Another Bulldog Tail Issue

Lynda sent me this email....

I was googling about options for my (child's) dog's tail and came across your blog post on the tail surgery. I have an amazing 2 month old English bulldog who has had a few tail infections over the past year.  It seems to be getting more regular and worse.  I took him to the vet to get x-rays this week but they said his tail is too hard for them to do the surgery in-house so we should wait on the x-rays until I see a specialist and try to clean it and treat it aggressively first. I thought I would be ok with waiting and trying the culture and more antibiotics but I am having a very hard time cleaning his tail and more so keeping it dry. He is obviously uncomfortable and the smell is taking over the house.

I saw that you went to NC State and that you are in Georgia now. I went to UGA, got my dog in Athens, and my first dog spent a lot of time at NCState vet school with Addison's disease and muscular distrophy.  I will do anything for my dogs.

I heard that there are multiple options for Geno's tail, but don't know who to trust or listen to. I heard they could seal up the folds with surgery without removing any part of the tail, I heard they could remove part of the tail to make the space less crowded and easier to keep clean and then I've researched the full amputation (which seems dangerous and risky). Can you tell me what options there are, (though they may not actually be options for us if he isn't a good candidate)? Is there anyone you would recommend that is a specialist in this specific area here in the Raleigh/Durham area?

I cried when I thought he was going to get x-rays so I can only imagine how I will be with surgery. But bottom line I want him to be happy and comfortable. Thank you in advance for any help and guidance.


Lynda was referring to a post I made earlier this year (click here).  This is certainly not a simple situation, but here is my reply to her.

I'm curious as to why they would take x-rays for a skin infection.  Were they worried about infection in the bone?

Doing an amputation of a bulldog's tail is certainly NOT easy, and if they don't feel comfortable with it I wouldn't want them to try it.  I also have some surgeries that I won't do because of lack of proper skill or abilities.  However, a skilled general practitioner should be able to do it, and it isn't necessarily something that can only be done by a specialist.  It all depends on the vets at that clinic or in the area.

One of the problems we see with infections in skin folds is the recurrent nature.  This can happen in deep folds around the face, tail, vulva, and just about anywhere else.  Yes, you can typically cure the infection for a time with appropriate antibiotics, topical medications, and cleansing.  But often these infections have yeast and not just bacteria, so you have to use multiple methods.  And because the reason for the infection is at least in part the deep folds themselves, it's likely to keep coming back until you fix that particular problem.  Many times you'll also find an underlying allergy disorder which needs to be addressed.  Even so, most sources I've seen agree that the best long-term management involves eliminating the deep fold itself, which requires surgery.  Facial fold removal, vulvoplasty, and even tail amputation are not uncommon surgeries for severe skin fold infections.

In my experience, the really deep folds around the tail in a bulldog make amputation the best option.  In order to remove the skin of the fold you have to cut so deep and extensively that you're just about amputating the tail anyway.  Personally, I find it easier to remove the stub of the tail (which they don't need) than to try to get the skin off the bone and then close the defect over the stub.  I would also question the idea of a partial amputation on a bulldog.  The problem isn't so much the tail itself, but the very deep skin folds around it.  Yes, you could remove the outer part of the tail, leaving the deeper bones and skin.  But is that really resolving the issue?  Is that taking enough of the fold away to keep the problem at bay?  If you remove ALL of the tail and skin fold, then you simply don't have that problem at any other point in the future.  The few cases in which I've recommended amputation have been so bad that a partial surgery wouldn't have fixed the problem.

If done properly and with a skilled surgeon, tail amputation is not a highly risky surgery.  You're not in danger of affecting the nerves or muscles of the rectum in most cases, and any bleeding or pain can be controlled.  I've done many partial and full tail amputations for various reasons, including everything from short bulldog tails to long, whip-like tails.  I've never had any serious complications and once they are healed the patients have always been better off than before the surgery.

As far as recommended referral practices, there is one in Cary that one of my former surgery professors, Dr. Gary Spodnick, left the vet school to help found. It's Veterinary Specialty Hospital of the Carolinas (http://www.vshcarolinas.com/), and they have multiple locations in the Triangle. I don't have much personal experience with them as I haven't lived or practiced in that area in over seven years, but I think they would be considered high quality.  Although if you're in that area the vet school is always a great option.

If you still have questions about the best option, I think it would be worthwhile to spend the money to get a couple of opinions.  Talk to your own vet about your concerns, as they know the case better than another doctor and may have very good reasons as to their recommendations.  If you're not quite satisfied, find a high-quality vet in your area and go for a second opinion.  If both doctors agree (which happens commonly), you'll have more assurance in your decision.  It may also be a good idea to consult with a veterinary dermatologist, looking for non-surgical options first.

Hope that helps!

More Ethical Challenges With Euthanasia

Ryan emailed this to me....

As a second year vet student, one thing I often think about is euthanasia.  I want to make sure that when I perform a euthanasia it is for the right reasons.  In regards to convenience euthanasia, I was wondering how you deal with the clients that you turn away.  I've read many blog posts about euthanasia (both yours and others) and I have heard that owners often threaten to kill the animal themselves.  This seems like a very troubling moral dilemma.

So, I guess my question is how do you react to different types of euthanasia requests and the clients behind them?  If an owner gets belligerent or threatens to harm their animal do you call animal control?  Warn other veterinarians that this client might be coming?  And I know this varies by location, but what can animal control officers do to owners that threaten to kill their animals?  Is merely trying to get a convenience euthanasia done grounds for calling animal control?  

This is not an easy or black-and white issue as it deals with often subtle differences as well as possibly varying systems of morality.  I've been a vet for over 16 years now and have learned to treat each euthanasia situation as a separate incident, dealing with the emotions and reasons individually.  I can't predict a person's feelings or reactions before I go in the room, so I have to be a bit flexible in how I handle them.

Let's look at each question separately.

1.  "How do you react to different types of euthanasia requests and the clients behind them?"

On either side of the spectrum the decision is easy.  If a client wants euthanasia because their pet is in the process of dying I gladly agree.  If someone wants it because they decided they don't want their otherwise healthy and happy pet anymore, I quickly decline to perform the procedure.  But the further away from the extremes you get, the trickier the decision can get.  What about the healthy 6 month old golden retriever with a badly fractured leg that the owner cannot afford to treat?  Do we euthanize a very sweet, young, healthy dog with a serious but very treatable problem when the barrier is money?  After all, if treatment can't be done the pet is going to suffer horribly.  Or what about a completely healthy cat that has been showing increased aggression to a member of the family, resulting in a few visits to the doctor to treat bite wounds?  There are many difficult decisions and you have to take them one at a time and judge the merits of each one separately.

2.  "If an owner gets belligerent or threatens to harm their animal do you call animal control?"

