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Friday, February 28, 2014

What To Do With A Constipated Dog

One of the most common questions I get at my clinic runs along the following lines....

"Hey, I just noticed my dog is constipated.  What can I give him for that?"

I'm sure that there will be some people that won't really read through the next parts, so if you found this blog entry by doing an internet search for the problem, please go through this carefully (and read my disclaimer sidebar).

In most cases where an owner thinks their dog or cat is constipated, they actually aren't.  In fact, they probably have diarrhea.  I don't have data on this, just nearly 17 years of being a practicing vet and numerous cases.  In almost every case of "straining to have a bowel movement" assumed to be constipation it turns out that the stool is actually very loose.  And giving medicine for constipation will make the problem worse.

When the colon is irritated or inflamed the body responds by increasing the strength and frequency of contractions.  The body is trying to expel whatever caused the problem. Unfortunately the contractions will continue even if there are no feces to pass.  Stop and think about this for a moment  because we've all been there.  All of us have had times when we've had a virus, food poisoning, or just something that really upsets our bowels.  We're sitting there on the toilet having rather uncomfortable straining and contractions even though nothing is coming our or getting stuck.  If you took a laxative at that moment, how do you think you're going to feel?

Don't get me wrong....animals can get constipated.  Cats are especially prone to a condition called megacolon where the lower GI tract becomes distended and cannot push feces out, resulting in dehydration of the stool and constipation.  If you ignore constipation you could be leading to more serious problems.  However, if you treat diarrhea as if it were constipation you're going to also cause worse problems.

So what do you do?  How do you tell if the pet is truly constipated?  Well, you have two options.  1) Put your finger in your dog's/cat's rectum, palpate the abdomen, and see if there is blocked or hard feces.  2)  Take your pet to the vet.  I certainly don't recommend option #1 as you could potentially hurt your pet, they won't like it, and most people don't know what "normal" is like in order to make the proper assessment.  That only leaves #2.  Yes, I know that's not what you wanted to hear, otherwise you wouldn't be looking for advice from "Dr. Google".  However, that's absolutely the best option.

The take-home lesson here is that what looks like constipation isn't always constipation, and you need a veterinary exam in order to make the best assessment.

Wednesday, February 26, 2014

Removing Microchips?

I have other emails that readers have sent me that are older than Mandie's, but hers really struck my interest, and is something I've never written about.  So hers goes first!

I would like to know the reality of removing a microchip from a pet. I adopted a dog from a "rescue" (one slightly neurotic woman) and have had the dog for 3 years. She refuses to transfer ownership of the microchip to me, preferring instead to simply add my information to hers. I'm sorry, but if my dog gets lost, I want to be sure I am the one that is called first, not her. I don't feel this is right. So I am wondering if it would be difficult, painful or dangerous to the dog to simply have the current one removed and my own put in. My dog is also only 3 pounds so I am worried of putting her at risk. 

One of the best things about microchips is that they are essentially permanent, and it is nearly impossible to remove one.  In the majority of situations this is a huge benefit, as someone can't simply make an incision and take out the chip, thus the identification of the owner is difficult to change.  However, this benefit turns into a major hassle in a situation like Mandie's.

I've never personally removed a microchip and would need a darn good reason to try.  These chips are small and are inserted under the skin between the shoulder blades.  When trying to remove one it can be a huge challenge because when it's been in place for a while it's nearly impossible to precisely identify the chip's location.  It should still be subcutaneous, but that can be a rather large area even in a tiny dog.  To fully explore the area I would need to make an incision several inches long and then carefully tease apart ("dissect") the tissues in the area and hope to find it.  If I was lucky it would be a minor surgery of only a few minutes duration.  However, if it was particularly deep it would take much longer and cause more trauma (though this should heal).

An x-ray may be able to localize the microchip a bit.  They show up very clearly on radiographic images and you could get a good idea of around which vertebrae it is.  However, there is still some movement so there would still be some exploration necessary.

Mandie, I sincerely sympathize with this situation, and agree that the previous owner is being unreasonable.  Your situation is certainly one in which I personally would consider the attempt at removal, though I wouldn't go against any other vet who refused to do so.  It wouldn't be easy.  The size of the dog in this case may actually be a benefit, as sometimes the chip can be felt under the skin in very small pets, and the area that would need to be searched is much smaller.  

