Lord Of The Mews

A few weeks ago we had to euthanize our oldest pet, a cat named Pooka.  He was the only one of our pets that could be dated B.C. (Before Children), but there were a lot of developing problems.  It was sad, but we knew it had to happen.

Our kids don't remember much back when we only had two cats.  For most of their lives we've had three at the same time, so of course they were convinced we had to always have three cats.  We weren't going to give in because we didn't feel a great need to get another cat.  However, our daughter was really broken up over losing Pooka (even though she was never really close to him and he was kind of a cranky cat...she's just tender-hearted and loves animals) so to placate her we said we'd look for a new kitten.

Shortly afterwards we found a family in our home school group that had a new litter of kittens that would be six weeks old on April 30th.  We looked at them two weeks ago, Elena picked out one she liked, and today we picked him up.

 This is Pippin, just after we brought him home and I gave him a bath (he had some fleas).  He's a surprisingly calm little guy who so far isn't really rambunctious.  He's very content to lay in someone's arms or next to somebody.  We were trying to come up with a good, uncommon name, and somehow Pippin (a.k.a. Peregrine Took) from Lord of the Rings came up.  I've always liked that character, especially as portrayed by Billy Boyd in the movies, and the name was cute for the kids.  Since our children hadn't yet seen the movies (they're 9 and 11) we watched Fellowship of the Rings this weekend.  My daughter especially loved it and now is all about the character of Pippin.

The other pets aren't sure what to make of him yet.  The cats have stayed away and seem mostly uninterested, though Ash did hiss once.  All of that is typical when you introduce a new cat to a home.  The dogs are extremely curious, though in a friendly way, and we have to watch them to keep them from trying to lick or play too rough and scare the poor little guy.  The newness will wear off and the dogs will get back to normal once they realize he's not going anywhere.

All-in-all I'm happy with our choice.  I know it's only been a few hours and his rottenness will likely come out soon, but it is nice to have a new addition.  Who seems to be taking the changes in stride (he's sitting on my shoulder as I type) and relaxing comfortably.

Fighting Complacency

When I was in college I was a DJ for the univeristy radio station.  I loved modern music (of that time...80s to early 90s) and thought that I was very hip and aware of what was on the radio.  It was unimaginable to me to not be aware of every musician out there and I anticipated always being this way even as I got older.

Flash forward to today...I recognize the names of modern artists such as Adele, Katy Perry, and Lady GaGa, but I couldn't tell you a single song they did.  This is despite having the radio on at work every day.  Getting older made me appreciate the "old" music more and though I don't hate contemporary pop, I'm comfortable in what I grew up with.  I've learned that this is a natural tendency, and extends beyond music.

Recently fellow veterinary blogger "The Homless Parrot" wrote an entry on how she has to fight against herself getting lazy with working up cases.  After 15 years in practice, I can completely relate, and have seen this in myself.

On any given day it's a virtual certanty that I will see at least one case of diarrhea, ear infections, skin disorders, dental disease, and lameness.  Seriously, these problems are this frequent.  Most of these cases are routine and I'm going to diagnose and treat them the same way.  My years of practice have also shown me that some of these cases get better despite us rather than because of us, and in the others almost any treatment I use will be effective.  It is so very tempting to see that dog with gooey, itchy ears and just give it some medication.  It's very likely that that itchy skin dog has allergies and will respond to antibiotics and steroids.  But just doing that is poor medicine.

Early in my career I would see older vets who would just throw antibiotics or steroids at a case and call it a day.  "I'll never be like that," I would think.  "I'll always keep up with current medicine and do the right things."  For better or for worse, I can now understand those older doctors better.

So many cases we see are identical and are seen time and time again.  I can do these cases in my sleep, and have a set pattern of diagnostics and treatment.  In recent months I have had to fight the tendency to just treat based on experience and instincts, avoiding proper diagnostic work-ups.  The sad thing is that if I just treated, most of the time I'd be right, even without testing.

So why bother doing the ear swab or the skin scraping?  Why do we go through all of this if our treatment plan would work anyway?

Because it's good medicine, and some cases surprise you.

Just today I saw a 15 year old outside cat who was lethargic and loosing weight.  With that background I was thinking hyperthyroidism, kidney failure, feline leukemia, and a host of other problems.  I wasn't seriously concerned about the discharge coming out of his right ear.  So we worked up the case with a battery of blood tests, and an ear swab almost as an afterthought.  As it turns out there wasn't a darn thing abnormal in his blood or urine, but the ear was heavily infected with a bad bacteria (rods, for my veterinary audience).  If I had just gone on an educated guess, I would have started talking about euthanasia due to some likely bad and incurable diseases.  Because I took the time to work it up I was able to make the proper diagnosis.

Situations like this are not uncommon.  Yes, I have practiced long enough that most of my guesses are right.  But I would hate to misdiagnose or mistreat a pet because I guessed wrong.  Doing the tests keeps me from guessing wrong.

The longer you practice and the more you see the same cases day after day, the more complacent you can get.  This is human nature, like my situation with the music on the radio.  To be a good doctor you have to actively, consciously fight this tendency.

Struggles With Struggling

One of the most daily frustrating facts of veterinary practice is the behavior of our patients.  Some of them are very well behaved and sweet, but others....not so much.  It can make our job very difficult and can even be dangerous to the pets if not handled appropriately.

Just today I spayed a small black poodle.  We always do preanesthetic blood testing and so went to collect the blood.  She cried, squirmed, and generally made it hard to keep her still.  This makes it tricky because we collect blood from the jugular vein in the neck.  If they are moving around we can't hit the vein, and if they move too much while the needle is in we can cause a hematoma or similar problem.  We finally did get the blood, but it wasn't easy.

A little later in the day I saw a German shepherd mix with an ear infection.  I needed to look down in the ears to see the extend of the problem and evaluate the ear drums for damage.  Unfortunately he wasn't nice and the ears were uncomfortable so he growled, lunged, and struggled.  With some care I finally did get a good look, but once again it was difficult.

I can't say that I completely blame our patients.  We are doing uncomfortable or painful things to them and they don't know us well.  We are restraining them in ways that can be frightening, and it prevents them from moving.  If people I didn't know held me down by my arms and legs in order to shove a stick up my bum, I would certainly struggle against them!  Veterinarians and our staff are scary people doing mean things.  We can't explain to our patients that it will only sting for a bit and then be over, or otherwise rationalize with them to keep them calm.

