration of immunity from vaccines, especially in cats.  This discussion is not new, having been going on for about 15 years now.  There is evidence that many vaccines provide immunity for at least three years, and some argue that it may be seven years or more.  However, there have been few challenge studies performed (where you try to induce the disease in a vaccinated pet) beyond one year.  Because of a lack of hard data, the USDA has listed most vaccines as providing immunity for only a year.  Some companies have some data that shows their vaccines can last for three years, though this can't go on the labels because they don't have government approval to say so.  Why not?  Such studies cost lots of money to perform, and the benefit of being able to change the duration on the label doesn't outweigh these costs.

Some veterinarians and immunologists are adamant that our current vaccines give immunity for 7-10 years.  However, there has been very little actual data provided, and most of the argument is based on rationalization related to how the immune system is supposed to work, as well as antibody titers.  For every specialist and immunologist that says the durations are close to a decade, there is one who says we don't have enough evidence to make such statements.  Even the specialists in the field are divided.  And titers really don't mean as much as many people think (see my discussion last year on that topic).

And to further complicate the issue, we have to look at each antigen individually, and can't make blanket statements about all vaccines.  For example, we do have good data that some vaccines for canine distemper and parvo are valid for three years.  But the leptospirosis vaccine is known to only last for one year.  Besides the antigen, the duration may vary based on the manufacturer.  And then if you throw in legal requirements for rabies we have a whole 'nother issue.

So where does this put Madeline's cats?  Honestly, a bit up in the air.  Because of these often heated debates among vets, not every veterinarian is going to do the same thing or view boosters equally.  What I say and do may be different from Madeline's vet.  Again, there is no general consensus on this topic that every vet agrees with.

Now that I've set up the background, let me give my personal opinion.  Remember, this is what I believe based on the data I've seen, articles I've read, discussions with immunologists, and conversations with the vaccine manufacturers.  I am general practitioner and not an expert, and fully realize that plenty of people may disagree with me.  But this is how I handle things in my own practice.

I do believe that many vaccines give immunity for longer than a year.  I routinely use three-year durations for rabies, canine distemper, and parvo.  With cats and the feline distemper vaccine ("FVRCP") it's a bit different because I don't think there is as much overwhelming evidence.  For cats that are high-risk and spend much of their time outside, I feel that it is important to provide the highest levels of protection and will give a duration of one year.  For completely indoor cats I will recognize the duration for three years.  I have been given support on this view by Pfizer, the brand of vaccines we carry.  

But how to booster in Madeline's case?  One thing she didn't say was when in 2011 the vaccines were due.  Was it in January and we're a year overdue?  Was it in November and we're only a few months out?  The answer does matter.  Realizing that immunity doesn't magically end on the 366th day after vaccinating, I do give a grace period.  For annual/triannual vaccines I will allow up to six months overdue and still be valid for a standard duration.  If it's supposed to be a three week booster, I'll allow up to eight weeks.  If it is beyond these periods I'll require an additional booster three weeks later to make sure that we re-stimulate immunity.  These protocols are based on discussions with specialists and vaccine companies, and are what we use.  I don't expect every vet to do the same thing.

Madeline, the best thing you can do is to talk to your vet and ask what they want you to do.  There is not one single answer to this situation and I can't say what you should or should not do in your specific case.

Saturday, January 28, 2012

One Of Those Days

Weird Al Yankovic reference again....and here's a link to the song.  Today I really felt like that.

The morning was busy, but I managed to get to surgeries mostly on time.  My first one was a spay and it didn't exactly go like expected.  As I ligated one of the ovarian pedicles (the part that attaches the ovary to the body wall and is filled with blood vessel) I put the needle through a vessel, causing a good amount of bleeding.  I clamped and tied this off, then continued along.  Then as I was doing more suturing the end kept slipping out of the needle holders before I could tie the knot; nothing serious, but frustrating.  Just before closing the abdomen I always check for excessive bleeding and found some pooling blood.  This meant that I had to extend my incision to look for the bleeder, which took some time (believe me, once you get to this point in the spay the vessels are deep in the abdomen and hard to find).  After a large amount of searching I was able to see my ligatures, but couldn't find the bleeding.  A few more minutes went by and eventually the bleeding stopped, not an uncommon occurrence.  I tied off a suspicious area just to be safe, but my suture broke as I was doing so.  Again, this is something that happens, but it was just adding to the whole frustration of the procedure.  The dog was never in any danger as none of the blood loss was excessive, and any vet will tell you that each and every problem I ran into has also happened to them.  Heck, a couple of times per week I pull a little too hard when tying a knot and have the suture break, forcing me to re-tie it.  The problem was that all of these little things happened in the same surgery!  Any one of them I would have been okay with, but the cascade of events caused the surgery to take twice as long and made me quite frustrated with myself.  Thankfully the patient recovered normally and is doing great.

But it didn't end there.

As I was walking in to start the next surgery I ran into the surgery stand where we had the blood pressure monitor placed, almost knocking it over.  Really? Thankfully that spay was routine.  But the next procedure was a cat neuter, and the pet just didn't want to go under anesthesia, being particularly resistant and taking longer than I wanted.  And it didn't end there.  We collected blood from a cat for routine organ screening and I dropped the CBC tube.  Thankfully it didn't break, as it was a difficult collection.  The rest of the day continued along these lines, with little things happening like me running into things, dropping things, and getting "fuzzy brain syndrome" multiple times.  As I said before, nothing was big, serious, or put any patients in danger.  But the sheer number of things made me want to go home hit "reboot" on the day.  

