Yesterday I saw a nine year-old mixed breed dog who came in because of a swollen belly. The owner reported that the abdomen had been growing larger and larger over the last six weeks or so. When I examined the dog she was about as wide as she was tall (a short dog, but still....) and was breathing somewhat rapidly. I suspected ascites (fluid in the abdomen), did a quick abdominal tap to confirm my thoughts, and was "rewarded" with a rapid 20ml of yellowish fluid. To make a long story short, the heartworm test was positive, indicating that the dog was in end-stage heartworm disease and right-sided heart failure. And yes, the dog had been coughing prior to the fluid ever being noticed.
The day before that one of my associates called me to tell me that a patient had pyometra, a severe and life-threatening uterine infection. The owner couldn't afford to take her to the emergency clinic for surgery, and was going to bring her to me the next day. I had been in the clinic a while yesterday morning with no sign of the client, so I had the other location called (I work for a practice with multiple satellite clinics, and I was working at a different one than my "home" location). Apparently the client wasn't going to be able to come in until after 3:00, which was too late to safely do surgery and monitor the patient as it would come too close to closing time. My associate was going to try and get her to somewhere else sooner, as I'm not working again until Tuesday, but the owner didn't seem rushed. While she's checking her calendar, her dog might not live.
All too often I see cases that happen entirely because of owner non-compliance or otherwise their failure to properly care for their pets. In the first case about $6 per month worth of prevention could have kept the dog from ever getting ill. And if they had brought the dog in at an earlier stage, it wouldn't have lead to such severe illness and could have been treated easier. In the second case, spaying the dog when she was young would have again completely prevented such a potentially deadly infection. And when your dog might die, do you really want to spend several days checking to see when a life-saving procedure fits into your schedule?
These situations are some of the greatest frustrations of a veterinarian. We go into this profession because we love animals and want to make and keep them healthy. We spend incredible amounts of time, stress, and money learning how to heal and do surgery, and then work hard to improve our skills once we're out of school. And in most cases the biggest barrier we have to successfully doing what we're trained to do is not a lack of skill or equipment, it's a lack of caring from owners. In the first case above, the client had thought the coughing might be heartworm disease, but didn't bring the dog in until it was almost too late. I don't know anybody who hasn't been told "spay or neuter your pet". And then when we do still have the ability to help these pets, often our hands are tied by the owners' decision.
And the hardest part to us is when these cases should never have even come up, as they are completely preventable.
Owners, please do what your vets tell you to do. We're honestly looking out for YOUR pet's health.
Sunday, October 16, 2011
Wednesday, October 12, 2011
Is Euthanasia Painful?
Stefanie sent me this email...
I have been reading "No Compromise" by Melody Green (a non-fiction book - an account of Keith Green's life and ministry) and towards the end - in just a very brief paragraph, it is discovered that Keith and Melody's dog becomes ill and they take it to the vet who tells them she has advanced cancer and the dog can either be euthanized at the vet office or taken home and shot. The vet strongly urged Keith to take it home and shoot the dog because it was more humane. I was a little taken aback by this and wondered - since this had happened in the early 80's - just how far humane euthanasia has come? I mean, were the injections given at that time painful or ineffective?
Some of my older readers may be able to help with this. I started working for a vet in 1984 and remember euthanasia as a simple, painless injection. I had dogs euthanized before that, but wasn't present. Still, I don't remember hearing it as a painful procedure. Readers older than me may be able to give a different perspective.
The American Veterinary Medical Association does have guidelines for humane euthanasia of all animals. Believe it or not, a properly aimed and delivered gunshot is considered a humane method of euthanasia. However, you have to do it the right way and have the right caliber of gun in order to provide an instantaneous kill, and because of this I really don't recommend anyone trying it. I've seen and heard of euthanasias attempted in this way going horribly wrong and the animal suffering.
For all of my studies and practice, euthanasia on companion animals is done by an intravenous injection of pentobarbital (sold under various brand names). In more dilute solutions, pentobarbital can actually be used as anesthesia, though not really safe anymore compared to other modern drugs. In human medicine it has been used to treat seizure conditions and similar brain disorders. The concentrated euthanasia solutions therefore induce a sudden and deep anesthesia, followed in seconds by cessation of brain activity and then heart activity. Because we're basically overdosing the pet on anesthesia, they literally fall asleep and don't wake up, hence the common term "putting them to sleep".
