Greenies Safety

Tiffany asked a very good question...

I was doing some research about the chewy Greenies. I have already given my 2 dogs these chewies for the last week. I have a 6 year old winnie dog (male) and a 5 year old basset hound Blossom (female). Both dogs LOVE them!

But last night/today Gir was severely constipated and I'm worried perhaps its the Greenies? I have seen alot of bad press reguarding the Greenies but most of the damning reviews are from years ago and not so many either way in recent years. I read that the company did change their formula and supposedly that "corrected" some of the issues. I did read where you allowed a Greenie to soak overnight and it did dissolve. So that's slightly setting my mind more at ease about it.

I just ordered another 36 Greenies for my Basset hound and now I'm on the fence wither I should continue to allow them to consume them.

In your opinion as a veterinarian, I understand fully you havent seen or examined my animals, do you think the "new formula" Greenies are OK for dogs as long as they dont swallow them whole? I'm just getting conflicting opinions from my vet, the internet and friends.

Personally and professionally I'm a big supporter of Greenies.  They are one of the most effective methods of tartar control other than brushing the teeth and are considered safe.  The safety concerns started about 7-8 years ago and involved cases where dogs died or required surgery because of obstructions.  In all of these cases the dog had swallowed a large piece of the Greenie rather than chewed it into small pieces.  At the time the treats didn't dissolve easily, resulting in serious intesintal blockages.  This was absolutely a problem with the treats.  However, it involved a very, very small minority of dogs who used the treats.  I don't remember the actual number of cases, but it amounted to significantly less than 1% of the millions of dogs who were given them.  Though it was a legitimate risk and was talked about a lot in the media, it was actually not a wide-spread issue.

Because of these events Greenies changed their formula to make it easier to dissolve.  As I mentioned in the previous blog post I have personally seen it soften and break apart easily after soaking overnight in plain water.  Since that I have not seen any reports in the trade journals, newsmagazines, or even anecdotally of obstructions due to Greenies.  In my opinion and based on what I've seen (or not seen, as the case may be) the change in formula worked.

Pets should always be supervised when given chew toys and treats.  These things are designed to be chewed on gradually, not swallowed in chunks.  ANY toy or treat can cause a problem if a large section is ingested, so you should be very aware of your individual dog's chewing habits.  Dogs who are likely to swallow rather than chew shouldn't be given any treat like this.

A general warning for any pet owner...be very careful what you read on the internet, especially on message boards.  Snopes.com is filled with details on various urban legends, especially emails that are passed around or posted on Facebook.  If someone sends you one of these chain emails or messages, always check Snopes first because odds are it's false.  In relation to pets you can find tons of reports of various foods or products causing pet deaths, serious illness, and so on.  In most of these cases the reports are overblown and are not a real concern. I've personally seen messages from people saying that "hundreds of pets have died!" but when you look at the FDA/USDA reports it turns out it was maybe a dozen and most of those were probably not related to the product people are worried about.  Always check around to various sources and ask for specific examples rather than a blanket statement of "I know someone who heard that a friend of theirs read a report...."  Then look at the true incidence compared to the number of pets who use such products.  Also keep in mind that many of these web pages or posters have a very personal vendetta against a product or vet and are griding their axe.  They may have a valid concern, but understand where they are coming from and why they are reporting the information.  Heck, take anything I say with a grain of salt!  I'm fully confident in my comments and firmly believe in having evidence to back up my opinion, but I'm not infallible and I don't know everything.

Tiffany, I hope this helps!

Dog 1, Pants 0

I deal with difficult patients on a daily basis and it's just part of the job.  But sometimes we get pets that really seem to go out of their way to be especially frustrating.

Today I had a young Rottweiler, about a year old, in for a neuter.  He wasn't aggressive but didn't seem like he had been trained and was extremely resistant to any restraint.  Vets and our staff are trained in safe and effective restraint techniques that work for us most of the time.  But this dog wasn't having any part in that!  We couldn't hold him still to even collect blood for pre-anesthetic testing.

But the worst part was when I attempted restraint.  I'm stronger than most of my staff so I end up holding pets that others can't handle.  I got him into one of my almost sure-fire grips and then he started to struggle.  His back leg landed on my inner thigh and he started to push and squirm.  His claws dug into my pants and leg and I ended up not being able to hold him.  I made the decision that rather than continuing to fight against him we would give him a sedative to knock him out enough to collect blood and place a catheter.