In general, no.  I've had many people threaten to go home and just shoot their pet after I've refused to treat due to lack of funds or I've refused to euthanize because I didn't think it was justified.  I really believe that very few of those people every followed through and were using the threat as a way to try and guilt me into doing what they wanted.  If I actually witnessed the person being violent or abusive to their pet, I would first sternly warn them and if it continued I would absolutely call animal control.

3.  "Warn other veterinarians that this client might be coming?"

This is a stickier moral situation.  Another vet might have a different viewpoint than my own, though in my experience it actually ends up being the other way around (they feel as I do).  I'm not going to tell another vet what they should or should not do in a situation like this, since euthanizing a healthy pet isn't illegal.  Also, while most vets in an area at least know of each other, the degrees to which they regularly communicate or are friends varies greatly.

4.  "What can animal control officers do to owners who threaten to kill their animals?"

I'm not a lawyer or police officer (which is what animal control falls under), so I have incomplete knowledge of the laws.  I don't know that a mere threat to kill an animal is sufficient grounds to arrest someone and confiscate their pet.  I also don't believe it's illegal to kill your own pet or livestock, as long as it's done in a recognized humane way and the animal doesn't suffer.  After all, domestic animals are legally a special form of property, and it's not illegal to destroy your own couch or car.  The AVMA does recognize guns as being a humane method of euthanasia, as long as it's done in the proper way.  But for a more complete answer you'd have to talk to some one in that profession.

5.  "Is merely trying to get a convenience euthanasia done grounds for calling animal control?"

I firmly believe that the answer is "no".  Part of this answer goes back to the things I've discussed above.  But making the inquiry alone isn't illegal.  In fact, I WANT clients to ask about that if it's on their mind.  Having a conversation with them allows me the chance to give them other options and convince them that what they are seeking is the wrong thing.  If I called the police merely because someone asked about it I would be losing that chance to save a life.

Ryan, I hope that helps!

What's Up With The Skin?

Here's a question from Victoria...

I have a 10 year old pure bred lhasa apsa who seems to be experiencing some kind of dry skin condition on his lower back. I initially brought him to our vet when he presented with what appeared to be cuts on his lower back,to my knowledge he hadnt injured himself so i was concerned. The vet explained he may be hypo glycemic and that can cause thinning of the skin. I.proceeded with the blood test to confirm this and when the test came back negative the vet concluded the dog must have cut himself on something without me knowing. I,thinking that was a totally plausible situation took my boy home and kept an eye on the healing of the cuts. The cuts have now healed but his skin seems to be blackening all on the lower back and almost 'flaking' off. The vet has said it is likely dry skin but hasnt really offered any reasons this skin condition would arise or how i can go about treating it. Any advice or insight you could offer would be much appreciated.

While diabetes can cause skin problems, it's not my first thought when dealing with a dermatology issue, especially if there aren't other symptoms.  The single most common symptom that leads to a diagnosis of diabetes in pets is an increase in drinking and urinating.

Victoria, a full exam and questioning would be necessary for me to give you a good answer, but here are some of the things I would consider in a case like this.  Are there any signs of fleas?  Has he been noticeably scratching or rubbing his skin?  Has he been going under low furniture such as beds, low tables, etc.?  Has he been anywhere new?  Has he been exposed to anything different recently?  Has he ever had any skin problems in the past?

The next thing that I would normally consider would be the trifecta of skin tests:  a skin scraping, skin impression, and fungal culture.  Every dermatologist will do these tests on pretty much every case, even if the referring vet has already done them.  A skin scrape looks for mites, the impression looks for bacteria and yeast, and the culture looks for ringworm.  If none of these are noted then it may be skin irritation or an allergy.  Unfortunately, many disorders can look the same and it make take several tests or treatments to make the proper diagnosis.

When dead skin scabs, it can look black and start to come off.  Also, chronically irritated skin will develop a dark pigment, though the pigment itself is normal and harmless.  Excessive flakiness is not normal and may be related to changes in the skin, nutritional deficiencies, and so on.  If the problem persists it should be further evaluated until appropriate treatment is determined and used.

I would first start with talking to your vet and asking more details.  The vet may actually have other ideas or directions to pursue when it becomes evident that the problem isn't simply some scrapes.  If your vet still doesn't want to look into it further, I'd look for a second opinion.

Cats Walking On Their Nails?

Back to my backlog of reader questions, this one from Paul....

Can a cat walk on its claws or does a cat have really tough pads on its feet?.  I ask because a neighbour's cat is a nuisance; it regularly kills birds in our garden and for us, the last straw was when it badly mauled a pigeon and left it so badly injured that its feathers were pulled out and its neck badly bleeding.  I rescued the bird (and as the vet was closed -  wildlife rescue said to take it to a vet as a vet is obliged to take the bird and treat it if possible), I put the bird in a warm, dark shed with some grain and water and hoped that at least it would be safe from the cat, rain and cold and I could get it to the vet early the next morning. (I was afraid to put anything on the bird's wounds as it was clearly very scared and I understand that a bird can die from stress of being handled and to be honest I did not know what to do with the animal - the rescue people said just keep it quiet in the dark and with water and some food and get to vet asap next morning).   To cut a long story short the bird died a long and painful death (I checked on the bird regularly in the night hoping it would make it till the morning when vet would be open at 8 - it was alive at 6am and dead at 8am).  I appreciate that cats are hunting animals but I don't own the cat and don't want one or its kill.  The cat has killed several birds in my garden in the last few weeks alone and I am tired of it.  The neighbour won't put a collar on the animal so that birds would be alerted to it and have made their own garden impossible almost for the cat to access it by growing all kinds of plants and climbing roses etc so cat cannot walk on the perimeter wall.  So I decided that I would grow  Pyracantha which is now over the fence and I have secured it to the fence in a way to prevent the animal from walking on it but it still does - its as if the nails and the huge thorns on the plant (which I can tell you would take the hand off a human were you to touch it without padded gloves) make no impression on the cat whatsoever.  I don't want to hurt the animal I just don't want it in my garden and don't want it where the birds are because of the huge carnage that it is causing.  I am convinced that the only way the cat can walk on the fence is because its pads are not being used ie that the animal is walking on its claws otherwise it has pads of cement!.  I have also tried cat repellent nothing works but the animal's feet have me baffled.  (any other suggestions to keep the animal out are welcome).

It's actually impossible for a cat to walk on its claws/nails.  They are simply not structured that way and will not support a cat's weight.  While a cat's pads are fairly tough, a thorn can certainly puncture it.  However, look at the spacing of the thorns on the pyracantha plant.  A cat is extremely agile and dexterous and their paws are typically no larger than two of our fingers put together...sometimes smaller.  So it is possible for one to step around the thorns and still walk on the plant or wall.  Sure, it takes more careful steps and some time, but it's not impossible.  I would also look around your fence to make sure there isn't a small hole or crack that the cat is using as an entry point, completely negating the need to climb or walk on the plants.