The procedure is generally considered quick and painless, no worse than being induced for anesthesia. In most cases the only pain involved is the quick needle poke from the injection or IV catheter (which I prefer to do, especially if an owner wants to be present). That doesn't mean that every case goes well. I have had pets suddenly move, pulling the catheter or needle out of the vein (another reason I tend to use IV catheters, as this is less likely to happen), requiring a second poke. Occasionally a pet will need a higher than normal dose, which is why I typically go ahead and give a little more than the calculated amount, and also keep the bottle in my lab coat pocket in case I need to give a little more.
Very rarely does the injection go horribly wrong. My worst experience was during a routine euthanasia on a cat. As soon as I gave the injection the cat screamed, launched itself straight up off the table a full 1-2 feet in the air, and then landed on the table dead. It happened suddenly, and I was at a loss. It freaked me and the owner out, and I had no explanation for the sudden reaction seconds before death. In my so-far 14 years of practice that was the worst one, and I hope the only one like it.
The huge majority of euthanasias are smooth and quick, with the pet quietly passing away within 10-20 seconds of giving the injection. Obviously this is the way we want it, as a dignified, peaceful exit from their life. And that's the way I've observed this procedure for a little under 30 years. If it wasn't so painless and easy, I wouldn't feel as comfortable doing it when the end of life comes. But with the drugs available, it's a way to end suffering, not cause more.
Tuesday, October 11, 2011
Economical Impact
Earlier today I was reading one of my regular journals, DVM Newsmagazine. In the most recent issue there were several articles on the impact of the current US economy on veterinary medicine, as well as changing trends in customer/client perceptions and actions when it comes to their pets. If you're interested, check out some of the articles above, including this link which is probably most relevant.
The articles show a growing problem in the veterinary profession with a reduction in income that can in part be tied to the economic downturn in recent years. However, there are other causes as well, including a push to increased duration of vaccines and a misconception on the part of pet owners that their dogs and cats don't need regular exams. I've seen it in my own practice, especially recently, where the last 4 weeks have shown us behind the revenue compared to the same four weeks in 2010 (though we're still ahead year-to-date compared to last year). Personally I think there are multiple factors, with the economy being a large part of that. What is interesting is that owner spending on pets as a whole has increased, while veterinary expenditures have decreased. So pet owners are simply not spending as much money at their vets, even while they are buying plenty of food, toys, and trinkets.
To me and many vets this trend is bothersome, and not just because it can affect our bottom line and our livelihood. Less spending at the vet and fewer visits means that pets aren't getting the care they need, especially preventative care. In the long run people can end up paying more by skipping visits, as we don't have as many opportunities to catch problems early.
I haven't done a poll in a while, so I think it's time to put up a couple. Since I have readers who are vets as well as readers who are just pet owners, I'm putting up one for each group. We'll review them at the end of the month and see what they look like in this very non-scientific survey.
The articles show a growing problem in the veterinary profession with a reduction in income that can in part be tied to the economic downturn in recent years. However, there are other causes as well, including a push to increased duration of vaccines and a misconception on the part of pet owners that their dogs and cats don't need regular exams. I've seen it in my own practice, especially recently, where the last 4 weeks have shown us behind the revenue compared to the same four weeks in 2010 (though we're still ahead year-to-date compared to last year). Personally I think there are multiple factors, with the economy being a large part of that. What is interesting is that owner spending on pets as a whole has increased, while veterinary expenditures have decreased. So pet owners are simply not spending as much money at their vets, even while they are buying plenty of food, toys, and trinkets.
To me and many vets this trend is bothersome, and not just because it can affect our bottom line and our livelihood. Less spending at the vet and fewer visits means that pets aren't getting the care they need, especially preventative care. In the long run people can end up paying more by skipping visits, as we don't have as many opportunities to catch problems early.
I haven't done a poll in a while, so I think it's time to put up a couple. Since I have readers who are vets as well as readers who are just pet owners, I'm putting up one for each group. We'll review them at the end of the month and see what they look like in this very non-scientific survey.