That's when I noticed my pants.  His struggles had split the seam on the inside of my thigh, leaving a large gap several inches long.  It was high enough on my leg that if I wore boxers you'd be able to see the Batman logo.  This was less than an hour into my day!  There was no way I was going to be able to make it through the day potentially flashing my clients.

Thankfully we are located next to a Target store.  Between morning appointments I ran over there and quickly bought a new pair of pants.  Thankfully there were no more "events" and the second pair of pants made it through the day without incident.

This kind of problem is exactly why I never wear nice clothing to work.

Q & A With A Vet

Recently I was contacted by a new web site, Jobstr.com, about doing questions and answers about the veterinary profession.  The site is set up to have representatives of various careers (police officer, teacher, investment banker, gentleman's club manager, etc.) available to answer questions about their jobs.  Really, it's not that different than what I've been doing for the last almost four years, but is geared more towards "what the job is like" than fielding case-related questions.  

So far I've been getting some good questions, different than what I have gotten here.  Since the answers are short it isn't really taking much time to do, so I'll continue to blog here.  But check it out and feel free to ask questions there.

Jobstr Veterinarian Q & A

Dogs Snacking In the Litter Box

Shirley emailed me with this question...

I have three cats and one dog. I feed all of them Iams food, as well as pet-intended treats, but not to excess. I also have two cat litter boxes that are cleaned each day. You probably see where this is going ;) . Why, in the name of all that’s not gross does Star-the-dog insist on snacking from the litter box? Everyone is at a healthy weight and has no medical problems for which they’re being treated. Is it just a case of “she’s a dog, and that’s what dogs do.”? 

This is actually a very common situation and one many pet owners face.  That includes me!  The litter boxes are in our laundry room and we keep a baby gate in the doorway to keep our dogs out of the "kitty crunchies".

One of the first things we have to remember is that a dog's palate is different than ours.  Things that make us gag just thinking about them are absolutely delicious to a dog.  Their taste buds are oriented to things like raw flesh and organ meat, so while few of us would dream of dining on raw intestines and liver, dogs are designed to be drawn to these things.  They are going to find many things tasty that we are repelled by.

Feces contain quite a lot of ingredients.  Besides the obvious waste, there will sometimes be food particles that pass through without being completely digested (something we've all witnessed in our own toilets with corn kernels).  Such undigested or partially digested food becomes more prominent if a pet has intestinal absorption issues or enzyme deficiencies, or if the pet is being fed more than their body needs.  Certain ingredients may also give a stronger odor as they are passing through, and these odors can be attractive to a dog.  If a dog is hungry or the odors are "good" enough, they will take to snacking on other animals' feces.

Additionally, feces are used for scent marking.  Dogs and cats have glands on either side of their anus that produce very malodorous secretions and are normally expressed onto the stool during a bowel movement.  Taste and smell are very closely connected, so licking or chewing something with a scent mark can be a way of getting a more detailed examination of the substance.

There are several ways to try and curtail this behavior.  First is to do something similar to what I do and keep the dog from having access to the feces.  Making sure there are no health problems and you aren't over-feeding is the next step, and it sounds like you have both of these situations covered, Shirley.  Lastly there are products you can get from your vet that are food additives which will make the feces less appealing.

In the end, though, the short answer is very much along the lines of "she's a dog and that's what dogs do."

Record-Breaking Stone? Almost.

I take out several bladder stones each year, and it's come to be a pretty routine and fun surgery for me.  I've posted about these before (here and here) and normally don't want to repeat myself.  However, this case was pretty remarkable and worth sharing.

Most stones that I remove are pretty small, no more than a centimeter or so in diameter.  You can see pictures of typical sizes of stones in the above links.  But this one was quite different.  The patient was a 100 pound Rottweiler that we started seeing this year.  Way back in February she was having bloody urine problems and we felt a possible mass in the abdomen.  Antibiotics resolved the issue then, but during exams for other issues over the last few months we kept noticing an abdominal mass.  The owners always declined doing x-rays.  Earlier this month she started having severely bloody urine and antibiotics didn't help this time.  I was convinced that she had a bladder stone and finally the owner agreed to radiographs.  Lo and behold, there was a large stone!  And thankfully they agreed to the surgery.

All of this is pretty typical.  But the size of the stone wasn't.  Here's a picture during surgery (don't worry, only a little gross).