Unfortunately that didn't happen, as we had an absolutely crazy busy day.  I literally had about 5-10 minutes at one point to eat my lunch before getting to my next patient (which is one of the reasons I almost always bring my own lunch) and otherwise was running non-stop from 9am until 7:30pm (we normally close at 7:00).  And today my popularity was part of my downfall.  It seemed like most of the clients wanted to see me and not my associate, so I saw around 2/3 of the patients, rather than the normal half.  The last two hours were especially bad, as every client wanted to see me.  My associate is a great doctor and has many loyal clients, but today it seemed skewed towards me.  Normally I'm grateful that clients like me, but this time it was a bit ridiculous.  My associate was available and I was trying to get caught up (or even just breathe), but no such luck. It was all on me.

Needless to say I was very glad to leave work and come home.  And after ten hours of back-to-back patients I am mentally, physically, and emotionally drained.  If there is any consolation to it all, we had a very good day business-wise.  But I'm not eager to do it on such as scale again.  I'm certainly going to enjoy the next two days off.

Thursday, January 26, 2012

Coming In To Ignore Us

You vets out there will be very familiar with this scenario.  A client calls up and makes an appointment because their pet is sick.  They show up at the right time and we do our exam.  A problem is noted (maybe serious, maybe simple) and we begin to talk about what we need to do to diagnose and/or treat the issue.  A treatment plan is worked up and then presented to the client.  For whatever reason the client declines everything on the plan and leaves without doing anything at all.

For the non-vets reading this, you'd be surprised how often this happens.  The client spends their time and money on the office visit, we spend our time trying to make the best recommendation for the pet, and then the client doesn't follow anything we want to do.  It's a source of great frustration for most veterinarians.

Now I completely understand that some clients simply don't have the funds to do hundreds of dollars of services every time, and am sympathetic to this plight.  Those aren't the clients I'm talking about.  Those clients will usually say that they can't afford something, and then we do the best we can to work within their budget and find a solution that is affordable yet still medically appropriate.  Just yesterday I had one of each situation.

The first was a client who brought in a cat with a wound on its tail.  When I saw him the wound was relatively minor, but did need antibiotics.  During the exam I also noted a lot of debris in the ears, and strongly suspected ear mites.  Additionally, the cat went outside, had never been vaccinated (at eight months old), and wasn't neutered.  I worked up an estimate for antibiotics, an ear swab, ear mite medications, vaccines, and a feline leukemia test.  The client said no to everything and took the cat home.

The other case was a localized dermatitis.  The client was honest that he really didn't have much money.  I looked at the dog, suspected that we were dealing with a local contact allergy, and prescribed some topical medication.  Normally I would have wanted to do more, but we were at least doing some treatment, the client's budget wasn't broken, and he was aware of what might need to be done in the future.

Here are some hints for anyone taking their pet to the vet, especially if you have financial issues.

First of all, expect the visit to cost more than the office visit.  Vets will have an office visit charge that covers the cost of the time, exam, and expertese.  Anything else will be extra.  And believe me, most of the time when you have a health concern with your pet we will want to do diagnostic tests and some form of treatment.  This is about good medicine, not the money; but it costs money to do good medicine.  Most of us routinely forget our crystal balls and magic wands at home, so we need to do more to figure things out.   Don't expect us to be able to determine what is wrong and treat your pet only from an exam.  Plan for extra costs.

Second, if you have money limitations, be honest with us.  Talk to us.  Most vets will do the best they can to work with you on prioritizing treatments.  For example, in the above case of the cat, I would have wanted to concentrate on the wound first, then get the cat back in a week or two to update vaccines, and lastly work on the ear mites.  Yes, it's better for the cat to do it all at once, but we know this can't always happen.  Most vets will tell you that we do need to do everything on the estimate, but we REALLY need to do x, y, and z items before the rest.  We can consider splitting some things up over several weeks, coinciding with someone's paycheck.  But also realize that sometimes we really, really need to do what we recommend.

And of course all of this goes back to something I've talked about before, but haven't brought up recently.  Have an emergency fund for your pets!  Set aside several hundred dollars (or Euros, Pounds, Pesos, etc.) in an account that you use only for animal care.  Such a savings account will enable you to do at least some things for your pet when money is tight.

Wednesday, January 25, 2012

Veterinary Medicine Meets Reality TV

Are you tired of reality TV shows?  Me too.  But apparently most people aren't because more and more crop up.  I think there is voyeuristic part of us that likes peeking into people's lives.  And the TV producers like it because the shows cost much less than scripted ones with paid actors, sets, and special effects.  The veterinary profession is not immune to these shows, and apparently there are more coming.

I remeber Emergency Vets on Animal Planet being one of the first, if not the very first.  I've also seen commercials for a show following veterinary students in the UK.  Honestly, I've never watched either one because by the time I get home I want to forget all about veterinary medicine rather than watching shows about it.

One of the most recent is The Incredible Dr. Pol on National Geographic Wild.  The show follows an older large animal vet as he sees patients.  Again, I haven't watched the show myself, but it's creating a good amount of controversy and backlash in the veterinary profession.  Complaints have been lodged by other practicing vets that Dr. Pol's medicine is very old-fasioned and sub-standard, creating a misperception in the public's eyes of how animals should be treated.  DVM Newsmagazine recently had an article on this controversy.  For example, here's a quote related to the type of medicine he practices. 

Brothers goes on to cite Pol splinting a calf's leg using wood slivers from a bushel basket and stitching a dog's tail that had been cut off by a screen door with little anesthesia and the owner holding it down.

