Yesterday I went to the ophthalmologist for my routine annual exam and had a rather rude reality check. She said that I was at the early point of needing bifocals. BIFOCALS! Yikes! Those are for old people. Okay, so the average age to start using bifocals is 40-45 years old, and I'm 42. But I dress up in costumes at sci-fi cons, collect action figures, and still watch cartoons. I really don't feel like I'm at my age, and have always looked at bifocals as being for older people.
Now I am one. That's a bit depressing, really, though it shouldn't change anything about who I am or how I feel. After all, it's just changing vision, right? Not a big deal and it doesn't mean that I'm falling apart. Right?
No, I'm not going to start going through a mid-life crisis, and I won't be buying a motorcycle or convertible any time soon. But it is a realization that I ain't gettin' any younger and can only expect more changes like this. Next thing you know my doctor will start talking about colonoscopies.
So say a few prayers for this aging doctor. I think I'm going to go eat some ice cream and play with my action figures.
Saturday, September 24, 2011
Friday, September 23, 2011
US Parasite Prevalence
I attended a lecture on parasite prevention this week and was directed to the Companion Animal Parasite Council web site. This is an organization here in the US that was developed to bridge the gap between veterinarians and physicians with regards to parasitic diseases in pets. The group also seeks to educate pet owners on the parasites and disorders that can happen in pets, several of which are transmittable to humans.
Now all of that is good, but not revolutionary. What grabbed my attention was an interactive map they have which shows county-by-county incidence of various diseases in the us. I would highly recommend all US vets and pet owners check it out if you aren't familiar with it. The map shows the rates of various tick-borne diseases (lyme, ehrlichia, anaplasma), heartworm disease, and intestinal parasites (hookworms, roundworms, whipworms) in dogs and cats (you can view by each species). And the results can be a bit surprising.
For example, let's look at heartworm disease in my state of Georgia. In 2010 there were 4647 positive diagnoses in dogs and 367 in cats. These are pretty high numbers, but we're not the highest in the Southeast (Florida had 1396 in just cats).
And here's the scary part. All of the numbers on this map are in all likelihood lower than the actual infection rate! The data is compiled from Banfield Pet Hospital (a nation-wide veterinary chain that has extensive computer records), Idexx Laboratories and Antech Laboratories (two large, national veterinary diagnostic labs). Records come from these sources' databases, as well as data sent in by veterinarians. However, not all vets will participate in these studies, so there are certainly positive cases that never make it into this data set. Also, many pets are never tested for these various diseases, so there are certainly positive cases that go undiagnosed. So when you review the numbers, realize that these are the bare minimum cases, and the actual infection rate is likely a good bit higher! Realizing how the data is collected puts in perspective the true incident rate.
I've made sheets to post in all of my exam rooms showing the rates in our state and county, to use as a conversation-starter with clients. If we can make more people aware of these diseases (all of which are considered preventable!), then perhaps we can lower the number of positive cases and improve the health of pets.
Now all of that is good, but not revolutionary. What grabbed my attention was an interactive map they have which shows county-by-county incidence of various diseases in the us. I would highly recommend all US vets and pet owners check it out if you aren't familiar with it. The map shows the rates of various tick-borne diseases (lyme, ehrlichia, anaplasma), heartworm disease, and intestinal parasites (hookworms, roundworms, whipworms) in dogs and cats (you can view by each species). And the results can be a bit surprising.
For example, let's look at heartworm disease in my state of Georgia. In 2010 there were 4647 positive diagnoses in dogs and 367 in cats. These are pretty high numbers, but we're not the highest in the Southeast (Florida had 1396 in just cats).
And here's the scary part. All of the numbers on this map are in all likelihood lower than the actual infection rate! The data is compiled from Banfield Pet Hospital (a nation-wide veterinary chain that has extensive computer records), Idexx Laboratories and Antech Laboratories (two large, national veterinary diagnostic labs). Records come from these sources' databases, as well as data sent in by veterinarians. However, not all vets will participate in these studies, so there are certainly positive cases that never make it into this data set. Also, many pets are never tested for these various diseases, so there are certainly positive cases that go undiagnosed. So when you review the numbers, realize that these are the bare minimum cases, and the actual infection rate is likely a good bit higher! Realizing how the data is collected puts in perspective the true incident rate.
I've made sheets to post in all of my exam rooms showing the rates in our state and county, to use as a conversation-starter with clients. If we can make more people aware of these diseases (all of which are considered preventable!), then perhaps we can lower the number of positive cases and improve the health of pets.
