Bob Beats The Odds

Last year I started seeing a hamster named Bob.  He presented to me with several abscesses under the skin, some pretty large.  I talked to the owner and he agreed to let me try and surgically remove them.  Now, this is a little hamster, about 37g, so any surgical procedure carries more than an average risk.  But this little guy (the nicest hamster I've ever seen) did great.  Unfortunately, some of the abscesses were very deep and had spread between some of the muscles and bones.  I told the owner that I couldn't remove all of them and he had a guarded long-term prognosis.  We started antibiotics post-operatively and hoped for the best, though I warned the owner that we might have to euthanize him soon if he didn't improve.

That was almost a year ago.  Bob has been back to see me several times, each time for a return of his abscesses.  We haven't done more surgery, but I drain them as best as I can, put him on antibiotics, and caution the owner that his prognosis is guarded.  Today he came in again for a new, large abscess, and we went through the same procedure.  Throughout it all, Bob has been a little trooper, handling the procedures well and continuing to be extremely well behaved.  And despite my continued warnings, he is still doing pretty good.

Bob has taught me a couple of things.  First, it reinforced my belief that a pet's monetary value has little to do with the emotional bond people have.  This owner has spent close to $400 in the last year for various visits, medications, and procedures; buying a new hamster would cost less than $10.  His owner loves him very much.  The second lesson is that we doctors don't have all of the answers (not that I needed too much reminding of that), and some pets simply defy the odds. 

Bob is now 1 1/2 years old, which is geriatric for a hamster (most live to be around 2).  I'm not sure how much longer he has, especially with a new abscess that I couldn't completely drain.  But I'm not giving up on him, and continue to be amazed by this little guy.

A Client's Bad Decision

Today I had a client who really frustrated me.  And this was a situation that I really haven't been faced with before, making it even more difficult to handle.

The client has a deaf boxer a little over a year old who has separation anxiety issues.  A few days ago he noticed the dog drooling, looked in his mouth, and saw that he had broken a tooth.  Today he brought him in for evaluation.  The dog was in overall good condition, but had broken off the tip of his upper right canine tooth.  The fracture was fairly close to the gum line and the pulp was obviously exposed.  So I began to work up an estimate for him.  A healthy canine tooth has a long, curved, thick root and is pretty hard to remove.  Generally the best way is to use dental drills to remove part of the bone away from the outside of the tooth, allowing it to be loosened and removed more easily.  Such a procedure also requires lifting part of the gum away from the bone and then suturing it back over the whole.  All of this requires general anesthesia since it is painful and can take quite a while to do.

I gave the estimate to the client.  He declined, but not for the reason I expected.  Instead, he said that his sister was a dentist (for humans), had removed broken teeth from his Rottweiler, and he was going to have her fly in to remove this dog's tooth.

WHAT????

This was wrong on several levels.  First of all, a human dentist is no more qualified to work on a dog's teeth than I am to work on my wife or children's teeth.  Just because you know about one species doesn't mean that you know about others.  There are certain similarities between teeth of various species, but the structure is certainly different.  Also, and most importantly, a human doctor is absolutely unqualified to perform anesthesia on an animal.  Drugs, dosages, and complications are all different.  What might be safe for one species doesn't mean that it's safe for all.  And dosages can be VERY different.  As an example (a non-lethal one), a human adult's correct dose of diphenhydramine (Benadryl) is 50mg.  In dogs we dose it at around 1mg per pound (2mg/kg).  That means that an adult human's dosage would only be enough for a medium-sized dog!  I would have no clue how to dose anethesia safely in a human.  So why would a human doctor feel that they can properly dose anesthesia in a dog?

The second issue is a very legal one.  Medical professionals are very specific in the species that they are legally allowed to see.  Human doctors are legally only allowed to work on humans.  Veterinarians are legally allowed to work on every species except humans.  So if I try to do a medical procedure on one of my kids, I can be arrested for practicing medicine without a license.  Similarly, when a human doctor works on an animal (say by, oh....doing a dental extraction on a dog) they are just as guilty of practicing medicine without a license.  If this dentist was ever confronted, she could potentially see jail time and lose her medical license.

I have no problems with a client wanting to save money.  But doing it in this way is putting the dog at a high risk of complications.  There is a right way and a wrong way to lower costs...and this is most certainly the WRONG way.  Also, I have no respect for the owner's sister at this point if she actually does this.  She is acting recklessly and extremely unprofessionally and should really know better.