I can't comment too much, as I haven't seen the show myself, but the complaints I've heard seem legitimate.  From the articles I've read, I'd be in big trouble practicing like he does.

National Geographic responds with comments like this....

It is an undisputed fact that Dr. Pol has helped thousands of animals throughout his 40-year career as a veterinarian. His very successful clinic has been in business for 30 years, where residents of Michigan count on him to help their sick pets and farm animals.

I hate to say it, but number of pets treated and length of time practicing does not automatically mean that the quality of that medicine and surgery is appropriate.  I've seen plenty of older, long-term vets who practice substandard medicine that borders (or crosses the line) on malpratice.  But I don't want to spend this blog picking on Dr. Pol.

Another foray into this topic is a new YouTube channel, Veterinarians on Call, which has webisodes following several livestock veterinarians from across the US (and according to the channel they are going to expand this to small animal vets).  I find this a little more interesting, as it seems that the type of practice is closer to the reality of most vets in that part of the profession.  I do like that people are getting to see more of what the daily life of a vet is like, which was one of the points of starting this blog in 2008.  Oh, and as an extra bonus, the boy who played Charlie in the Gene Wilder version of Willy Wonka and the Chocolate Factory, Peter Ostrum, is a currently practicing large animal vet and is one of the doctors featured on this channel.

Even though I don't have cameras around me, a blog like this (and other veterinary blogs) shows those things that go on "behind the curtain" of a vet practice.  As I've seen over the years, this reality can surprise many people, and it's not always in a pleasant way.  Recently it has come to the forefront of my mind as I think about the things I've written over the last three and a half years.  I'm being introduced to some opportunities that may get me some national media exposure (no, not my own reality series...I certainly DON'T want that!), though we'll see how that works out (remember my GabCast TV experience?  No?  Search the blog archives).  However, as I contemplate being on morning network TV shows I wonder about how some comments in this blog will be perceived.  Because if I end up on the Today Show you darn well know people are going to Google my name and find this blog.**  I don't regret things I've said and I stand by all of my comments, good and bad.  But in this era of instant internet searches what you put out there is easy to find.  For better or for worse, Dr. Pol and the doctors of Veterinarians on Call are now in the public eye and are having their lives and practices scrutinized.  Will they regret what they say and do when brought to a national stage?  If I end up becoming more well known, will vets and pet owners be kind or cruel to this blog?  We'll just have to see.

And yes, I'll talk more about these opportunities if they pan out.

**If you do a Google search for "Chris Bern" the top search result is for the president of the Iowa Teacher's Union, not for me.  But I'm not far down the list, and I'm noticing that I'm getting higher in ranking compared to last year.  Yes, periodically I search for my own name.  Has the man in Iowa ever come across me and wondered?

Tuesday, January 24, 2012

Shakespeare Meets Pirates

My latest foray into community theater is a production of Romeo and Juliet.  My wife is the costume designer and is making most of the costumes herself.  The production is traditional Shakespeare, but we're using Pirates of the Caribbean as a setting inspiration.  The Capulets are based around the British of the 18th century and the Capulets are being dressed like pirate lords.  The sewing has been consuming my wife lately, but thankfully the production is in four weeks, so there is light at the end of the tunnel.

Last night we had some of the cast in partial costumes to take some promotional photos.  I took the opportunity to bring my camera and take some personal pictures.  Which I'm sharing here!  

 My beautiful wife as Lady Capulet.

 Lord and Lady Capulet.

 Me as Paris.  She's still working on the costumes and the pants aren't ready, so I'm wearing jeans here.  

Me and my wife again.

And my wife made all of the costumes! I'll share more official photos if we get some closer to the show date.

Saturday, January 21, 2012

"You're Going To Let My Dog Die?"

Today my associate saw a dog who was in pretty bad shape:  painful in the abdomen, lethargic, not able to urinate or defecate, and generally not doing well.  She found a firm mass in the abdomen and the dog had apparently eaten part of a steak bone. However, the mass was larger than the size of the bone, so she knew something else was going on.  Being a great doctor, she obviously developed a treatment plan that started with radiographs and went from there.  

As commonly happens the client said that they couldn't afford to do anything, and in fact had come to us because they couldn't afford the $100 to walk in the door at the emergency clinic.  We gave them the information for Care Credit, and they were declined.  She didn't really have many options at this point and told the client this.  The client's response?

"So, you're just going to let my dog die?"  followed by "What vet doesn't take payment plans?"


And this isn't the first time I've run across this attitude and comment.  Plenty of clients think that it is our obligation to treat pets and do surgery, even if the client doesn't have any way to pay.  After all, if we really loved animals we'd just go ahead and do it (another comment I've heard before).  If the client can't pay and we decline to treat for free, somehow we are the ones letting the pet die, not the client.  It's our fault that we won't give away hundreds or thousands of dollars in services, but it's not the client's fault that they don't have any funds in a savings account or have such horrible credit that they can't qualify for a payment program.

I really think many people don't realize that we can't operate a veterinary practice without charging.  There are so many little things that people never think about....payroll, rent, utilities, liability insurance, worker's compensation, taxes, and many dozen other items that quickly build up and take up any revenue.  We as vets have our own personal mortgages, student loans, and other debts, as well as families to support.  And most vets aren't driving BMWs or Lexuses while living in 4000 square foot homes.  If we give away too many services, we can't pay our bills.  If we fall behind on our bills, we have to fire staff, cut services, and eventually will go out of business.  In fact, such discount practices are the number one reason veterinary practices close, and it's much more common than anyone outside of the profession realizes.