Tuesday, September 20, 2011
Finish The Meds!
I have to be honest and admit that I don't always follow my own doctor's directions. I'll forget to take a dose, or get near the end of a prescription and decide that I probably don't need to continue taking them. And I know better!!!! "Bad, Dr. Bern! Take your meds!" As someone in the medical profession, I know all of the reasons why I need to follow my doctor's recommendations.
So why is it so important? And why bring that up in a mostly-veterinary blog? The exact same problem happens with pets and their owners. A pet will start to feel better or symptoms will improve and the owner will stop giving medications. Or they miss several doses and get off schedule. Several studies have shown that pet owners' compliance with the vet's directions is far lower than we veterinarians believe. Such noncompliance can actually have negative consequences. Let me go over a couple of examples.
Antibiotics normally need to be given for at least 10-14 days, and often longer (especially with severe skin or urinary infections). You should never stop antibiotics as soon as the symptoms go away because the bacteria may not be gone. There needs to be a certain level of infection before you notice an issue clinically. An infection may still be present, but the bacterial numbers have been reduced to the point of no longer seeing an obvious problem. We call these sub-clinical infections. However, in these cases the bacteria are still there! When you stop antibiotics, any remaining bacteria can then start to grow again and the problem can come back as bad as ever. Dermatologists recommend continuing antibiotics for two weeks past complete resolution of symptoms! Another danger is that any remaining bacteria were not killed immediately and so may have some degree of natural resistance to medications. Allowing them to live and reproduce could be selecting for a resistant strain that then won't respond well to antibiotics.
Another example...demodex mites are not uncommon in puppies and there are various treatments available (oral ivermectin, amitraz dips). These mites are pretty sturdy and it normally takes several months of continual treatment to cure the pet. As the pet is improving any hair loss starts to resolve and grow back. I have had clients stop treament once this happens, and in many cases they end up back in my clinic because the problem came back. They didn't follow my recommendations and stopped treatment too soon, before all of the mites were dead.
Doctors don't prescribe medications for a given length of time based on how much money they want to make. There are well established protocols based on strong data for how long it takes to eradicate a given infection or cure a problem. The length of time will vary based on the severity of disease, the tissues involved, the type of bacteria, and other similar factors. So some infections may be gone in 10 days, but others may take 2-3 months. This extends beyond infections to other diseases as well. The frequency of administration (once daily, twice daily, etc.) is also important and varies between medications based on their method of action. Not giving it at proper intervals (such as giving a twice daily medication only once daily) can prolong a disease or result in a lack of a cure.
The bottom line is that you need to competely follow your vet's directions for your pet. Finish the medications as they are directed!
And yes, I'm going to finish my own.
So why is it so important? And why bring that up in a mostly-veterinary blog? The exact same problem happens with pets and their owners. A pet will start to feel better or symptoms will improve and the owner will stop giving medications. Or they miss several doses and get off schedule. Several studies have shown that pet owners' compliance with the vet's directions is far lower than we veterinarians believe. Such noncompliance can actually have negative consequences. Let me go over a couple of examples.
Antibiotics normally need to be given for at least 10-14 days, and often longer (especially with severe skin or urinary infections). You should never stop antibiotics as soon as the symptoms go away because the bacteria may not be gone. There needs to be a certain level of infection before you notice an issue clinically. An infection may still be present, but the bacterial numbers have been reduced to the point of no longer seeing an obvious problem. We call these sub-clinical infections. However, in these cases the bacteria are still there! When you stop antibiotics, any remaining bacteria can then start to grow again and the problem can come back as bad as ever. Dermatologists recommend continuing antibiotics for two weeks past complete resolution of symptoms! Another danger is that any remaining bacteria were not killed immediately and so may have some degree of natural resistance to medications. Allowing them to live and reproduce could be selecting for a resistant strain that then won't respond well to antibiotics.
Another example...demodex mites are not uncommon in puppies and there are various treatments available (oral ivermectin, amitraz dips). These mites are pretty sturdy and it normally takes several months of continual treatment to cure the pet. As the pet is improving any hair loss starts to resolve and grow back. I have had clients stop treament once this happens, and in many cases they end up back in my clinic because the problem came back. They didn't follow my recommendations and stopped treatment too soon, before all of the mites were dead.