There was only one stone, and it was rather big.  The bladder wall was also extremely thickened and inflamed, much thicker than a normal bladder.  That wasn't too surprising considering that this stone has been sitting there rubbing against the inside of the bladder for at least 4-5 months.  

Here's a better photo to appreciate the scale, with the stone cleaned up.

Yes, this came out of a dog's urinary bladder! Is it any wonder that she was having bloody urine?  And just for fun here's a picture of what it looked cut in half.

The analysis of the stone showed that it was mostly struvite, which is the most common stone type I see.

All of that is very interesting and this was a really big stone.  But it's actually not the largest one I've removed!  About nine or ten years ago I removed one from a dog that was flatter and had a larger diameter.  Instead of filling up most of my palm it covered my entire palm!  Unfortunately I took that out long before I had a digital camera so I don't have any pictures of it.  It was pretty amazing, though!  And to this day, that remains my record urinary stone.

Repeat After Me: "I Won't Change Inuslin Without Permission."

Sometimes I wonder why people come to a vet in the first place.

Earlier this week my colleague received a call from a vet who was boarding a patient of ours.  The cat had recently been diagnosed as a diabetic and had just started on insulin injections.  The vet was calling because the original prescription had been written for 2 units, and someone had crossed that out and written 1 unit.  It took a little digging, but apparently the owner had done this.  Why?  She had switched from dry to canned food and for whatever reason decided that this meant she needed to decrease the insulin dosage.  The cat wasn't regulated yet and she had never called to check with one of us.

It's not an isolated incident.  Several months ago I talked to a client who hadn't been consistent with the insulin doses on their dog and on a routine exam the blood glucose was too high.  Apparently the owner was changing the dog's dosage every day based on it's mood.  Nope, they weren't checking the blood sugar levels at home or talking to us about the case.  They were just altering insulin from dose to dose based on how the dog was acting.

Insulin is a serious drug with serious consequences.  If you give too little the blood sugar remains high, which could lead to life-threatening situations (ketoacidosis) if there are prolonged elevations.  At the minimum the pet is uncomfortable and can have chronic changes such as cataracts.  Give too much and the blood sugar can drop precipitously, reaching the point where the brain is starved of energy.  A very low glucose level can result in neurological signs, seizures, and even a coma.  There are also several different types of insulin!  Some act longer than others, so you can't just switch from one to another while keeping the dosage the same.  If you go from a short-acting insulin to a long-acting one you may have to decrease the dose or frequency in order to prevent hypoglycemia.

Altering insulin doses should never be done without veterinary advice and counseling.  We make changes based on clinical symptoms at home as well as repeated blood tests to measure the glucose levels.  When you are nearing proper regulation there won't be significant behavioral or personality changes, so you can't tell just by watching a pet.  For numerous reasons an owner should never change or stop insulin that their vet has prescribed without first talking to the vet.  Ignoring this advice can lead to very serious health problems.

"He'll Starve!".....Nope....

We're very spoiled in modern Western civilization.  Despite the very real numbers of underfed people in the US and other first-world nations, the large majority of people in these countries have never truly gone hungry.  If we miss one meal we say that we're "starving" and lament on how hungry we are.  Most of us (myself included) don't know what it's like to actually starve and have rarely missed a meal.  This kind of attitude also carries over to our pets, where many (if not most) clients seem to think that if their dog or cat misses a single feeding then they're quickly on the way to death.

The average person or pet can go for days without eating and have no significant adverse effects.  I have personally done a 10-day fast of only liquids and personally know someone who has done a 40-day liquid-only fast.  Though you have to do extended fasts carefully in order to remain healthy, it certainly can be done.  The same is true of dogs and cats.

The reason for bringing this up is what happens when people see their pet miss a meal.  The scenario is all too common....a dog or cat misses one feeding, often for less than 24 hours and the owner panics.  Suddenly they worry that their pet will starve to death and scramble to get them to eat "anything".  They may offer ham, hot dogs, steak, hamburger, cottage cheese, rice, bread, and many other things, usually food items that we recommend never to feed.  It can be really frustrating to vets as these things can cause or compound disorders besides whatever caused a decrease in appetite in the first place.