Sunday, October 2, 2011
Reflections In A Cemetery
Last night my wife and I participated in a local event at the city cemetery. For the last seven years the local history museum has organized walking tours through the cemetery with actors portraying people buried there, telling stories of a bit of the history in the area. This was the first year that my wife and I were actors, having been given the opportunity through our involvement in the local community theater groups.
My character was Augustus Foute. He and his three brothers fought in the Civil War, lost his arm in the Battle of Kennesaw Mountain, and afterwards he settled down in this area and became a judge at the city court. I was standing next to his grave all night and had the opportunity to study his family as well as neighboring graves. The grave with the oldest known date in the cemetery dates to 1844, but there are unmarked graves that likely date earlier.
As many readers know, I'm a big history buff. And one of the things I enjoy most about history is the daily lives of the people. How did people live in a given time period? What they do day-to-day? What did they do for work and for fun? Because of my slant on history, I've always been kind of interested in graveyards, reading the headstones and tombs and wondering about their lives. For example, Foute married in 1875 and had two children buried there who each lived only a year. He married his wife when she was 29, rather old for that time period. My wife's character was from the same time period and married when she was 36, an old maid by standards of the time. She died after a year and a half of marriage and her husband never remarried. What were the lives of these people like? How did they get by after the deaths of their children? Did the husband of my wife's character love her so much that he could never bear to be with another woman again? Foute fought in many battles during the war, and though he lost an arm he lived a long life. What was it like to pick up and start a life, working for the legal system in a country that he fought to prevent?
Yes, you can get a bit melancholy in a cemetery, contemplating your own mortality among the graves. What will my grave say? Where will it be? In 150 years will I have someone portraying me in a historical reenactment? What will they know and remember about me? But at the same time, I find that places like that can be very life-affirming. Foute went on to be very successful after a brutal war and the loss of young children early in his marriage. The grave sites around me held several generations of people, showing that life continued. And we were remembering and honoring the lives and memories of these people who thought dead, were not forgotten.
To me one of the attractions of history is to put perspective on our current lives and times. Hardship and trials will always exist. It's our ties to family and love for each other that will get us through and will help us be remembered.
My character was Augustus Foute. He and his three brothers fought in the Civil War, lost his arm in the Battle of Kennesaw Mountain, and afterwards he settled down in this area and became a judge at the city court. I was standing next to his grave all night and had the opportunity to study his family as well as neighboring graves. The grave with the oldest known date in the cemetery dates to 1844, but there are unmarked graves that likely date earlier.
As many readers know, I'm a big history buff. And one of the things I enjoy most about history is the daily lives of the people. How did people live in a given time period? What they do day-to-day? What did they do for work and for fun? Because of my slant on history, I've always been kind of interested in graveyards, reading the headstones and tombs and wondering about their lives. For example, Foute married in 1875 and had two children buried there who each lived only a year. He married his wife when she was 29, rather old for that time period. My wife's character was from the same time period and married when she was 36, an old maid by standards of the time. She died after a year and a half of marriage and her husband never remarried. What were the lives of these people like? How did they get by after the deaths of their children? Did the husband of my wife's character love her so much that he could never bear to be with another woman again? Foute fought in many battles during the war, and though he lost an arm he lived a long life. What was it like to pick up and start a life, working for the legal system in a country that he fought to prevent?
Yes, you can get a bit melancholy in a cemetery, contemplating your own mortality among the graves. What will my grave say? Where will it be? In 150 years will I have someone portraying me in a historical reenactment? What will they know and remember about me? But at the same time, I find that places like that can be very life-affirming. Foute went on to be very successful after a brutal war and the loss of young children early in his marriage. The grave sites around me held several generations of people, showing that life continued. And we were remembering and honoring the lives and memories of these people who thought dead, were not forgotten.
To me one of the attractions of history is to put perspective on our current lives and times. Hardship and trials will always exist. It's our ties to family and love for each other that will get us through and will help us be remembered.
Friday, September 30, 2011
Two-Faced Cat
File this one under "tales of the bizarre".
A doctor we recently hired told me a few days ago about one of his old colleagues who had just seen a puppy with three hind legs and two vaginas. He showed me a picture of the newborn, and it was truly odd-looking. We began talking about other genetic abnormalities that were likely to go along with such deformities, and that the puppy had a low chance of survival. Our discussion turned to similar deformities in other species, such as two-headed snakes. No kidding!