Doctors don't prescribe medications for a given length of time based on how much money they want to make. There are well established protocols based on strong data for how long it takes to eradicate a given infection or cure a problem. The length of time will vary based on the severity of disease, the tissues involved, the type of bacteria, and other similar factors. So some infections may be gone in 10 days, but others may take 2-3 months. This extends beyond infections to other diseases as well. The frequency of administration (once daily, twice daily, etc.) is also important and varies between medications based on their method of action. Not giving it at proper intervals (such as giving a twice daily medication only once daily) can prolong a disease or result in a lack of a cure.
The bottom line is that you need to competely follow your vet's directions for your pet. Finish the medications as they are directed!
And yes, I'm going to finish my own.
Saturday, September 17, 2011
Nonchalant About Bites
If you're in the veterinary field for long, it's pretty much a given that you're going to be bitten or scratched. After a while most of us take it as almost a routine occurrence. Obviously we don't want to get so relaxed that it happens every day, but I receive minor scratches and abrasions several times per year. I've been bitten numerous times, thankfully never very severe and I only have minor scars from those cases. What becomes almost amusing is the nonchalant nature some of us take.
A few days ago I was dealing with a cat that started becoming fractious. It had already been to another vet that day and the owner said it was lunging at that vet. We got her out of her carrier and at first she acted fine, so we started working with her. The longer we handled her the more irritated she became, until she started getting aggressive. At one point she suddenly "flipped out" and managed to squirm out of my grasp. I made a sudden grab for her, and she managed to land a quick bite on my finger before I was able to get her back under control. We finished the vaccines, put her back in the carrier, and took her back to the client.
Now first let me say that cat bites can get severely infected very quickly, so nobody should take them lightly. If you are bit by a cat, seek medical attention, even if the wound is not severe.
But in my case it wasn't my first rodeo (as we say here in the States). I've been bitten enough times and been to the doctor enough times that I know how to treat my own wounds. I washed the wounds out, flushed them with chlorhexidine (a disinfectant), applied antibiotic ointment, and placed simple band-aids. Then I finished the rest of my day. It didn't seem bad, but the finger was painful that night and by the next day there was mild swelling, redness, and warmth so I suspected that the bite went deeper than my original impression. It was just the tip of my left index finger, but I didn't want to have a problem so I went to the doctor.
The ONLY reason I saw a doctor is because I can't legally write a prescription for any humans, including myself. I think the doctor's office was a little surprised because I had a laid-back attitude about the whole event. I described what had happened and how I treated it and told the doctor that I knew I was going to be put on Augmentin (amoxicillin & clavulenate....we call it Clavamox in the veterinary field) and was only there because I need a prescription from him. And like I expected, he really didn't need to do anything to me. I got my prescription and was out of there pretty quickly. This exact pattern has happened before (thankfully it's been around 8 years since my last real bite wound), and I get a little amused at the expressions on the human medical team when they realize that I did everything for them.
So how bad is it that I've had enough wounds that I know how to self-treat and know exactly what my physician will do? When I get this jaded and nonchalant, it's an indication that I've been doing this waaaay too long!
A few days ago I was dealing with a cat that started becoming fractious. It had already been to another vet that day and the owner said it was lunging at that vet. We got her out of her carrier and at first she acted fine, so we started working with her. The longer we handled her the more irritated she became, until she started getting aggressive. At one point she suddenly "flipped out" and managed to squirm out of my grasp. I made a sudden grab for her, and she managed to land a quick bite on my finger before I was able to get her back under control. We finished the vaccines, put her back in the carrier, and took her back to the client.
Now first let me say that cat bites can get severely infected very quickly, so nobody should take them lightly. If you are bit by a cat, seek medical attention, even if the wound is not severe.
But in my case it wasn't my first rodeo (as we say here in the States). I've been bitten enough times and been to the doctor enough times that I know how to treat my own wounds. I washed the wounds out, flushed them with chlorhexidine (a disinfectant), applied antibiotic ointment, and placed simple band-aids. Then I finished the rest of my day. It didn't seem bad, but the finger was painful that night and by the next day there was mild swelling, redness, and warmth so I suspected that the bite went deeper than my original impression. It was just the tip of my left index finger, but I didn't want to have a problem so I went to the doctor.
The ONLY reason I saw a doctor is because I can't legally write a prescription for any humans, including myself. I think the doctor's office was a little surprised because I had a laid-back attitude about the whole event. I described what had happened and how I treated it and told the doctor that I knew I was going to be put on Augmentin (amoxicillin & clavulenate....we call it Clavamox in the veterinary field) and was only there because I need a prescription from him. And like I expected, he really didn't need to do anything to me. I got my prescription and was out of there pretty quickly. This exact pattern has happened before (thankfully it's been around 8 years since my last real bite wound), and I get a little amused at the expressions on the human medical team when they realize that I did everything for them.