So let's be clear here.  If your pet hasn't eaten in a few days, please don't try to feed them whatever you have available in a desperate attempt to get nutrition in them.  Unless they are severely underweight already, are very young, or of a species that needs to eat frequently (such as some rodent species), they won't starve to death in a couple of days.  Even breeds of dogs that may have a tendency for hypoglycemia are usually going to be fine.  Now, if there is some underlying medical condition such as diabetes you certainly want them eating regularly.  But that is the time to see your vet, not try random foods.  Many human foods can cause digestive upset, pancreatitis, blood sugar imbalances, and even potential toxicities.  If the pet is just being picky, by giving in to them and feeding human food you are actually encouraging and reinforcing such behavior.  Don't do it! 

There are reasons why pets will decrease or stop eating.  It might be pickiness or it might be a serious illness.  Regardless of the cause the answer is never "feed anything".  Talk to your vet, get to the root of the problem, and then choose appropriate and healthy measures to correct the issue.

Tax Deductions For Pets

It's kind of an old joke now, but one I can relate to.  Many people wish they could add their pets as dependents on their tax forms, getting breaks and credits for the money they spend on care and food.  With eight pets of my own I agree that it would be nice.  Unfortunately the tax codes in most countries (though I can only really speak for the US) don't allow such deductions.

Or do they?

Today I came across a rather interesting and slightly provocative article entitled "Can I Write Off My Dog?"  Despite our wishes and the lead into the article, it still isn't easy.  But it can be possible!  There are limited circumstances where you actually can use your pet as a tax deduction.  Really it comes down to whether or not the animal is a legitimate medical necessity (service dogs and the like) or business expense (guard dogs, breeding expenses, etc.).  Thought the government doesn't include our fuzzy/feathered/scaly family members as true dependents, it's nice to think that there are a few situations where some people might get a tax break.

The topic also got me thinking in relation to the recent push in some areas of people being "caretakers" rather than "owners" and being able to sue for emotional damages related to pets and not just the actual value.  I think it's almost inevitable that society and therefore the legal system will continue to move towards pets as more than just specialized property, giving them emotional value as well.  If this happens then there is a strong likelihood that not properly caring for them could fall into the same category as failing to give emotional and medical attention to children.  And if we follow that line of thinking along its logical track, we open up the door for animals becoming honest-to-goodness legal dependents.  Once the government and laws grant animals legitimate emotional needs and personalities, then we go down the road of granting them limited "personhood".  And that means they are a specialized form of "child" rather than the current system where they are a special form of property.

Good or bad?  I'm not sure. 

Advice For A New Vet

I received the following email from Amanda....

I am a newly graduated veterinarian (I actually had my convocation from OVC in Guelph today - so surreal) and recently stumbled across your blog.  I have gone back and read all of your entries - I love your blog!  I will be starting my first "real vet job" in mid July....I was hoping you could provide some words of wisdom in regards to making the transition from student to professional. Is there any advice you wished someone had passed onto you before your first day?  I feel as though I am going to get to the clinic and forget how to vaccinate a dog.

First I have to say congratulations, Amanda!  It's quite the accomplishment to reach this point in your education, where you can switch from learning to doing.  Enjoy this time!

It's hard to give enough advice since you still have so much to learn and experience.  But there are a few things I can pass along.

1.  Realize that you WILL make mistakes.  It's definitely a matter of "when", not "if".  You are only human, and EVERY SINGLE DOCTOR AND VET has made mistakes, likely the very same ones you're going to make.  Learn from these mistakes and never do the same one twice, but realize in most cases it's not as bad as you think and you aren't going to loose your career. 

2.  Text books are your best friends!  Make sure you have a good library of books in your clinic because you're going to be looking up a whole lot of things.  I still use my texts every day for one thing or another.  There is no way to remember every dosage or every detail of a disease, so don't feel like you're an incompetent vet if you have to check a reference on a case.  At veterinary conferences the text book companies are usually the busiest vendors, and they are marketing to existing practitioners.

3.  Keep a "cheat book" in your pocket.  I have a little inexpensive notebook where I write common drug dosages, protocols, and so on, and I still use it every day.  Noting your most common drugs and diseases in an at-hand reference really speeds you up.

4.  Don't get jealous at vets who can do a spay in 15 minutes or rattle off dosages for several dozen drugs.  They've been doing this for years or decades and have had time to remember them.  I'm one of those doctors, but my first spays were 45-60 minutes and I couldn't remember any dosages.  With time and repetition your speed will pick up.