When I was attending the University of Tennessee for my Master's degree I saw a two-headed python in their reptile research department, alive and well. One head was the dominant one and tended to control the body, but sometimes the heads would fight over a prey item. It was really strange, but interesting at the same time.
Then today I just came across a story on the front page of FoxNews.com, about a two-faced cat who was 12 years old and still doing very well, thereby setting a Guinness World Record. Click on the link above to see the story as well as a short video of the cat and his owner
I have to admit that even having seen many things in 14 years of veterinary practice, this one took me a bit by surprise. I've seen photos and even preserved specimens of two-faced cattle, sheep, and other animals, but none of them survived long. These types of deformities are usually so severe that life-expectancy for the unfortunate animals is measured in days from birth. So it was quite strange to see a cat living a normal life-span with this condition and seemingly very happy and otherwise normal.
I'm not sure that I have a real point or comment about this cat. But I certainly wanted to share!
A doctor we recently hired told me a few days ago about one of his old colleagues who had just seen a puppy with three hind legs and two vaginas. He showed me a picture of the newborn, and it was truly odd-looking. We began talking about other genetic abnormalities that were likely to go along with such deformities, and that the puppy had a low chance of survival. Our discussion turned to similar deformities in other species, such as two-headed snakes. No kidding!
When I was attending the University of Tennessee for my Master's degree I saw a two-headed python in their reptile research department, alive and well. One head was the dominant one and tended to control the body, but sometimes the heads would fight over a prey item. It was really strange, but interesting at the same time.
Then today I just came across a story on the front page of FoxNews.com, about a two-faced cat who was 12 years old and still doing very well, thereby setting a Guinness World Record. Click on the link above to see the story as well as a short video of the cat and his owner
I have to admit that even having seen many things in 14 years of veterinary practice, this one took me a bit by surprise. I've seen photos and even preserved specimens of two-faced cattle, sheep, and other animals, but none of them survived long. These types of deformities are usually so severe that life-expectancy for the unfortunate animals is measured in days from birth. So it was quite strange to see a cat living a normal life-span with this condition and seemingly very happy and otherwise normal.
I'm not sure that I have a real point or comment about this cat. But I certainly wanted to share!
Wednesday, September 28, 2011
You Control The Weight
Yesterday I was talking to a client about their overweight pet and mentioned to her that she has complete control over how much her dog weighs. She seemed surprised by this revelation, so I thought I'd share it with everyone.
Yes, YOU are the one who determines how much your pet will weigh. Think about that for a moment. Who places the food in the bowl? Who decides to take the dog for a walk or at least let them out in the yard? Who gives the treats? Who feeds from the table? In each of these circumstances the answer is "the pet owner". And that means you. So if your dog gets too many treats, gets to large of a portion each day, or doesn't get enough exercise, who is to blame? Do you see where I'm going with this?
Yes, there are a few circumstances where there is a metabolic problem causing the weight gain. Most of the time this is related to low thyroid hormone (hypothyroidism), which is a diagnosable and treatable disorder. But medical conditions are the exception rather than the rule when it comes to overweight pets. So if you take away problems with a dog's metabolism, that leaves feeding and exercise, both of which are under a client's control.
Many people don't realize just how little a pet needs to eat. In fact, once a pet is spayed or neutered their metabolic requirements lower dramatically. You know the feeding guides on the package of dog or cat food? Most of those are based on an "intact" pet. If your pet has been "fixed" (spayed or neutered), he or she actually needs at least 30% LESS than that recommended amount! If your pet is particularly inactive, that requirement may go down even more. And that doesn't include treats, which can add up much faster than people realize.
So let me be very blunt for a moment. If your pet is overweight it's almost always because YOU have over-fed or under-exercised your pet (or have allowed it to happen in your family). This can be a serious health concern and lead to shorter life spans and more health problems. The fix? Talk to your vet about a good weight loss program and food. It's all up to you.
Yes, YOU are the one who determines how much your pet will weigh. Think about that for a moment. Who places the food in the bowl? Who decides to take the dog for a walk or at least let them out in the yard? Who gives the treats? Who feeds from the table? In each of these circumstances the answer is "the pet owner". And that means you. So if your dog gets too many treats, gets to large of a portion each day, or doesn't get enough exercise, who is to blame? Do you see where I'm going with this?