So how bad is it that I've had enough wounds that I know how to self-treat and know exactly what my physician will do? When I get this jaded and nonchalant, it's an indication that I've been doing this waaaay too long!
Thursday, September 15, 2011
Cats Need Care Too
There is a disturbing trend in veterinary medicine. The number of visits by feline patients has been steadily decreasing for several years. Much of this has to do with a trend in increasing duration of vaccines, especially in cats, as well as a mistaken perception that cats don't need vaccines and therefore don't need to see the vet. These attitudes do cats a great disservice.
Today I saw a cat who is seven years old and hasn't been to the vet since she was a kitten. Cats age much faster than we do, so this patient was in a situation equivalent to a 50 year-old human who hadn't been to a physician, ophthalmologist, or dentist since they were around 10. Putting it in this perspective really emphasizes the complete lack of medical care that this cat was receiving, as few humans would go 40 years between doctor's visits.
The American Veterinary Medical Association recommends twice annual exams for dogs and cats. Why? Because of the speed of their aging compared to humans and the ability for vets to often detect problems in the early stages of disease rather than waiting for it to become advanced. In a veterinary visit the most important component is the physical exam. We can discover many problems that the owner may not even be aware of. On routine exams I've discovered broken and loose teeth, mammary tumors, bladder stones, developing cataracts, and other serious issues; all of which the owners had not noticed! Without routine exams these abnormalities would have gone undiagnosed even longer and may have created serious health risks.
Let me give you another example, emphasizing the importance of routine exams and blood testing in cats. Our feline patients are very prone to kidney disease as they age. In fact, a number of years ago I heard a specialist lecture on this subject and he said "cats are kidney disease waiting to happen." The kidneys are remarkable organs with amazing redundancy, which is why people can donate a kidney and be perfectly fine with only 50% of the renal function they were born with. In order to show up as abnormalities on routine blood testing you have to have lost at least 66% of kidney function. However, you have to have 75% loss before a patient will act sick. So there is a window between 2/3 and 3/4 kidney loss where we can detect it but the patient acts perfectly normal! You can't look at a cat with a 70% loss of kidney function and tell that there is anything wrong. If we detect the problem early, we can potentially intervene and slow the progression of the disease.
So for those of you who have cats, don't neglect their medical care, even if they are receiving vaccines only every three years. Regular veterinary exams are the key to good preventative medicine and therefore a longer and healthier life.
Today I saw a cat who is seven years old and hasn't been to the vet since she was a kitten. Cats age much faster than we do, so this patient was in a situation equivalent to a 50 year-old human who hadn't been to a physician, ophthalmologist, or dentist since they were around 10. Putting it in this perspective really emphasizes the complete lack of medical care that this cat was receiving, as few humans would go 40 years between doctor's visits.
The American Veterinary Medical Association recommends twice annual exams for dogs and cats. Why? Because of the speed of their aging compared to humans and the ability for vets to often detect problems in the early stages of disease rather than waiting for it to become advanced. In a veterinary visit the most important component is the physical exam. We can discover many problems that the owner may not even be aware of. On routine exams I've discovered broken and loose teeth, mammary tumors, bladder stones, developing cataracts, and other serious issues; all of which the owners had not noticed! Without routine exams these abnormalities would have gone undiagnosed even longer and may have created serious health risks.
Let me give you another example, emphasizing the importance of routine exams and blood testing in cats. Our feline patients are very prone to kidney disease as they age. In fact, a number of years ago I heard a specialist lecture on this subject and he said "cats are kidney disease waiting to happen." The kidneys are remarkable organs with amazing redundancy, which is why people can donate a kidney and be perfectly fine with only 50% of the renal function they were born with. In order to show up as abnormalities on routine blood testing you have to have lost at least 66% of kidney function. However, you have to have 75% loss before a patient will act sick. So there is a window between 2/3 and 3/4 kidney loss where we can detect it but the patient acts perfectly normal! You can't look at a cat with a 70% loss of kidney function and tell that there is anything wrong. If we detect the problem early, we can potentially intervene and slow the progression of the disease.
So for those of you who have cats, don't neglect their medical care, even if they are receiving vaccines only every three years. Regular veterinary exams are the key to good preventative medicine and therefore a longer and healthier life.