5.  You know more and are better than you think. Just because you weren't explicitly taught a surgical procedure or disease work-up doesn't mean that you can't do it.  You were taught the basics and therefore can handle most things that were thrown at you.  There are numerous procedures that I had never done, but when the need arose I looked it up in a text (back to that again) and moved ahead to do it.  I had never actually watched a cherry eye surgery before I did my first one!  I studied the book, remembered my tissue handling, and said "Yeah, I can do this." 

6.  Your true success as a veterinarian is going to come not by your surgical or medical skills but by your people skills.  Practice and perfect your communication techniques and really work on being personal and somewhat extroverted with clients.  That will go a LONG way towards building your clientelle and business.  I've known doctors who where far smarter and more knowledgeable that me that clients didn't like because they had poor interpersonal skills.

7.  Your vet school experiences and grades really don't have much to do with your long-term success.  I graduated dead-middle of my veterinary class, and I've become very successful and well-respected by my colleagues and clients. 

So that's a quick list!  I know that a lot of my readers are veterinary students or new vets, so this can apply to you guys as well.  And here's a challenge to my readers who are experienced veterinarians!  What other nuggets of wisdom would you pass on to Amanda and other recent graduates?  Put them in the comments!

Best of luck to you, Amanda!

Sea Lions, the new S.E.A.L.s

Okay this article is now five months old, but I still find it interesting.  I've known of the US Navy using dolphins and sea lions for search and rescue as well as find and eliminate mines, but this gives a good bit of detail.  Here are some of the more interesting (to me) parts of the article:

Just as dogs can detect bombs with their exceptional sense of smell, dolphins can locate objects in the water with their natural sonar, useful where hardware sonar performs poorly due to acoustic conditions.
Dolphins are therefore deployed on “swimmer defense,” meaning they detect enemy divers, swimmers and swimmer delivery vehicles. 
 ..........
It can take a sea lion less than a minute to locate a mine embedded in a pier. When detected, it reports back and the Navy divers are deployed for further action.
Ordinarily, recovering unarmed test ordnance is complex and dangerous: Human divers must contend with poor visibility, currents and limited windows of time. They also require surface support, a recompression chamber and medical personnel.
But it takes just one sea lion, two handlers and a simple rubber boat to conduct the same recovery to a depth of 1,000 feet, well beyond the standard 650 feet.
 ...........
Not only can they locate and recognize different shapes of mines, they have been trained to attach a leg cuff -- the sea version of handcuffs -- around a diver’s thigh. The cuffs are attached to a line so their handlers can reel in a saboteur for questioning.
Sea lions patrol in a special video-equipped harness that gives sailors a live, real-time window on underwater threats. Both dolphins and sea lions move so much more quickly and accurately in water than humans that the animals are typically in and out without the bad guys knowing they were there.

I find such training and tasks fascinating.  Animals assisting humans has become more common over time, to where we don't see anything unusual about seeing-eye dogs.  I've seen discussions on using monkeys to help people in wheelchairs and dogs who can detect a seizure before it happens.  All of these instances illustrate how close the human-animal bond can be.  Instead of humans "owning" or "using" animals, we are coming to rely on them more and see them as partners rather than tools

And that's a good thing.

The Joy Of Pets

Last week I took my car to a local business to have the oil changed.  This is a privately owned facility and not a chain.  You actually get out of your car and wait in the waiting room until your vehicle is ready.  They're a little more expensive that going some other places, but the customer service is great, they also wash cars, and they're faster than anyplace else I've been.

One of the managers has a dog that hangs out in the lobby.  His name is Rojo and he is a young golden retriever mix.  He's very calm and laid-back, spending his time wandering around the chairs, going to different people for petting and attention.  It's obvious that he loves people and nothing seems to phase him.  All of the regulars know Rojo and seem to look forward to visiting him while they're waiting for their vehicles to be worked on.

As I sat waiting I noticed the reactions of the other customers.  When he would walk over the person's hand would reach out to start scratching him and they would smile.  Because of how sweet he is there was an immediate bond that seemed to lighten people's burdens.  Watching this interaction it hit me how universally people seem to love being around pets.  It's been long known that pet owners live longer and have lower stress hormone levels.  

I'm not saying that pets can't be a problem.  I've certainly dealt with enough chewed up clothing, scratched up furniture, and carpet stains.  I also see the medical and behavioral frustrations that pets may cause my clients.  But people still care for their fuzzy, feathered, and scaly friends despite these issues.