There are many skills a vet must master, and wiggling, struggling pets is one of the biggest.  It takes great patience to work with them as you try again and again, getting more frustrated with each attempt.  In many cases we can't simply give up since we need to collect the samples or do the procedure right then.  It is one of the most irritating parts of the job, because if the patient would simply be still we would be finished in a fraction of the time.  Anyone entering the profession needs to be prepared for this as a daily issue.

Learn The Language, Please

Ready for a politically incorrect rant?  Good.

I am an American and therefore English is my native language.  I did learn German in high school and used to be passably fluent, but over 20 years of disuse has made me very rusty in that language.  My lack of multilingualism isn't a hardship to me because I live in an English-speaking country.  But what would happen if I moved to Russia?  Or to Japan?  Or France?  I would have major problems communicating and even getting by in day-to-day life.  With no skill in the languages of those countries I would have to rely on people being able to speak to me in my own language, or use an interpreter.  For a short visit the latter choice might be best, but not if I was living there long-term.  I would need to learn the language in order just to get by.

But what if I didn't?  What if I didn't bother learning Japanese while I was living in Tokyo?  My life would be really difficult and mere existence would be a major challenge.  Let's not even get into the situation of a medical emergency for me or my pets.  How can I talk about or understand a medical situation if I don't have even a basic competency with the language?

Astute readers will see where I'm going with this situation.  Here in the US we have many immigrants who don't have even the most simple skill in English.  And I'm not speaking of any particular ethnic group because I've seen this problem across nationalities.  As a vet this makes it very difficult to communicate with clients, especially if I have to tell them about a medical problem or make a recommendation for preventive care.  What ends up happening is the client doesn't understand what I'm saying and so doesn't do what I'm suggesting.  The pet may suffer or be at risk for disease because of this language barrier.

Yes, we try to accommodate some of these clients by keeping a selection of educational handouts in Spanish.  However, that's still not enough for full communication and doesn't include any other language groups. Early in my career I had to recommend neutering a dog to a client through the translation of her nine or ten year-old daughter, which was incredibly awkward.  Just this week my associate had to handle a client who didn't seem to understand much of anything she said, yet she was trying to go over even the basics of vaccines and heartworm disease.  It is a highly significant barrier to proper pet care and is frustrating to us.

In our society it seems like the onus of responsibility in communication is on us, the business.  It is somehow our fault that we don't speak the client's native language, even though they came to our country.  And we have to go out of our way to provide clients with information in a language that they understand or we're not doing enough to serve them.  I believe that this is backwards thinking.  THEY came HERE.  The responsibility should be on THEM to learn OUR language.

Now before anyone starts to blast me for being anti-immigrant or somehow racist, keep in mind several things.  First, I'm not talking about any specific group here, and have seen this issue with Hispanics, Asians, and Europeans.  Second, I'm very pro-immigrant, as long as they are following the laws in coming to the country (I won't get off on that tangent right now).  In fact, I am the son of an immigrant!  My father is originally from Sweden and is a naturalized US citizen.  I am very proud of my Swedish heritage and being the child of someone from another country makes me more interested in learning about other people's homeland.  But my father and I agree on this point.  If you're going to move to and live in a country, it is your responsibility to learn that language.  In fact, I personally believe that a working fluency should be a requirement for any kind of long-term visa or green card.  I don't exclude myself from this situation.  If I decided to live in another country, I would certainly expect to learn that language, starting before I ever moved.  I need to have responsibility for myself and my own survival, not expecting someone over there to accommodate me.

I welcome people from other countries, and have had many great ones as clients and employees.  But please learn how to speak and understand our language.

Getting Used To Seeing Suffering

One of the things I've grown to love most about being a blogger is having developed an international readership.  It's very cool to be in contact with people from all over the world.  Here's a question from Ruaridh in Ireland.

The reason I'm emailing you today is I have a question or two that I feel, after reading your blog, you would be equipped to answer. I want to be a vet and if I was to gain entry I feel with much work I could be able to handle the academic side of the course. However the side I feel I may have some trouble adjusting to is the aspect of seeing animals in pain. I know how silly that sounds and the simple answer is of course not to be a vet, but for some reason I can't turn away from the idea. My question for you is this: As an animal lover how did you adjust to seeing animals in pain? I've always acknowledged the fact that to be a veterinarian you need more than that "love of animals" to make it but just how do you adjust to it? I took a year out last year to do some work experience and I must say I loved it I just feel that if I was to experience this day in day out  it would wear me down.

This is a great and insightful question, one that people in this profession regularly struggle with.  As a short answer I don't think you ever get "used" to it, but you usually do find ways to cope.

Most people go into the veterinary profession because they love animals and feel real compassion for them.  They dream of helping animals heal from illnesses and injuries and in all ways ease their suffering.  There are some people who are so sensitive and soft-hearted that they simply cannot handle seeing even minor pain or discomfort in our patients, and it breaks their hearts to be around such situations.  These people don't last long as vets or support staff, and I hold nothing against them for their tenderness.

On the opposite end of the spectrum are people who simply don't give a flip.  They're so focused purely on the acadmeic and intellectual aspect that they may forget about any suffering, or simply don't care.  It's a good thing that people like this are very rare in the profession.  Unfortunately I see too many of them as pet owners.

So what's the balance?  How do you deal with it?  I can only tell you my personal experience, realizing that everyone is different psychologically and have different coping mechanisms.

You are going to see animals in pain.  It's simply a fact of the job.  Sometimes you create the pain, such as through injections, surgeries, and so on.  It's a temporary pain for greater gain, and you can certainly come to terms with it this way.  You'll also see pets who have been injured or are sick and you have to handle them.  I remember years ago having a whippet come in screaming because both front legs were broken when the kids had been jumping on the bed and accidentally landed on the dog.  In any of these situations we have several kinds of pain medications, including morphine, which we can use to at least lessen the discomfort.  I am a firm believer in anlagesia, especially preemptively, and most vets I know share the same outlook.

What about the ones who are sick but not painful?  Such as a patient in kidney failure or severe anemia.  They too are "suffering", and you have to do the best you can to treat them.  In some cases you can't, and that's where euthanasia comes in.  I never like putting a pet to sleep, but I can do it easily in most situations because I know that very shortly they won't be suffering anymore.