Now we can talk a bit about how to keep a cat out of your yard.  First, you need to make the yard unappealing.  By providing bird feeders, houses, or plants that make good nesting you are encouraging birds to come into your yard.  Predators follow their prey, so the birds are a good incentive for the cat to come in the area.  If you want the birds there it becomes a little trickier.  

One of my favorite tricks is a motion-activated sprinkler.  They stay off until something triggers the motion sensor and then they spray harmless water.  A cat is NOT going to want to go into a yard where this keeps happening!  There are also ultrasonic devices you can use that are similarly triggered by motion.

Below are a couple of links that may help!

ASPCA--Keeping Cats out of Your Yard

Neighborhood Cats

Interview On Ethical Issues

Yes, I'm still around, and yes, I know I haven't been blogging much.  I'll admit that after five years of regular writing I'm starting to lose some motivation.  But I'm not out of the game yet.

I recently received a series of questions from Amy, who is doing a report in college on ethical situations vets face in everyday practice.  I agreed to answer them and found them very interesting and challenging.  I hadn't thought of some of these issues to a great degree, so it made me think hard about my answers.  I thought it would be interesting to share them in this blog.

What do you believe the veterinary oath is trying to convey?  Does it say that veterinarians have a duty to animals or to their owners?

The oath is trying to emphasize that our focus is on helping animals and the public health, and if we can't help them we need to at least relieve suffering.  It also emphasizes the need for ethical behavior and life-long learning since medicine is constantly changing.  The oath itself does seem to indicate that our primary responsibility is to the animal, not the owner.  However, the oath is a starting point and isn't meant to be the only thing we consider with deciding responsibility, and is also not legally binding like a law.  So there is room for interpretation.

Do you believe that veterinarians should meet the needs of the furry patient first or to the owner?  

This is actually not a clear-cut issue.  Personally I believe that our first responsibility is to the patient, but we also cannot remove the owner from the discussion.  If the owner cannot afford treatment we cannot proceed with a surgery or even diagnostics.  Yes, we feel that we should be able to just treat the patient as would be best, but the owner has primary decision making and we can't supersede their right.  But when making the recommendations to the owner we should always state what is best for the animal and not consider the client's financial situation ahead of time.

In real life, do veterinarians try to meet the needs of the furry patient or the owner?

This varies between situations and doctors.  I'd like to think that we always put the patient first, but sometimes we do think of the client when making recommendations.  In the end, the reality is that we can't meet the patient's needs if we haven't met the owner's.

How do you handle patients that cannot afford to pay the medical bill?  Is there any sort of health care or insurance plan for pets?

Unless heavily subsidized through grants or donations, veterinary practices have to make money in order to pay their staff, buy supplies, cover rent and costs, and otherwise stay open.  If we give away too many services we will end up going bankrupt and closing our doors.  It may be a harsh reality, but that's the way things are.  Looking at this business aspect most vets treat clients like any non-medical business.  If a client can't pay but they agreed to treatment, they may face being sent to a collections agency for non-payment.  Most vets don't do payment plans because of the risks of losing money, which happens more times than not.  However, some vets will work individual deals with a good client.  There are several companies that sell pet insurance, though they vary widely in what they cover.  Many vets also accept credit cards or Care Credit, something specific to human and veterinary medical fields.

What are possible cases where you step in for the patient instead of the owner? (When do you say that a patient needs a treatment instead of listening to the owner, if ever?)

We as veterinarians have no legal right to make decisions for the pet if the owner is present or able to be reached.  Legally an animal is considered a special category of property, not a legally separate individual.  A vet deciding to treat a pet without consent would be like a mechanic deciding to repair an engine on a car without the owner's permission.  Without the consent of the pet owner we can only make decisions for the pet in rare circumstances.  That may be in cases of verifiable abuse where the client is potentially legally liable, or in situations where immediate therapy is needed (such as life-threatening cases) and the client can't be reached.  If a client declines a truly necessary treatment and decides to leave the office, there really is very little that we can legally do to stop them or otherwise intervene.

Do you personally report cases of abuse when you see them?   What cases do you consider abuse?

This is actually something that can be tricky to determine.  A vet might suspect criminal abuse or neglect, but proving it can be difficult.  The animal can't tell us that they were abused and the client can easily tell a lie about what happened.  If we don't have a witness or other record of the abuse, it is difficult for us to report a case.  Some of them may be obvious, such as severe malnourishment or repeated bite wounds consistent with deliberate animal fighting, but not all of them are.  If it is truly abuse I feel that we do have an ethical responsibility to report the case to authorities.  However, sometimes we will give the client an opportunity to fix the problem with the understanding that if they don't or if it happens again they will be reported to police.

Are there conflicting culture views on how pets should be treated, both in everyday care and health care?

Absolutely!  Sometimes it is a different attitude based on non-native cultures, such as someone of Asian or Arabic origins who moved to the US.  Sometimes it's age-related, such as older generations who aren't used to extensive pet care and grew up just keeping pets in the yard and putting out table scraps for them to eat.  Sometimes it's a personal background where someone grew up believing "it's just a dog".  All of these differing views can make it challenging to talk to some clients when they have a bias of some sort against treatment that might be necessary.

Do you think society looks down on people who cannot pay for advanced medical care for their pets? (Advanced medical care being major surgeries and expensive treatment plans for diseases)

At this point, no I don't.  It's still uncommon for people to spend thousands of dollars on a single surgery or course of treatment and society doesn't yet hold the standard of "treatment at all costs" for pets.  It's acceptable in society and veterinary medicine for a person to decide that they can't afford treatment and elect euthanasia as a humane option.  But as animals are seen more as family members and not just pets, I anticipate that expectations will change, especially if people are able to sue for pain and suffering rather than just financial loss or damages.  In the future there may be more societal pressure for people to go further with treatment.

What are society's expectations of veterinarians and do veterinarians compete with this view?

I believe that society expects vets to be compassionate, have extensive knowledge, provide fast, skilled treatment, and do all of that at a low cost.  For the most parts I and other vets would agree with the first part, but disagree with the last.  High quality doesn't come cheaply and we have huge loan burdens to repay.  The profession as a whole is trying to move away from the "cheap" idea and focus on the compassion and quality.

I hear the word "client" used very often on your blog.  Why do you (and others I have read) use "client" even though you are in a medical setting?   