Yes, there are a few circumstances where there is a metabolic problem causing the weight gain. Most of the time this is related to low thyroid hormone (hypothyroidism), which is a diagnosable and treatable disorder. But medical conditions are the exception rather than the rule when it comes to overweight pets. So if you take away problems with a dog's metabolism, that leaves feeding and exercise, both of which are under a client's control.
Many people don't realize just how little a pet needs to eat. In fact, once a pet is spayed or neutered their metabolic requirements lower dramatically. You know the feeding guides on the package of dog or cat food? Most of those are based on an "intact" pet. If your pet has been "fixed" (spayed or neutered), he or she actually needs at least 30% LESS than that recommended amount! If your pet is particularly inactive, that requirement may go down even more. And that doesn't include treats, which can add up much faster than people realize.
So let me be very blunt for a moment. If your pet is overweight it's almost always because YOU have over-fed or under-exercised your pet (or have allowed it to happen in your family). This can be a serious health concern and lead to shorter life spans and more health problems. The fix? Talk to your vet about a good weight loss program and food. It's all up to you.
Tuesday, September 27, 2011
Lawnmower 1, Dog 0
There are certain things in life that tend to be "givens". The sun rises in the east, taxes are always painful to pay, people will normally call while you're taking a shower, etc. Another given is that rapidly spinning hunks of metal will always win when put in opposition to an animal's appendage.
This past Saturday a client called with an emergency. Apparently his dog was playing around while he was mowing his lawn, and was jumping over the mower. One of the times she did so, her foot slipped underneath the mower. I don't think I need to spell out what happened next and why he was rushing his dog in. Remember, it's a given that lawnmower blades will win out over a boxer's paw.
When she came in she was a bit shocky, likely due to the pain, but stable. The only injury was the right rear paw, and this was pretty bad. A couple of toes were missing, a couple were hanging on by strands of skin, and the bones in the paw (metatarsals) were easily visible. There was comparatively mild bleeding, and certainly nothing requiring a transfusion. However, the end of the dog's paw was pretty much gone with bones and tissue being traumatically mangled (not that there's a way to atraumatically mangle something).
There was no way to save the paw, but he came in just a couple of hours before closing so it was too late to be able to do surgery on her at our practice, even though I could certainly handle something like this. I gave her some potent pain medication right away, gently bandaged the paw, and sent her to the local emergency clinic. He couldn't afford surgery there, so ended up looking around for a couple of days before finally having surgery done yesterday. There were no other injuries, so the dog is likely going to heal well and do okay, even if she's missing part of her paw. But I can't imagine her having a mangled foot and having to wait two days before the owner could find someone to do the surgery at a price he could afford.
Here's a rather simple lesson. If you're running a lawnmower, realize that the blade can chop through bone and skin just as easily as through twigs and grass. And don't let your dog play anywhere near the mower!
This past Saturday a client called with an emergency. Apparently his dog was playing around while he was mowing his lawn, and was jumping over the mower. One of the times she did so, her foot slipped underneath the mower. I don't think I need to spell out what happened next and why he was rushing his dog in. Remember, it's a given that lawnmower blades will win out over a boxer's paw.
When she came in she was a bit shocky, likely due to the pain, but stable. The only injury was the right rear paw, and this was pretty bad. A couple of toes were missing, a couple were hanging on by strands of skin, and the bones in the paw (metatarsals) were easily visible. There was comparatively mild bleeding, and certainly nothing requiring a transfusion. However, the end of the dog's paw was pretty much gone with bones and tissue being traumatically mangled (not that there's a way to atraumatically mangle something).
There was no way to save the paw, but he came in just a couple of hours before closing so it was too late to be able to do surgery on her at our practice, even though I could certainly handle something like this. I gave her some potent pain medication right away, gently bandaged the paw, and sent her to the local emergency clinic. He couldn't afford surgery there, so ended up looking around for a couple of days before finally having surgery done yesterday. There were no other injuries, so the dog is likely going to heal well and do okay, even if she's missing part of her paw. But I can't imagine her having a mangled foot and having to wait two days before the owner could find someone to do the surgery at a price he could afford.
Here's a rather simple lesson. If you're running a lawnmower, realize that the blade can chop through bone and skin just as easily as through twigs and grass. And don't let your dog play anywhere near the mower!
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