It's also not smart for most vets to set up their own in-house credit system.  I've seen this done, and more times than not clients fail to make payments appropriately.  Practice consultants routinely say that this is a bad idea for vets to do.  And if someone doesn't have good enough credit to have credit cards or Care Credit, this means that their revenue and ability to repay people is below acceptable standards.  In other words, they are very poor risks. So why should the vet take those risks?  I know that everyone says "Oh, don't worry, I'll be the one to make payments on time."  Call me cynical, but in my personal experience that is rarely the case.  Which is why most vets don't take payments, especially for first-time clients (which this dog was).

So what happens in these situations?  Unfortunately, the pet suffers.  But who is responsible for that pet's care?  It's the owner, not the vet.  The vet is the agent of treatment, but we can only advise decisions.  Ultimately the client must agree to the treatment plan, and the client is also ultimately responsible for the pet's well-being.  If the client can't pay, it's simply not the vet's fault or responsibility.  And most of us have learned not to let the client guilt us into doing it anyway.

In this case the client had enough money to afford euthanasia, which was the best decision if they couldn't do any diagnostics or treatment.  The dog didn't have to suffer for long.

It's about personal responsibility, folks. Something I think that much of American society has forgotten.  Too many people want to blame others for their failings and hard situations, when the huge majority of the time the fault is really with the person themselves.  People need to take responsibility for their own actions and for the care of the people and pets entrusted to them.

Friday, January 20, 2012

May The Bark Be With You

I don't typically share videos, links, and similar things on this blog just for entertainment purposes.  That's what Facebook is for.  However, this time I simply couldn't resist.  As a geek, Star Wars fan, veterinarian, and dog lover, I have fallen in love with this commercial.  Many of you may have seen this, as it's going viral on the internet.  Enjoy!

Thursday, January 19, 2012

Febreze Me

Here in the US there have been a series of commercials by Febreze air freshener.  The set-up is that they have a very dirty, gross, nasty location, such as an unclean restaurant or musty room.  They spray the location with Febreze, then bring blindfolded people into the room and ask what they smell.  In the commercials people only smell good things.  Here's one of them to show you what I'm talking about, in case you haven't seen them.

Today we had a dog with pretty severe gastroenteritis.  She had projectile vomiting, diarrhea, and was lethargic.  We did her work-up and didn't find anything really severe (no parvo, giardia, toxicity, etc.), so she's going home on some medications to help symptomatically.  While she was in the clinic she had blow-out, severely liquid diarrhea in her kennel.  This was one of the worst odors I've ever smelled, and that's saying a lot!  I've been in this profession for almost 28 years (nearing 15 as a vet) and so I'm pretty immune to most smells of pus, infection, diarrhea, vomit, and so on.  I was having a hard time being around the kennel or in the treatment area, and my stomach actually churned!  We obviously got her out right away and began cleaning it up.  It was decided that the blanket in her kennel was a lost cause, so we just threw it away without bothering to try and clean it.  But the smell permiated the clinic!  My office manager and receptionist had to stay up front to avoid the smell.  My tech had to wear a surgical mask while cleaning it up.  And I had a client walk into one of the exam rooms and begin gagging at the smell from the back.

Once everything was cleaned up we liberally sprayed Febreze around the clinic.  Which brought the thought to my mind.  In one of their commercials they should come into a small animal veterinary practice where there are a few parvo cases or other gastroenteritis.  Leave the vomit and diarrhea, spray the Febreze, then bring people in blindfolded and ask them to smell.  Now THAT would be a real test of the product!  But somehow, I don't think that commerical will ever get produced.

Thankfully, though, I have to say that the Febreze did a really good job.

Tuesday, January 17, 2012

Scared Of Shadows

Stefanie emailed this question...

Just after Christmas, I adopted a blue heeler mix from a rescue group. She is approximately 4 years old. I took her to the vet and since I live in the desert - had them run a full desert blood panel on her. All results came back negative. Her white blood cell count was slightly elevated, but I was told that may be due to allergies or the tail end of a parasite she may have been fighting. She will be retested in a couple of months to see if that has improved. The only other health issue that was revealed by x-rays was hip dysplasia and she is currently on Phycox to manage that.
I have only had her a few weeks, so I realize that I will continue to notice new things about her as her personality unfolds. Just last night though, she became nervous and fearful of shadows on the wall. And then this morning, she saw my reflection in a window and that made her run back inside of the house. I called her outside again and she did her business and seemed ok. I just avoided walking in front of that particular window. It's hard to say what kinds of experiences she may have had in her previous home - but I was wondering if this is one of those things that will just fade away or if there is a serious neurological reason that this has started to occur? Please keep in mind, I don't coddle her when she fears something - I go about normal business and use a happy voice so I don't reinforce her fearful behavior. There haven't been any other changes as far as her house training, eating, drinking - all of those continue to be normal. She does sleep a lot - but again, she's only been with me a few weeks and I'm thinking that the walks/hikes are contributing to that and as she becomes used to the exercise - she'll be more active.
Some dogs are just scaredy-cats (irony intended), and it may have nothing to do with previous abuse.  One of my dogs, a very sweet young yellow lab, is like this.  A flock of birds suddenly flying from the trees can send her running back to the porch with her tail between her legs.  Just last night we came home from theater rehearsal and I deliberately hid in the darkness inside when my wife let her out, just so I would scare her a little and get her to bark.  She did bark, jumped back a little, then relaxed when she saw who it was. 
I share this about my dog to show how some pets can have this kind of personality.  We picked out my dog when she was less than two weeks old and took her home at around 6-7 weeks old, so I know she hasn't been abused (quite the opposite...she is very spoiled by my wife).  Stefanine, in your case we probably will never know what kind of life your dog had over the last four years, and it is possible that she was abused and now is scared of relatively simple things such as shadows and reflections.  However, it is just as likely that this is simply her personality.  Many behaviors do begin with a trigger, and something in her past may have caused her to be jumpy at indistinct shapes.  But regardless as to whether or not there is a causitive factor, you still have the current behavior to deal with.
I would first talk to your vet about her vision.  If there is any question whatsoever, you may consider having an ophthalmology specialist evaluate her.  Sometimes vision problems can be subtle, and if she has any deficits in her sight it can cause her to have difficulty telling what is a shadow and what is real.  Unfortunately a dog cannot tell us what they see, so it can sometimes take specialized knowledge and equipment to assess her vision in detail.
If everything is fine with her physically, continue to praise and reward calm behavior.  When she sees shadows but doesn't react, give her good attention and a small treat.  An adage I use frequently is "behavior that gets rewarded gets repeated", so reward the good behavior and try to ignore the bad.  If she persists or worsens, you may want to talk to your vet about various antianxiety treatments, ranging from Dog Appeasing Phereomone (D.A.P.) to Thunder Shirts (not just for storms), and even prescription medications.  Since your vet knows your dog better than I do, and can see her in the clinic, they are better positioned to help determine the cause and treatment.