It's a common convention that has to do with who our patient really is.  In human medicine the patient is generally the person giving the information and making the decisions.  In most situations the patient and "client" are the same.  But in veterinary medicine our patients do not tell us what has been happening, do not make treatment decisions, and do not pay the bills.  We have a distinction between "client", meaning the owner, and "patient", meaning the animal.  Our relationship with our patient is a more traditional medical one, and the relationship with the pet owner is closer to one seen in business.

Do you think people who can afford basic supplies and medical care for their pet(s) but not advanced treatment like serious medical injuries or accidents should own pets?

That's a tough one.  Personally if a client is unable to do treatment for a broken leg, bite wound, or ear infection they shouldn't own a pet.  But that's hard to say to people.  Most pets will only need vaccines, heartworm prevention, dental cleanings, and other routine preventative care.  Truly serious medical conditions are uncommon in an average pet and so many people feel that they only need to prepare for basic preventative costs.  But injuries or serious illnesses happen often enough that clients absolutely need to be prepared for this eventuality.  While I can be understanding about someone who can't afford extensive cancer treatment, being able to handle an average injury is something every owner should be able to do.  When someone accepts a pet they are committing to handling certain responsibilities and care.  If they can't do so, they shouldn't take on the care of that animal.

If the owner refuses medical care other than for financial reason, is that considered animal abuse?  Is that person considered a "bad" person and pet owner?

That's difficult to answer based on the question.  There are legitimate reasons for declining care other than financial.  Maybe the owner won't be able physically provide a certain treatment because of physical limitations or an aggressive pet.  Sometimes the pet simply doesn't allow treatment and and a client risks injury in the attempt.  I've had cases where a client isn't going to be home often enough to consistently treat a condition.  Simple refusal to treat isn't automatically "abuse" or neglect as it depends on the case, condition, and other factors.  But there are clients who just don't want to do any treatment and the pet suffers.  Depending on the nature of the problem and degree of pain or illness, this could potentially be considered criminal neglect.  The difficulty comes when the client wants a different option for some reason, especially one that may not be the "best".  If they are wanting to pursue some form of treatment even if we don't agree completely with their decision we can't consider them as being abusive.

How do you handle strays that people find off the street?  Do the people who bring them in pay or are there other means?

We're not a shelter or rescue group and so we are not set up to handle and adopt out strays.  Most of the time the person bringing the stray in will pay for initial exams and treatment, even if they don't plan on keeping the animal.  For more long-term solutions we maintain contact information for local organizations that provide this service and will refer people to these groups.

Wednesday Addams, You've Met Your Match

My daughter is a rather unique little girl.  She's 10 years old, but isn't typical for a girl her age.  Yes, she likes My Little Pony, anything colored pink, shoes and clothes, and lots of sparkles.  She's silly and cute and for all the world often seems like the little princess.

But she also has a rather creepy, darker side.  Over the years she has shown a growing interest in monsters, zombies, and other things that go bump in the night.  This year we began watching episodes of The Walking Dead together, and she loves the show.  She's really into the Monster High line of dolls and Vamplets stuffed creatures.  She has a pet rat and loves snakes, spiders, and other creepy-crawlies.  Nothing seems to phase her, including monstrous costumes we see at Dragon*Con every year.  So we decided to really put her to the test.

Near Atlanta is one of the country's biggest and scariest haunted attractions, Netherworld.  Each year it ranks in the top haunted houses in America, and has amazing special effects, animatronics, and Hollywood quality makeup.  Adults will run screaming in fear through this attraction.  I've always kind of liked haunted houses and have been eager to visit it, but had never been able to.  For the last year I've worked on my daughter, eventually convincing her to try it.  We did a minor haunted house last year and she wasn't scared or impressed.  So I thought that surely Netherworld would make her tremble.

There was no fear in her as we drove to the attraction, and when she saw some of the actors in costume she became more excited.  She had already thought it through, planning on dressing in her cutest pink outfit so that the monsters would expect her to be frightened.  

Does that look like someone worried about seeing some of the best that American haunts have to offer?  Yeah, that's what I thought.

None of the characters outside bothered her at all.  Two of the creepiest actually were her favorites and she deliberately went to talk to them when she saw them from a distance.

So we went into the two sections of Netherworld.  One was smaller ad dealt with the Bogeyman and primal fears.  The other was a pretty standard haunted house with mirror mazes, monsters, dead bodies, and plenty of people jumping out to scare us.  Yes, there were moments that she and I were startled, but at no point were we really scared.  I think she threw most of them for a loop because when they came out at her she would just give her brightest, cheeriest smile, wave, and say "Hi!"  One of them leaned over her with claws bared and a menacing growl, twisting his head back and forth in an effort to intimidate her.  She just calmly looked up at him and twisted her head to mirror his motions.

I really think she surprised the actors, all of whom are used to teens and adults screaming and running in fear.  But then this cute, petite blonde comes through, bedecked in pink, and they can't make her jump.  After failing to frighten her, some of the characters would give her a high-five or fist-bump, impressed by her bravery.  One of them told her that she was braver that most of the adults that came through.  Netherworld had someone going through taking videos, and he followed us for a short distance.  At one point he came closer to me and commented that he couldn't believe how brave and unfazed she was.

By the end I realized that she simply couldn't be scared.  In fact, she was fully in her element!  She kept talking about wanting to work there and was describing how she was planning on creeping up to people and scaring them.  In fact, she became "pinky buddies" with the troll!  

I can imagine that some of the actors may have gotten together after it shut down for the night and started talking about how things went, especially since this was opening night for this year......

"Okay, good first night, everyone.  Let's talk about how things went.  Anyone have anything strange to report?"

"Um, yeah.  There was this little blonde girl in pink.  I'm not sure what happened, but I jumped out and growled, and she just smiled and said 'Hi'!"

"Dude, yeah, I saw her too!  My best growl and howl and it didn't phase her!  She just grinned and waved.  Maybe I'm losing my touch."

"Okay, so how many of you saw her come through?"

A few dozen hands raise.

"And how many of you were able to scare her?"

All hands lower.

"....Well....Pretty awesome little girl!"

While my daughter is not typical in any sense of the word, I'm proud of her.  She exudes self-confidence and revels in her weirdness.  She has figured out her own style and way of being, and doesn't want to march to the beat of anyone else's drum.  That's hard to come by in this world, and I really hope that she continues to defy convention and peer pressure to become her own person.

And yes, we'll be going back to Netherworld again next year.  

Problems With Broth?

Here's a letter from reader "M",

First I will apologize for the long email, as my husband tells me frequently that I have alot to say.