If this was my patient, I'd first try to feel it.  If I could, it should be a minor procedure to remove it.  If it wasn't palpable I'd recommend x-rays to get a better idea of the specific location.  Then I'd have a long talk about the safety of anesthesia and surgery.  Mandie, this is something to discuss with your own vet, as there are different methods of anesthesia and different drugs, some safer than others.

I wish you the best of luck!

Wednesday, February 19, 2014

Random Fun

I swear that my life seems busier and busier every day.  Work is expanding rapidly, which is good, but it's wearing me out (10 hour days with no breaks, eating lunch while I'm writing notes in records).  Our private life is filled with many activities (a convention this weekend in Tennessee where my wife runs the kids track of activities) which also wears me out.  So I go from a crazy day at work to a busy evening at home.  And this past week has been busy enough that I haven't had time to blog regularly.

And still don't!  Okay, yes, I'm blogging now, but I have to rush off to work on more things.  But I don't want to get out of the habit and go a few months without writing again, so just a quick noted today.  Oh, and some fun random animal-related things that I've collected recently!  No rhyme or reason to them, other than the fact that they amused me and were related to animals.  Enjoy!

Wednesday, February 12, 2014

Snowmageddon, Round 2

Well, it's happening again.  Here in northern Georgia we're getting blasted with severe winter weather.  This time, however, everyone was ready and expecting it.  So nobody's been stuck on the roads for 20 hours trying to get home (no, that's not an exaggeration...happened two weeks ago).  But this time it's actually worse.  A few weeks ago it was 2-3 inches of snow.  Now it's snow plus extreme amounts of ice.

For those not used to ice storms, this is very bad.  Even 1/4 inch of ice can cause branches to fall and powerlines to come down.  But some parts of metro Atlanta are expecting a full inch of ice!  In my particular part of the region we had about an inch of snow, then some rain/sleet mix which froze in the evening, and now we're going to get about 3 inches of snow on top of that.  Even if the snow melts tomorrow afternoon it will still leave pure ice underneath.  Nobody can safely drive on that.   Thankfully things have been closing around here and even major interstates have no cars at all.  Much better than two weeks ago.

Want to see how crazy this is?  Here's a picture a friend posted on Facebook.

How weird is that?  And here are some pictures that I just took from my front and back porches.

So I had another snow day home from work, and at best we won't open the clinic until noon tomorrow.  I've been facing a major frustration in that one of the high-level practice managers (if you don't remember, we are a clinic with multiple locations and I manage just one of them) is from New Jersey and I don't think she really understands how even this small amount of snow and ice can affect us Southerners.  I've been fighting to keep us closed when she wants us to try getting in "just in case someone needs to come in".  Really?  When the governor has declared a state of emergency and the sheriff's department in our county has told everyone to stay off the roads?  It doesn't help that she's in Florida this week attending a meeting.  But I'm not willing to risk the safety of myself or any of my staff.

What's a bit interesting is that this time last week I was on a cruise in the Caribbean, enjoying weather like this.....

So we'll see what happens tomorrow.  At least we are warm, have power, plenty of food, and everyone's safe.


Here are some pictures that I took this morning.  We got a total of around 6 inches of snow, which is perfect for me.  Honestly, I love winter and snow, so this is perfect weather for me.  I'd rather be in a cabin on a snowy mountaintop than on a lounge chair on a Caribbean beach.  But the area is going to quickly return to normal.  We're expecting a high around 41F (5C) today with plenty of sunshine.  Already my street is pretty much clear of snow and ice and I can see the snow melting.  The next few days are going to be warmer so within 48 hours it's going to be completely gone.

Yes, that's my tauntaun plush.  It was a Christmas present and it does make tauntaun noises.  Hey, I'm a geek!  And I though it was particularly appropriate today.

Sunday, February 9, 2014

LinkedIn For Vets

Nope, I didn't disappear again.  Just went on vacation for a week.  More on that once I've downloaded the pictures from my camera.

In the meantime, here is a quick question from Jordana....

I love your blog! I am super interested in getting a bit more information about the type of linkedin groups that vets join once they are out of school, for career and job information, so that I can start looking. 