The worst cases are the ones where the pet is sick or injured, and the client can't or won't do anything about it.  I've seen pets come in with broken bones and the owner can barely afford an office visit and pain medications, let alone proper care.  It's also happened in pets with skin infections, parvo, and other diseases where the client declines care.  There have been times where I've offered free euthanasia just to stop the pet's suffering, and still the client refuses, taking the painful or sick pet home to who knows what kind of fate.  These owners infuriate me, and there is really nothing at all I can do about it because legally that is their property and I can't make them do anything.  I also can't give away services regularly or we'd end up closing our doors.  I have been tempted to contact the police about animal cruelty cases, but for various reasons have never made that call (though I know vets who have).

Over time you develop a clinical detatchment that allows you to assess a case with little emotional invovlement.  At the same time you should never loose your caring or feeling because then their pain won't matter to you.  It's a constant balancing act.  Thankfully as a vet you have the training and tools to stop infection, help pain, and fix many of the problems.  It's that hope of a cure or resolution that allows us to look at the big picutre rather than the short term.  We know that given some time and proper treatment the pet will be better, happier, and free of suffering.  Sometimes looking at it that way is the only thing that keeps us from breaking down.

Ruaridh, I hope that helps you out!  I'm sure my colleagues that read this blog can chime in with their own hints and experiences.  Good luck pursuing your dream!

Getting The Experience

Kimberly (a fellow Browncoat....Shiny!) sent this in...

I'm a pre-vet student who just decided to change career plans after getting my bachelor's degree in history, and I'm currently trying to navigate the prerequisites for vet school. Luckily, I live in an area that happens to have a fantastic community college and numerous universities, so meeting the classroom requirements won't be an issue. The thing I'm having the most trouble with is getting the necessary clinic experience to be a serious candidate for vet school. I have a lot of large animal experience (lifetime caring for horses and part-time job as a livestock handler on a working farm), but I'm trying to broaden my background and acquire some experience that is more focused on the day-to-day of veterinary practice.

Unfortunately, the feedback I've been getting even from small animal vet clinics so far is that they don't generally take volunteers because of the insurance risk. They suggested that I try volunteering at animal shelters, but I'm concerned the experience I get there won't get me the necessary clinic experience, especially since I full-time job and can't volunteer during the week when the vets are around. Do you have any insight on what kind of experience vet schools typically consider considered clinic experience, and how hands-on I should expect things to be? I know some schools like CSU break it down into general animal experience and vet clinic experience, and I want to make sure I'm getting enough of the clinic side of things.

Next, I've shadowed a large animal vet a couple of times, and hope to do so more regularly (especially since that's what I want to go in to), but am not sure how this will be reflected on my application. Will this even be considered experience on a vet school application?

The first thing I would recommend is to talk to the admissions office at any school you are considering.   Though all US schools have similar requirements, they aren't all the same so it's difficult to make blanket statements.  I've known people to get into vet school with no prior experience, or only a few months working at a vet.  Most schools do look at your clinical experience, but it's going to vary.  

The best experience is to actually work directly for a vet.  This isn't just to meet vet school requirements, but to get a hands-on look at what it's like to be in the profession.  Unless you've spent some time behind the scenes in a veterinary clinic you honestly don't know what you're getting yourself into.  There are a lot of things vets have to do and deal with that the general public isn't aware of.  Even blogs like my own only give you glimpses and are not a replacement for practical experience.  You may find that dealing with difficult clients, getting urine and feces on you daily, being bit at regularly, and working long hours isn't really what you wanted to do.  It's better to know this before going into school than only after you're in practice.

How you actually go about getting this experience can be tricky.  Volunteering at a shelter is nothing like being in daily practice.  Sure, you'll get to be around animals, but this is nothing like working as a private practitioner, even if you spend time with the shelter vets.  Continuing to spend time with a large animal vet will be a great idea.  The application will ask you to list your experience, and this does count.  The admissions office won't check on the number of hours you worked, so as long as you're honest and do list your time with vets, you're okay.  Also, you will need at least one veterinarian to write a letter of recommendation, so you'll need to develop that relationship.

If it won't burn you out, look at working part-time overnight or on weekends for an emergency clinic.  Getting people to do those shifts can be tough, so you'll be filling a need as well as getting great experience.  Your lack of experience before applying may make it difficult to get a job, but it never hurts to try.  Large animal vets do a lot of their own weekend and emergency calls, so you can continue to work with the practice you mentioned.

Again, start with the admissions office and see exactly what they're looking for.  Best of luck!

Stinky, Slobbery Mouth

Here's a good question from Ra...

I have a 2 year old Lhasa apso. She's a bit flat, she's really vocal though, and shes salivating alot, like her chin is always wet. Plus her breath reeks and it never did before. I tried to open her mouth and look in before and she wanted to bite me-she yelped. there was alot of chewed up food (biscuits) just sitting at the front of her teeth. London is littered with chicken bones-what do you think, maybe there is a chicken bone stuck in her mouth somewhere? P.s.I took her to the vet and they found nothing...yet I'm not sure they thoroughly checked her mouth as I wasn't there.

There are several things that can cause a foul odor, excessive salivation, and a painful mouth.  One of the most common is periodontal disease.  Severely infected gums and teeth will lead to these symptoms and can be quite painful.  I've seen many cases where the infection is so bad I will literally have my stomach churn as I'm looking at the mouth and then extracting teeth.

However, there are certainly other causes of these symptoms.  Oral tumors as they become necrotic can look like this.  And then there are foreign objects in the mouth, such as bones, sticks, and so on.  Something stuck in the mouth is a real concern.

Unfortunately it can be difficult to figure out what is in the mouth in some patients.  Most of them don't like us opening the jaws and sticking fingers or probes in the mouth, especially if it's painful.  It's common for pets to swing their head around and generally try to keep us from doing a good exam.  With a very well behaved and tolerant patient we can get a good look in the mouth.  Otherwise it's pretty tough.  If we really need to do an extensive exam in a resistant or aggressive patient, we're going to need to use a sedative of some sort.

If this was my patient and I couldn't get a good enough look on a routine exam, I would recommend a short-acting immobilization agent such as propofol or Dexdomitor.  Once the dog is fully asleep we can look and probe all we want.  It may also be necessary to take x-rays of the jaw and skull if the problem isn't very obvious.

Talk to your vet more about this, Ra.

50 Secrets? Not So Much.

The latest issue of Reader's Digest (May 2012) has a big cover story.  "50 Secrets Your Vet Won't Tell You."  Of course this is a very provocative title, especially for someone in the veterinary profession.  I was curious to find out what sort of secrets me and my colleagues are holding back from telling our clients.  My wife picked up a copy at the grocery store and I read through it today.