Sunday, January 15, 2012

Pet Obesity Hits Mainstream

Today I was looking at Fox News (yes, I'm one of those) and saw an article about pet obesity in America.  My attention was grabbed by the title (Face It, Your Dog Is Fat) and I think the article was something that will be eye-opening for many pet owners.

Obesity in our pets is a rapidly growing problem, and something that every vet talks to clients about.  However, I honestly think most of my clients don't really understand the significance or severity of the problem.  Most will acknowledge that their dog or cat may need to "loose a few pounds", but I don't think that really makes much of an impression on them.  I do my best to make them aware of the potential health problems and shortened life span, but I must not be doing a very good job because few pets come back on their next checkup having lost enough weight.  Of course, I'm not the only vet with this problem, as the number of obese pets is growing, not shrinking.

The article mentions a phenomenon that most vets and veterinary staff are aware of.  Pets who are overweight very commonly have owners who are overweight.  This situation makes the conversation more difficult, as we have to be careful to only judge the pet and not the owner.  Sometimes this can make discussions awkward.  But more importantly it indicates the root of the problem, a lack of understanding of proper health and nutrition on the part of the owners.

Keep in mind, the pets don't pick which foods or how much they are fed.  This is completely in the control of the owner.

The article additionally discusses a web site that I wasn't previously familiar with, Project Pet Slim Down.  There is a lot of good information there about how to help pets loose weight, as well as charts for dogs and cats, showing what they look at various weights and body conditions.  I would encourage every owner to really take careful assessment of their pet and do something to keep them at a normal weight.

And I'm very glad that this issue is reaching beyond the vet office and being talked about in mainstream news sources. 

Saturday, January 14, 2012

Facebook Rules The World

Can anyone believe that just a few years ago nobody new what Facebook was?  Now it's pretty much impossible to get away from it and most people we know are found there.  Facebook is changing how we use the internet and how we communicate with each other.  No, this isn't an ad for Zuckerberg's creation, just a rant and some thoughts.

I started using email and computer networking back in the early '90s, when it was mainly BBS and Usenet.  I remember the great novelty of the World Wide Web when I was in vet school and how new all of that seemed.  As the Internet grew, we moved from usegroups to online forums, which really dominated social networking until Facebook came around.  And now it seems like all of this is morphing again, with older forms falling by the wayside.

A group I'm heavily involved in, Fans For Christ, started as a forum several years ago.  A couple of years ago we started a Facebook group which has really taken off through 2011.  As the traffic on Facebook has increased, the posting on the forum has significantly decreased.  We've even brought this point up in discussions, and it seems that people are just on Facebook so much that they'd rather communicate there than on the forum.  This is despite the fact that our group is so active that posts and discussions quickly get lost as new comments are made, something that isn't a concern on a forum.  In a way, Facebook is hurting our forum and it doesn't look like this is going to reverse.

I've recently made a foray into Google+, which was supposed to be Google's answer to Facebook.  Really, it doesn't seem like much is going on there, and few people are very active.  I've even talked to some of my friends and they admit they are much more active elsewhere.  And guess where that is?  Ding-ding!  Yep, Facebook.

Thankfully we still have blogs for more long-form writing, though I'm waiting for Facebook to somehow take over that area as well.  And I can't really blame anyone, because I'm on Facebook also!

Give it another five years or so and I'll be we'll see the next iteration of electronic social interaction.  Think not?  Remember MySpace?  Yep, that's what I thought.

Wednesday, January 11, 2012

I Think I'm A Clone Now

Any Weird Al Yankovic fans out there?  If so, you'll get the reference in this blog title.  For those who don't know much about this classic music artist, here's a YouTube link.  But he's not the reason for today's post.

Today at work we were talking about a recent news story involving a woman who traveled to South Korea to have her recently deceased dog cloned.  She spent $50,000 to have a company harvest her dog's cells, develop an embryo, and implant it in a surrogate mother.  In her case it worked, and she now has a living clone of her old dog, whom she says is identical in every way to the dog she lost.