Why?

Because of the joy they bring.  Rojo wants nothing more than to be loved and petted.  He asks nothing else from these perfect strangers, and people very obviously love doing so, which in my mind means that they're getting something back.  Most people like not only to be loved but to give love, and pets want our love more than anything else.

Our new kitten, Pippin (who is about 3 months old now) is being kept in our master bathroom at night to keep him out of trouble while we sleep.  And to keep him from pouncing on our faces in the middle of the night!  When we go in there in the morning he begins to meow and carry on.  But it's not because he's hungry as he will initially ignore the food we'll put in his bowl.  He's very vocal because he wants attention and to be held, purring loudly as soon as we pick him up.  There is something incredibly satisfying about seeing his joy at our love, which in turn gives us joy.

So let's all remember how much our pets mean to us, and forgive the latest chewed up pair of underwear. 

Euthanasia Is Not "On Demand"

My associate ran into a rather difficult client this past Tuesday.  I wasn't there, but heard the story from her and some staff members.  The lady brought in a nine week old puppy to be euthanized because of multiple health problems.  According to the owner the puppy was very sick, couldn't do anything with its mouth (while it was chewing on her pants leg), had some sort of neurological problem (while it was playing on the floor), and had been to another vet and specialists who couldn't figure out what was wrong.  She had come to our clinic to have the puppy put to sleep because the staff at the other vet's office were too attached and she didn't want them to have to do the deed.

When my associate examined the puppy she noticed a very healthy, happy young dog who was in good body condition.  The only abnormality was a "cherry eye" (prolapsed third eyelid gland), a disorder that is considered very fixable and isn't close to being fatal.  She saw no signs of the kinds of problem the lady was talking about, and certainly didn't see any reason to euthanize.

So she declined euthanizing the puppy.  The owner went ballistic!  She started ranting and raving, actually yelling at our doctor.  One of our staff took a position just outside of the exam room in case the owner became violent and intervention was necessary.  Eventually after being quite loud the owner left with her still-alive puppy.

There were many things strange about the lady's story, mainly that this supposedly deathly sick puppy had been eating well and was playing in the room.  She had bred the dogs that resulted in this puppy's litter, so there was speculation that she want the puppy put to sleep because it had the cherry eye and didn't want to have to try and sell it.  That was pure guesswork, but it made some sense.

Let me be very clear here.  Veterinarians have no obligation whatsoever to euthanize a pet simply because an owner wants it.  This is an irreversible decision that ends a life.  Putting it very bluntly, we are killing an animal.  We do not do so lightly.  

Euthanasia has its place and time and requires careful thought.  We use it only to end suffering, and not as a convenience to the owner.  I have refused to do so many times, and don't regret any of them.  Though I will counsel owners and respect their decision if it makes sense, but in the end it is MY decision to actually perform the act.  I have every legal right to refuse this service and it is not malpractice to do so.  The ethical side of things may be a bit trickier at times, but I use a pretty simply rule of thumb...what will the quality of the pet's life be if we do nothing but leave it alive? If that quality is very poor, euthanasia is often the right choice.  If the pet will be perfectly fine, then I will usually disagree with the choice.

This lady was unreasonable and I feel no regrets at her leaving.  The right decision was made and I fully support my associate. 

Yearning For Simple Boosters

Business has been growing at my practice far faster than we had expected this year.  As a business leader this is a very good thing.  As a doctor it's wearing me out!  

The last two Wednesdays I've left work about an hour later than normal because of the sheer volume of cases.  And it's not just the actual number, it's the kind also.  When you're dealing with annual vaccines or puppy/kitten boosters it's normally a fairly quick visit.  My staff does most of the client education, with me answering questions and filling in any gaps that haven't been covered.  Most of the time I'm making sure the pet is healthy, reviewing and double-checking preventative care, then giving the vaccines.  My time in most of these rooms is no more than 10 minutes, often less, and it's easy on my mind.

But lately we have been getting a lot of sick pets coming in.  Most of them aren't serious illnesses, but it takes more time to examine them, run diagnostics, evaluate the test results, and determine what we need to do.  These cases can take hours to fully work up and are much more mentally draining.  