What a let-down.  Really, there are no great "secrets" in the article, and there isn't anything I and other veterinary bloggers haven't been saying for years.  Most of the so-called secrets are things I regularly talk to my clients about.  All of the comments are based on interviews with 18 veterinarians and vet techs. Let's look at a few of them....

1.  "People always ask, 'How handle pit bulls and rottweilers and big German shepherds?' The truth is, the dogs that scare me most are the little Chihuahuas.  They're much more likely to bite."
Geez, I tell a client something along these lines almost every day.

7.  "Here's a pet peeve:  owners who don't want to pay for diagnostic tests but then cop an attitude because you don't know what's wrong with the animal.  Since you wouldn't let me do the blood work or X-rays, how the heck do you expect me to know?"

How many times have I blogged about this exact issue?  And this is supposed to be a "secret"?

22.  "I hate to break it to you, but your $2000 designer dog is a mutt.  Puppy stores and breeders have created these cute names like Morkipoos and Puggles, and now people are paying $2000 for a dog they couldn't give away at the pound 10 years ago.  Whoever started the trend is a marketing genius."

Yeah, I've talked about this numerous times to clients, staff, and on this blog.  Secret?  Not so much.

50.  "If you live in a one-bedroom apartment with no patio and minimal space, and you're gone ten hours a day at your job, a 100-pound Great Dane may not be the best choice for you.  Maybe start with a goldfish?"

Well, DUH!

And the whole article is pretty much like this.  The huge majority of the points are no secret at all and are things commonly communicated by vets and easily found on the internet.  However, there are a few of the items that I do have a bit of a beef about and want to discuss.

20.  "Your veterinarian may not have gotten into vet school!  Vets who can't get into the traditional U.S. veterinary programs due to bad grades and poor test scores often go to for-profit schools in the Caribbean, where, basically, if you can pay the tuition you get in."

Wow!  Did the editor not do any fact-checking before letting these comments go to print?  This statement was made by "a vet in California".  While the other quotes had a specific name, several only had this rather anonymous author.  I'm sure that the students and graduates of the Caribbean veterinary schools (specifically Ross and St. George's) would take great offense to such words.  First, there are private, for-profit universities in the US, and several have vet schools.  Since when are "profit" and "good education" mutually exclusive?  Second, there are certainly admission standards at those schools and people don't get in simply because they have enough money.  Saying so is a gross misrepresentation of what goes on.  The students at these schools also normally do senior clinical rotations in US veterinary colleges, getting experience along with "normal" vet students.  Lastly, there is a very strict process for getting a veterinary license in the US.  If you graduate from a non-US school (or from some of the few foreign schools authorized by the AVMA) you must take a rigorous set of tests that I honestly wonder if I'd be able to pass.  To even take the exams you must have graduated from a recognized veterinary program.  So saying that "your veterinarian may not have gotten into vet school!" is completely and utterly wrong!  Anyone licensed to practice in the US must have gone through equivalent training and testing, regardless of where they went to school, and are equally as qualified.  I've known several vets from the Caribbean schools and I can't tell their veterinary skills are any different than those graduated from US schools.

27.  "After their kitten vaccinations, indoor cats don't really need to be vaccinated.  They're not going to get rabies sitting in the house.  Vaccines have the potential to create a lot of harm for cats, including possible tumors at the vaccine site." 

First, we need to do a little critical thinking and look at the small type identifying the quote's author...."Jim Elliot, DVM, owner of Holistic Vet in New York and New Jersey."  Do you think a holistic vet would be against vaccines?  Yep!  Though there are some risks with vaccines, they are overwhelmingly safe.  There are a few other things to consider.  In every US state the rabies vaccine is required by law, regardless of your cat's living status.  If your cat isn't vaccinated and then bites someone you can be fined and the cat can be quarantined.  This does happen....a couple of years ago one of my staff was bit by a cat who wasn't vaccinated and animal control came to take the cat and put it in quarantine.  That would have been avoided if the cat had been previously vaccinated.  I also know very few cats who have never escaped outside at some point in their long lives.  This point should have been eliminated as opinion instead of being presented as fact.  Again, poor editorial oversight.

32.  "The vets who work for most coporate-owned vet hospitals are being paid monthly bonus checks based on how much money they bring in from clients.  So if it seems like you are paying more at one of these hospitals, you likely are."  

I know the processes of the two largest US veterinary corporations, VCA and Banfield, and this is a misrepresentation.  It also ignores the fact that most vets in the US use a production-based salary system.  This method is commonly called "pro-sal", and is currently recommended by most veterinary consultants.  The system works as follows:  a vet is paid a small base salary and then a percentage of the production they personally bring in.  Though this may seem like a commission system, it actually stems from the history of vets making more money than they bring in.  If you're getting paid $80,000 per year you should be bringing in enough revenue to at least pay for yourself.  Some vets don't, either by not seeing enough patients or not charging appropriately.  If the practice owner is paying the vet more than they're bringing in, the owner is losing money.  A base salary ensures at least a minimal salary (though usually not liveable by itself) and the production encourages the vet to practice good medicine and good business.  In some situations in private practices vets are paid entirely on production!  I've never known a corporate practice to do that.  I can also tell you from personal experience and first-hand knowledge that corporate practices (at least VCA and Banfield....I can't speak for the smaller ones) aren't usually more expensive, and in fact deliberately try to price themselves in the middle of the market.

I know that Reader's Digest isn't exactly hard-hitting journalism.  However, this is a very poor article.  First, it's misleading by insinuating that there are big secrets vets keep from their clients, when it's actually common knowledge they're printing.  Second, there are some big fact-checking mistakes that a competent editor should have caught, as I've pointed out above.  Rather than simply taking the word of the vets and techs, the magazine should have double-checked the truth of anything they printed.  If they had instead done an article on behind-the-scenes comments and insights into life as a vet, I wouldn't have had as much of a problem.

But then, if you want those sorts of things, you have this very blog!

Gecko Boy Parts

Here's another fun case, and one that most vets wouldn't touch.  In fact, the owners had gone to or called several other vets before being referred to me because I work with exotic pets.  

They had a two year old leopard gecko that was generally in very good health.  They were doing everything they were supposed to do, which can't be said about all exotics owners.  A few days before coming in they had noted something swollen around its cloaca (the single urogenital opening for reptiles and birds).  They had done their research and had a good idea of what was going on.  I was able to quickly confirm their suspicions.  The gecko had prolapsed a hemipenis.