When a client makes a poor decision, it's not them who suffers.  It's their pet.

Whose Fault?

From Robbie...

I recently adopted a lardge bloodhound from the pound. He was too awesome a dog to get put down, and besides, my other bloodhound needed a playmate.Being from the pound, I was required to have him neutered. The procedure went well, but something did go wrong. His scrotum had swollen immensely, and so two days later they did an emergency surgery to remove it. Afterwards, the vet explained that the problem was one vein he had tied off wasn't tied tight enough and had filled the scrotum with blood. I know very well that mistakes happen, and I'm just glad the problem was resolved. However, this surgery drove the total cost up quite a bit. Times are tough and frankly, I can't afford it, but the vet is charging me full for both surgeries. I don't really see this as fair because the second surgery resulted from his mistake during the first. Do I have any options? Thank you. 

About 12 years ago my father collapsed in his bathroom and my mother called the paramedics. When he got to the hospital the doctors worried that he was having a heart attack and placed a catheter into his artery.  While doing so they accidentally tore a coronary vessel, causing him to bleed around his heart.  This required emergency open-chest surgery.  Thankfully, they fixed the problem and he's doing fine today.  And yes, the hospital charged a the full price for all procedures, including the surgery to correct their "mistake".  After he recovered, my mother was asked if she was planning on suing the hospital.  After all, it was their fault that he bled and almost died.  There was actually a good chance that she would win the suit.  However, my mother replied "Why should I sue?  They saved his life."

I really respected my mother for this decision.  I believe that far too many people sue in our society, and that people are simply not allowed to ever make mistakes.  My mother looked at the larger picture of the fact that the doctors had done everything they could and succeeded in saving my father.

Now back to Robbie's situation (yes, there was a point to my little story).  I have had dogs that I neutered develop a scrotal hematoma, similar to what Robbie describes.  All of them developed a swollen, bruised scrotum, though they did not require surgery.  Most cases like this will eventually reabsorb and resolve without further surgery, though the dog may be more uncomfortable than normally happens post-op.  In all of these cases I performed the surgery within acceptable standards and to the best of my ability.  If a suture wasn't tight enough or had slipped off, it wasn't due to neglect or inability on my part.  So even though this complication happened after I performed the surgery, I don't know that it was due to my "mistake".  Unfortunately, nobody can be perfect, even doctors.  There will be times that a doctor does everything correctly, but something still goes wrong.

Robbie, the vet does have a right to charge for both procedures.  They also have a right to waive any fees.  When I made my mistake (which you responded to) I chose to avoid charging for the second surgery, though I did not refund any fees for the first one. However, in that particular case I had accidentally created a life-threatening condition, though it was a once in a career situation.  Your case has happened to almost every vet out there, and is not life-threatening.  Was a second surgery even necessary?  I can't say, as I didn't see your pet, and I can see justification for and against a second procedure.

There are a couple of ways you can choose to act.  Because there is a chance that the vet did not perform the surgery adequately, you could consider a lawsuit.  However, I think it would be a tough case to win, as you would have to prove malpractice or neglect.  A slipped suture causing a non-life-threatening condition is a potential risk of a surgery.  However, I'm not a lawyer so I can't say for certain if it's a valid suit.  Or, you could take an attitude like my mother did and realize that the vet did help your dog, and had to use his time, equipment, and materials and it is fair for him to be reimbursed.  In the end, the decision has to be yours.

Top 10 Poisonous Human Medications

There was a recent article by a vet with the Pet Poison Helpline describing the top 10 human medications that poison pets, and I thought it was worth repeating here.  Credit for this information goes to Ahna Brutlag, DVM.