This isn't the first time pet cloning has been in the news.  Animal cloning first went public in 1996 with the famous development of Dolly the sheep.  Since then many livestock have been cloned.  Back in 2001 a cat was cloned, and several dogs and cats have been created this way since then.  A few companies have been founded with the goal of making pet cloning a commercially viable endeavor, with prices ranging from a few thousand to tens of thousands.

I know that people dearly love their pets.  I certainly do mine, and I can think of several that had their lives cut short and would love to have back again.  It's also understandable that people become attached to a particular pet over others and never want to loose that bond.  But I also have a lot of difficulties with the idea of cloning and would never do that with my own pets.

First, there is the cost.  Approximately 3-4 million animals are euthanized in shelters every year in the US.  Yet someone will spend $50-100,000 to clone their pet?  I can think of so much more that can be done with that money that will benefit animals in a far greater way.  Still, it's their money, and I don't have much problem with people being stupid with their fiances if they came about the money honestly. 

Second, there are serious medical and ethical concerns in the cloning process.  Many embryos never become viable, and there is a high rate of birth defects in the process.  Is it fair to develop several deformed animals in order to get one good pet?  Also there is the question of the surrogates.  If you read articles about South Korea's cloning industry (such as the one linked above), many of the surrogate mothers end up on "farms" and may not be treated properly. 

Lastly, you simply don't get the same pet.  You are copying genetics, but that doesn't mean that it's going to be 100% the same.  Even with identical twins you will have differences in personality and even looks.  My wife's brothers are identical twins and do share many similarities.  But I can tell the difference between them most of the time, even in older photos, and they do have several different personality traits.  That's been the same with every set of twins that I've known.  You can have completely identical DNA, but how each gene is expressed and which ones are turned "on" and "off" can vary.  The first cat cloned, CC (short for Carbon Copy) was a calico, and though gentically identical the original and the clone have different markings.

A person or pet's behaviors are a combination of genetics and environment.  So rather than "nature versus nurture", it's about how nature is affected by nurture.  Environment is never going to be the same.  In the article above the woman got her beloved dog when she was 18 years old and the dog lived for 18 years.  The circumstances and situations that were around 18 years ago are not going to be the same now that the woman is in her late 30s.  Yes, you will have genetic tendencies for behavior, but how those tendencies are molded by experiences is going to be different now.  So no matter how similar the clone is to the original, it will never be the same.

Don't even get me started on human cloning!  It's great in science fiction, but that gets too much into the realm of souls for my taste, and I'm completely against it.

And all of this brings me to the latest poll.  If you had the money or could get it done for free, would you have your favorite pet cloned?  I'm interested to see the results.

Tuesday, January 10, 2012

Second Guessing

It's not easy being involved in literal life or death situations on a daily basis.  Honestly, I think this is one of the biggest sources of stress in my career, and I can't imagine what human medical professionals go through.  Multiple times per day I have to make decisions that will affect the life and health of my patients, sometimes in life-threatening circumstances.  I always try to use my years of knowledge and training to the best of my ability, but I'm an imperfect human and there is no way I can be right 100% of the time.  I know this may be a rude awakening for some people, but there is no doctor on the face of the earth that hasn't made mistakes or misdiagnosed cases.  Simply put, nobody is perfect and nobody can always be right.  Hopefully, though, with care, training, and a little luck the mistakes will be few and far between.

But doctors aren't the only ones who wrestle with serious decisions.  I can't make choices for my clients.  Instead I have to give them enough education and opinions that they can make their own decisions for their pets.  In the end, it comes down to choices from the owner, not from me, even though I can guide those thoughts and options.  This means that in many cases the client is ultimately responsible for the case outcome, as I can't do anything they don't approve.  Many clients know this and wrestle with tough decisions, such as whether to treat or euthanize.

On both sides of the issue this can lead to second-guessing yourself.  I'll often come home worrying about decisions I've made in cases, wondering if I prescribed the right treatment or handled it appropriately.  It drives my wife crazy, and honestly isn't the best thing for me mentally.  I know that some of my clients wrestle with similar thoughts, trying to figure out if they picked the best options.  When you're passionate and you care about something, you always want to do the best.  But because we're imperfect people, we realize that whichever option we pick may not always be the right one.  So after the fact we re-analyze things and may doubt our initial decisions.

Yes, recent cases brought this to mind.  I have recently been treating a case of nodular panniculitis, an immune-system disorder where the body attacks the subcutaneous fat, with a strong immunosuppressive drug.  The dog has been doing fine on the medication for a month, but developed sudden and severe anemia within the last week and ended up being euthanized as the emergency clinic yesterday.  When I found that out I scoured the record and the dosages, double-checking to make sure that I had made the right choices and calculated dosages correctly.  Yes, I had, but I still have to wonder if there was something else I could have done.  When I talked to the owner this morning, she was also second-guessing herself, wondering if she should have brought her pet to us sooner, when she was just starting to act a little strange.  I feel that I handled the case appropriately and the client made good decisions in the end, but we both still worried.

Another case came in today for some odd behavior and a possible ear infection.  We ended up diagnosing a life-threatening anemia due to destruction of the red blood cells by the immune system (yes, odd that both cases had similarities, but they really were different).  Treatment would have been costly and extensive and there would have been no promise of a cure; at the same time the pet couldn't survive without therapy.  In the end the client opted to euthanize her dog, but she wondered if she was making the right choice.  I tried to assure her that she was, but I'm sure there was still part of her that didn't listen to my words and doubted her decision.

Second-guessing yourself is human nature.  However, it doesn't help much and can lead to anxiety and depression.  Believe me, I know this first-hand.  But it's one thing to wonder if you locked the door to your car.  It's another thing completely to wonder if you chose the right diagnosis to start treating.  I wish I had great advice to give on how to overcome this problem, but I'm still struggling with it myself.  Really, this is just another peek behind the scenes, showing what goes on in the mind of a vet.