Honestly, I don't participate in LinkedIn as I don't have a real need to network out of my immediate area.  I've received invitations from friends and acquaintances over the years, but it really doesn't interest me.  So why am I trying to answer the question?  Because I know I have several readers who are involved in this profession and I'm sure some of them are on LinkedIn!  So let's see if anyone can help out Jordana in the comments below.

Saturday, February 1, 2014

A Healthcare Rant

I deliberately try not to get too political on this blog.  And I know full well that I'm getting ready to open an industrial-sized can of worms, especially with an international readership.  However, this is something that really gets my hackles raised.  A friend posted the following picture on their Facebook timeline (and this is a friend that I actually do like).

Here's what I posed in response.....

You can NEVER take into account only the price a business pays for something.  In the veterinary business a rabies vaccine might cost less than a dollar to purchase, yet we may charge $15 to administer.  Sounds unfair, right?  But in that markup you have to account for the pay of all staff and doctors, liability insurance, health insurance and other benefits, rent, utilities, equipment maintenance, time to inventory and manage the supplies, medical waste disposal fees, simple cleaning items (paper towels, floor and surface cleaner, laundry detergent, etc.), depreciation on equipment, etc., etc., etc.  If you only charge enough to break even the business will never gain enough profits to invest in newer and better equipment, more staff, expanded services or facilities, and so on.  There is a LOT more built into these prices that people think!!!!
Human hospitals also have the dilemma of being legally required to treat people regardless of their ability to pay, and many of those people end up defaulting on the charges, forcing the hospital to eat the costs.  If the hospital didn't somehow recoup those costs they would quickly go bankrupt and close their doors.  How much help would they then be able to give people?  What good is a hospital that can't pay its own bills?  So hospitals have to account not only for many of the costs listed above, but they also have to cover unpaid bills.  How much are those unpaid bills?  Oh, somewhere around $45 BILLION DOLLARS annually in the US!!!!!  There is no way in the world that hospitals could cover that much debt without passing along the costs.

And let's not get into malpractice insurance.  Because of our sue-happy society and the often outrageous judgments in malpractice suits, insurance costs for doctors are really high, and that gets passed along.  An average physician pays $3,000-4,000 annually for malpractice insurance.  If you're an ER doctor it's around $10,000-15,000.  Surgeons pay closer to $20,000.  OB/GYN premiums can run $40,000 or more per year.  How many people reading this would be happy making around $40k per year?  Now imagine you having to PAY an extra $40k per year just to be able to work!!!!

Suddenly $800 for a bag of fluids doesn't seem so unreasonable, does it?

And on the issue of for-profit healthcare.  Why is anyone against this?  Do you not realize the incentive this gives?  What if you would make $50,000 annually no matter what you did?  You could do a great job and really rise to the top of your profession, but you'd still only make $50k.  You could slack off and do the bare minimum to not be fired and you'd make $50k.  In a system like that, do you think the average person would really have the drive and motivation to be at the top?  Now what if you could make an extra $10k per year if you did extra work and really pushed yourself?  Would you consider doing that?  This principle is true in any business.  If all healthcare companies and systems didn't have the ability to make a profit, why would they ever want to do more than the minimum?  What would the incentive be for them to streamline their systems, create new technology, and be innovative?

Don't believe this principle is true?  Look at closed highly communist societies like the old Soviet Union and modern-day North Korea.  Their technology and care was significantly behind the rest of the world because there was no profit or upward mobility for the majority of people.  There was no incentive to do better.

Now I'm not saying that our system isn't broken.  It absolutely is.  When hospitals HAVE to charge this much just to stay open, we have a problem with insurance, lawsuits, taxes, and a whole host of other problems.  Why don't we try and fix the whole system and not just get mad at what a hospital charges?  Let's look at WHY they are charging that.  And Obamacare is NOT going to make it better.  Just wait and see (you can hold me to this...feel free to remind me again in about 4 years and see which of us has changed their opinion).

This is a much more complicated issue than paying $800 for something that cost the business $1.  And if you don't understand that, YOU are part of the problem!

Yes, this issue gets me a bit heated and frustrated.  I really hate when people just pass along a meme as a knee-jerk reaction and don't really pay attention to what they're really trying to say, or the validity of the meme's message.

And thanks for taking the time to read this far. :)

Okay, let the heated responses and flame war begin.  But remember that if there is any foul language, personal insults, or direct attacks I will delete the offending post.  This is true no matter who it is from or to whom it is directed.