For those who don't know much about the anatomy and physiology of reptiles, let me break the story to give a quick lesson.  Unlike mammals reptiles have a single opening, the cloaca, where the urinary, digestive, and reproductive systems empty.  In males they have a hemipenis purely for reproduction that is outside of the cloaca.  Again unlike mammals, the penis has nothing to do with the urinary system.  And to make it even stranger, many reptiles have two of them, hence the name "hemi"-penis to refer to one of them.

In a situation like this where it had been prolapsed for several days, the only option is amputation.  The prolapsed organ becomes damaged and dried and will eventually become dead and infected.  Thankfully, amputating one hemipenis doesn't affect urination and even leaves the lizard able to reproduce since he still has another one.  Thankfully the owners agreed to the surgery.  Here are some pictures!

The red object in these pictures is the hemipenis.  In the middle one you can see a slight bump on the other side of the cloacal opening which is the non-prolapsed hemipenis.  Amputation is actually pretty simple.  Under anesthesia you ligate around the base of the organ and then cut it off.

In these pictures I have the hemipenis held with my forceps, making it look longer than in the first pictures.  The bottom picture is of me doing he actual amputation after having ligated it.  And here's the "after" picture.

He woke up well and was doing fine at his post-operative recheck.  I like seeing exotics because it gives me some variety in my day and allows me to see and do things that most other vets pass on.  It's fun for me and I get to provide a service to clients that may not have other places to go.

The Final Option

The problem started six or seven years ago.  When leaving for a couple of days away from home the owner accidentally closed the door to the office where the litterbox was, leaving two cats with no option but to eliminaed elsewhere in the house.  Unfortunately, they seemed to choose the daughter's room, causing quite an odor. After that one of the cats continued to urinate from time to time in that room.  Over the next year or so they tried various enzymatic cleaners to get rid of the odor and urine stains, but the problem continued to happen sporadically.

The people moved to a new house in a new state and they expected the problem to go away since there was no odor of urine in the home.  However, the problem continued.  At first it seemed to be mostly on the daughter's clothing and carpet, anything that was on floor level.  They continued to clean and disinfect the area to little avail.  Fast forward over the next few years and the urinating continued to happen and started being in other rooms.  Though infrequent it was any jacket, bedspread, clothing, or rug.  The owners started closing bedroom and bathroom doors to keep the cat out of it. 

As the problem worsened they tried to find other solutions.  They used Feliway pheromones, but the urinating was infrequent enough that it wasn't easy to tell if there was any effect. When "outbreaks" happened they had blood and urine tests performed, looking for kidney problems, urinary infections, or diabetes, but the tests always came back normal.  The  problem was getting worse and the cat was causing destruction to carpets and clothing.

As they thought about it they realized that there had been a lot of upheaval in the previous years. They had originally gotten the kitten in Utah when they had two other cats.  Since then they had moved to Illinois, North Carolina, and finally Georgia.  Over the years they had lost the two cats the problem one had grown up with, then added three dogs, two more cats, and two children.  The cat was always a bit "crotchety" and cranky, and was only really bonded with the wife.  Though he could be affectionate with some of the other family members, he only seemed to tolerate them. He never got along well with the other pets, and would continue to hiss and growl at the dogs even when the dogs never did anything to him and they had lived together for years.  Additionally he was the most destructive with his claws, resulting in damaged dressers and bedposts, even despite nail trimming.

Finally they tried behavioral medication, hoping that it would help mellow his mood.  The cat quickly learned that food or treats contained the pills, and it wasn't really possible to forcably pill him every day.  They went to a compounding pharmacy and got the medication made into a chicken-flavored liquid, but still the cat refused it.  There was no way they were going to be able to give the cat its medicine every day for even the three to four weeks needed to see if it would work, let alone for months or even the rest of the cat's life.

So they were faced with a bad situation.  They had a 13 year old cat who was ruining their home and had behavioral issues for half his life.  He couldn't be medicated.  He didn't really deal with change well or get along with other people or pets, so adoption wasn't considered a good option.  Even if they took him to an adoption agency he would likely not get a new home and end up being euthanized because of his age and attitude.  Even in a foster home the cat likely wouldn't be happy.  He had always been an indoor cat so they didn't think he would do well outside.  Though there were significant behavioral issues, he wasn't dangerously aggressive and was otherwise very healthy.  But they couldn't continue to allow their home to be ruined any further. They felt backed into a corner and didn't have any good options.

We euthanized him today. 

Yes, that may seem cruel to some.  However, I don't think there were any other good options here. The people had honestly tried everything they could think of and had put up with the problem for a very long time.  At the end of their rope they wanted to find the most humane option, and a quick injection seemed the only solution.

These are very tough situations to deal with.  I do think that in behavioral cases the client should do everything they reasonably can, and I won't euthanize on the first visit unless it's a severe aggression cases where human and animal health is at risk. But what do clients do?  They can't continue to tolerate it and the problem can't be fixed if the pet won't allow medication.  Other options could be cruel and would only potentially pass the problem to someone else.  These are very much situations of "damned if you do and damned if you don't".

All Work And No Time To Work

Marianne sent this to me....

I just wanted to ask you one question: Had you been working during your Veterinary studies? I know that the scedule of a veterinary student is extremely demanding. Was it possible for you?

the reason I'm asking this is that I wish to study Veterinary Medicine but since I'm not 18 anymore, I don't want to burden my parents with any tuition fees or other expenditure whatsoever. I just need to know, is it possible for someone to study and work at the same time?

Being a veterinary student IS a full-time job.  You're going to easily put in 40-60 hours per week in class and lab time, studying, and otherwise being a student.  It is an extremely demanding and pressure-filled schedule.  Not only do you spend most of your day in classes and labs, but you often have study sessions in the evenings and weekends as well as intensive solo studying.  There are papers to write, research to look up, and an incredible amount of information to learn and memorize.  There simply isn't time to hold down a full-time job and be a vet student at the same time and the schedule makes it hard to keep regular job hours.

Part-time jobs are possible, and most people do have one where they can work weekends and some evenings.  During breaks (Summer, holidays, etc.) many people get a job with full-time hours to save as much as possible for when they can't do so during the school year.  But working for the equivalent of four or so months out of the year doesn't cover expenses for the rest of the year. During my own studies I worked when I wasn't in school as a way to help offset some costs, but I still had to take out student loans.