1. NSAIDs (e.g., ibuprofen, naproxen)—Topping our list are the common household medications called non-steroidal anti-inflammatories (NSAIDs), which include common names such as ibuprofen (e.g., Advil and some types of Motrin) and naproxen (e.g., Aleve). While these medications are safe for people, even one or two pills can cause serious harm to a pet. Dogs, cats, birds and other small mammals including ferrets, gerbils, and hamsters may develop serious stomach and intestinal ulcers as well as kidney failure.
2. Acetaminophen—When it comes to pain medications, acetaminophen (e.g., Tylenol) is popular. Even though this drug is safe for children, it is not safe for pets—especially cats. One regular strength tablet of acetaminophen may cause damage to a cat’s red blood cells, limiting their ability to carry oxygen. In dogs, acetaminophen leads to liver failure and, in large doses, red blood cell damage.
3. Antidepressants (e.g., Effexor, Cymbalta, Prozac, Lexapro)—While these and other antidepressant drugs are occasionally used in pets, overdoses can lead to serious neurological problems such as sedation, incoordination, tremors and seizures. Some antidepressants also have a stimulant effect leading to a dangerously elevated heart rate, blood pressure, and body temperature. Pets, especially cats, seem to enjoy the taste of Effexor and often eat the entire pill. Unfortunately, just one pill can cause serious poisoning.
4. ADD and ADHD medications (e.g., Concerta, Adderall, Ritalin)—Medications used to treat Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder contain potent stimulants such as amphetamines and methylphenidate. Even minimal ingestions of these medications by pets can cause life-threatening tremors, seizures, elevated body temperatures, and heart problems.
5. Benzodiazepines and sleep aids (e.g., Xanax, Klonopin, Ambien, Lunesta)—These medications are designed to reduce anxiety and help people sleep better. However, in pets, they may have the opposite effect. About half of dogs that ingest sleep aids become agitated instead of sedate. In addition, these drugs may cause severe lethargy, incoordination (including walking “drunk”), and slowed breathing in pets. In cats, some forms of benzodiazepines can cause liver failure when ingested.
6. Birth control (e.g., estrogen, estradiol, progesterone)—Birth control pills often come in packages that dogs find irresistible. Thankfully, small ingestions of these medications typically do not cause trouble. However, large ingestions of estrogen and estradiol can cause bone marrow suppression, particularly in birds. Additionally, intact female pets are at an increased risk of side effects from estrogen poisoning.
7. ACE Inhibitors (e.g., Zestril, Altace)—Angiotensin-converting enzyme (ACE) inhibitors are commonly used to treat high blood pressure in people and, occasionally, pets. Though overdoses can cause low blood pressure, dizziness, and weakness, this category of medication is typically safe. Pets ingesting small amounts of this medication can potentially be monitored at home, unless they have kidney failure or heart disease.
8. Beta-blockers (e.g., Tenormin, Toprol, Coreg)—Beta-blockers are also used to treat high blood pressure but, unlike with ACE inhibitors, small ingestions of these drugs may cause serious poisoning in pets. Overdoses can cause life-threatening decreases in blood pressure and a very slow heart rate.
9. Thyroid hormones (e.g., Armour desiccated thyroid, Synthroid)—Pets—especially dogs—get underactive thyroids too. Interestingly, the dose of thyroid hormone needed to treat dogs is much higher than a person’s dose. Therefore, if dogs accidentally get into thyroid hormones at home, it rarely results in problems. However, large acute overdoses in cats and dogs can cause muscle tremors, nervousness, panting, a rapid heart rate, and aggression.
10. Cholesterol lowering agents (e.g., Lipitor, Zocor, Crestor)—These popular medications, often called statins, are commonly used in the United States. While pets do not typically get high cholesterol, they may still get into the pill bottle. Thankfully, most statin ingestions only cause mild vomiting or diarrhea. Serious side effects from these drugs come with long-term use, not one-time ingestions.

So be aware of the risks of these medications you may have around your house!  If you think that your pet may have swallowed anything listed here, talk to your vet right away.

Parenting Gets Hard

Part of my purpose of this blog is to give people a peek into the life of an average veterinarian.  Those of you who are parents are going to understand today's discussion.

I have two kids, a son who is almost 9, and a daughter who is 7.  They are great kids and I love them dearly.  Sure, they have their "moments", but they are generally sweet, well-behaved creative and intelligent children.  Though I would never say that parenting is easy, it hasn't been as hard as I believe it's getting ready to be.

My son has started making friends with some other boys in the neighborhood, both older than him.  He has wanted to start riding his bike with them and hanging out.  The extra freedom he wants has brought up several rather sticky subjects.  We've already talked to the kids about strangers and being safe.  But now we have to talk more about other subjects, such as drugs, sex, and other things.  Pretty soon I'm going to need to have "the Talk" with my son.  My wife and I are also trying to figure out just how far we're going to allow him to wander the neighborhood without us watching him.

When I was growing up the world was different.  I would wander by myself in the woods behind my house for hours.  I would ride my bike with friends for several miles.  Yes, there were worries and concerns, but today's world seems so much more filled with predators, drugs, pornography and other bad things that we want to try and protect our kids from.  I see reports on the news about kids, teens, and college-age people who are molested, kidnapped, or murdered and I worry about my own children.  I know that I can't shelter them, but I also don't want to unnecessarily expose them to risk.  It's a delicate balance, giving them a taste of freedom while still keeping them safe.