We have 3 wonderful Boston Terriers, ages 5, 4, and approximately 3 years old (this one is a guesstimate, he's a rescue!).  All 3 are on Banfield's wellness program and have been since 8 weeks of age for my 5 and 4 year old, and since we have had our rescue, almost 2 years.  Their diet consist of Nutro Natural Small Breed and for the past couple of months, adding Blue Buffalo Small Breed, for variety. I use a little canned food (same brands) on their kibble as well.  I decided about a month ago to stop giving them store bought treats (pupperoni, beggin strips, dingo dental sticks and chicken sticks) after scaring myself to pieces reading internet reviews on different treats.  We still do the dentastix as our Banfield vet recommended them for their teeth. What I have done once a week for the past month is purchased SAMs boneless chicken breast (they are very large breast) in about a 5 lb pack, cut all the "ooey" out, cooked them for about 3 hours on 375 then in the food dehydrator for an hour or so to make homemade jerky.  They love it!  Poops have been normal, no other problems.

I just realized the package says the breast are injected or enhanced with broth.

Now I am concerned about the ingredients in the broth. I don't have the package but I would imagine it contains salt.  My 4 year old baby girl weighs 12 pounds and today she has not eaten and vomited white foam (empty tummy?).  My other 2 are boys, 27 pounds and 24 pounds.  They have not had any problems. We are out of town but I will get to SAMs immediately when we get home to check the ingredients.  I am concerned this might be related to the chicken jerky.  She hasn't had any today but it has been their main source for treats for the past month.  Of course I will continue to watch her and get her to a local vet if an emergency arises and the nearest Banfield is a little over an our away from where we are now.  My question is could I have made my babies sick using chicken breast enhanced with broth?   I understand without knowing the contents of the broth, you may not want to comment, but I would appreciate any help!

Yes, without knowing the contents of the broth it is a bit difficult to make an assessment.  However, if there was a real problem with the home-made jerky I would expect it to affect all of your pets relatively equally, despite the size difference.  It would also be more likely to have caused vomiting or diarrhea shortly after using it rather than after a month or more.  With your cooking method I wouldn't expect any bacteria to still be present, but salmonella contamination is a reason why mass-produced chicken jerky has been recalled a few times.  If this is something that persists, absolutely have your girl examined by a vet right away.  If the other dogs become affected, I would recommend talking to your vet about having the jerky tested for bacteria.

In general this kind of treat isn't a concern to me.  However, anything made at home needs to be processed carefully and all of the ingredients analyzed.  Humans and dogs have somewhat similar physiologies, but there are also significant differences.  Some things that are safe for one species aren't safe for another, and without proper knowledge you can't easily make that assumption.  When in doubt about something be sure to check with your own vet.

How Our Pets See Us

I saw this on Facebook a few days ago, and felt that it was very appropriate.  While humorous, I think it does illustrate (no pun intended) the differences between dogs and cats.  We like different pets for different reasons.  My family has two dogs, three cats, a bearded dragon, a Guinea pig, a rat, and a betta.  So we have quite a variety of perceptions and experiences!

Golden Retriever Lifetime Study

Has it really been three weeks since I posted?  Yikes!  No, I haven't dropped off the face of the earth, and yes, I'm doing just fine, thanks.  Chalk it up to lots of events and activities over the last few weeks combined with a bit of a lack of motivation to blog.  But let's try to get back on track!

Recently an email came through my inbox about a new study on Golden Retrievers in the US.  The study is open to just about anyone with a dog of this breed and is interesting because it will follow the participants for their entire lives.  Here's a description of the reasoning for the study....

More than half of Golden Retrievers die from cancer, and it is the leading cause of death in all dogs over the age of 2. By participating, you will help scientists:

• Identify ways in which genetics, environment and diet may affect a dog's risk for cancer
• Determine risk factors for other major health disorders in Golden Retrievers
• Learn how to better prevent, diagnose and treat cancer and other canine diseases
• Improve the health of future generations of Golden Retrievers and help create a healthier tomorrow for all dogs

The study is being supported by the Morris Animal Foundation, a well-known non-profit organization.

If you'd like more details, click below.

Golden Retriever Lifetime Study

Justifying Euthanasia

From death, to humor, back to death.  Some variety in the posts lately, eh?  Today's comes from a reader in Korea.

Hello! I am an aspiring veterinarian studying in Korea. Ever since I had to put down my dog after he got severely injured by a wild animal, the idea of becoming a vet just stuck in my head.

 However, what bothers me most about becoming a vet is how vets often have to perform euthanasia. Just by reading your blog I can get a good grasp of how many of those I have to go through each week. In no way am I suggesting that what you had to do was unreasonable, but the ethical issues regarding euthanasia bothers me to no end. I mean,

 So in what ways can euthanasia be justified? And does having to put down pets bother you much? 

Euthanizing animals isn't easy.  Doctors are trained how to preserve and extend life, sometimes through very extreme and heroic measures.  Our main motivation for becoming vets is to make sick and injured pets better.  So making the decision to end a life is often difficult.  And because it is an irreversible decision it isn't something to be done lightly.

I am 100% against "convenience" euthanasia.  Many times I have refused to euthanize a pet because a client couldn't keep it any more, was aggravated by it, was moving, and so on.  There are always other options for an unwanted pet and I'd rather an animal go to a shelter or foster home rather than be put to sleep.

To me euthanasia is completely justified when the animal is suffering and there aren't any other options.  It's a rather cold, sometimes depressing fact, but we can't fix everything.  There are some animals whose injuries are too severe for them to survive for long.  There are some diseases that we can treat and extend life, but at some point will be fatal, such as kidney failure and some forms of cancer.  The hardest cases are the ones that we're fairly certain we can help, but the clients cannot afford treatment.  Regardless of how it happens, there are pets that simply can't be helped and will die.

But most deaths aren't quick and quiet while sleeping.  Liver and kidney failure can cause a pet to linger for days or weeks, feeling sick and suffering the entire time.  Heart failure that leads to fluid in the lungs results in severe difficulty breathing.  Perhaps a dog is hit by a car and has multiple limb fractures that can only be fixed with surgery, but the client can't afford the procedure and their pet is screaming in pain.  I've seen many dogs who have such severe arthritis and joint disease that are generally healthy, but they literally cannot stand or walk and all attempts at pain relief have failed.

At these times we have to look at the best interests of the pet.  Is it the most humane, ethical thing to let them lay there, sick, painful, unmoving until they eventually die from thirst, starvation, or toxins?  I think most people would agree that this is not an ethical choice.  We want to stop suffering, not allow it to linger.  The pet can't make the decision or talk to us, so between the client and the animal we have to make the decision for them.  

When I agree to euthanize a pet, I make sure that there aren't other options.  I look at the case and think "What would happen to this pet and how would they feel or survive if we did nothing?"  If the answer is that the pet would die or suffer extensively I think the most ethical thing is to humanely end their life.  Then there is the quality of life question.  I'll ask the client if the pet is having more "good" days or more "bad" days.  If I know that the case will be terminal anyway and the bad days outnumber the good, why would I want the animal to suffer even more bad days before the inevitable outcome?