Sunday, January 8, 2012

When Vomiting Really Isn't

Believe it or not, vomiting isn't always vomiting and it's something that vets really do have to worry about.  Let me give you a quick lesson so you can help your vet determine what is wrong with your pet.

Producing fluid or food from the mouth generally falls into two broad categories:  vomiting and regurgitation.  The distinction is important because each can point to different disease processes.  Few clients understand this difference (which is what I'm hoping to correct) so most people simply think that their pet vomited.  In a nutshell, vomiting is active and regurgitation is passive.  But let's look at the two in a little more detail.

Regurgitation normally involves stomach contents coming up and out through the mouth without active muscle contractions.  If the esophagus is enlarged and dilated (such as in megaesophagus), food can come back up because it sits in the esophagus rather than making it to the stomach.  It can also happen if the upper sphincter in the stomach (the cardiac sphincter) is loose, not sealing food in the stomach.  When regurgitation happens the pet usually just stands there, opens its mouth, and fluid or food comes out.  Because there are no muscle contractions it just sort of falls out and there is no force behind it.

When a pet vomits, the esophagus and cardiac sphincter are functioning normally, pushing and keeping food into the stomach.  When the nausea centers are triggered the stomach and abdominal muscles contract, resulting in the contents being expelled from the mouth.  The difference is that there is force behind vomiting.  You can see the abdomen contracting and the vomit may be "projectile", covering some distance.  It's not uncommon to have multiple episodes of vomiting close together, which is much less common with regurgitation.  You can often see a "lead-up" to the actual vomit where the pet feels the nausea and contractions then gets into the position to expel.  Regurgitation more typically involves a sudden "splort" (my word) without any real warning.

We vets do try to differentiate between the two because the things that cause regurgitation are usually different than the causes of vomiting.  It's kind of like trying to tell the difference between "dry" and "wet" coughs.  So the next time your pet seems to vomit, try and pay close attention so you can give more information to your vet.  It may actually make a difference with your pet's diagnosis.

Saturday, January 7, 2012

A New Look

Every once in a while you need to shake things up a bit.  I noticed that Blogger had some new templates, and was thinking about changing the look of my blog.  Partly this was to alter the width of the posts so I could include bigger pictures and videos.  Well, I accidentally clicked on "apply" too early, and lost my old template.  I found it and was getting ready to put it back when I realized that maybe my mistake was an opportunity in disguise.  So I took this time to completely rearrange the blog, add some new features, and make it a little more personal (such as including my dogs, Yvaine and Inara, as my background). 

Hopefully you folks will like it, or at least not be too annoyed by it.  Comments are welcome!

Friday, January 6, 2012

Body Language Masters

Regular readers will know that animal behavior is a strong interest of mine and I've done a lot of study in this area.  Often I point out to clients that dogs are masters at reading human body language.  Much of their own communication is non-verbal and a lot can be "said" with changes in posture.  Because they are hard-wired to pick up on these cues, the notice a lot of the signals we send without realizing it.

Though this is generally accepted and well-understood by behaviorists, there hasn't been much scientific evidence.  That is, until now.  Today I just read an article about this subject, describing how dogs will follow a person's gaze in the same way that human infants and toddlers will do.  Though it may seem simple to us, it's proof that dogs really are aware of us and in tune with our movements.

Why does this matter?  Because we need to keep in mind our non-verbal signals in relation to our pets.  The volume and tone of our voices, our posture, the strength of our gestures, and a hundred other little things communicate various things to our pets.  When talking to clients who have dogs with behavioral issues I will usually ask about any stresses, arguments, or changes in the humans of the household.  Arguments among the humans can cause problems for the dogs as well.

In client service training I've been told that about 80% of communication between humans is non-verbal.  However, most people don't pay conscious attention to this even if they still pick up on it.  The animals around us are more consciously aware of these cues.  If we pay attention to such communication when we're training and teaching our pets, we can have better behaved dogs and cats and closer bonds with them.

Thursday, January 5, 2012

Owners Giving Vaccines

Controversial subject?  We'll see.

Most vets don't recognize vaccines given by breeders or owners and most boarding facilities I know of also will only accept vet-given immunizations.  This can cause some disgruntled people as they have to get vaccines done again through a vet if they want to board or groom their pet.  Some vets may also not allow unvaccinated pets to stay in the hospital for simple things like spays and neuters without proper vaccinations.  I've known a lot of owners and breeders who have gotten upset in circumstances like this and I've had to try and explain it to them.  There really are very valid reasons, and it's not about the vets trying to squeeze more money out of people.

I will be the first to admit that giving a vaccine isn't rocket science and I can train someone to give injections just as well as I can.  It's also common for most people with horses, cows, goats, and other livestock to give their own vaccinations rather than going through a vet.  In most states of the US the rabies vaccine must by law be given by a vet, but other vaccines are not legally mandated.  So yes, legally an owner can give their own vaccines (other than rabies) without breaking the law.  You can easily purchase distemper and parvo vaccines at feed stores or online, so they are available to clients.

With this in mind, what is the problem with owners giving vaccines?  Why bring it up now?

Yesterday I had an 11 month old Yorkshire terrier come in and within an hour die from parvo virus infection.  A few days prior to that a littermate died at home from parvo.  We managed to treat and save one of the dogs in the litter.  This is a good bit older than most dogs are when they succumb to parvo.  And the owner was the one giving the vaccines.  In fact, the only adult dogs I've seen who have come down with parvo had their vaccines given by the owner.