Unless you have tens of thousands of dollars (or your country's equivalent) in savings going into vet school or unless you are independently wealthy, you will need to take out loans.  Even people who get scholarships to cover tuition have to cover living expenses.  And scholarships are much harder to come by in vet school than they are in undergraduate college.  The high expenses and low ability to work is one of the things that makes a veterinary education so expensive, and why most graduates have over $100,000 in loan debt.  I maxed out on my loans during vet school, having started there with no previous debt whatsoever.  I was lucky and only racked up around $40,000 in loans, below average even for when I graduated in 1997.  And I'm still paying those off 15 years later.

As I've mentioned several times previously, getting a veterinary education in the US is becoming very burdensome, and more vets are finding it difficult to repay the high loans once they graduate.  Debt is growing at a much faster rate than starting salaries which makes for a low quality of life for most new graduates as they struggle to make enough just to pay all of the bills.  You should only seek a veterinary education if you really want to be in the profession and you are prepared for the financial burdens you will certainly face when you graduate.

Little Dog, Big Stone

Several weeks ago I saw a chihuahua mix for a problem of bloody urine.  I realized that this wasn't a routine urinary tract infection when I did my exam and felt something rather large and hard in her abdomen. A quick x-ray later and my suspicion was confirmed...there was a particularly large stone in her bladder.

For those who aren't used to looking at radiographs, the stone is the big egg-shaped object on the right near the femur.  

Unfortunately, the owner couldn't afford surgery and went home with antibiotics.  A couple of weeks later she came back because her dog seemed to be whining and uncomfortable.  After another exam and checking a few things I concluded that she was painful from the stone, and only removing it would help.  I sent her home with some pain medications, and thankfully the owner was able to get an extension on her Care Credit.  We scheduled the surgery quickly and I went to work.

**Graphic images to follow**

That object is the urinary bladder before I cut into it.  The surgical approach is actually rather simple, not much different than doing a spay.  In fact, we went ahead and spayed this dog while we were in the abdomen, something the owner said she wished she had done years ago.

This is the stone coming out of the bladder.  As you can tell, the stone pretty much filled the entire bladder, and the bladder wall was very thickened and inflamed because of the irritation.  In this particular case it was one single stone, which is less common than having several smaller ones.

Here is the stone after surgery with a scalpel handle for scale.  This is nowhere near the largest stone I've removed.  The winner would be one that was the size of my whole palm, removed from a large dog many years ago.

The patient recovered and is doing fine.  We're waiting on the results of analysis of the stone to determine its composition which will allow us to determine the best way of preventing it from happening again.

Happy Easter

No big, grand post today.  Just a desire to wish everyone a Happy Easter and hope that you know and understand the importance of celebrating the resurrection of Christ.  May every have a blessed day in whatever way you celebrate it!

But if it is preached that Christ has been raised from the dead, how can some of you say that there is no resurrection of the dead?  If there is no resurrection of the dead, then not even Christ has been raised.  And if Christ has not been raised, our preaching is useless and so is your faith.  More than that, we are then found to be false witnesses about God, for we have testified about God that he raised Christ from the dead. But he did not raise him if in fact the dead are not raised. For if the dead are not raised, then Christ has not been raised either. And if Christ has not been raised, your faith is futile; you are still in your sins.

1 Corinthians 15:12-17

Getting Predictable

I do a lot of mentoring and training as part of a multi-location practice.  Every few months I have a new doctor spend a few days with me, either learning about exotic pet medicine (sort of a crash course) or teaching new graduates the basics of real practice.  My staff has gotten used to vets passing through our clinic and have heard me teach numerous people.

I didn't realize how much my team had heard me lecture until this week.  Once again I had a new doctor with me and was talking to him about spaying.  One of the things I try to teach new graduates is that you should make the incision as long as you need to for proper visualization and externalization of the organs, not worrying about how small it is.  "Remember,"  I say, "Incisions heal from side-to-side, not end-to-end, so a large incision will heal just as quickly as a small one."

Suddenly I heard snickers and laughs from the other end of the treatment table where two of my assistants were doing a dental cleaning.  I looked at them with a puzzled expression and asked them what was so funny.  Apparently one of them had whispered my exact quote to the other one just before I said it.

Earlier in the same day I had joked to the other doctor that my staff had heard my talks so often that they could probably give them instead of me.  It looks like I was being a bit prophetic!  It makes me wonder how predictable I'm getting in other ways.

So-Called "Sketchy" Vets

Here's an interesting and potentially controversial topic sent in by a regular reader....

You often talk about clients that cannot afford proper care for their pets.  I'd like to hear your thoughts on vets that engage in what I can only describe as irresponsible medicine, so actually end up making the problem with clients not wanting to spend money worse by offering diagnosis of hip dysplasia without x-rays and then prescribe Rimadyl for that young dog or those vets that will actually send an animal home with syringes and fluids (cat got into Ibuprofen) because the owner doesn't want to spend the money to keep the pet at the vet office overnight.  The cat owners have no medical background and have called on friends and family (that have medical backgrounds with humans) to give these fluids.  I have recently had contact with two pet owners that have experienced these situations and of course - these owners couldn't be more pleased because they didn't have to spend that much at the vet so of course the vets get glowing reviews on the Internet.  Or am I in the wrong here and what they are doing is acceptable?

There are really a several things to address in this situation, so let me start with more general thoughts.  I'll apologize in advance for such a long discussion, but I want to explore it fully.

As I'm sure most people are aware, there are normally several levels of care and service in any profession from doctors to bankers, mechanics to barbers, and pretty much anything that involves providing a service to other people.  The majority of such professionals are good, solid individuals.  Some will be truly superlative and some will be rather "sketchy", bordering or crossing the line of malpractice (or the equivalent in their given profession).  Clients/customers should not judge a profession by the actions of a few individuals carrying that title.  For example, if you see a TV report where some police officers beat a suspect, you shouldn't assume that all police are like this.  There will always be bad apples in any bunch.  And yes, that means that there are some vets who really shouldn't be practicing and should be brought up on malpractice charges.  I've known several of them.  But the vast majority of vets are good doctors, even if they may differ in opinions on treatments from each other.