Yes, some cases bother me, but those are normally pets that I have seen for a long time and to which have become emotionally attached.  I've shed tears along with the client many times.  But the other cases don't bother me as much because I know that I'm ending their pain and suffering.  If I didn't have the assurance that I was fulfilling my oath to help illness and pain I wouldn't be able to do it.

I hope that explains some of the thoughts and justifications behind veterinary euthanasia.  As a would-be vet you'll be faced with these situations, and it might be a good idea to find a local vet and shadow them for a while to see these cases in the real world.

Not Always Right...At The Vet

I've mentioned it before, but the website NotAlwaysRight.com is one of my favorite daily visits.  After a long day dealing with sometimes difficult people, it's nice to see what other people have to put up with.  Often it puts things in perspective for me and my own cranky clients don't seem as bad.  While most of the stories are related to fields other than my own, I still enjoy them and can relate.

Every weekend they do a themed "Weekly Roundup".  This week was the first time I've seen the Roundup be veterinary themed!  Since I don't have a lot else on my mind today to blog about, I thought I'd share the link.  Everyone in the veterinary profession can absolutely relate to these clients, and maybe the pet owners have seen people like this when they visit the vet's office.

At The Vet....Clients Are Not Always Right

The Final Gift

This has been one of those "Dr. Death" weeks, where I've had to euthanize several pets.  All of them were severely ill and terminal, so it was completely justified.  But it still isn't easy for me or the clients, and I found myself teary-eyed more than once.

Euthanasia is hard.  But it allows an ease of suffering and a peaceful passing.  In many ways it's a gift, the final one we can give.  Our pets have given us so much life and joy, and we can help them end life peacefully.  This was brought to my attention in this way by one of my clients whose pet I put to sleep.  She has lost pets before and with her permission I'm sharing a poem she wrote about the experience.  I hope this can help those who have lost their own furry, feathered, or scaly loved one.

The Gift

It was Christmas of Nineteen Eighty Five

And my beloved cat Prince was no longer alive.

He'd died of pneumonia just three weeks ago

Prince was only three - it was a terrible blow.

That Christmas began just like any other -

Presents exchanged between sister, father, and mother,

But - surprise!  One final gift, sitting in Mom's lap

A teen week old bundle of fur, taking a nap.

She opened her eyes; they were a lovely amber-green,

Then, much to our delight, she started to preen.

She had a beautiful tail and long soft hair.

Cute white feet - a dainty lady most fair.

All she needed was a name, for she was all mine.

It had to be special for a kitten so fine.

Because it was Christmas, I chose Tiffany

It was appropriate, meaning "God's Gift" to me.

She was with me for many of life's trials.

My parents' divorce, a move of many miles.

A new school, new friends, my first summer job

She soothed me when all I could do was sob.

Then she had kittens - five months, two litters!

A total of ten, but they were cute little critters.

Mom said "Spay her!" so my first gift to her

Was no more worry about becoming a mother.

Then came college and yet another move

Tiffy took it in stride, like she had something to prove.

Then marriage, more moving, finally my degree.

And always Tiffany; her presence was her gift to me.

Many years passed and Tiffany grew older.

She didn't play as much, just wanted me to hold her.

Then an unexplained illness, and the dreaded answer.

My beloved gift was suffering from terminal cancer.

The veterinarian kindly explained there was no hope

After fifteen years together how could I cope?

So we took her home to love her while we could.

We gave plenty of treats, but not more than we should.

Finally, the time came, when she would no longer eat.

We took her to the vet and gave her one final favorite treat.

Never again to hear her loving, sweet purr.

No more suffering, eternal peace, my final gift to her.

The 2013 State Of Pet Health

Love it or hate it, Banfield Pet Hospital is the largest veterinary practice in the world and has over 800 locations throughout the United States.  Their computer databases can tally data from millions of pets every year and analyze it in many different ways.  For the last couple of years they have released an annual "State of Pet Health" using this data, showing how different diseases or trends affect pets.

In this year's report they break it down by state.  Now, there are certain limitations to their data as it is only from their clinics, but it's more than most other sources have so it can be educational.  Here are some highlights from my own state of Georgia.

Dogs average a lifespan of 10.9 years.

Cats average a lifespan of 12.1 years.

Dental tartar and ear infections are the most common diagnoses made in dogs.

Dental tartar and fleas are the most common diagnoses made in cats.

Bella and Max are the most common dog names.

Kitty and Tiger are the most common cat names.

Labrador retrievers and shih tzus are the most common dog breeds.

The most common pure-bred cat is the Siamese.

Other data....

Overall 1 in 4 pets is overweight or obese.  The highest rate of this in both dogs and cats is in Minnesota.

The highest prevalence for diabetes can be found in Iowa for dogs and Nevada for cats.

Louisiana and Mississippi have the highest rats of heartworm disease in dogs.

In both dogs and cats the rate of ear infections is highest in Mississippi and Florida.

All-in-all some interesting data and trends.  Though I don't find that anything here will change my personal way of practicing, looking at national trends can be helpful in seeing how well we as a profession are diagnosing, preventing, and treating given health problems in pets.

Kids, Reality, And Facing Death

My last case of the day yesterday was a difficult one.  A father came in with his two daughters and an injured hamster.  The oldest girl was about eight or nine years old and obviously very attached to the hamster, Sugar.  Earlier in the day they had noticed a problem with one of Sugar's back legs and had made the appointment to have her seen.

The hamster was in good overall health, very active, friendly and surprisingly sound for being over two years old.  That was the good news.  The very bad news was the left hind leg was badly broken and bone was protruding through the skin.  The fracture had happened in the tibia, and one of the broken ends had worked it's way through the skin, causing damage and infection.  I was actually very surprised that she was acting perfectly normal and had been eating well.  Somehow she didn't seem bothered at all by the fact that her foot was dangling by some skin and muscle.  Unfortunately due to the extent of the injury the only option was to amputate part of the leg.

This is actually something that I've done before.  I've amputated toes, feet, or legs on hamsters, lizards, chinchillas, and birds, all very successfully.  In some ways this is much easier than with a dog or cat as the bones and blood vessels are much smaller and therefore easier to remove and handle.  However, there is greater risk due to the size of the patient and difficulties in typical surgical precautions (IV catheters, endotracheal tubes, monitoring equipment, pre-anesthetic blood testing, etc.).  Even though Sugar was very old for a hamster she was in great condition and so I thought she was a good surgical risk.

The daughter was upset by this discussion.  She knew her hamster was badly injured and didn't like looking at the bone.  I could see her obvious nervousness and distress, which she also was quick to verbalize.  The idea of surgery worried her as there was concern about Sugar surviving.  However, as I talked she decided that she wanted to do the surgery.  In a way it was very sweet and amusing as she was adamant about the need for surgery.