Sunday, September 11, 2011
Risking Pets On The Highway
Please excuse me while I rant for a little bit. Today I saw something that I witness from time to time and it really bothers me both as a pet owner and a vet: dogs riding in the bed of a pickup truck on the highway.
One of the first times I really noticed this was many years ago when I saw a truck going down an eight-lane interstate. There was a lab sitting on top of the tool box behind the cab of a fully-laden pickup traveling at around 80 mph. Today it was a German shepherd standing up and walking around in a mostly-full truck bed going around 70 mph. Whenever I see this I cringe and want to make the driver pull over and take their dog inside the cab with them.
This is a huge risk for injury! Yes, most dogs will probably stay in the back and be okay, which is what lulls people into a false sense of security. Dogs don't have the cognitive reasoning to be able to think about what harm would happen if they jumped out of a moving vehicle. They may realize some danger and try to avoid it, but a strong enough stimulus could cause them to make the leap. The other risk is if the driver of the truck suddenly has to swerve or slam on breaks to avoid a road hazard or other vehicle. Such a sudden move could send the dog out of the truck and onto the highway or into another vehicle. Even if the dog is secured by a leash, there could be a risk of it falling over the side while still being attached, causing it to be dragged or strangled. In any of these circumstances we have a deadly situation. If the dog jumps or falls onto a busy highway going at high speeds that dog will die.
I simply don't understand why people take these sorts of risks. They would never consider doing that with one of their children, so why do they do it with their pet?
One of the first times I really noticed this was many years ago when I saw a truck going down an eight-lane interstate. There was a lab sitting on top of the tool box behind the cab of a fully-laden pickup traveling at around 80 mph. Today it was a German shepherd standing up and walking around in a mostly-full truck bed going around 70 mph. Whenever I see this I cringe and want to make the driver pull over and take their dog inside the cab with them.
This is a huge risk for injury! Yes, most dogs will probably stay in the back and be okay, which is what lulls people into a false sense of security. Dogs don't have the cognitive reasoning to be able to think about what harm would happen if they jumped out of a moving vehicle. They may realize some danger and try to avoid it, but a strong enough stimulus could cause them to make the leap. The other risk is if the driver of the truck suddenly has to swerve or slam on breaks to avoid a road hazard or other vehicle. Such a sudden move could send the dog out of the truck and onto the highway or into another vehicle. Even if the dog is secured by a leash, there could be a risk of it falling over the side while still being attached, causing it to be dragged or strangled. In any of these circumstances we have a deadly situation. If the dog jumps or falls onto a busy highway going at high speeds that dog will die.
I simply don't understand why people take these sorts of risks. They would never consider doing that with one of their children, so why do they do it with their pet?
Tuesday, September 6, 2011
Dragon*Con 2011
Anyone who reads this blog for long and looks at my links will easily see that I'm a big geek. And for fans of anything geek-related there isn't much better than Dragon*Con. This multi-genre convention takes over five hotels in downtown Atlanta every Labor Day weekend, and 40,000+ people attend. This year was the seventh year that my wife and I attended, and the fifth year for our kids. We also attend as part of our group, Fans For Christ. As usual, we had a blast! We spent the long weekend hanging out with friends, seeing celebrities (William Shatner walked across the street about five feet in front of me!), and taking pictures of amazing costumes. And like the big geeks we are, my family and I dress in costumes.
Here we are as Nymphadora Tonks, Remus Lupin, Luna Lovegood, and Harry Potter, with a friend of ours dressed up as Hagrid. We won "Cutest Family" at the Harry Potter costume contest!
My wife as Tonks and a friend of hers as Bellatrix Lestrange.
A closeup of me as Lupin, showing the fake scars we added. This was my first attempt and we learned a lot about making them, so next time they'll be pretty screen-accurate.
Us as Flynn Rider and Rapunzel from Tangled.
The kids were a young Rapunzel and Eugene Fitzherbert (aka Flynn Rider).
My wife's friend again, dressed as Mother Gothel.
Oh, and my wife made all of our costumes herself!!!! She's going to start a custom costuming business soon due to so many requests for people to make things for them.
So once again we have to go back to reality and I go back to work tomorrow. But it is one of our favorite events of the year and we always look forward to it. Only 359 days left until the next Dragon*Con!
Oh, and my wife made all of our costumes herself!!!! She's going to start a custom costuming business soon due to so many requests for people to make things for them.
So once again we have to go back to reality and I go back to work tomorrow. But it is one of our favorite events of the year and we always look forward to it. Only 359 days left until the next Dragon*Con!
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