Which brings up my second thought.  After 15 years practicing and a total of around 28 years in the profession, I have learned a few very important lessons.  There is usually more than one way to do the same thing correctly.  As an example, some people are very adamant that an IV catheter must be taped in place in a very specific manner.  But I've seen numerous ways of doing it, and they all work equally well.  The other important lesson is that very smart experts can have radically different opinions on some topics.  It actually can be confusing to a general practitioner when you listen to lectures by board-certified specialists and come away with different ideas on diagnosis and treatment depending on who you listen to.  So just because one person says that something should be done a certain way doesn't mean that this is necessarily true, no matter how strong their opinion on the matter.  This principle is not true in every situation, so proper judgement is needed.

A harsh reality of veterinary medicine is that we often don't get to do what we want to do and know that we should do.  Because there are few clients with insurance and lots of money, it's not uncommon to have to cut out certain diagnostics due to financial limitations.  Using the above hip dysplasia as an example, perhaps the dog is painful and we want to do x-rays, but the client can't afford it.  In a case like this we have to make our best judgement even if we know that we really should confirm it with the radiographs.  Sometimes we just send home pain medications because that's all the client can do.

But sometimes we can tell a whole lot just on an exam and by getting a good history.  Any regular reader will know that I have frequently and rather vehemently talked about the importance of the physical exam.  Let's go back to the hip situation.  I have a client who brings in their eight year old Labrador retriever.  The dog is happy but has been having problems with stiffness and soreness in the mornings or after laying down.  He isn't as active and playful as he used to be, though he's eating okay and seems okay otherwise.  Upon questioning I learn that the dog is slow on stairs and sometimes seems to sway a little in the hind end.  When I do my exam I notice a little roughness in the knees when bending, though no pain or swelling.  There is definitely some discomfort when I move and extend the right hip, less so on the left.  However, the dog walks around normally and the rest of the exam is unremarkable other than a moderate amount of dental tartar and needing to loose about five pounds.  Any vet who reads this description has likely already made their diagnosis, and 9 out of 10 times will be right.  I'd bet my next paycheck that this dog has arthritis, and likely hip dysplasia (which really is a specific type of arthritis or degenerative joint disease).  Should I do x-rays to confirm the diagnosis and see the extent of the changes?  Absolutely.  Will those x-rays change the treatment recommendations?  In this case, likely not.  I've seen many cases where the degree of changes on x-rays doesn't correlate with the degree of pain.  I've seen horrible joints where the dog isn't limping at all, and I've seen great joints that are very painful.  I would be doing the best practice by recommending x-rays.  However, I wouldn't be "sketchy" or a poor quality doctor by making an initial diagnosis and starting treatment based on these signs alone.

Let's take the situation of fluids, because that's a different discussion.  It's actually very common and considered a normal standard of practice to send clients home with fluids and needles for cases of chronic kidney disease.  Giving cats fluids under their skin several times per week can help support them when their kidneys fail, and is something most clients can learn.  In these cases we take some time to teach the client how to do it properly and allow them to continue treatment at home.  It would be cost prohibitive for the client to come in a few times per week for the rest of the cat's life in order for the vet to do it.  I've had many clients over the years who have done this.  But in a case like ibuprofen toxicity I wouldn't recommend it.  That patient really does need to be on continual IV fluids and probably 24 hour observation at an overnight facility.  Knowing that the cat is suffering from toxicity and telling the client all they need to do is give fluids at home is what I would consider poor quality medicine and could be argued as malpractice.

HOWEVER....sometimes clients don't give us the choice.  Let's say we have a good doctor who thinks the cat needs to be transferred to the local emergency clinic.  The client doesn't have the money for something that could easily reach $1000 for one night.  So the vet offers to keep the cat on fluids at her clinic overnight, with the warning that it's not the best treatment and the cat wouldn't be observed and could die.  The client either doesn't want to leave their pet or can't even afford that.  Knowing the cat likely isn't going to survive the vet recommends euthanasia.  The client says no.  What does that vet do then?  In a situation like this I would agree with the vet sending the client home with some inexpensive fluids and hoping for the best.  It's substandard care, but the client isn't really giving the doctor many options.  Now the vet does always have the choice of saying that she can't recommend other therapy and the client simply has to take the cat home and pray for a miracle.  But something small is often better than nothing at all and we hate to completely give up.  

I've been in those situations when the client won't let me do even minimal care.  And I've had to tell the client that I can't do what they want me to do and will have to take their pet home without anything at all.  It's always difficult and hard to deal with, but we can't force the client to do anything.

Okay, all of that is fine and good, but what about truly "sketchy" vets.  These are the ones who hardly keep records, throw antibiotics at everything, rarely do blood tests, and plenty of other bad things.  These are also normally the vets who are dirt-cheap and under-charge compared to the rest of their colleagues.  Of course many clients love them because it costs so little.  And unfortunately many clients keep going back because of the cheap cost and not because of the quality of medicine.  These doctors hurt the quality, reputation, and business of the profession as a whole, and most vets don't like associating with them.  However, they usually don't get malpractice claims or state board action taken against them so they continue to stay in business.  It's a bad situation but one that the rest of us have to learn to live with, similar to great mechanics having to deal with a shady and unscrupulous one in their area.

There are "standards of care" in any profession.  Sometimes these standards are well documented and even put into law.  Others are determined by a consensus of a board or of lawyers when claims are brought forward.  But many vets practice "under the radar" and avoid any problems.  I wish more clients would try to find someone who is high quality rather than simply go based on costs.  But this is human nature, and the problem will never completely go away.

Safe Chew Toys

Regular reader Stefanie sent in this question....

What are the safest dog chews on the market?  I usually give my dog Nylabones to chew on - but I notice that in addition to the traditional rawhides, Greenies, and other processed chews - there are bully sticks (which I didn't know what these were made out of until just today and was a little taken aback), deer antlers, and even Himalayan (hard cheese) dog chews - which are safest or are any of them?  

There seems to be a lot of debate among veterinary professionals as to the best and safest chew toys on the market.  I'll share my opinion and what I tell my clients.

I am definitely against using any kind of really hard substance to chew on, especially antlers and bones.  I know that it's rather stereotypical to give dogs bones, as you see it in cartoons and movies.  They also really seem to like them and these products are easily available in any pet store.  However, bones and antlers can cause severe fractures of the teeth, especially of the upper molars.  The broken tooth is not only painful but can lead to abscessing of the tooth root. I've also seen bones get stuck on the teeth and even cause constipation.

Hard rubber toys like Nylabones run a smaller risk of breaking teeth.  The material is not digestible, but in small pieces will pass through the dog safely.  The risk comes if the dog breaks off and swallows a large enough piece to cause an obstruction.  Even so, I do let my dogs chew on these products, though I check the toy regularly to make sure large sections aren't coming off.