The problem came when I had to start talking to the father about the costs.  This was not a simple procedure, and once I added everything together it came out to around $450.  This is definitely an expensive surgery for a pet that can be purchased for around $10, but is still about 1/3 of what it would cost for a dog or cat.  In this particular case there were really only two options...amputate the leg or euthanize the pet.  There was no intermediate option to bandage or fix it and allow it to heal.

I was trying to be careful how I worded things to the father since the girls were right there beside us.  I wanted to communicate to him the truth of the situation without upsetting his daughters too much.  Unfortunately there is no easy way to present euthanasia versus expensive surgery.  The older girl was still very certain that Sugar needed surgery and if it was up to her we would have done it right away.  But at her age she didn't understand the reality of the expense of doing so, or whether her parents could afford it.

I really hate being in these situations, and it happens more frequently than I'd like.  Kids become very attached to their pets and haven't learned to control their emotions as well as an adult.  They wear their feelings on their sleeves and it comes out quickly when discussing a very ill pet.  I've been in rooms many times when a parent and I have talked about a potentially terminal case while their child was next to us, and then have that child begin crying.  That's never easy, especially since I'm a parent.  We've lost several pets over the years and I've had to help my children through the grieving process, so when I see another parent having to do the same it really hits home to me.  Though I've learned how to handle being around upset and grief-stricken children, I can't say that it ever gets easier.  Often times the parent has an idea of the severity of the situation before they come to me and may have started the discussion at home.  But it becomes more "real" to the child when the doctor is the one talking about it.  And as hard as it is for them, this is a lesson that children have to learn at some point.

Any time I deal with terminal disorders and grief it makes me uncomfortable.  I'm not the kind of person who handles death well around others, whether it is human or pet death, and like many people I have a hard time knowing just what to do with a stranger's emotions.  That discomfort is multiplied when a child is involved as they are still learning how to process those feelings and cannot be consoled as easily.  In 16 years of being a vet I've been in these situations enough to learn how to handle most of them, and have learned that really anyone about to lose a pet just needs compassion and understanding.  And though I still don't like it, this is a reality of being a vet and something I can't ignore.  For the sake of my clients and their families I've had to learn how to balance truth, clinical detachment, and human compassion. 

In this case the father needed to go home and talk to his wife.  We started Sugar on antibiotics and tentatively planned the surgery for Saturday (I'm off work today and my associates aren't comfortable with this kind of surgery on a hamster...also there are virtually no other vets in my area who would even touch this case).  They were supposed to call this morning and let us know what they were going to do.  I won't find out until I get to work tomorrow morning, though they may come in today for euthanasia.  I might be surprised, but typically in these cases euthanasia is chosen for financial reasons, which I completely understand and don't begrudge the client.  But that can be another hard discussion and dose of cold reality for the daughter.

Nobody said that life lessons were easy.  And these are the things that veterinary students typically aren't trained for.

Free Time As A Vet?

Jessica emailed with the following....

 I'm an undergrad student at Allegheny College. I have wanted to be a vet for years, and after getting a work-study position working for a wildlife rehabilitation center, I can't see myself doing anything else besides working with animals.

However, I'm told that being a veterinarian doesn't allow for any free time. Is this true? I love being busy and consumed by what I'm doing, but I would like to take some vacations from time to time. 

This is a common concern of veterinarians, but I don't think that it's as bleak as you may have been told, Jessica.  Much of this opinion comes from older vets who are used to being on call day and night, putting in 50-60 hours per week.  And as a practice-owner and single doctor, it really is hard to take time off.  But I'd summarize the answer as "it depends".

One of the changes that has been discussed about the recent generation of veterinarians is that they are not driven in their careers as much as previous generations might have been.  Vets who graduated in the last decade or so will work very hard, but are concerned about the work-life balance.  They want to put in solid, busy days at work, and then have time to have and enjoy a family.  Newer vets want to work hard for 40 hours per week and then have time off.  They're not lazy, they just realize that there is more to life than work and want to have time to use their hard-earned money.

If you work in a multi-doctor clinic you can likely have the opportunity to take vacations and have regular days off.  I'm in such a situation and work four days per week, putting in 10-11 hour days.  That means that though I have long days, I get three days off per week, as well as getting over two weeks paid time off per year.  I do feel that I get enough time to have a life outside of work.

As I mentioned first, if you are a single doctor and a practice owner, your options are much more limited.  It will likely be years before you have built up to the point where you can regularly take time for yourself, though that certainly isn't always the case.  This is the more difficult route to go, but can lead to greater long-term rewards if you're a good business leader and manager.

How much free time you have also depends on how well you can leave your work at the office.  I'm always trying to teach younger vets to avoid looking up cases at home, researching things every night.  While that may be necessary at times, it can lead to burn-out if done too often.  Everyone deserves to have time for themselves to forget their job and be something else.  This is a learned skill and something that can take years to master (if you ever do).  But it's important to try and develop the ability to leave work behind.

So Jessica, whether or not you get much free time depends on your personality and circumstances.  Being a vet is hard work and often long hours, but it doesn't have to consume your every waking moment.

Lord of the Rings YMCA

Keeping in mind that this blog is as much about an average vet's life as it is about veterinary medicine itself, form time to time I like to share about non-veterinary things that interest me or strike my fancy.  Today is one such time.

Regular readers know that I'm a big geek, with a long-time interest in fantasy and science-fiction.  So it should be no surprise that I love the Lord of the Rings movies.  My father just sent me a link to a video that amused me so much that I've shared it on Facebook and want to share it here.  The person who made this obviously had a whole lot of time on their hands, but the results are very impressive.  I hope this brings a smile to my readers.

When Bad Vets Cause Major Problems

Ready for a long one?  No names are used as this will likely end up in a lawsuit.

I'm usually quick to defend my colleagues and point out that veterinarians are human and make mistakes.  I've even posted some of my mistakes on this blog, and they are certainly only part of them.  But as in any profession there are absolutely vets who simply shouldn't be allowed to work anymore.  Recently I ran into a situation regarding one of these doctors.

The client came to me last week, having brought in her young male boxer for an exam.  I had seen him previously for a minor issue when her regular vet was closed, and she had liked me so she wanted a second opinion.  The boxer was very sweet, but had lost weight since I had seen him a few months ago, and had an obviously distended abdomen.  The owner had brought him to me because at a vaccine clinic a vet had said that the fluid in the abdomen needed to be checked, so this was my main focus.  On the exam he was bright and alert, and at home had been eating well, drinking normally, and having good bowel movements.  In fact, he had been acting normally and would have seemed healthy other than the slow increase in the size of his belly over a couple of months.  With him being a boxer my first thought was heart disease, as this breed is prone to cardiomyopathy.  I also ran through  a few other possibilities, such as low blood proteins and liver disorders.  I recommended x-rays and blood tests, whether they were done with me or her regular vet.  She took the estimate home and was going to consult with her vet.