If vaccines are so available and so easy to give, why are breeder- and owner-given vaccines not effective?  Usually it comes down to inappropriate administration.  Vaccines must be started at a certain age and boostered at proper intervals in order to stimulate long-term immunity.  Vaccines must also be mixed properly and stored at the proper temperature in order to be effective.  Mix them wrong, store them for too long at too high of a temperature, or otherwise mishandle them and the vaccine will not work.  Also, not all vaccines are equally effective, and owners usually don't have the information available to make those decisions between manufacturers.

I routinely see breeders starting vaccines at four or five weeks old, when the minimum age should be six weeks (this is due to proper immunology).  I have seen pet stores giving vaccines weekly, when a duration shorter than two weeks doesn't do anything to booster immunity.  I've had clients who give one vaccine and think the pet is protected.  One time I had a client bring in the bottles of the vaccine given by the breeder, where the breeder had used the diluent liquid and the dry powder from two different company's vaccines.  Anyone who is in the veterinary field knows exactly what I'm talking about.  For anyone who hasn't worked in veterinary medicine, please believe me that these sorts of things happen much more commonly than you realize.

When we see a vaccine record from a breeder or an owner, we honestly have little to no idea if the vaccines were administered and handled properly.  Many of them might be, and I've known breeders who give the same vaccines I use and do so in a very medically appropriate way.  But based on some paper or labels we have no idea whether or not that is the case.  It is in the best interest of the pet and ensures the best health for a veterinarian to be the one to give the vaccines.  Can vets mess things up?  Sure, we're only human and as prone to failings and lies as much as the next person.  But you are much less likely to have improper vaccination through a vet than through an owner.  Vets simply have more knowledge and training than the huge majority of pet owners and breeders, as well as have their licenses and careers on the line when it comes to medicine and record-keeping.

I know that money is tight for people, and many give vaccines to help their budget.  But you are potentially leaving your pet open to infection, as well as preventing them from getting full exams to look for other issues.  It's simply in your pet's best interests to let a veterinary medical professional be the one to do vaccinations.

Tuesday, January 3, 2012

Post-Traumatic Stress In Dogs

Post-traumatic stress disorder (PTSD) is a well recognized phenomenon in people.  Though most commonly thought of in relation to military personnel (and at one time called "shell shocked" during my father's generation), this problem can affect anybody who has been through a sufficciently traumatic event.  But humans are not the only ones who can suffer after trauma.

Recently I've seen a few articles on this subject in dogs, specifically military dogs (for example, see this article from the New York Times).  As someone with a strong interest in animal behavior, I found myself really thinking about it.  Apparently it's a growing concern in dogs serving in the military.  From the article....

By some estimates, more than 5 percent of the approximately 650 military dogs deployed by American combat forces are developing canine PTSD. Of those, about half are likely to be retired from service, Dr. Burghardt said.

It may sound a bit strange to people, but it makes perfect sense to me.  Every vet knows that our patients often quickly develop an aversion to the office, often showing signs of anxiety as soon as they pull into the parking lot.  Formerly friendly dogs can develop fear-related agression towards veterinarians after the patient has undergone extensive and potentially painful treatment after a serious injury or illness.  We also commonly see phobias and anxiety develop after a traumatic experience.  For example, a dog has a ladder fall near them noisily during a storm and from that point on is afraid of thunder.  Or a cat develops an aversion to the litterbox because it had pain when defecating and the cat associated the pain with the litterbox.

All of that makes sense, right?  So it surprised me that the article mentions that the topic is being debated.

Though veterinarians have long diagnosed behavioral problems in animals, the concept of canine PTSD is only about 18 months old, and still being debated. But it has gained vogue among military veterinarians, who have been seeing patterns of troubling behavior among dogs exposed to explosions, gunfire and other combat-related violence in Iraq and Afghanistan.

Frankly, as a behaviorist (though not a specialist), I'm surprised that we haven't recognized this problem sooner.  It's a well known behavioral principle that traumatic events can lead to future anxiety when presented with similar circumstances.  Perhaps the difference is in the current state of military affairs, with more improvised explosive devices and urban warfare than in the past, presenting dogs with situations that may more closely resemble their home life and environment.

Treatment is possible, and the techniques appear similar to what we use in treating any phobia or aversion.  I've used similar methods many times in storm phobias, and desensitization techniques are used to train hunting dogs not to be afraid of the gunshot.

More serious cases will receive what Dr. Burghardt calls “desensitization counterconditioning,” which entails exposing the dog at a safe distance to a sight or sound that might set off a reaction — a gunshot, a loud bang or a vehicle, for instance. If the dog does not react, it is rewarded, and the trigger — “the spider in a glass box,” Dr. Burghardt calls it — is moved progressively closer.

Some dogs are also treated with the same medications used to fight panic attacks in humans. Dr. Burghardt asserts that medications seem particularly effective when administered soon after traumatizing events. The Labrador retriever that cowered under a cot after a firefight, for instance, was given Xanax, an anti-anxiety drug, and within days was working well again.

It's an interesting subject, and I'd recommend the article to anyone with an interest in pet behavior.  I also think it's important to reconize that the men and women in the military are often supported by canine soldiers, and we need to honor their service as well.

Sunday, January 1, 2012

Happy 2012

Welcome to 2012.  No flying cars or moon bases yet and the world's supposed to end on December 21st, so we'll just have to make the best of things.  In the spirit of the new year, here's something that all vets and pet lovers can related to.