For example, let's look at today.  I had a cat with a torn toenail from a dog fight, several ear infection cases, two dogs with bloody urine (one of which had a palm-sized bladder stone), two dogs with sudden lameness, a dog with fever and lethargy, a few skin cases, a heartworm diagnosis, a skin lump to check out....and I'm probably forgetting some.  All of those cases can be a full day by themselves! Then throw in two dental cleanings and a spay, five or six well-pet drop-offs, and a good handful of pets needing vaccines spread throughout the day.  A grand total of 37 pets seen in a 10 hour period, all by my little lonesome!  For those who haven't been in the veterinary profession, that is A LOT!

And it wouldn't be so bad if it didn't seem like 2/3 of the patients had some major or minor medical problem to deal with.  I am really looking forward to a day when most of the pets are well, and we're doing lots of boosters on young pets.  My brain needs a break!

Mysterious Vomiting

Melinda emailed me with this...

My aunt has a 9 year old boxer that has been vomiting for the last 3 weeks. She has taken her to the vet. Bloodwork was normal. Tried a different diet, as well as medications: still vomiting. The boxer is acting normal. She is clearly hungry and wants to eat. She tries to hand my aunt her food bowl. Her vet is baffled. My aunt did say that it has been a year since the boxers mother passed away (my aunt owned her as well). She was curious if it could be grieving? Any clues? I have never heard of this happening before. 

Sounds like a strange case.  I definitely wouldn't think it's grieving.  First, it's been a long time and a dog's memory isn't that good.  Second, grieving normally won't cause vomiting.  Any diarrhea? There could be an inflammatory bowel disease problem.  An older boxer shouldn't be developing allergies (such as food-related), so I don't think that would be the case.

If all of that has been considered, I'd recommend an abdominal ultrasound.  Years ago I had a cat that had very similar symptoms and it ended up being stomach cancer.  I didn't figure that out until the cancer had spread so much that I could palpate it in the abdomen.  All tests had been normal up to that point.  I did an exploratory surgery but the mass involved too much of the stomach to be operable and I ended up euthanizing him before he woke up from anesthesia.  A boxer is big enough that a smaller mass near the pylorus (outflow of the stomach into the intestine) may not be felt and wouldn't show up on x-rays.  An ultrasound would easily detect something like this.  That's where I would proceed next.
 

Multi-Location Pros And Cons

It's not uncommon in American veterinary medicine for a veterinary practice to be part of a larger group.  Though single-location clinics are the norm, multi-location practices are not rare.  The number of locations can vary from 2-3 in a network within a single town or county to a practice with hundreds of locations such as Banfield Pet Hospitals and VCA.  

My own practice has multiple locations, as I've mentioned before, and I've found many benefits to such an arrangement.  I have a network of many doctors that I can talk to as colleagues, bouncing cases off them and sharing opinions.  It's a lot more interactive than online resources such as Veterinary Information Network.  It's also easier to get coverage when I'm sick or want to take time off, since we can switch locations easily; I haven't had to worry about hiring a relief vet in a very long time.  We're large enough that we have help with business and payroll management beyond what I've seen in single-owner practices.

Now there are some down sides to such a practice.  We have a process by which we decide which products and pharmaceuticals we will carry, so I can't just order something I saw in a journal.  Change in practice policies and habits happens slowly since there's not a single person making the decisions.  And I sometimes find that I get asked to go to a location not my own in order to help out.

I manage the location where I work, and am responsible for both business and medical supervision.  I have a great staff and clientele, and prefer to be in that clinic since I'm used to it.  Tomorrow I have to go to a different location because they had a doctor call out and are short-handed.  As one of the main leaders in the practice, I feel an obligation to help out and make sure the larger practice succeeds, not just my own little corner of it. And since I always hope to get help when I need time off, it's a bit of tit-for-tat.  I don't really look forward to it since it's a longer drive, but at the same time I don't feel that I can say no.

In the end, despite the problems I may face I really like working at my practice.  I've been here for 13 years (other than a 9 month stint teaching) and believe that I've found my niche.  It's something that many vets don't experience, but it's a good fit for me.

Generic Heartworm Prevention

Recently I was interviewed for a pet website, Dogasaur.com about generic versus brand name heartworm prevention.  I've gotten so I enjoy doing these things and getting my presence out there, along with educating people on pet health.  Instead of repeating the information, I'll just link to it and get some traffic over there!

Dogasaur heartworm prevention article.