Yesterday she dropped off a copy of the x-rays because she wanted another opinion.  And this is where the story gets more interesting.  Apparently the dog had had a problem this past December (2012) and x-rays were taken.  According to the owner the vet had said he had a wire in his intestinal tract and gave him some oil to help it pass.  When I looked at the x-rays, I noticed a couple of things.  First, the image only had the upper (dorsal) half of the abdomen.  The bottom half was completely out of the view and hadn't been taken.  His body was rotated, so it wasn't a straight-on side view like we're supposed to take.  And then I noticed the metallic thread or wire in the abdomen, inside some kind of cyst or mass.  It was a very poorly positioned image and one that any of my radiology professors would have flunked me for.  And despite that "wire", the vet never did follow-up with the clients.

A slight aside.....This isn't directly relevant to the case, but talks strongly about the quality of vet they had.  There were a few dozen x-rays of different pets on the disc the owners brought to me.  Initially I didn't know which one was the boxer's, so I looked through all of them.  I repeatedly saw human hands and arms in the image, holding the pets.  This is a HUGE workplace safety violation, and a major problem.  The humans whose hands were in the field of the x-ray were getting repeated doses of radiation, and the owner of that practice is responsible for any damage or cancer risks.  X-rays are safe when done in small doses, but repeated frequent doses can be a health risk.  My jaw dropped a little when I saw so many repeated major violations of basic radiation safety.

Besides the disc from over seven months ago, the vet did x-rays two days ago and the owner gave me a copy of that.  This one was much better positioning, but the object from December was still in the exact same place.  What was more worrying was that there was almost nothing normal about how the abdomen looked.  In fact, I had a hard time making heads or tails of what I was seeing, other than displaced organs and this large mass with metallic thread in the center.  Her other vet had told her that the dog had swallowed something that was stuck in the intestines and needed surgery.  

Let's take a slight digression for those not in the veterinary field.  When a dog has an obstruction in the intestinal tract it is going to cause serious issues.  The dog typically will stop eating, likely will vomit, and won't be producing any feces.  This is something that develops obvious symptoms quickly.  Yet this boxer had none of these symptoms and was eating and defecating normally.  The lack of GI symptoms combined with the fact that the object was the same over a nearly eight month period made me significantly doubt this analysis.  

Back to our story....the client didn't completely trust what the other vet was telling her.  She had dropped her dog off for the x-rays, and then called later in the afternoon.  The vet answered the phone himself, but when she identified herself he put her on hold and had one of his assistants pick up the phone and talk to her.  When she came to pick up her dog the vet was at the front desk and as she walked in he went to the back of the clinic.  At no point did she get to talk directly to him about the situation, and in fact it seemed like he was deliberately avoiding her.  With that feeling she wanted my opinion on the x-rays.

I studied the images, trying to piece together what could have caused this particular problem and appearance.  Then a thought occurred to me.  I asked her if by chance he had ever had an abdominal surgery in the past.  She said that when he was a puppy he was cryptorchid (a retained testicle) and had surgery to remove it.  That strengthened my suspicions.  Many kinds of surgical sponges have a metallic thread woven into them so that if they accidentally get left in the abdomen they can be easily noticed on an x-ray.  My fear was that during the abdominal cryptorchid surgery a sponge or gauze had been left in the belly, which would explain all of the problems.  

To shorten the story just a little bit (yeah, I know...too late) I referred her to a local surgical specialty practice because if my suspicions were correct I knew it was going to be a bigger problem than I felt qualified to handle.  They went today and I talked to the surgeon this afternoon.  He said that the surgery was long and difficult, and the abdomen was "a hot mess" (direct quote).  The large mass was obvious, with lots of abdominal tissue around it and multiple adhesions within the abdomen.  About six inches of intestine had to be removed, even though the mass was outside of the GI tract.  And what was in the mass?  A surgical laparotomy sponge, obviously left in after the original surgery.  

The owners are obviously livid about this situation, and I can't blame them.  I had told them that if it turned out to be a sponge it was the liability and fault of the veterinarian who performed the surgery.  In this situation they have an open-and-shut lawsuit and I'm sure they will pursue this option.  One of the things that made me upset was the denial or evasiveness of this vet.  If I suspected a surgical sponge without first knowing there was an abdominal surgery, surely the vet who actually did the surgery and used those sponges would come to the conclusion more quickly.  If I had made this mistake I would have admitted it and faced the consequences.  Don't believe me?  I actually blogged about one of my mistakes back in 2009, and was very open with the clients.  In this current case it seemed like the vet was deliberately avoiding the client.

Now it gets really bad....This afternoon after I spoke with the specialist I was talking about the case with a couple of my staff who had overheard my side of the discussion.  One of them is very experienced and has been in our area for a long time, even having worked for a few different vets.  She really knows the veterinarians in the local region.  She asked me what vet had done the cryptorchid surgery.  I was trying to remember but was having trouble, when she asked if it was "So-and-So" clinic.  I recognized the name and told her that was right.  She became immediately upset because she was able to guess the specific doctor and office.  Apparently this isn't the first time this doctor has left behind surgical sponges in patients.  She told me that she knows that he has been sued several times in the past for the same kind of thing, one time leaving six gauze pads in a dog during a routine spay.  According to her he has had to change the name of his clinic several times because of these lawsuits.

Frankly, if all of that is true I don't know why his license hasn't been taken away or why any company would grant him malpractice insurance.  But if he pays out of pocket and doesn't report it to insurance, they might not know.  And if the client only sues and doesn't report it to the state veterinary board then no action is taken towards license revocation.  

We all make mistakes.  I've been open about mine.  But I can be confident that I learn from my mistakes and don't make the same one twice (at least in my job....my wife might disagree about repeating mistakes in my home life).  But someone who repeatedly makes the same mistakes shouldn't be working in that profession any more.  As I said at the beginning of this blog, I'm quick to defend other veterinarians and give them the benefit of the doubt.  I never directly bad-mouth another vet just because I have a different opinion on a case.  But I also don't want to ignore true malpractice, and will strongly encourage these clients to look into options for a lawsuit as well as recommend that they contact the state board.

What about the dog?  He had major surgery that even a specialist had a hard time with.  There was also evidence of possible infection within his abdomen.  So he isn't out of the woods yet.  Though the surgery went as well as expected and the surgeon is hopeful, we won't know his short-term prognosis for at least another day or two, and then it will be another week after that before we can start seeing that he may fully recover.  If things go well he can likely end up living a normal life.  I'll certainly be praying for him and will follow-up with the client.