In my opinion there is a lot of misinformation about rawhide chews.  I have never seen a case of rawhides getting stuck in the intestines, and they won't sit there indefinitely.  I've never even talked to a colleague who has seen this happen.  However, there are a few things to be careful of.  Some dogs will be sensitive to the material, resulting in diarrhea or even vomiting.  This isn't truly dangerous but is obviously something people want to avoid.  The only real big risk is if the dog swallows the knot or strip whole.  You need to watch your dog's chewing habits and make sure they aren't prone to doing so.  Since the material won't dissolve in the stomach a large enough rawhide could cause an obstruction.  The one time I did see a potentially serious rawhide issue was when a dog swallowed the knot whole.  The owner brought her in and she vomited it up in the lobby without any treatment.  However, that could have been a surgical case.  I had to stop giving rawhide strips to one of my dogs because she would stick it half-way down her throat while she was chewing and I was worried that she would swallow it.  Otherwise I don't mind rawhides.

Greenies developed a bad reputation over five years ago because of some isolated cases of dogs swallowing large parts of the treat and developing intestinal obstructions.  Some of these cases resulted in surgery and even death.  After this became a national problem (even though it happened in less than 1% of dogs) Greenies changed the formula so it would actually dissolve in the stomach.  After talking to a rep at a conference I took one home, set it in a glass of water overnight, and was pleasantly surprised to see it come apart easily the next day.  Greenies are also one of the best treats for dental care, so I fully endorse them.

In general I approve of softer treats specifically designed for dogs as long as that individual doesn't develop any particular digestive problem.  However, you should always watch your dog very carefully to make sure they are chewing slowly and not taking off large chunks.  If too large of a piece of any treat is swallowed, it can be potentially dangerous.  And stay away from anything that is harder than the dog's teeth.

Help For Humping

Here's a rather interesting situation sent in by Olivia....

Background: We have an outdoor cat and 2 indoor dogs who go outside (fenced in back yard) during the day when we are at work or away. They have access through a dog door into a heated garage with carpeting and dog beds. The cat spends most of his time in the backyard with the dogs. He will even arrive at the back door in the morning to greet the dogs when they are let out. They all seem to get along.  The dogs are both female. One is about 3 years old and 20 lbs. The other is 11mos and 12 lbs. The older dog will often go up on the picnic table (which the puppy cannot get up onto) and sunbathe.

The other day I came home to find the female dog mounting the cat and very actively humping him (I'm not sure what other word to use here). They were both on top of the picnic table. The puppy was below bouncing around below trying to see what was going on. I have never seen something so weird before in my life. I know some female dogs will mount other dogs out of dominance, but why would she be mounting the cat and more importantly, why would the cat be allowing it? When they noticed me, the dog came running over and the cat laid down on the table to roll around and then proceeded to lick/clean hi crotch. He was obviously not distressed or trying to get away.

What is going on?

When someone sees a dog "humping" or "mounting" (both appropriate terms) it is usually assumed that the behavior is sexually related.  However, we can see this happen in pre-pubertal dogs as well as females.  In the former there is no sexual drive yet and in the latter, well, they simply don't do that during sexual intercourse.  So why do such antics happen?

Mounting does have an obvious sexual function and is a normal behavior during sexual arousal. In neutered or pre-pubertal males you can see them humping pillows and stuffed animals as a form of masturbation.  Even though they don't have the testosterone stimulating the behavior, they do get some physical pleasure from the act.

But sex certainly isn't the only reason for dogs acting this way.  As Olivia mentioned, dominance is one potential cause.  In humans many sexual behaviors have their origin in a desire to dominate rather than just sexual pleasure.  Many animals will mount subordinates in their social group as such a sign of dominance.  However, there are also other reasons for dogs to mount, and I don't think Olivia's dog is being dominant.

One of the most common reasons for humping is excitement and over-stimulation.  When a dog is playing and has lots of stimulation going on, it will trigger centers in the brain that can lead to mounting behavior.  One of my own dogs does this!  Inara is a three year-old lab mix, and not particularly dominant.  Overall she's pretty calm and laid-back.  Yvaine is our very playful 1 1/2 year old lab, whose favorite game is tug-of-war.  When they're playing by themselves, I don't see any humping from Inara.  But many times when I'm playing tug with Yvaine, Inara will want to join in on the fun and will start to nip or paw at Yvaine.  This isn't mean and is just Inara's way of saying "Hey, don't leave me out."  Often I'll see her try to mount Yvaine and start humping.  I can tell that she's not being dominant and is just wound up because of the play that she isn't a part of.  The only way to stop this particular form of behavior is to avoid the excitement, which obviously isn't always possible.

Olivia, my suspicion is that your dog was mounting the cat because of some kind of mental over-stimulation or excitement.  Maybe she was playing with the puppy, or the puppy was aggravating her,  and the cat just happened to be there.  In a spayed female towards a cat there certainly wouldn't be anything sexual.  And dogs generally find other ways to be dominant, especially towards cats.  Without observing the situation myself or seeing a video I can't say for certain, but I would strongly suspect that this falls in the excitement/stimulation category.

But what about the cat?  Why would he tolerate this?

Some cats are very bonded to the dogs in their family and are particularly docile.  One of my own cats, Tristan, is such a cat.  Many times we have seen the dogs, especially Yvaine, mouthing him and virtually chewing on him like he is a toy.  They are gentle and don't do any harm, but they are definitely working him over.  Sometimes we've seen him walking around with his fur wet and sticking up in odd directions and know that the dogs have been on him.  What is strange is that he tolerates this treatment.  He will just lay there letting the dogs chew, though he does have a rather pitiful expression on his face.  When they are done or when they look up, he just calmly gets up and walks away.  He is definitely the sweetest and most tolerant cat I've ever known.

Here's my reconstruction of what may have happened with Olivia's pets.  The dogs were outside, perhaps playing, and maybe the puppy was bothering the older one a bit.  She jumped up onto the table as is normal, and there was the cat.  The dog was over-stimulated and the cat was in her place, so she started humping him.  He knows the dogs well, is a calm cat, and wasn't being hurt, so he just lay there, not really knowing what was going on.  After a little bit the dog stops and the cat gets up.  As I said, I can't prove this, but from what I know of animal behavior this is a reasonable assumption.

I hope this helps Olivia as well as others that have dogs who do similar things.