So yes, I have to have a nice long talk with my son.  And I know my daughter isn't far behind.  Ah, the joys of parenting.

The Right Toothpaste

Sam asks this question...

At my puppy’s first vet visit I was given instructions on how to brush my dog’s teeth and a couple of sample toothpastes. I am almost out of the samples, so I stopped by PetSmart the other day to pick up some more and was a bit overwhelmed at the varieties (vanilla-, mint-, beef-flavored, “Natural”, and even some advertising they contain fluoride). They did not have the brand my vet uses (CET). Of course I know not to use human toothpaste for dogs, but now I am wondering: what ingredients to look for and what ingredients to avoid. Is the kind my vet uses better and if so, how? Any insight you have in regards to this issue would be greatly appreciated.

First, Sam, I have to commend you for working on brushing your dog's teeth.  Regular dental care will help prevent periodontal disease and keep our dog healthy.  This is something that not many people do consistently, but those that do will find their pets live longer, have lower risk for certain diseases, and will save money on expensive dental medical bills.

Personally, I don't see much of a difference between brands of toothpaste, and don't recommend one particular kind.  I do recommend one designed for pets, as the human kinds foam excessively and can cause nausea.  The basic function of tooth paste is to provide a safe but slightly abrasive substance that can be used to remove plaque from the teeth.  Many will also have enzymes that can help reduce tartar formation.  

Even with human toothpastes there aren't a lot of significant differences between brands.  Some may whiten teeth, have breath fresheners, or other gimmicks, but they all do the same basic thing....clean teeth.  All of the flavors and extras are mostly marketing tools and tricks.  Pet toothpastes are similar, in that they all do the same basic job and differences are usually minor and designed more for the owner than the pet.  I am familiar with the CET brand, and it's a very good company.  But I think that you can do just as good with other kinds.

So Sam, here's my advice.  Find a toothpaste that is reasonably priced and that your dog likes and stick with that. You don't have to worry about a specific brand or reading the labels in detail.

"Handicapped" Vets?

An interesting question was sent to me yesterday.

I stumbled upon your website through google and found it most interesting.  You also seemed pretty friendly so I thought I'll email you.

I'm a 19 year old girl going to University of Sydney to study to be a vet! This has always been wanted to do and I'm so glad I've gotten an offer.

However, I have unusually shaky hands that still tremble slightly despite supporting my hands on the table etc....

Would that affect a vet student drastically? Do you have any advise?

Thank you so much.

I wanted to bring this up in a public forum because it brings up an interesting and relevant question.  What do you physically need to be a successful vet?  Can you do it with physical handicaps or limitations?

The short answer is "yes", you certainly can do it.  The long answer is "it depends".  In this specific case I think it depends on how bad the trembling is, especially when the hands are not supported.  A general practitioner is going to be doing a lot of surgery, as well as often delicate procedures.  The blade of grass I removed from the cat's throat yesterday needed a quick and calm hand to grasp it.  As you go through your studies, you will quickly learn your capabilities.  You will need to be steady enough to use a syringe to collect blood, aspirate masses, use a scalpel to do skin scrapes (checking for skin mites), and so on besides just surgery.  If you can keep your hands steady enough to do these things quickly and easily, then a small tremor shouldn't hamper you at all.  However, if the trembling is significant, then you will indeed find some serious challenges in developing necessary skills.

There are certainly other areas of veterinary medicine that you can do besides general practice.  Pathology would be a good choice since most of what you are doing is looking at prepared slides and samples, so steady hands aren't as important.  Radiology is another good choice that doesn't require delicate hand-eye coordination (and this one would allow you to still see patients).  Talk to your professors and clinicians and see what they recommend after having witnessed you in action. 

What about other "handicaps" or limitations?  I would say that blindness is the only issue that would completely preclude someone from being a veterinarian, as all aspects of medicine require a doctor to be able to see.  Deafness may make general practice difficult to impossible since you spend much of the time listening to the chest.  However, specialties like pathology and radiology would still be possible.  I knew a vet who was paraplegic and did quite well doing exams and surgeries in his wheelchair.  Having limited physical capabilities doesn't limit a person's mind or cognitive abilities, and these are really the most important part of being a vet.  Others out there may have other experiences with vets who have been successful despite not having all senses or capabilities, and I would love to hear about them.

Good luck!  I certainly wish you the best in pursuing this dream!